How are eating disorders treated?
The goals of treatment are to:
- Stabilize weight.
- Begin nutrition rehabilitation to restore weight and/or normal body functions.
- Eliminate binge eating/purging behaviors and other ritualistic eating patterns.
- Treat emotional issues such as low self-esteem.
- Correct distorted thinking about body image.
- Develop long-term behavioral changes for health and wellness.
For people who are overweight or obese and have an eating disorder, treatment goals are to stabilize eating and restore periods, heart rate, or other physiologic factors indicating health.
Treatment options vary depending on the individual’s needs and specific eating disorder. Treatment most often involves a combination of the following strategies.
Cognitive (brain) therapy
Goals of this therapy are to improve mood and psychological symptoms (depression, anxiety and obsessive-compulsive disorder), improve body image, and ability to function in society. Treatment includes practical techniques for developing healthy attitudes toward food and weight, as well as approaches for changing the way the person responds to difficult situations. Different forms of therapy, mentioned in alphabetical order, include the following
- Acceptance and Commitment Therapy: This therapy’s goal is to develop motivation to change actions rather than your thoughts and feelings.
- Cognitive Behavioral Therapy (CBT): This therapy’s goal is to address distorted views and attitudes about weight, shape and appearance and practice behavioral modification (if “X” happens, I can do “Y” instead of “Z”).
- Cognitive Remediation Therapy: This therapy uses reflection and guided supervision to develop the capability of focusing on more than one thing at a time.
- Dialectical Behavior Therapy (DBT), is CBT plus insight: This therapy helps the individual not just develop new skills to handle negative triggers, but also helps the person develop insight to recognize triggers or situations where a non-useful behavior might occur. Specific skills include building mindfulness, improving relationships through interpersonal effectiveness, managing emotions and tolerating stress.
- Family-based Treatment (also called the Maudsley Method): This therapy involves family-based feeding, which means putting the parents/family in charge of getting the appropriate nutritional intake consumed by the individual with the eating disorder.
- Interpersonal Psychotherapy: This therapy is aimed at resolving an interpersonal problem area. Improving relationships and communications and resolving identified problems has been found to reduce eating disorder symptoms.
- Psychodynamic Psychotherapy: This therapy involves looking at the root causes of the eating disorder – what are the patient’s true underlying needs and issues – as the key to recovery.
Medication
Medications may be prescribed to manage your underlying illness or particular symptoms. Medications are particularly useful for individuals with eating disorders who also have extreme anxiety, depression, or obsessive-compulsive symptoms. Your healthcare provider will work with you to decide what medications might be most helpful for your specific eating disorder.
Nutrition counseling
A registered dietitian with experience in eating disorders can help develop a healthy approach to food and body, restore normal eating patterns, and tailor a meal plan to your specific needs. Children, adolescents and young adults through age 26 need a higher percentage of fat intake (50-90 grams per day) than do older adults. Other nutrient needs may also vary with age. The dietitian can help teach best strategies for meals, meal prep, shopping and other life activities around nutrition, as well as identify myths or misperceptions that enable the eating disorder and sabotage health.
Group and/or family therapy
Family support is very important to treatment success. It is important that family members understand the eating disorder and recognize its signs and symptoms. People with eating disorders might benefit from group therapy, where they can find support, and openly discuss their feelings and concerns with others who share common experiences and problems.
Children and adolescents may benefit from family-based feeding, also called the Maudsley method, an evidence-based method used in youth with anorexia nervosa. Resources are available online to learn more about this method (see resources).
Hospitalization
Hospitalization may be needed to stabilize individuals with electrolyte imbalances, very low heart rate or other abnormal rhythm. Once stable, treatment can take place in various settings, including residential settings where 24/7 care is available, day treatment programs that tend to run for five hours, five days a week and intensive outpatient therapy where group counseling occurs for one to three hours, one to five days a week. Individual therapy or weekly family-based therapy in the form of Maudsley coaching can also occur. To be considered for outpatient therapy, patients need to be medically and psychiatrically stable and not require daily medical monitoring.