Anorexia nervosa - Treatment 

Treating anorexia  

If you are diagnosed with anorexia nervosa, your GP will probably be involved in your ongoing treatment and care.

Other healthcare professionals involved in your treatment may include a:

  • specialist counsellor
  • psychiatrist (doctor who specialises in treating mental health conditions)
  • psychologist
  • nurse
  • dietician (specialist in nutrition)
  • paediatrician (in cases of children and teenagers)

This group is known as your care team.

Your treatment plan

Where you are treated may depend on how severe your condition is. You may be treated as:

  • an outpatient (this is most common)
  • a day patient or in a day unit
  • an inpatient in hospital or specialist centre, if your weight loss or symptoms are severe

It is important to start treatment as early as possible, particularly if someone has already lost a lot of weight.

Treatment for anorexia usually includes:

  • psychological treatment  talking to a therapist or counsellor
  • advice about eating and nutrition to help you gain weight safely

These treatments work better when combined, rather than on their own.

Your physical health will be monitored closely during your treatment. Your weight will be checked regularly and you will also have regular health checks. In children and young people, their height will also be regularly checked.

Other health problems caused by your anorexia will also be treated. For example:

  • if you vomit regularly, you will be given dental hygiene advice to help prevent stomach acid damaging the enamel on your teeth; you will also be advised to visit a dentist regularly
  • if you take laxatives or diuretics, you will be advised to reduce them gradually so your body can adjust; stopping them suddenly can cause problems, such as feeling sick and constipation

Gaining weight safely

You will be given advice about how to increase the amount you eat so you can gain weight safely, ensuring you receive the vitamins and nutrients you need.

You will be encouraged to eat small amounts of food and gradually increase what you eat as your body will not be used to dealing with normal amounts. The aim is to have a regular eating pattern, with three meals a day.

You may also need to take supplements to adjust the chemical balance in your body.

If you are treated as an outpatient, the aim will be to gain an average of 0.5kg a week to avoid complications associated with gaining weight more quickly, such as a chemical imbalance in your body.

If your weight loss is severe, you may be admitted to hospital. This is known as ‘re-feeding’. People treated as inpatients should aim to gain an average of around 0.5-1.0kg (1-2lbs) a week.

For more information, see ‘How can I gain weight safely’and treating malnutrition.

Types of psychological treatment

A range of psychological treatments are used to treat anorexia, such as:

  • cognitive analytic therapy (CAT)
  • cognitive behavioural therapy (CBT)
  • interpersonal therapy (IPT)
  • focal psychodynamic therapy (FPT)
  • family therapy

These are discussed below.

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 events in your past that explain why the unhealthy patterns developed
  • recognition  admitting how these patterns are contributing towards your anorexia
  • revision  identifying changes you can make to 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. In turn, our actions can affect how we think and feel.

The therapist will show you how the symptoms of anorexia are 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 you to adopt 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 our relationships with other people and the outside world in general have a powerful effect on our 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, being re-acted in adult life.

FPT encourages you to think about how early childhood experiences may have affected you. You may then be able to find more successful ways of coping with stressful situations and negative thoughts and emotions.

Family therapy

Anorexia does not just impact on one individual; it can have a big impact on the whole family.

Family therapy involves the family discussing how anorexia has affected them.

Medication

Medication alone is not usually effective in treating anorexia. It is usually only used to treat associated symptoms, such as obsessive compulsive disorder (OCD) or depression.

Medication will usually be recommended in combination with psychological or nutritional treatments.

Selective serotonin reuptake inhibitors

The selective serotonin reuptake inhibitors (SSRIs) type of antidepressants are usually recommended to treat mood disorders such as depression or OCD.

However, due to the risk of complications, SSRIs can only be used in people who have gained at least 85% of their recommended weight.

SSRIs are not usually recommended for children under 18 years of age.

Common side effects of SSRIs include:

  • feeling sick
  • blurred vision
  • diarrhoea or constipation
  • dizziness 
  • feeling agitated or shaky

These side effects should improve over time, although some can occasionally persist.

Olanzapine

A medication called olanzapine may be useful in treating anorexia in people who do not respond to other treatments.

Olanzapine was originally designed to treat psychosis but has been found to be helpful in reducing a person’s anxiety around issues such as weight and diet.

Side effects of olanzapine include:

  • sleepiness
  • dizziness
  • muscle stiffness or spasms
  • constipation
  • dry mouth
  • rash

Compulsory treatment

Occasionally, someone with anorexia may refuse treatment even though they are severely ill and their life is at risk.

In this situation, 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’.

Page last reviewed: 16/05/2012

Next review due: 16/05/2014

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Private therapy

Private treatment for anorexia is available in most areas.

It is important to choose someone appropriately qualified (usually a therapist) with expertise in eating disorders.

It is recommended  you choose someone accredited by either the UK Council for Psychotherapy (UKCP) or the British Association of Behavioural and Cognitive Psychotherapies (BABCP).

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) is a type of problem-solving therapy – find out more here