Before your treatment begins, you will probably have an overall assessment of your health. This may be done by your GP or another healthcare professional, such as one that specialises in eating disorders.
The assessment will help your healthcare professional draw up a plan for your treatment and care. For example, they may assess:
- your health and medical needs
- your social needs, such as support from family and friends
- any risks that affect you, such as whether you are at risk of harming yourself
- how mild or severe your condition is, in case any urgent action is needed
Your care team
If you are diagnosed with anorexia nervosa, your GP will probably be involved in your ongoing treatment and care. Other healthcare professionals may also be involved in your treatment, such as:
- a specialist counsellor
- a psychiatrist (doctor who specialises in treating mental health conditions)
- a psychologist
- a nurse
- a dietician (specialist in nutrition)
If a child or teenager has anorexia, a paediatrician (doctor who specialises in children) may also be involved in their treatment.
Your treatment plan
Where you are treated may depend on how mild or severe your condition is. For example, you may be treated:
- as an outpatient (this is most common)
- as a day patient or in a day unit
- as in inpatient in hospital, if your weight loss or symptoms are severe
In some areas, eating disorders such as anorexia are treated by community mental health teams, which are made up of different health and social care professionals.
In other areas, there are units that specialise in treating eating disorders. Some services that treat eating disorders also specialise in treating young people.
It is important to start treatment as early as possible, especially if someone has already lost a lot of weight.
Treatment for anorexia usually includes:
- psychological treatment – talking to a therapist or counsellor
- advice on 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. For example:
- your weight will be checked regularly
- you may have regular health checks with your GP or another healthcare professional
In children and young people with anorexia, their growth, development and weight will be monitored closely. Their height will also be checked regularly against the average for their age and sex.
Other health problems caused by your anorexia will also be treated. For example, if you:
- vomit regularly, you will be encouraged to stop. You will be given advice on dental hygiene to help prevent stomach acid damaging the enamel on your teeth. You will also be advised to visit a dentist regularly
- take laxatives or diuretics, you will be advised to reduce them gradually so that your body can adjust. Stopping them suddenly can cause problems, such as nausea and constipation
Gaining weight safely
Your healthcare professional will give you advice on how to increase the amount you eat so you can gain weight safely.
They will probably ask about your current eating habits and how much fluid you drink, as well as lifestyle issues, such as smoking and alcohol. This will determine what advice they give you, and help them to identify any deficiencies in your diet, such as a lack of vitamins.
Your healthcare professional will help you to develop healthy eating habits, such as:
- eating more food
- eating more healthily
- increasing the nutrients and calories you get from food
You may need to start by eating small amounts of food, then gradually increase what you eat. Your body will not be used to dealing with normal amounts.
You may need to take supplements, such as multivitamins or multiminerals, to adjust the chemical balance in your body. Some experts think that this should be done before you start gaining weight.
Work towards having a regular pattern of eating, with three meals a day. A target weight may be set, so you can aim for a minimum healthy weight.
If you are treated as an outpatient, aim to gain an average of 0.5kg a week. Most people can achieve this by eating around 3,500 to 7,000 extra calories each week. This level of weight gain helps to avoid complications that can occur if you gain weight more quickly, such as a chemical imbalance in your body.
If your weight loss is severe, treatment in hospital may be needed to help you start to gain weight. This is sometimes called ‘refeeding’. Your health will be closely monitored, particularly in the first few days. People treated as inpatients should aim to gain an average of around 0.5–1.0kg (1-2lbs) a week.
Types of psychological treatment
Various types of psychological treatment can be used to treat anorexia, such as:
- cognitive analytic therapy (CAT)
- cognitive behavioural therapy (CBT)
- interpersonal therapy (IPT)
- focal psychodynamic therapy (FPT)
- family therapy
These different types of psychological treatments are discussed below.
Cognitive analytic therapy (CAT)
CAT is based on the theory that serious mental health conditions such as anorexia are caused by unhealthy patterns of behaviour and thinking, which a person has developed in their past, usually in their childhood.
CAT involves a three-stage process that you will work through with your therapist:
- reformulation – you look for events in your past that may explain why the unhealthy patterns developed. For example, you may have felt in control by not eating during a time in your life that was particularly chaotic or stressful
- recognition – you admit and recognise how these patterns are contributing towards your anorexia
- revision – after discussion with your therapist, you identify 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. It is therefore necessary to change the act of thinking (cognition) and our behaviour at the same time.
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 the 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.
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 that are caused by problems with interacting with people.
During IPT, the therapist will explore any 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, that are 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.
Anorexia does not just impact on one individual; it can have a big impact on the person’s family.
Family therapy involves the person with anorexia and close members of their family discussing how anorexia has affected the family, and the positive changes the person and their family can make.
Choosing a psychological treatment
With the exception of family therapy, there is little scientific evidence to show that the treatments listed above are effective in treating anorexia.
This is not to say they are ineffective; just that very little research has been done to investigate their effectiveness in anorexia.
Little research has been done in this area because many people with anorexia are in denial about their condition, so are unlikely to take part in medical trials. Also, many medical trials that were done had to be abandoned because many of the participants dropped out.
The type of treatment you choose may be based on personal preference and what services are available in your local area. Some people find using a combination of different treatments useful, such as family therapy and CBT.
Research studies have shown that medication alone is not usually effective in reducing anorexia symptoms.
Medication is usually only recommended to treat any associated symptoms, such as obsessive compulsive disorder (OCD) or depression.
Any medication that is prescribed for you, such as antidepressants, will be recommended in combination with one of the psychological or nutritional treatments described above.
Research has found that 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 (where you are unable to distinguish between reality and imagination), and some researchers have argued that it may also be helpful in reducing a person’s anxiety around issues such as weight and diet.
Side effects of olanzapine include:
Occasionally, someone with anorexia may refuse treatment even though they are severely ill and their life is at risk.
In such a situation, doctors may decide to admit the person to hospital for compulsory treatment under the Mental Health Act. This is sometimes called ‘sectioning’ or being ‘sectioned’.