Anorexia nervosa (frequently referred to simply as anorexia, or as AN) is a serious and potentially life-threatening eating disorder that can be successfully treated with the right treatment program that’s individually designed and delivered by an experienced team of specialists.
Signs and Symptoms of Anorexia Nervosa
Anorexia is characterized by extreme food restriction as well as an intense fear of weight gain. People suffering from anorexia have a tendency to regularly and obsessively watch their weight, avoid certain foods, and extremely restrict their caloric intake.
Aside from an irrational fear of gaining weight, people struggling with this eating disorder usually have a distorted body image. They often view themselves as overweight even if they are actually dangerously underweight.
A person suffering from anorexia typically consumes a limited amount of calories and eats very few food items, which often leads to a dangerously low weight that’s unsuitable for their age, height, and overall health and functioning. In addition, a person with anorexia may also exercise excessively and/or purge food he or she consumes. The latter is done either through vomiting, laxative abuse, or other ways.
People of all ages, genders, ethnicities, economic status, and weights can all suffer from anorexia. While it usually affects teenagers and young female adults, children, men, and older adults can also struggle with this condition.
At least 9% of the world population (equivalent to at least 720,000,000 people) are estimated to suffer from an eating disorder. Anorexia affects about 1% to 2% of the global population, with roughly 0.3% of adolescents worldwide affected.
Risks and Complications of Anorexia Nervosa
Anorexia is a serious disorder that requires immediate treatment. That’s because, when left untreated, it can lead to malnutrition and starvation, which can negatively affect various organs in the body. In severe cases, vital organs like the heart, brain, and kidneys can suffer damage that’s irreversible even after recovering from anorexia.
Eating disorders (including anorexia) are among the most deadly mental health conditions, next only to opioid addiction. People with anorexia are five (5) times more likely to die prematurely, and 18 times more likely to die from suicide.
Here are some of the health complications that can occur when anorexia is left untreated:
- Anemia
- Insomnia
- Loss of bone mass (osteoporosis) and erosion of tooth enamel
- Irregular heartbeats (arrhythmia), including ventricular arrhythmia
- Mitral valve prolapse (due to loss of heart muscle mass)
- Cardiac arrest
- Fatty liver disease (steatosis)
- Liver and kidney damage
- Rhabdomyolysis (rapid breakdown of skeletal muscle) resulting from water loss and electrolyte or acid-base imbalances
- Seizures due to an extremely low blood sugar level (hypoglycemia)
- Impaired growth and development
- Menstrual problems
- Fertility problems
- In the worst cases, anorexia can lead to death due to severe medical conditions or self-inflicted in the form of suicide.
Besides physical complications, many people suffering from anorexia also struggle with other mental health conditions such as:
- Anxiety, depression, or other mood disorders
- Obsessive-compulsive disorders
- Personality disorders (e.g., borderline personality disorder)
- Substance abuse (e.g., alcohol)
Most people with anorexia also have relationship issues and other social problems. All of these can lead to a significantly low quality of life, in addition to increasing the risk of shortening their lifespan. Moreover, those conditions can complicate anorexia, so an experienced treatment team of a patient with anorexia will likely want to tackle those conditions alongside the eating disorder.
Treatment Requirements and Objectives for Anorexia
The good news is that anorexia can be effectively treated, and many people who have suffered for years from this eating disorder have successfully adopted healthy eating patterns and regained a healthy weight.
However, it should be noted that there is a high risk of relapse with this condition, so effective recovery involves long-term treatment along with the patient’s dedication to getting better. Treatment for anorexia should address both the patient’s physical and psychological health.
As with other eating disorders, treating anorexia is normally conducted using a team approach that involves medical doctors, mental health experts (e.g., psychiatrist, psychologist, family therapist), dietitians, and so on. These professionals have the training and experience in treating a wide range of eating disorders. The guidance of a dedicated team of specialists and the support of loved ones are both essential in helping a patient achieve effective and lasting recovery from this condition.
Like for other eating disorders, anorexia requires a customized treatment program that’s created especially for each patient. It’s designed with the patient’s distinct case, health condition, type and severity of anorexia, co-occurring or comorbid disorders (if any), and other unique factors in consideration.
Generally speaking, the main objectives of anorexia treatment include helping the patient:
- Regain good states of physical and mental health
- Challenge (and eventually, change) negative beliefs about one’s weight and body
- Transform disordered eating patterns into healthier eating behaviors
- Develop and follow a realistic plan for preventing and managing relapse
Treatment Options for Anorexia Nervosa
Effective treatment for anorexia depends on the patient’s specific needs and usually involves a combination of these strategies:
PSYCHOTHERAPY (INCLUDING GROUP AND/OR FAMILY THERAPY)
Psychotherapy is a kind of one-on-one counseling that aims to change the thoughts (cognitive therapy) and resulting behaviors (behavioral therapy) of patients with eating disorders. It includes useful techniques to form healthy and realistic views and attitudes toward one’s weight and food. It also teaches strategies for dealing with challenging situations, such as relapse. (Please refer to the next section for some of the common therapies used in treating anorexia.)
