How are eating disorders treated?
In general, treatment for eating disorders is best provided by a team of professionals with expertise in eating disorders, usually including a mental health professional such as a psychiatrist, psychologist or social worker; a dietitian; and a primary care clinician.
Treatment for eating disorders will vary depending on the disorder and the severity of the illness.
For individuals with anorexia nervosa who are at very low weight, renourishment is often conducted in specialized inpatient eating disorders programs. Those with very low weight, very low heart rates, or other severe medical complications may need intensive care or cardiac monitoring.
Individuals who are less ill, but still need 24-hour care, may be treated in residential treatment centers. Day programs (partial hospitalization) provide intensive treatment for patients well enough to be at home in the evenings and on weekends. Those needing fewer hours of treatment may benefit from intensive outpatient programs (several hours of treatment daily or several days per week).
Early detection and specialized treatment early in the course of the illness may allow a person to recover with outpatient treatment and not require higher levels of care.
The first step in care is a comprehensive assessment by an eating disorder specialist or team. They will help the patient and family consider the various treatments and develop a plan. Treatments for eating disorders often focus initially on symptom management; restoring weight if it is low and stopping binge eating and purging behavior if it exists. This phase of treatment is often very challenging for patients, but it is essential.
Depending on the nature of the eating disorder, a variety of treatment options are available:
- Family-Based Treatment (FBT) – FBT is designed for children and teens especially with recent onset of anorexia. The parents are encouraged to take charge of feeding their child to ensure weight restoration. At later phases in treatment, control is returned to the patient.
- Cognitive-Behavioral Therapy (CBT) – CBT is a well-studied treatment for BN and BED and may also benefit those with AN after weight restoration. Individual or group sessions usually occur once a week. Patients are asked to keep track of all relevant events including food consumed, binge eating, purging by any means, as well as events preceding and following the event. Various behavioral strategies are used to facilitate healthful regular eating and avoidance of purging behavior and to challenge distorted thoughts about food and weight.
- Dialectial Behavior Therapy (DBT) – This is a treatment that has been shown to be of benefit for BN and BED, as well as those who have additional self-harming behaviors such as cutting, substance abuse, anger problems, or suicidal thinking. It focuses on developing the skills to regulate emotions, improve distress tolerance, and develop more effective behaviors and interpersonal skills.
- Medication – Certain medications may be useful in reducing anxiety and rigid thinking in some people. For those with BN, fluoxetine (Prozac) in a specific high dose is of proven benefit and is approved by the FDA for that purpose. Other medicines are commonly of benefit for those with both BN and BED – both for help with symptom management and for the associated difficulties with mood that often co-exist. Medication is used as an adjunct to other treatments.
The most important thing is to get treatment early and to seek out specialists in eating disorders who are familiar with the most effective treatments and can match the right ones to the patient and family.
GFED is working to expand and improve the treatment available and promote their availability to those who need them.