Anorexia Nervosa

Finding The Right Treatment

Treatment

Anorexia nervosa is treated with a combination of psychotherapy, nutritional assistance, and medication. Some individuals with AN require hospitalization or residential treatment, prior to seeking outpatient treatment, to restore and nourish their bodies because of deteriorating health and dangerous health complications that require a higher level of care.

Finding a treatment team

The ideal treatment of Anorexia Nervosa involves a comprehensive treatment team including:

• Psychiatrist and/or other medication providers (psychiatric nurse practitioners or physician assistants)
• Internist/Specialists
• Psychotherapists (clinical psychologists, licensed professional counselors, licensed social workers, and licensed marriage and family therapists as it is important that the whole family is involved in one's treatment)
• Registered Dietitians

Having a complete and collaborative treatment team is the standard of practice for treating eating disorders. All work together. Finding a therapist that specializes in eating disorders is important, as not all therapists have experience treating them. Certified eating disorders specialists, by the International Associations of Eating Disorders Professionals (iaedp) are the gold standard of professionals that provide treatment.

To find a trained eating disorders team, visit iaedp.com for resources in the area.

Medical nutrition therapy

Medical nutrition therapy or nutrition counseling is an important part of treatment for anorexia nervosa. A nutritionist provides vital information about nutrition and overall health. They collaboratively assist the person with AN to develop meal plans that meet their nutritional needs. A nutritionist that specializes in eating disorders understands that for people with anorexia the solution isn’t just eating more calories, it’s about nourishing the body and offering support along the way.

Individuals with AN often benefit from talk therapy of the following styles:

• Cognitive Behavioral Therapy uses techniques to replace unhelpful thoughts and all or nothing thinking, such as feelings about one's body along with changing behaviors.
• Dialectical Behavior Therapy brings in skills to manage emotions around stressful situations and building positive relationships in order to have social support.
• Acceptance and Commitment Therapy offers competencies to accept thoughts and feelings, stay in the present moment, and choose a valued direction in the recovery process.
• Mindfulness-Based Cognitive Therapy uses mindful meditation to understand one’s thought process and how the mind becomes entangled by emotions and feelings.
• Body-Centered Therapies integrate talk therapy with techniques that bring the body into counseling as a therapeutic resource to increase awareness of body sensations, behaviors, emotions, and thoughts so to learn the relationships between them. Body centered therapies may include yoga therapy, dance, breath work, and meditation.

Depending on the severity of one's condition, a higher level of care may be warranted such as inpatient hospitalization for medical stabilization; residential treatment for excessive and daily behaviors that undermine health; partial hospitalization for those with daily behaviors but are able to function in normal social, educational, or vocational situations; or intensive outpatient therapy for those who are psychiatrically stable and have symptoms under sufficient control to be able to function in normal social, educational, or vocational situations, while continuing to make progress in recovery.

The decision to start therapy

Many people try to cope with their distress on their own, and then feel disappointed when they find that this is very difficult to do. Deciding to start therapy can be hard; it takes courage.

For some people, it can take time to warm up to the idea of sharing one’s intimate thoughts or disclosing details of one’s life, especially for those who grew up in a culture where seeking psychological help was frowned upon.

Psychotherapy is increasingly accepted as not only a way to improve mental health symptoms, but also a means for self exploration and personal growth. No problem is too small for a trained therapist: an individual need not worry that others may have it worse. The willingness to reach out for help is increasing: in 2020, one out of every six Americans (men and women) reported seeing a therapist.

Seeing a therapist with whom one feels comfortable, and a sense of connection, and who also participates in their insurance network, is essential. It may take a couple tries to find a therapist who feels like the right fit. If therapy didn't help the first time around, it can be helpful to give another therapist a try because therapeutic styles vary so much from therapist to therapist.

Where to start

Asking one’s physician to make a referral is often a good place to start. Many health insurance cards have websites or 1-800 numbers to call for a list of in-network providers.

To find a therapist who takes your insurance, the National Institute of Mental Health offers a comprehensive list of resources.

Psychology Today also lists therapists by type, location and insurance.

Determining whether medications will play a role in treatment

There is no medication that has been proven to be effective for treating anorexia, specifically. However, many people with anorexia nervosa also struggle with depression, anxiety, and other psychiatric conditions. Improving these other conditions may help the person with anorexia think somewhat more clearly.

Antidepressants

For most with depression or anxiety, the first step is to try a medication in the category of selective serotonin reuptake inhibitors (SSRIs or SRIs), which include fluoxetine (Prozac), escitalopram (Lexapro), and a few others. As a class of medications, antidepressants often take 10 days to two weeks to begin working. The full effect of the medication is not realized for two months.

FDA warning about suicide risk with antidepressants

Some research exists that, occasionally, newly initiated anti-depressants may increase the risk of suicide. If an individual begins to have these thoughts after starting an anti-depressant, please stop this medicine and contact a prescriber immediately. This risk is more evident in children, adolescents, and young adults.

Healthcare providers that can prescribe medications

Psychiatrists, psychiatric nurse practitioners, and physician assistants are practitioners who are trained to diagnose and treat mental health conditions by prescribing medications. Sometimes it's hard to find a psychiatric provider because there are so many people who need them. So, individuals often choose to see a different kind of provider who can prescribe. This could be a doctor they already see, like a primary care doctor, family doctor or OB/GYN, or a new primary doctor.