Treatment Of Anorexia Nervosa
Anorexia Nervosa is very common, so there is a good chance that you or someone you know may be struggling with this disorder. Anorexia must not only be treated medically, but also through nutritional guidance, therapeutic intervention, and often times psychotropic medication. Exploring treatment for a loved one can be an especially daunting and scary time, but there are numerous options and various types of treatment to fit the individual need.
Levels of Care
Inpatient Treatment or Hospitalization
Inpatient treatment is an intensive treatment recommended if the individual’s physical health is extremely compromised and/or they have little to no motivation for recovery. Inpatient treatment provides 24-hour care and monitoring, and is equipped with gastric feeding tubes for clients, should that be necessary. Unfortunately, this often means a parent or loved one must impose treatment on the individual. This can become increasingly difficult if the anorexic is an adult and is unable to see the need for treatment. If this occurs, petitioning for involuntary hospitalization, might be a lost option. Laws and procedures vary from state to state, so researching one’s state of residency would be the initial step.
Residential treatment provides a structured environment and 24-hour care, much like inpatient treatment, but in a more home-like atmosphere. An individual must be medically stable to be appropriate for a residential treatment center.
Partial hospitalization, or a day program, is for individuals who need ongoing structure and support but no longer need 24-hour care or supervision. This means client is medically and psychiatrically stable, but still experiencing functional impairments as a result of the anorexia. These individuals necessitate continued participation in therapeutic modalities like individual and group counseling, nutrition counseling and support around meals.
If the individual is able to manage maintaining a healthy weight and following an appropriate meal plan, outpatient services are a viable option. These include individual therapy and nutritional counseling sessions anywhere from 1-3 times per week. There are numerous therapeutic approaches that have shown success in the recovery from anorexia.
There is no medication proven to “cure” anorexia nervosa, yet medication can be beneficial in dealing with the underlying mental illness of the individual. Anti-depressants can intervene on depressive symptoms that frequently come with anorexia. Other psychiatric medications used to treat Obsessive-Compulsive Disorder (OCD) have been prescribed for anorexia; the thought being these medications will interfere with the drive for perfectionism that often accompanies anorexia.
Important to note: It is up to the person struggling with anorexia to make the choice to get into treatment and recover. As a parent, you can put your child into treatment, but no one (child or adult) can be forced into recovery. There are ways to compassionately encourage a loved one to seek treatment, and methods of supporting them throughout the process.
Cognitive Behavioral Therapy (CBT)
Shown to be one of the most effective treatments for anorexia nervosa, CBT helps change the negative pattern of thinking that creates the harmful behaviors contributing to the maintenance of the anorexia itself. The process of CBT begins with identifying or “catching” the negative self-talk, then challenging that self-talk by distinguishing the unrealistic thoughts or beliefs. Then, the process of incorporating healthier, more realistic thoughts can take place.
Dialectical Behavioral Therapy (DBT)
Dialectical behavioral therapy is focused on mindfulness, emotional regulation, distress tolerance, and radical acceptance. DBT skills are easily accessible in everyday life and are effective in decreasing depressive symptoms. DBT’s is especially useful in working with individual’s with eating disorders due to the emphasis on personal acceptance.
Family therapy is especially popular for children, teens, and young adults with anorexia. Families are not only often a contributing factor to the development of anorexia, but can also be a huge influence on the recovery process. Family therapy can provide insight into the history and origin of the individual’s eating disorder. Although the focus of the treatment is on the person with anorexia, family therapy is also a place where the family can gain their own support and education.
Many people who suffer from anorexia have experienced trauma at some point in their life, and the eating disorder becomes a way to deal with the ongoing affects of that trauma. Thus, healing the trauma is essential to healing the anorexia. There are a numerous approaches to address this trauma.
- Eye Movement Desensitization and Reprocessing (EMDR): based on the idea that a traumatic event overloads the body’s natural coping mechanisms, causing them to shut down, essentially overloading the brain and leaving the disturbing images or events “frozen” or unprocessed. EMDR uses a standardized set of protocols to help the brain create connections and allow the reprocessing of the traumatic event.
- Trauma Releasing Exercise (TRE): helps release the physiological stress and tension are the result of traumatic experiences
- Emotional Freedom Technique (EFT): uses acupressure through fingertips to work on obstructed energy fields in the body thought to be the source of emotional pain and anxiety.
Adventure therapy, sometimes known as wilderness therapy is a unique intervention for those struggling with anorexia. Adventure therapy provides a way to learn and grow in areas such as self-esteem, leadership, communication, teamwork, and mindfulness.
Do’s and Don’ts of Supporting an Individual with Anorexia
- DO educate yourself: read up on Anorexia nervosa; explore eating disorder self-help books
- DON’T use scare tactics: usually people with anorexia know the potential medical complications and life threatening implications – it does not help to reiterate them
- DO listen: be open, do not judge
- DON’T threaten: No one can force someone to recover from anorexia; don’t get into a power struggle
- DON’T comment on appearance or weight (of anyone!)
- DO encourage seeking help or treatment: offer to help research treatment centers or therapists; suggest going with your friend or loved one to his or her appointments
- DO identify your own views on body image and mental health: if you have unhealthy views about your own body, or biases around mental health, you may not be suitable to help your loved one.
- DON’T be the food police: monitoring your loved one’s food intake can create a strained relationship, resentment, and guilt and shame.
- DO get your own support: be a good role model; deal with your own struggles and stressors; seek any treatment you may need for yourself (eating disorder or otherwise)