The treatment for anorexia nervosa usually involves a combination of psychological therapy and supervised weight gain.
It is important to start treatment as early as possible, particularly if someone has already lost a lot of weight, to reduce the risk of serious complications of anorexia.
The treatment plan
GPs will normally be closely involved in ongoing treatment, although other healthcare professionals are usually involved, including:
- specialist counsellors
- specialist nurses
- paediatricians – in cases affecting children and teenagers
Before treatment starts, members of this multidisciplinary care team will carry out a detailed physical, psychological and social needs assessment and develop a care plan.
Most people are treated as an outpatient, which means they visit hospitals, specialist centres or individual members of their care team for appointments, but return home in between.
In more severe cases, people may need to stay in hospital or a specialist centre for longer periods during the day (day patient) or may need to be admitted as an inpatient.
A number of different psychological treatments can be used to treat anorexia. Depending on the severity of the condition, treatment will be for at least 6 to 12 months or more.
Cognitive analytic therapy (CAT)
CAT is based on the theory that mental health conditions such as anorexia are caused by unhealthy patterns of behaviour and thinking developed in the past, usually during childhood.
CAT involves a three-stage process:
- reformulation – looking for past events that may explain why the unhealthy patterns developed
- recognition – helping people see how these patterns are contributing towards the anorexia
- revision – identifying changes that can break these unhealthy patterns
Cognitive behavioural therapy (CBT)
CBT is based on the theory that how we think about a situation affects how we act and that, in turn, our actions can affect how we think and feel.
In anorexia, the therapist will attempt to show how anorexia is often associated with unhealthy and unrealistic thoughts and beliefs regarding food and diet. For example, thinking that:
- "putting on weight is the single worst thing that can happen in my life"
- "everyone I know secretly thinks I am fat"
- "if I finish the whole meal then people I am eating with will think I am greedy and worthless"
The therapist will encourage the adoption of healthier, more realistic ways of thinking that should lead to more positive behaviour.
Read more about cognitive behavioural therapy.
Interpersonal therapy (IPT)
IPT is based on the theory that relationships with other people and the outside world in general have a powerful effect on mental health.
Anorexia may be associated with feelings of low self-esteem, anxiety and self-doubt caused by problems with interacting with people.
During IPT, the therapist will explore negative issues associated with your interpersonal relationships and how these issues can be resolved.
Focal psychodynamic therapy (FPT)
FPT is based on the theory that mental health conditions may be associated with unresolved conflicts that occurred in the past, usually in childhood.
The therapy encourages people with anorexia to think about how early childhood experiences may have affected them. The aim is to find more successful ways of coping with stressful situations and negative thoughts and emotions.
Anorexia does not just impact on one individual. It can have a big impact on the whole family. Family interventions are an important part of treatment for young people with anorexia.
Family interventions should focus on the eating disorder. They involve the family discussing how anorexia has affected them. They also help the family understand the condition and how they can help.
Gaining weight safely
The care plan will include advice about how to increase the amount eaten so weight is gained safely.
Physical health – as well as weight – is monitored closely. The height of children and young people will also be regularly checked to make sure they are developing as expected.
Only small amounts of food will be expected to be eaten at first, gradually increasing as the body becomes used to dealing with normal amounts.
The eventual aim is to have a regular eating pattern, with three meals a day, possibly with vitamin and mineral supplements.
An outpatient target is an average gain of 0.5kg a week. In a specialist unit, the aim will usually be to gain an average of around 0.5-1.0kg a week.
See treating malnutrition for more information about what gaining weight at home or in hospital may involve.
Occasionally, someone with anorexia may refuse treatment even though they are severely ill and their life is at risk.
As a last resort in these cases, doctors may decide to admit the person to hospital for compulsory treatment under the Mental Health Act. This is sometimes known as "sectioning" or being "sectioned".
Treating additional problems
In addition to the main treatments mentioned above, other health problems caused by your anorexia will also need to be treated.
If you make yourself vomit regularly, you will be given dental hygiene advice to help prevent stomach acid damaging the enamel on your teeth.
For example, you may be advised to not brush your teeth soon after vomiting to avoid further abrasion to tooth enamel and to rinse out your mouth with water instead.
You may also be told to avoid acidic foods and mouth washes. You will also be advised to visit a dentist regularly so they can check for any problems.
If you have been taking laxatives or diuretics in an attempt to lose weight, you will be advised to reduce them gradually so your body can adjust. This is because stopping them suddenly can cause problems such as nausea and constipation.
Medication alone is not usually effective in treating anorexia. It is usually only used in combination with the measures mentioned above to treat associated psychological problems, such as obsessive compulsive disorder (OCD) or depression.
Two of the main types of medication used in people with anorexia are:
- selective serotonin reuptake inhibitors (SSRIs) – a type of antidepressant medication that can help people with co-existing psychological problems such as depression and anxiety
- olanzapine – a medication that can help reduce feelings of anxiety related to issues such as weight and diet in people who have not responded to other treatments
SSRIs tend to be avoided until you have started to gain weight as the risk of more serious side effects is increased in people who are severely underweight. They are only used cautiously in young people under 18.
Read more about the side effects of SSRIs.