How is anorexia treated?

How to treat anorexia nervosa

Anorexia is a complex mental health condition involving various physical and psychological factors. As such, treatment for anorexia requires a multidisciplinary approach, with input from several professionals, such as a dietitian, therapist, mental health nurse, psychiatrist, and physician, who work collaboratively to treat the individual ^[1].

Nutrition therapy

The priority when treating anorexia is increasing nutritional intake and electrolyte levels, as this is the cause of potentially fatal medical complications. This typically involves a specialist dietitian who is trained in treating eating disorders and can provide specialized treatment for anorexia ^[1][2].

Due to the nature of the condition, encouraging weight gain and increased dietary intake can be very distressing and challenging for the individual, so the dietitian will also aim to provide education around healthy eating habits, help to reduce unhealthy habits and thoughts around food, and increase the individual’s understanding and acceptance of feeling hungry and full ^[2].

Nutrition therapy takes place within both inpatient and outpatient treatment and may require monitoring by hospital staff or parents to ensure nutrition is entirely consumed and the individual is not engaging in behaviors, such as hiding or throwing away food, or purging ^[3].

The aim is to gradually increase calorie intake, providing supplements for electrolytes, vitamins, and minerals to restore physical health, which often also contributes to improvements in mental health. This process will depend on the individual and their starting weight and physical wellbeing, and will continue until physical health has improved and healthy weight is restored ^[1].

Therapy

Various types of therapy have been found to improve symptoms of anorexia and can be crucial to recovery and in preventing relapse.

CBT-E

Cognitive behavioral therapy (CBT) is a type of talk therapy that helps to reduce negative thoughts and behaviors and teach positive coping strategies. An adapted form of CBT, known as CBT-E, has been created specifically to treat eating disorders ^[4].

CBT-E focuses on altering eating habits and behaviors, reducing excessive exercise, purging, and other compensatory behaviors, and challenging negative thoughts and beliefs about weight. It has been shown to be very effective in the treatment of anorexia and can significantly aid recovery and prevent relapse ^[4][5][6].

Other cognitive-behavioral interventions

Several other types of cognitive-behavioral therapies have been developed specifically to treat anorexia and other eating disorders, such as an adapted version of exposure and response prevention (ERP), which was initially developed to treat obsessive-compulsive disorder (OCD), known as AN-EXRP ^[5][7].

AN-EXRP helps to improve dietary intake and reduce negative emotions around eating by recognizing disordered eating behaviors and replacing them with positive habits ^[7].

Similarly, acceptance and commitment therapy (ACT), Maudsley anorexia nervosa treatment for adults (MANTRA), and an adapted version of dialectical behavior therapy (DBT) can also be effective in the treatment of anorexia, helping to reduce and change harmful thoughts and behaviors, while increasing distress tolerance and acceptance ^[5][6][8].

These types of therapeutic intervention are relatively new and so require further research into their use and effectiveness but have so far been shown to be successful in the treatment of eating disorders such as anorexia ^[5].

Other talk therapies

Interpersonal therapy can help patients to explore and understand underlying issues that may contribute to the development of anorexia and provide psychological support in managing and reducing the impact of these issues. It can also help with gaining education around the medical condition and recovery process, setting goals and finding motivational factors, and reducing distress that can occur within the context of the condition or during the recovery process ^[5][6][8].

Family therapy

Family therapy has been shown to be significantly effective in treating adolescents with anorexia, so it is a recommended part of treatment for this age group ^[5][8]. It can provide parents and siblings with a better understanding of anorexia and how best to support their loved one during their recovery.

Family-based therapy can demonstrate helpful communication between parents and their child, while also advising what type of language may be unhelpful. It can also aid in developing therapeutic relationships within the home and preventing exposure to negative emotions and criticism from parents while they are assisting in promoting weight gain and recovery ^[5][6][9].

Medication

Generally, medications are not prescribed in the treatment of anorexia nervosa, as there is limited evidence for their effectiveness in reducing disordered eating habits or improving mood, and there may be an increased risk of side effects in those who are underweight and malnourished ^[5][6][10].

Selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant medication, are sometimes prescribed in the medical treatment of anorexia, as they are considered the safest type of antidepressant in this group, but they are generally found to be ineffective at reducing psychological symptoms or promoting weight gain ^[5][11].

Second generation antipsychotic medications, such as olanzapine, are known to cause a side effect of increased appetite and weight, so they may in some cases help with weight gain for individuals with anorexia but tend not to impact psychological symptoms of the condition ^[10][11].

When would someone with anorexia need hospitalization?

Anorexia can result in severe medical complications caused by malnutrition if left untreated, many of which could end in death. These complications include ^[1][6][11]:

• Heart problems, including low blood pressure and irregular heart rate
• Neurological changes, including reduced cognitive functioning and seizures
• Hormonal abnormalities, such as reduced estrogen, which can lead to menstrual irregularities and changes in bone density
• Gastrointestinal complaints, such as constipation, reflux, and esophagus tears
• Impaired kidney function
• Blood issues, such as anemia (low red blood cell count) and leukopenia (low white blood cell count)
• Dental issues, including decay and discoloration

If the individual is dangerously underweight, severely physically impaired, deemed to be a high risk of suicide, or is unable or unwilling to safely engage in treatment, it may be necessary for them to receive inpatient treatment ^[8][9].

While in hospital, a multidisciplinary team would provide care to treat their physical and mental health to ensure their safety, while providing guidance and support in increasing nutritional intake. This will likely involve dietary support, with the aim to increase weight and reduce the impact of medical complications, and therapeutic interventions to manage emotional distress ^[9][11].

NG Feeding

In some cases, someone with severe anorexia may feel unable to resume eating due to their illness, causing their physical health to further worsen and potentially endangering their life. In these cases, it may be necessary to begin refeeding with a nasogastric (NG) tube to provide lifesaving nutrition ^[12].

NG feeding can be very distressing for the individual, especially if it is administered under restraint, so is only administered by trained professionals. It is important that patients requiring this treatment are then given opportunities to discuss and explore their emotional responses to the experience within a therapeutic setting to aid in their recovery ^[12][13].