What is the most effective way to approach the treatment of anorexia nervosa?
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For our 2022 review of the evidence base for eating disorder treatment, click here. Show
To start, what does evidence-based treatment mean? Evidence-based treatments are interventions (“therapies”) that are supported by published research demonstrating effectiveness (the “evidence”). In other words, these are treatments that have been well tested, compared against other established treatments, and then highlighted as producing the best outcomes. So what is the evidence base for eating disorder treatment? The Evidence Base for Eating Disorder Treatment for Anorexia, Bulimia, and Binge Eating DisorderThere was a recent exhaustive review[i] of the most current treatments for feeding and eating disorders like anorexia, bulimia, and binge eating disorder in adults and adolescents. Here are the headlines: 1. In the majority of clinical trials, Enhanced Cognitive Behavioral Therapy (CBT-E) has been shown to be the most effective treatment for adult anorexia, bulimia and binge eating disorder.Enhanced CBT (CBT-E) was designed specifically for eating disorders. It is a very structured, time-limited treatment with three distinct phases. The primary focus of the treatment – regardless of the condition – is to establish a regular pattern of stable, flexible eating and addressing the different factors (things like extreme focus on shape and weight or mood-related eating) that keep the eating problem going. 2. There is broad agreement that, whenever possible, patients should be treated in the least restrictive setting.In other words, more restrictive settings, like hospitals and residential treatment centers, are for those with the most severe symptoms or medical complications. Day Treatment Programs, Partial Hospital, Intensive Outpatient Programs, are more intensive and structured settings if the individual is not progressing in standard outpatient care. For those who are medically stable and able to participate in outpatient treatment, it is in their best interest to do so. 3. Children and adolescents with anorexia or bulimia should be treated with Family-Based Treatment (Maudsley).Research studies have consistently shown FBT to be the best treatment for children and adolescents with anorexia. An emerging body of evidence is showing similar effectiveness for children and adolescents with bulimia. The beauty of FBT is that not only is it so effective, but it is also time-efficient (once weekly meetings), cost-effective (a fraction of the cost of intensive residential programs), and delivered in a “real-life” setting (home). 4. According to a recent paper in the American Journal of Psychotherapy[ii], there is good evidence to support the use of DBT skills training with adult bulimia and binge eating patients.The evidence on anorexia is less compelling, but encouraging. There is promising evidence to support the use of DBT with any eating disorder patient who also has Borderline Personality Disorder. According to one study, about 20 percent of eating disorders patients have co-morbid BPD[iii]; given the effectiveness of DBT with BPD, it makes sense that DBT would be effective for this subpopulation. References: [i] Hay P, Chinn D, Forbes D, Madden S, Newton R, Sugenor L, Touyz S, Ward W. Australian & New Zealand Journal of Psychiatry 2014, Vol. 48(11) 977–1008 [ii]Wisniewski, L & Ben-Porath, D. D. (2015). Dialectical Behavior Therapy and Eating Disorders: The Use of Contingency Management Procedures to Manage Dialectical Dilemmas. American Journal of Psychotherapy, Vol 69, No. 2, 129-140 [iii]Milos, G. F., Spindler, A. M., Buddeberg, C., & Crameri, A. (2003). Axes I and II comorbidity and treatment experiences in eating disorder subjects. Psychotherapy and Psychosomatics, 72, 276-285 It's important to start treatment as early as possible to reduce the risk of serious complications, particularly if you've already lost a lot of weight. Treatment for anorexia is slightly different for adults and those under 18 years old. Treatment for adultsA number of different talking therapies are available to treat anorexia. The aim of these treatments is to help you understand the causes of your eating problems and feel more comfortable with food so you can begin to eat more and reach a healthy weight. You may be offered any of the following types of talking therapy. If you feel one is not right for you or is not helping, you can talk to your doctors about trying a different kind of therapy. Cognitive behavioural therapy (CBT)If you are offered CBT, it'll usually involve weekly sessions for up to 40 weeks (9 to 10 months), and 2 sessions a week in the first 2 to 3 weeks. CBT involves talking to a therapist who'll work with you to create a personalised treatment plan. They'll help you to:
They'll ask you to practise these techniques on your own, measure your progress, and show you ways to manage difficult feelings and situations so you stick with your new eating habits. Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)MANTRA involves talking to a therapist in order to understand what's causing your eating disorder. It focuses on what's important to you and helps you to change your behaviour when you're ready. You can involve your family or carers if you think it would be helpful. You should be offered 20 sessions. The first 10 should be weekly, with the next 10 scheduled to suit you. Specialist supportive clinical management (SSCM)SSCM involves talking to a therapist who'll help you understand what's causing your eating disorder. You'll learn about nutrition and how your eating habits cause your symptoms. You should be offered 20 or more weekly sessions. Your therapist will set you a target weight and, over the course of the 20 weeks, will help you reach it. Focal psychodynamic therapyFocal psychodynamic therapy is usually offered if you do not feel any of the above therapies are right for you or if they do not work. Focal psychodynamic therapy should include trying to understand how your eating habits are related to what you think, and to how you feel about yourself and other people in your life. You should be offered weekly sessions for up to 40 weeks (9 to 10 months). Diet adviceDuring your treatment you'll probably be given advice on healthy eating and your diet. However, this advice alone will not help you recover from anorexia, so you'll need to have talking therapy as well as dietary advice. Your doctors will probably also advise you to take vitamin and mineral supplements so you get all the nutrients you need to be healthy. Treatment for children and young peopleChildren and young people will usually be offered family therapy. You may also be offered CBT or adolescent-focused psychotherapy. CBT will be very similar to the CBT offered to adults. Family therapyFamily therapy involves you and your family talking to a therapist, exploring how anorexia has affected you and how your family can support you to get better. Your therapist will also help you find ways to manage difficult feelings and situations to stop you from relapsing into unhealthy eating habits once your therapy ends. You can have the sessions together with your family or on your own with the therapist. Family therapy is sometimes offered in a group with other families. You'll usually be offered 18 to 20 sessions over a year, and your therapist will regularly check that the schedule is still working for you. Adolescent-focused psychotherapyAdolescent-focused psychotherapy will usually involve up to 40 sessions, and normally lasts between 12 and 18 months. You'll have sessions more often in the beginning to give you more support. The therapist will help you:
You can have the therapy alone or with your family. Diet adviceIf you have anorexia, you may not be getting all the vitamins and energy that your body needs to grow and develop properly, which is especially important as you reach puberty. During your treatment, your doctor will give you advice about the best foods to eat to stay healthy. They'll probably also advise you to take vitamin and mineral supplements. They'll also talk to your parents or carers about your diet so they can support you at home. Bone healthAnorexia can make your bones weaker, which can make you more likely to develop a condition called osteoporosis. This is more likely if your weight has been low for a year or more in children and young people, or 2 years or more in adults. Because of this, your doctors may suggest you have a bone-density scan to check the health of your bones. Girls and women are more at risk of getting weak bones than men, so your doctor may prescribe you medicine to help protect your bones against osteoporosis. MedicineAntidepressants should not be offered as the only treatment for anorexia. But you may be offered an antidepressant, such as fluoxetine (Prozac), in combination with therapy, to help you manage other conditions such as:
Antidepressants are very rarely prescribed for children or young people under 18. Where treatment will happenMost people with anorexia will be able to stay at home during their treatment. You'll usually have appointments at your clinic and then be able to go home. However, you may be admitted to hospital if you have serious health complications. For example, if:
Your doctors will keep a careful eye on your weight and health if you're being cared for in hospital. They'll help you to reach a healthy weight gradually, and either start or continue any therapy. Once they're happy with your weight, as well as your physical and mental health, you should be able to return home. Compulsory treatmentOccasionally, someone with anorexia may refuse treatment even though they're seriously ill and their life is at risk. In these cases, doctors may decide, as a last resort, to admit the person to hospital for compulsory treatment under the Mental Health Act. This is sometimes known as "sectioning" or "being sectioned". Check-upsIt's important that you receive ongoing support after your treatment is finished. You should have checks of your weight at least once a year, as well as of your mental and physical health. This will usually be done by your GP, but it may be with an eating disorder specialist. Further supportThere are many organisations that support people with anorexia and their families, including:
Joining a self-help support group, such as the Beat online support group for people with anorexia, may also be helpful. Which is the most common technique to treat anorexia nervosa?However, many people with anorexia do see an improvement with therapy. CBT and IPT are the most established treatments for binge eating disorder and bulimia nervosa. FBT is the most established type of therapy for children and adolescents with anorexia nervosa, and may also be beneficial for those with bulimia nervosa.
Which of the following is the first step in treatment of anorexia nervosa?Getting a diagnosis is the first step towards recovery from an eating disorder. Treating an eating disorder generally involves a combination of psychological and nutritional counseling, along with medical and psychiatric monitoring.
What is the best medication for anorexia?Drugs such as Zyprexa and Eli Lilly have been used to help stimulate appetite and weight gain in individuals with anorexia [1]. These drugs may be useful for a patient whose poor appetite is preventing them from eating during treatment.
What type of treatment is most effective for individuals with bulimia nervosa?When you have bulimia, you may need several types of treatment, although combining psychotherapy with antidepressants may be the most effective for overcoming the disorder.
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