Treatment for Anorexia

By Jim Haggerty, M.D.

Hospitalization:

In cases where a patient is severely ill and has a relapse from baseline weight, or is below 15 percent of appropriate body weight; OR the patient has other medical problems, inpatient hospitalization may be necessary. Patients are encouraged to eat regular meals with liquid supplements, but those who refuse feedings are given feedings through a nasogastric tube (plastic tube passed through nose, down esophagus, into stomach). Group and individual therapy supplement dietary and medical therapies. At one time inpatient treatment lasted many weeks, if not months, but in todayÆs climate the goals of hospitalization are weight gain and medical stabilization. The patient is moved to outpatient therapy when it is considered safe to do so.

Psychotherapy:

Psychotherapy can involve a significant time and financial commitment but you are worth it! Particularly if you are struggling with other issues (sexual abuse, depression, substance use, relationship problems), psychotherapy can be very helpful in addressing not only your disordered eating, but also your overall emotional health and happiness.

• Cognitive -Behavioral Therapy includes standard elements of behavioral treatment with a focus on identifying and altering dysfunctional thought patterns, attitudes and beliefs, which may trigger and perpetuate binge behavior or restrictive eating. Monitoring your intake of food is an important component, along with identifying triggers and developing alternative reactions to them
• Interpersonal Psychotherapy: IPT focuses on relationship difficulties, self-esteem, assertiveness, social skills and coping strategies.
• Family Therapy: There is no one unified form of family therapy. The goal of the family therapist is to help members of the family change behaviors that may have contributed to the development of some of the anorexicÆs pathologic thoughts and activities. Blame is not placed on one individual.
• Group Psychotherapy: When anorexics are recovering, group therapy can be very helpful. The group format allows people the opportunity for a sharing of information, survival skills, feedback about one with others, and it is a chance to enhance a personÆs self esteem by helping others. A trained leader or two directs the group.

Medications:

Unlike depression or panic disorder there are no specific medications that are used to treat anorexia nervosa. First and foremost, the doctor will prescribe medication that will treat any medical problems, like electrolyte abnormalities or abnormal heart rhythms.

• Antidepressants: Many patients also have depression, and their symptoms may respond to antidepressants . There is no data, however, that shows that antidepressants are effective in the acute treatment of Anorexia Nervosa, and actually since people with Anorexia Nervosa may be more at risk of suffering from side effects. Research has shown that people respond to medication much better after they are restored to a more normal weight. The antidepressants like Fluoxetine ( Prozac ), Sertraline (Zoloft ), Paroxetine (Paxil) - which are approved for depression and obsessive compulsive disorder may help the anorexic have fewer depressed feelings, as well as be less obsessed with food and their weight.
• Tranquilizers: Short-term use of medicines called benzodiazepines may help anorexics deal with some of their anxiety. These medicines are highly addictive, so they should not be used in individuals who have had problems with drugs or alcohol.
• Estrogen: Women with anorexia are at risk of fractures; this is as a result of osteoporosis. The lack of periods from their low body weight puts them in a state like early menopause. There is some suggestion that taking estrogen can help some women remineralize their bones and perhaps keep them from having fractures in the future.

Self-Help Programs and books:

There are a variety of materials available. Some people are able to make significant gains in this way. Other people require the structure of groups or more supervised treatment in order to recover fully.

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