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Treatments and drugs
By Mayo Clinic staffWhen you have anorexia, you may need several types of treatment. If your life is in immediate danger, you may need treatment in a hospital emergency department for such issues as dehydration, electrolyte imbalances or psychiatric problems.
Treatment of anorexia is generally done using a team approach that includes medical providers, mental health providers and dietitians, all with experience in eating disorders.
Here's a look at what's commonly involved in treating people with anorexia:
Medical care
Because of the host of complications anorexia causes, you may need frequent monitoring of vital signs, hydration level and electrolytes, as well as related physical conditions. A family doctor or primary care doctor may be the one who coordinates care with the other health care professionals involved. Sometimes, though, it's the mental health provider who coordinates care.
Psychotherapy
Individual, family and group therapy may all be beneficial. Individual therapy can help you deal with the behavior and thoughts that contribute to anorexia. In psychotherapy, you can gain a healthier self-esteem and learn positive ways to cope with distress and other strong feelings. A type of talk therapy called cognitive behavioral therapy (CBT) is most commonly used but lacks strong evidence that it's superior to other forms of therapy. The mental health provider can help assess the need for psychiatric hospitalization or day treatment programs.
Family therapy can help resolve family conflicts or muster support from concerned family members. Family therapy can be especially important for children with anorexia who still live at home. Group therapy gives you a way to connect to others facing eating disorders. And informal support groups can also be helpful. However, be careful with group therapy. For some people with anorexia, group therapy or support groups can result in competitions to be the thinnest person there.
Nutritional therapy
A dietitian offers guidance on a healthy diet. A dietitian can provide specific meal plans and calorie requirements to help meet weight goals. In severe cases, people with anorexia may require feeding through a tube that's placed in their nose and goes to the stomach (nasogastric tube).
Medications
There are no medications specifically approved by the Food and Drug Administration (FDA) to treat anorexia since they've shown limited benefit in treating this eating disorder. However, antidepressants or other psychiatric medications can help treat other mental disorders you may also have, such as depression or anxiety.
Hospitalization
In cases of medical complications, psychiatric emergencies, severe malnutrition or continued refusal to eat, hospitalization may be needed. Hospitalization may be on a medical or psychiatric ward. Some clinics specialize in treating people with eating disorders. Some may offer day programs or residential programs, rather than full hospitalization. Specialized eating disorder programs may offer more intensive treatment over longer periods of time. Also, even after hospitalization ends, ongoing therapy and nutrition education are highly important to continued recovery.
Treatment challenges in anorexia
Anorexia occurs on a continuum. Some cases are much more severe than others. Less severe cases may take less time for treatment and recovery. But one of the biggest challenges in treating anorexia is that people may not want treatment or think they don't need it. In fact, some people with anorexia promote it as a lifestyle choice. They don't consider it an illness. Pro-anorexia Web sites are proliferating, even offering tips on which foods to avoid and how to fight hunger pangs.
Even if you do want to get better, the pull of anorexia can be difficult to overcome. Anorexia is often an ongoing, lifelong battle. It may wax or wane. Even if symptoms subside, you remain vulnerable and may have a relapse during periods of high stress or during triggering situations. For some women, for instance, anorexia symptoms may subside during pregnancy but return after pregnancy. Ongoing therapy or periodic appointments during times of stress may be helpful.
Lack of health insurance coverage also can interfere with treatment. Many health insurers don't cover lengthy treatment programs, particularly inpatient programs. Relapse rates are higher when treatment ends too soon.