NUTRITION COUNSELING
Nutrition counseling is an important element in the holistic treatment of anorexia. It involves (but is not limited to) the following:
- Restoration of normal and healthy eating behaviors
- Development of a better and healthier view of weight and food
- Reconstruction of a healthy personal relationship with food and eating
- Discussion of the value of nutrition and a balanced diet
- Helping patients gain a better appreciation of the effects of nutrition to their brain chemistry and emotions is essential in treating anorexia. Along with the medical and psychiatric elements of treatment, a nutritionist can help create a customized meal plan for each patient to help restore his or her healthy weight. Patients are encouraged to actively participate in planning and preparing their meals, which are extremely beneficial even after they finish their treatment program.
- Through nutrition counseling, patients with anorexia can also begin to consume food intuitively, viewing it for its benefits in terms of nutrition and pleasure, rather than simply from the lens of fat, calories, and so on.
MEDICATION THERAPY
There is currently no medication that can completely treat an eating disorder. In fact, the American Psychological Association discourages the use of medications as the primary treatment for anorexia. However, certain medications are available to help patients deal with various symptoms or manage conditions (such as anxiety and depression) that are related to their eating disorder.
Some medications that are commonly prescribed to patients with anorexia are anti-anxiety drugs, antipsychotics, mood stabilizers, and antidepressants like fluoxetine (Prozac). The antipsychotic medication olanzapine (Zyprexa) can be prescribed to help patients regain a healthy weight. Medications may also be given for period regulation and other symptoms or reversible complications related to the eating disorder, such as constipation, anemia, and osteoporosis.
A word of caution: Some medications are contraindicated for patients suffering from anorexia. One example is bupropion (Wellbutrin), which is typically prescribed for depression and smoking cessation. Wellbutrin is associated with a higher likelihood of seizures when taken by people with anorexia.
MEDICAL CARE (INCLUDING HOSPITALIZATION, IF NEEDED)
Generally, treatment for anorexia initially focuses on stabilizing patients’ condition and restoring their health. Anorexia often causes nutritional deficiencies, which has various physical and medical consequences. A good eating disorder rehab center will have an in-house medical team (e.g., clinical nursing staff). If they don’t have medical doctors onsite, they are usually affiliated with a local hospital that can serve patients’ medical needs.
Medical providers in hospitals, clinics, and recovery centers monitor each patient’s health status (including their vital signs, electrolytes and hydration level, and other physical conditions) on a regular basis. Medical care and monitoring is a crucial element of the treatment for anorexia, since this disorder usually leads to a number of physical and psychological issues.
If a patient’s health is in immediate danger, hospitalization and/or treatment in an emergency room might be advised. This usually happens in cases where the patient suffers from severe health complications like dehydration, electrolyte imbalance, a heart rhythm disturbance, or a psychiatric emergency (including having suicidal thoughts or behaviors), extreme malnutrition, or continued failure or refusal to eat. In severe cases, patients might need to be fed using a tube that’s inserted in their nose (called a nasogastric tube), which delivers food directly to their stomach.
Receiving treatment for anorexia may come with the risk of a serious complication called refeeding syndrome. This life-threatening condition occurs when severely malnourished patients who start receiving nutrition again are unable to successfully restart their body’s metabolic process. Patients who experience refeeding syndrome can suffer from gastrointestinal issues, swelling of the entire body (edema), heart or lung failure, severe muscle weakness, delirium, and even death. Because of these serious and potentially lethal side effects, it’s imperative for patients with anorexia to receive proper and urgent medical attention.
Lastly, there are a few clinics that specialize in providing treatment to patients suffering from eating disorders, which is usually in the form of either outpatient or residential treatment instead of full hospitalization.
Some studies have also shown that alternative or complementary therapies such as meditation, yoga, meditation, and relaxation techniques may provide benefits to patients struggling with anorexia.
Support groups for people with anorexia can also be very helpful but should never be used as a substitute for proper treatment provided by professionals.
The Most Successful Psychotherapy Treatment for Anorexia Nervosa
Treating anorexia often involves a comprehensive program that involves multiple forms of therapy. Many of these therapies can be performed in either inpatient (e.g., in a recovery or rehab center) or outpatient settings. Some common approaches are the following:
DIALECTICAL BEHAVIOR THERAPY (DBT)
DBT is a form of CBT that was initially created for treating borderline personality disorder, but is increasingly being used for treating eating disorders like anorexia, as well as psychological conditions like PTSD and depression. Being dialectical, this therapy focuses on acceptance and change. A study found that DBT helped lessen eating disorder symptoms among teenagers with anorexia.
At ‘Ai Pono Hawaii Eating Disorder Treatment Program, DBT Skills are integrated on a daily basis, with particular emphasis on emotional awareness and assertive communication skills.
