Anorexia Nervosa - Treatment Overview

Treatment Overview

All people with anorexia nervosa need treatment. In most cases, this involves seeing a health professional, as well as having regular counseling sessions. A hospital stay is needed for those who are seriously underweight or who have severe medical problems. The goals of treatment are to restore a healthy weight and healthy eating habits.

Achieving a more healthy weight helps the body as well as the brain to recover from anorexia. When the body and brain are no longer in starvation mode, you'll find that you can think more clearly. And, you may have more control over your eating disorder behaviors, rather than being controlled by obsessive thoughts.⁸

Initial treatment

Ideally, you can take charge of anorexia with the help of a team that includes a mental health professional (such as a psychologist or licensed counselor), a medical health professional (such as a doctor or nurse), and a registered dietitian.

If your medical condition is not life-threatening, initial treatment likely will include:

• Psychological counseling. A counselor will help you learn healthy ways to think about food and your body. Family therapy can also help your family members support your recovery.
• Medical treatment. If malnutrition or starvation has started to break down your body, medical treatment will be a top priority. Your health professional will treat any medical conditions that have been caused by anorexia, such as osteoporosis, heart problems, or depression.
• Nutritional counseling. A registered dietitian will help you take charge of your weight in a healthy way. You will learn healthy eating patterns and gain a good understanding of nutrition.
• Family therapy. Parents learn about anorexia and how to help their child change her diet and exercise patterns. This includes preparing meals for their child and monitoring eating and exercising.

An important part of your recovery will include learning new eating behaviors, learning emotional self-care, and developing trust in people who are trying to help you.

For the teen with anorexia, family involvement is a key part of treatment. Family therapy helps parents support their child, both emotionally and physically. Any brothers or sisters also need support during treatment. Family, group, and individual counseling are all effective and are often combined.²

For the adult with anorexia, family members may be involved in treatment, though less so than with a teen.

Ongoing treatment

Chronic forms of anorexia may require ongoing treatment for many years, including hospitalizations when needed. Ongoing treatment usually includes:

• Psychological counseling. A counselor will help you develop your own plan to use new coping and stress management skills and prevent relapse. Your counselor can help you at those times when it is hard to stick to healthy ways of thinking about food and your body. Family therapy can also help your family members support your recovery.
• Medical treatment. Your health professional will follow your health and weight, because anorexia affects all organ systems in your body. If needed, you will be treated for conditions such as osteoporosis, heart problems, or depression.
• Nutritional counseling. A registered dietitian will help you take charge of your eating and weight in a healthy way. Your dietitian can help you to adjust what you eat along with your changing health needs.

There are no medicines to treat anorexia. But if you are depressed or anxious, your doctor may prescribe an antidepressant medicine.

Antidepressant medicine is most proven for treating bulimia.² For more information, see antidepressant medicines for the treatment of bulimia nervosa.

Over time, your goal is to continue taking control of your eating habits, learning emotional self-care, and developing trust in people who are trying to help you.

Some people fully recover from anorexia. Many people with anorexia have ups and downs over the years. Try thinking of treatment as an ongoing process.

Treatment if the condition gets worse

Being severely underweight can cause dehydration, starvation, and electrolyte imbalance—any of which can be life-threatening.

If anorexia causes life-threatening medical problems, you need urgent medical treatment. Treatment in a hospital or eating disorder treatment center will first include:

• Treating starvation. This can include treating medical problems it has caused, such as dehydration, electrolyte imbalance, or heart problems. If you can't eat, you are given your nutrition in fluid form.
• Nutritional rehabilitation. The medical team helps you work toward a healthier weight carefully and gradually, learn when your body is hungry and full, and start healthy eating patterns.

People who are 15% below their healthy weight, or thinner, have great difficulty gaining weight without the help of a highly structured treatment program.⁸ For example, if your lowest healthy weight is 125 lb (56.7 kg) and you drop to about 105 lb (47.6 kg) or less, you are likely to need an eating disorder program to recover.

In general, it is recommended that people who weigh 25% below their healthy weight need to be hospitalized in an inpatient treatment program. For example, if your lowest healthy weight is 125 lb (56.7 kg) and you drop to about 100 lb (45.4 kg), you are likely to need hospitalization. For a person who is more than 30% below his or her healthy body weight, inpatient treatment can take 2 to 6 months.⁹

Insurance coverage for inpatient treatment of eating disorders varies. Check with your insurance carrier to learn about your coverage.

What To Think About

Anorexia can be difficult to treat. If you have an eating disorder, try not to resist treatment. Although you may feel intensely fearful of gaining weight, try to think of weight gain as a life-saving measure. With help, you can learn to eat well and keep your weight at a healthy level.

Anorexia can be a lifelong illness. Many people who have anorexia recover, some improve, and some have problems with anorexia throughout their lives.

• People with anorexia who are young and who start treatment early in their illness usually do well.
• Anorexia is more difficult to treat when it has gone untreated for a long time.

Around half of people who have anorexia will go on to develop binge-purge behaviors associated with bulimia.⁹ People who have other mental health conditions, such as depression or obsessive-compulsive disorder, along with anorexia usually need longer treatment than people who have anorexia and no other mental health problems.

For family members

All families have patterns that can get in the way of change. To make healthy change easier, have everyone in the family take a look at how they handle your loved one's eating disorder. See a family therapist to help you find new ways to handle frustration, worry, grief, anger, power struggles, and food issues and to support your loved one's recovery.

Severe weight loss makes a person unable to think clearly or function well in daily life. This is a sign that medical care is needed.