Eating Disorders
Treatment
for Anorexia, Bulimia
Eating disorders are most successfully treated when
diagnosed early. Unfortunately, even when family members confront the ill
person about his or her behavior, or physicians make a diagnosis, individuals
with eating disorders may deny that they have a problem. Thus, people with
anorexia may not receive medical or psychological attention until they have
already become dangerously thin and malnourished. People with bulimia are often
normal weight and are able to hide their illness from others for years. Eating
disorders in males may be overlooked because anorexia and bulimia are
relatively rare in boys and men. Consequently, getting--and keeping--people
with these disorders into treatment can be extremely difficult.
In any case, it cannot be overemphasized how important treatment is--the
sooner, the better. The longer abnormal eating behaviors persist, the more
difficult it is to overcome the disorder and its effects on the body. In some
cases, long-term treatment may be required. Families and friends offering
support and encouragement can play an important role in the success of the
treatment program.
If an eating disorder is suspected, particularly if it involves weight loss,
the first step is a complete physical examination to rule out any other
illnesses. Once an eating disorder is diagnosed, the clinician must determine
whether the patient is in immediate medical danger and requires
hospitalization. While most patients can be treated as outpatients, some need
hospital care.
Conditions warranting hospitalization include excessive and rapid weight
loss, serious metabolic disturbances, clinical depression or risk of suicide,
severe binge eating and purging, or psychosis.
The complex interaction of emotional and physiological problems in eating
disorders calls for a comprehensive treatment plan, involving a variety of
experts and approaches. Ideally, the treatment team includes an internist, a
nutritionist, an individual psychotherapist, and a
psychopharmacologist--someone who is knowledgeable about psychoactive
medications useful in treating these disorders.
To help those with eating disorders deal with their illness and underlying
emotional issues, some form of psychotherapy is usually needed. A psychiatrist,
psychologist, or other mental health professional meets with the patient
individually and provides ongoing emotional support, while the patient begins
to understand and cope with the illness. Group therapy, in which people share
their experiences with others who have similar problems, has been especially
effective for individuals with bulimia.
Use of individual psychotherapy, family therapy, and cognitive-behavioral
therapy--a form of psychotherapy that teaches patients how to change abnormal
thoughts and behavior--is often the most productive. Cognitive-behavior
therapists focus on changing eating behaviors usually by rewarding or modeling
wanted behavior. These therapists also help patients work to change the
distorted and rigid thinking patterns associated with eating disorders.
National Institute of Mental Health-supported scientists have examined the
effectiveness of combining psychotherapy and medications. In a recent study of
bulimia, researchers found that both intensive group therapy and antidepressant
medications, combined or alone, benefited patients. In another study of
bulimia, the combined use of cognitive-behavioral therapy and antidepressant
medications was most beneficial. The combination treatment was particularly
effective in preventing relapse once medications were discontinued. For
patients with binge eating disorder, cognitive-behavioral therapy and
antidepressant medications may also prove to be useful.
Antidepressant medications commonly used to treat bulimia include
desipramine, imipramine, and fluoxetine. For anorexia, preliminary evidence
shows that some antidepressant medications may be effective when combined with
other forms of treatment. Fluoxetine has also been useful in treating some
patients with binge eating disorder. These antidepressants may also treat any
co-occurring depression.
The efforts of mental health professionals need to be combined with those of
other health professionals to obtain the best treatment. Physicians treat any
medical complications, and nutritionists advise on diet and eating regimens.
The challenge of treating eating disorders is made more difficult by the
metabolic changes associated with them. Just to maintain a stable weight,
individuals with anorexia may actually have to consume more calories than
someone of similar weight and age without an eating disorder.
This information is important for patients and the clinicians who treat
them. Consuming calories is exactly what the person with anorexia wishes to
avoid, yet must do to regain the weight necessary for recovery. In contrast,
some normal weight people with bulimia may gain excess weight if they consume
the number of calories required to maintain normal weight in others of similar
size and age.
Anorexia
The course of anorexia nervosa varies greatly among patients, ranging from
spontaneous recovery without treatment, to recovery after a variety of
treatments; to a fluctuating course of weight gain followed by relapse; or,
rarely, to a gradually deteriorating course resulting in death caused by
complications of starvation.
By the time a person with anorexia nervosa comes to medical attention, the
disorder usually has progressed to a considerable degree, and weight loss has
become apparent. Often, amenorrhea (ending of monthly periods) is the first
manifestation of the disorder to come to the attention of the physician, as it
often appears before weight loss is noticeable. From 30 to 50 percent of
anorexia nervosa patients also have the symptoms of bulimia nervosa.
In general, the prognosis for anorexia nervosa is not favorable. While a
patient may return to his or her normal weight, moderate to severe
preoccupation with food and body weight often continues, social relationships
are frequently impaired, and many patients are clinically depressed. Studies
have shown a range of mortality rates from 5 to 18 percent, although the higher
rates almost certainly occur in persons with associated disorders (e.g.,
depression, OCD, or substance abuse).
Click here for specific treatment
information on Anorexia.
Bulimia
Little is known about the long-term course of bulimia nervosa, and the
short-term outcome is variable. However, it seems to have a better prognosis
than anorexia nervosa. In the short run, bulimia patients who are treated
report more than 50 percent improvement in binging and purging; among
outpatients, improvement seems to last more than five years. The patients,
however, are not symptom-free during periods of improvement, as bulimia is a
chronic disorder that waxes and wanes.
Click here for specific treatment
information on Bulimia.
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