The following topics are included in this section:
- Eating disorders treatment
- Treating Anorexia Nervosa
- Treating Bulimia Nervosa
- Treating Binge-Eating Disorder
- Teen eating disorders prevention
- Family-focused Therapy
Eating Disorders Treatment
Adequate nutrition, reducing excessive exercise, and stopping purging behaviors are the foundations of treatment. The National Institutes of Health recommends that specific forms of psychotherapy, or talk therapy, and medication are also effective for many eating disorders. However, in more chronic cases, specific treatments have not yet been identified. Treatment plans often are tailored to individual needs and may include one or more of the following:20
- Individual, group, and/or family psychotherapy
- Medical care and monitoring
- Nutritional counseling
Some patients may also need to be hospitalized to treat problems caused by mal-nutrition or to ensure they eat enough if they are very underweight.
Treating Anorexia Nervosa
Treating anorexia nervosa involves three components:21
- Restoring the person to a healthy weight
- Treating the psychological issues related to the eating disorder
- Reducing or eliminating behaviors or thoughts that lead to insufficient eating and preventing relapse
Some research suggests that the use of medications, such as antidepressants, antipsychotics, or mood stabilizers, may be modestly effective in treating patients with anorexia nervosa. These medications may help resolve mood and anxiety symptoms that often occur along with anorexia nervosa. It is not clear whether antidepressants can prevent some weight-restored patients with anorexia nervosa from relapsing. Although research is still ongoing, no medication yet has shown to be effective in helping someone gain weight to reach a normal level.
Different forms of psychotherapy, including individual, group, and family-based, can help address the psychological reasons for the illness. In a therapy called the Maudsley approach, parents of adolescents with anorexia nervosa assume responsibility for feeding their child. This approach appears to be very effective in helping people gain weight and improve eating habits and moods. Shown to be effective in case studies and clinical trials, the Maudsley approach is discussed in some guidelines and studies for treating eating disorders in younger, non-chronic patients.
Other research has found that a combined approach of medical attention and supportive psychotherapy designed specifically for anorexia nervosa patients is more effective than psychotherapy alone. The effectiveness of a treatment depends on the person involved and his or her situation. Unfortunately, no specific psychotherapy appears to be consistently effective for treating adults with anorexia nervosa. However, research into new treatment and prevention approaches is showing some promise. One study suggests that an online intervention program may prevent some at-risk women from developing an eating disorder. Also, specialized treatment of anorexia nervosa may help reduce the risk of death.
Treating Bulimia Nervosa
As with anorexia nervosa, treatment for bulimia nervosa often involves a combination of options and depends upon the needs of the individual. The National Institutes of Health recommends that to reduce or eliminate binge-eating and purging behaviors, a patient may undergo nutritional counseling and psychotherapy, especially Cognitive Behavioral Therapy (CBT), or be prescribed medication. CBT helps a person focus on his or her current problems and how to solve them. The therapist helps the patient learn how to identify distorted or unhelpful thinking patterns, recognize, and change inaccurate beliefs, relate to others in more positive ways, and change behaviors accordingly.
CBT that is tailored to treat bulimia nervosa is effective in changing binge-eating and purging behaviors and eating attitudes. Therapy may be individual or group-based.
Some antidepressants, such as fluoxetine (Prozac), which is the only medication approved by the U.S. Food and Drug Administration (FDA) for treating bulimia nervosa, may help patients who also have depression or anxiety. Fluoxetine also appears to help reduce binge-eating and purging behaviors, reduce the chance of relapse, and improve eating attitudes.
Treating Binge-Eating Disorder
Treatment options for binge-eating disorder are similar to those used to treat bulimia nervosa. Psychotherapy, especially CBT that is tailored to the individual, has been shown to be effective. Again, this type of therapy can be offered in an individual or group environment.
Fluoxetine and other antidepressants may reduce binge-eating episodes and help lessen depression in some patients.
Teen Eating Disorders Prevention
To help prevent teen eating disorders, talk to your teen about eating habits and body image. It might not be easy, but it's important.
The Mayo Clinic recommends that following steps to get started:22
- Encourage reasonable eating habits
- Discuss media messages
- Promote a healthy body image
- Foster self-esteem
- Share the dangers of dieting and emotional eating
- Use food for nourishment — not as a reward or consequence
Psychotherapy, or "talk therapy", is a way to treat people with a mental disorder by helping them understand their illness. It teaches people strategies and gives them tools to deal with stress and unhealthy thoughts and behaviors. Psychotherapy helps patients manage their symptoms better and function at their best in everyday life.23
Sometimes psychotherapy alone may be the best treatment for a person, depending on the illness and its severity. Other times, psychotherapy is combined with medications. Therapists work with an individual or families to devise an appropriate treatment plan.
Types of Psychotherapy
Many kinds of psychotherapy exist. There is no "one-size-fits-all" approach. In addition, some therapies have been scientifically tested more than others. Some people may have a treatment plan that includes only one type of psychotherapy. Others receive treatment that includes elements of several different types. The kind of psychotherapy a person receives depends on his or her needs.
This section explains several of the most commonly used psychotherapies. However, it does not cover every detail about psychotherapy. Patients should talk to their doctor or a psychotherapist about planning treatment that meets their needs.
CBT for Eating Disorders
Eating disorders can be very difficult to treat. However, some small studies have found that CBT can help reduce the risk of relapse in adults with anorexia who have restored their weight. CBT may also reduce some symptoms of bulimia, and it may also help some people reduce binge-eating behavior.
CBT for Depression
Many studies have shown that CBT is a particularly effective treatment for depression, especially minor or moderate depression. Some people with depression may be successfully treated with CBT only. Others may need both CBT and medication. CBT helps people with depression restructure negative thought patterns. Doing so helps people interpret their environment and interactions with others in a positive and realistic way. It may also help a person recognize things that may be contributing to the depression and help him or her change behaviors that may be making the depression worse.
Family-focused Therapy (FFT) was developed by David Miklowitz, Ph.D., and Michael Goldstein, Ph.D., for treating bipolar disorder. It was designed with the assumption that a patient's relationship with his or her family is vital to the success of managing the illness. FFT includes family members in therapy sessions to improve family relationships, which may support better treatment results.
Family-based therapy may also be used to treat adolescents with eating disorders. One type is called the Maudsley approach, named after the Maudsley Hospital in London, where the approach was developed. This type of outpatient family therapy is used to treat anorexia nervosa in adolescents. It considers the active participation of parents to be essential in the recovery of their teen. The Maudsley approach proceeds through three phases:
1. Weight restoration. Parents become fully responsible for ensuring that their teen eats. A therapist helps parents better understand their teen's disease. Parents learn how to avoid criticizing their teen, but they also learn to make sure that their teen eats.
2. Returning control over eating to the teen. Once the teen accepts the control parents have over his or her eating habits, parents may begin giving up that control. Parents are encouraged to help their teen take more control over eating again.
3. Establishing healthy adolescent identity. When the teen has reached and maintained a healthy weight, the therapist helps him or her begin developing a healthy sense of identity and autonomy.
Several studies have found the Maudsley approach to be successful in treating teens with anorexia. Currently a large-scale, NIMH-funded study on the approach is under way.