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Eating disorders

		

Treatment

Eating disorders are one of the psychological problems least likely to be treated. Yet they don’t go away by themselves.

Leaving eating disorders untreated can have grave consequences, including death. The National Institute of Mental Health notes that one in ten cases of anorexia results in death from starvation, suicide, or severe medical complications.

Treatment often combines a multidisciplinary team approach involving dietitians, counselors, and medical professionals. Treatment for eating disorders can work. And the sooner the treatment begins, the greater the benefits. The longer disordered eating patterns continue, the more they become entrenched—and the harder they are to treat.

Anorexia
treatment

Anorexia nervosa treatment

Anorexia nervosa cases vary widely. Some cases are more severe and require intensive treatment. Other cases are less severe and require less time to achieve recovery.

Self-awareness, a key to recovery
One of the most difficult aspects of treating anorexia is that a person with the condition may not think she needs treatment. One of the symptoms of anorexia nervosa is that people cannot recognize themselves as ill. They believe that they are making a choice to perform these behaviors when, in fact, the behaviors are out of their control.

Overlapping treatments
During treatment, healthcare providers often use these three overlapping approaches: getting your weight back into a healthy range, identifying and treating additional psychological conditions (depression, for example), and reducing unhealthy food-related thoughts and behaviors.

Specific types of treatments:

  • Nutritional rehabilitation: The goal is to restore you to a healthy weight and re-establish normal eating patterns. Dietitians help develop healthy meal plans.
  • Psychosocial interventions: Addressing any underlying issues is a vital part of creating a permanent return to healthy eating patterns. Group, family, or individual therapy helps you learn new eating habits, recognize and change unhealthy thoughts about your eating disorder, rebuild relationships, and re-engage socially. Therapy can also help you improve your body image, working through cultural ideals and messages and self-perception issues.
  • Medication: The results of studies haven’t shown direct and significant benefits from medications for people with anorexia nervosa. But medications used to treat other existing psychological conditions, such as anxiety or depression, may provide a secondary benefit of helping support your other nutritional and/or psychological treatment for anorexia. Many of these medications are most helpful after your weight is restored.
  • Hospitalization: Some people with anorexia who are medically or psychologically unstable may need to be hospitalized to treat medical complications, psychiatric emergencies, or malnutrition.

Settings available for treatment:

  • Inpatient treatment centers: If you need intensive medical attention, an inpatient treatment center offers a secure, consistent environment in which to begin recovery; this type of setting can help during times when you are unable to function normally in social, school, or work settings.
  • Full-day (partial hospitalization) treatment programs: These are beneficial when you no longer need medical monitoring, yet require ongoing assistance to achieve recovery. In these programs, you would go to all-day treatment at a hospital or facility four to five days a week and eat your meals there.
  • Intensive outpatient treatment: This is a step down from full-day treatment and may involve two to three hours several days a week. This allows you to practice your skills in the real world while still receiving an intensive level of care.
  • Outpatient treatment: This is the least intensive level of care and can involve seeing members of your treatment team in a group, individual, or family format for psychotherapy, nutritional counseling, and medical monitoring.

Even if you have acknowledged an eating disorder and want to be well, recovering from anorexia can be a long-term battle. Although some people recover completely, others who overcome anorexia may find themselves struggling against a relapse throughout their lives, as the familiar feelings are triggered during times of stress. The good news is that seeking talk therapy during these times helps you avoid returning to your dangerous habits.

Bulimia
treatment

Bulimia nervosa treatment

Treatments that are effective for bulimia include talk therapy, self-help, medication, and nutritional support.

Talk therapy

There are several different approaches to talk therapy. In the treatment of bulimia, research suggests that cognitive behavioral therapy (CBT) is effective in helping you change your thoughts and behaviors around body image. One study found that family-based therapy—which involves intense parental involvement and a therapist trained in this approach—was effective for treating teenagers still living with their parents.

There is another option, too, that research suggests is helpful in bulimia treatment. Self-help, such as research-based online information or books, can be effective. These sources of information and reference can be a useful complement to help from a therapist or doctor. It is important to understand the difference, however, between Web sites that offer valid, research-based information and the pro-mia sites that either overtly or covertly offer tips for “being a better bulimic.”

Medication

An antidepressant may be prescribed to treat bulimia. It’s important to note that Prozac (fluoxetine) is the only medication approved by the U.S. Food and Drug Administration (FDA) to treat bulimia. According to the National Institute of Mental Health, fluoxetine appears to help alleviate the binge eating/purging behavior and decreases the likelihood of relapse while also helping to improve your attitude toward eating. Medication should be used in combination with talk therapy, not in place of it.

Antidepressants are not a cure-all; in fact, they can pose their own risks. The FDA has issued a warning on the use of antidepressants for teens and young people under the age of 24 due to research suggesting possible increase in suicidal thinking and behavior.


Nutritional counseling

As with treatment for anorexia, a dietitian can provide much-needed help during initial treatment by working with you to create meal plans and reinforce healthy eating patterns. A nutritional counselor helps you learn how normal meals and snacks regulate appetite. While nutritional counseling teaches the patient about healthy eating patterns, it’s often not an effective treatment by itself. It is most powerful when combined with talk therapy.

Binge eating
disorder treatment

Binge eating disorder treatment

Shame, poor self-image, and other unhelpful emotions tend to drive binge eating disorder, so treatment usually focuses on addressing psychological issues.

Talk therapy

 Psychotherapy can help you let go of unhealthy behaviors in exchange for new, healthier ones. The types of talk therapy that have been shown to be specifically helpful in treating binge eating disorder are cognitive behavioral therapy (how to change your thinking and change certain identified behaviors), interpersonal therapy (examination of relationships and how distressing relationship patterns can trigger binge eating), or dialectical behavior therapy. This type of talk therapy aims to teach you new ways to better tolerate stress, control or regulate emotions, and improve relationships.

Medications

 The U.S. Food and Drug Administration (FDA) has not approved any drug specifically to treat binge eating disorder. The study results on their effectiveness have been mixed; researchers tend to agree that more studies need to be done. That being said, however, certain antidepressants may be helpful.

  • Serotonin reuptake inhibitors and tricyclic antidepressants may affect brain chemicals that control mood. And changing mood may alleviate the need to binge. Antidepressants pose their own risks. The FDA has issued a warning on the use of antidepressants for teens and young people under the age of 24 due to research suggesting possible increase in suicidal thinking and behavior.
  • Topamax, an anticonvulsant used to control seizures, may also help reduce binge eating episodes, according to the results of some studies. But the drug has serious side effects, including vision changes, dizziness, drowsiness, jumbled thinking, and physical clumsiness.
  • Meridia, an anti-obesity drug, is an antidepressant. The FDA has given its approval for long-term obesity treatment. This drug may be helpful for those who have a binge eating disorder and who are obese. One of its most serious side effects is significant change in blood pressure.


Weight loss programs

A weight loss program might be used in conjunction with talk therapy. These programs are usually supervised by a healthcare provider and focus specifically on reducing weight safely to a healthy level. The programs may touch on the issues that set off binge eating behavior but don’t delve as deeply into issues as psychotherapy does. Weight loss programs are not typically used until the binge eating disorder is successfully treated.

Find Help

Locate mental health and well-being support organizations in your area.