Treatment

Patients with eating disorders typically require a treatment team consisting of a primary care physician, dietitian, and a mental health professional knowledgeable about eating disorders. The multidisciplinary membership of the Academy for Eating Disorders reflects the consensus view that treatment must often involve clinicians from different health disciplines including psychologists, psychotherapists, physicians, dietitians, and nurses.

Research on the treatment of eating disorders is exploring how different treatments can be helpful for different types of eating disorders. The American Psychiatric Association has published a set of practice guidelines for the treatment of patients with eating disorders (American Psychiatric Association, Practice Guidelines for Eating Disorders, American Journal of Psychiatry, 2000).

There is general agreement that good treatment often requires a spectrum of treatment options. These options can range from basic educational interventions designed to teach nutritional and symptom management techniques to long-term residential treatment (living away from home in treatment centers).

Most individuals with eating disorders are treated on an outpatient basis after a comprehensive evaluation. Individuals with medical complications due to severe weight loss or due to the effects of binge eating and purging may require hospitalization. Other individuals, for whom outpatient therapy has not been effective, may benefit from day-hospital treatment, hospitalization, or residential placement.

Treatment is usually conducted in the least restrictive setting that can provide adequate safety for the individual. Many patients with eating disorders also have depression, anxiety disorders, drug and/or alcohol use disorders and other psychiatric problems requiring treatment along with the eating disorder.

Initial Assessment
The initial assessment of individuals with eating disorders involves a thorough review of the patient's history, current symptoms, physical status, weight control measures, and other psychiatric issues or disorders such as depression, anxiety, substance abuse, or personality issues. Consultation with a physician and a registered dietitian is often recommended. The initial assessment is the first step in establishing a diagnosis and treatment plan.

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Outpatient Treatment
Outpatient treatment for an eating disorder often involves a coordinated team effort between the patient, a psychotherapist, a physician, and a dietitian (yet, many patients are treated by their pediatrician or physician with or without a mental health professional's involvement).

Similarly, many patients are seen and helped by generalist mental health clinicians without specialist involvement. Not all individuals, then, will receive a multidisciplinary approach, but the qualified clinician should have access to all of these resources.

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Psychotherapy
There are several different types of outpatient psychotherapies with demonstrated effectiveness in patients with eating disorders. These include cognitive-behavioral therapy, interpersonal psychotherapy, family therapy, and behavioral therapy. Some of these therapies may be relatively short-term (i.e., four-months), but other psychotherapies may last years.

It is very difficult to predict who will respond to short-term treatments versus longer term treatments. Other therapies which some clinicians and patients have found to be useful include feminist therapies, psychodynamic psychotherapies and various types of group therapy.

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Psychopharmacology
Psychiatric medications have a demonstrated role in the treatment of patients with eating disorders. Most of the research to date has involved antidepressant medications such as fluoxetine (for example Prozac®), although some clinicians and patients have found that other types of medications may also be effective.

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Nutritional Counseling
Regular contact with a registered dietitian can be an effective source of support and information for patients who are regaining weight or who are trying to normalize their eating behavior. Dietitians may help patients to gain a fundamental understanding of adequate nutrition and may also conduct dietary counseling, which is a more specific process designed to help patients change the nature of their eating behavior.

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Medical Treatment
Patients with eating disorders are subject to a variety of physical and medical concerns. Adequate medical monitoring is a cornerstone of effective outpatient treatment. Individuals with anorexia nervosa may be followed quite closely (i.e., weekly or more) because of the significant medical problems that this disorder poses for patients. Individuals with bulimia nervosa should be seen regularly, but may not require the intensive medical monitoring often seen in anorexia nervosa. Individuals with binge eating disorder may need medical treatment for a variety of complications of obesity, such as diabetes and hypertension.

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Day Hospital Care
Patients for whom outpatient treatment is ineffective may benefit from the increased structure provided by a day hospital treatment program. Generally, these programs are scheduled from three to eight hours a day and provide several structured eating sessions per day, along with various other therapies, including cognitive behavioral therapy, body image therapies, family therapy, and numerous other interventions. Day Hospital allows the patient to live at home when they are not in treatment, and often continue to work or attend school.

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Inpatient Treatment
Inpatient treatment provides a structured and contained environment in which the patient with an eating disorder has access to clinical support 24-hours a day. Many programs are now affiliated with a day hospital program so that patients can "step-up" and "step-down" to the appropriate level of care depending on their clinical needs.

Although eating disorder patients can sometimes be treated on general psychiatric units with individuals experiencing other psychiatric disorders, such an approach often poses problems with monitoring and containing eating disorder symptoms. Therefore, most inpatient programs for eating disordered individuals only treat patients with anorexia nervosa, bulimia nervosa, binge eating disorder, or variants of these disorders.

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Residential Care
Residential programs provide a longer term treatment option for patients who require longer term treatment. This treatment option generally is reserved for individual who have been hospitalized on several occasions, but have not been able to reach a significant degree of medical or psychological stability.

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