COGNITIVE BEHAVIOUR THERAPY (CBT)
Perhaps the most well-known psychotherapy in contemporary time, CBT works on helping each patient let go of his or her dysfunctional thinking patterns and irrational thoughts that sustain those thoughts. CBT teaches patients new skills that help them label and challenge unhelpful beliefs and behaviors that cause and maintain their eating disorder.
CBT is known as the most heavily researched and most recommended anorexia treatment for adults. CBT also typically includes psychoeducation and the development of a unique meal plan, as well as tips for managing familial, psychological, and societal elements surrounding a patient’s experience of anorexia.
Enhanced cognitive behavioral therapy (or CBT-E) is a type of CBT that specifically tackles eating disorders and the psychology around them. CBT-E may be customized for each patient’s unique case.
In CBT, an experienced therapist will work with the patient to develop a personalized treatment plan for anorexia. CBT usually involves weekly therapy sessions that may last up to 40 weeks (9 to 10 months), with 2 sessions per week in the first 2 to 3 weeks. However, the exact duration and frequency of sessions will depend on each patient’s case.
FAMILY BASED TREATMENT (FBT)
FBT is considered to an effective treatment for anorexia in children and adolescents. FBT is a therapeutic, outpatient treatment that involves the patient’s family working together to tackle the patient’s eating disorder. The family supports their loved one in reclaiming control of his or her life.
At its best, FBT allows patients to freely express themselves in a safe space. Including their close family in the treatment process enables patients to learn possibly dysfunctional roles they have in their family, which could be a major factor in their disordered eating patterns. Sometimes, family members even take part in sessions that don’t include the patient. Since the underage patient is not capable of making the best decisions when it comes to health and food, parents are empowered to help their children in the re-feeding and weight restoration stages while their children begin to learn to make better decisions in relation to food.
The Maudsley Method is a specific family-based therapy that guides parents in taking responsibility for their children’s eating patterns, focusing on a good eating schedule and a sustainable diet. Controlled trials have shown that a staggering 70 percent of teenagers with anorexia regained their normal weight after completing this program. There is also what’s called the Maudsley Anorexia Nervosa Treatment for Adults (MANTRA), which involves talk therapy with an experienced therapist to help an adult patient with anorexia discover the causes of his or her eating disorder. The objectives of the Maudsley method serve as three treatment stages:
- Help the patient regain any weight he or she needs to
- Help the patient learn new (i.e., healthier) eating habits
- Help the patient establish a secure sense of self
FBT is not for everyone and every family, however. Putting parents in such a primary role can lead to role confusion in the house and cause disruptions in the organic parent/child dynamic. This relational confusion and strain can in some cases compound issues and cause significant distress, anxiety, or even anger in the patient and parents alike.
ART THERAPY
This type of psychotherapy utilizes art media as the creative outlet and main instrument for communication as well as therapeutic healing of patients struggling with anorexia. Guided by an art therapist, patients can learn to express their own thoughts, emotions, and stories through various art forms such as drawing, painting, sculpting, clay making, and more.
DANCE/MOVEMENT THERAPY
Dance is also used as a form of therapy by serving as a unique channel for self-expression. Dance was shown to be effective in healing a variety of disorders, such as mood disorders and learning disabilities. Dance therapy for eating disorders like anorexia usually includes guided movements.
INTERPERSONAL PSYCHOTHERAPY (IPT)
IPT is a popular and evidence-based therapy originally designed to help patients with depression. It has been included in the treatment plan of eating disorders like anorexia because it enables patients to deal with symptoms related to their social relationships. In a review, IPT was found to be as effective as CBT in treating anorexia, and it also provided positive long-term results, like helping patients sustain their recovery.
ACCEPTANCE AND COMMITMENT THERAPY (ACT)
ACT was developed to improve the mental flexibility of patients with eating disorders through acceptance and mindfulness, as well as commitment and behavior-changing techniques. Although ACT is relatively new and research on its effectiveness for anorexia is still ongoing, some studies have already shown that it helps patients develop better eating behaviors.
ACT focuses on six core values:
- Acceptance
- Cognitive defusion (teaching the patient how to deal with uncomfortable thoughts and emotions)
- Awareness of the present moment
- Self-as-context (reinforcing the knowledge that a patient is not his or her thoughts and emotions)
- Values
- Committed action
Successful Treatment for Anorexia and Other Eating Disorders
Every patient’s anorexia recovery process is unique. With enough dedication, the right treatment program, and strong support, it is possible for anyone to heal from this potentially lethal eating disorder. Seeking help as early as possible will help prevent or minimize serious complications, as well as improve one’s chances of a lasting recovery from anorexia.
A tranquil treatment center based in Maui, ‘Ai Pono Hawaii has been providing more than 35 years of successful and holistic treatment for anorexia and other eating disorders.
