Treatment of Anorexia

A successful eating disorder treatment program should address both the physical and psychological aspects of the eating disorder. The patient, who is often initially reluctant, must be a willing participant in the treatment plan to maintain long-term positive outcomes. Hospitalization, psychotherapy and pharmacotherapy are all viable treatment options.

Hospitalization

The first consideration in the treatment of anorexia nervosa is to restore the patient¹s nutritional state, since dehydration, starvation and electrolyte imbalances can lead to serious health problems and, in some cases, death. According to The New Harvard Guide to Psychiatry (Nicholi, ed. 1988), suggested criteria for hospitalization include:

• weight loss of greater than 30 percent over three months
• severe metabolic disturbance
• severe depression or suicide risk
• severe binging and purging
• failure to maintain outpatient weight contract
• complex differential diagnosis
• psychosis
• family crisis
• need for confrontation of individual and family denial and initiation of individual and family therapy and pharmcotherapy

Inpatient psychiatric programs for anorexia nervosa patients generally use a combination of behavioral therapy, individual psychotherapy, family education and therapy, and, in some cases, psychotropic medications.

Patients often resist admission and, for the first several weeks of eating disorder treatment, will make dramatic pleas for the family's support to obtain release from the hospital program. In addition, the vast majority of patients with anorexia nervosa require continued intervention after discharge from the hospital.

Psychotherapy

Many clinicians prefer cognitive-behavioral approaches to monitor weight gain and maintenance and to address eating behaviors. Cognitive or interpersonal strategies also have been recommended to explore other issues related to the disorder, such as depression. Family therapy has been used to examine interactions among family members, since unresolved conflict within the family is often implicated in the illness.

Pharmacotherapy

While clinical studies have not yet identified a medication that improves the core symptoms of anorexia nervosa, several medications have demonstrated benefit. Some studies support the use of Periactin® (cyproheptadine), which has both antihistaminic and antiserotonergic properties, in the restricting type (no binge eating or purging behavior) of anorexia. Elavil® (amitriptyline) also has been reported to have some benefit in anorexia patients.

In patients with coexisting depressive disorders, other antidepressants have shown little benefit. In addition, the use of tricyclic drugs in low-weight, depressed patients can be risky, since these patients may be vulnerable to hypotension, cardiac arrhythmia and dehydration.

Electroconvulsive Therapy (ECT)

Some evidence indicates that electroconvulsive therapy (ECT) is also beneficial in certain cases of anorexia nervosa with major depressive disorder.

Self-Management

To make the fullest possible recovery, a person with anorexia must:

1. Participate actively in the treatment plan.
2. Complete the inpatient program when necessary.
3. Maintain weight independently within 5 pounds of assigned target weight.
4. Function independently in activities of daily living.
5. Regularly attend individual, group and/or family psychotherapy.
6. Regularly visit your internist to safeguard your physical health.
7. Demonstrate effective coping skills.
8. Ask for assistance when needed.
9. Be honest with your therapist and internist. No withholding of information.

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