Treating Anorexia Nervosa:
Anorexia, or anorexia nervosa, is an eating disorder characterized by mental symptoms that cause the patient to restrict food intake.
Data suggests this disease affects approximately one percent of the population, a rate that appears to be consistent over time. Onset is usually in late puberty. The medical consequences of the restrictive eating of anorexia nervosa can be disabling or fatal. The cognitive and mood symptoms of both restriction and the illness itself are severe and self-perpetuating - suicide accounts for half of those who die of anorexia. When a parent or caregiver suspects anorexia or associated disorders it is imperative to seek care immediately, whether the patient is cooperative or not. Anorexia causes anosognosia and patients are often unable to mentally process the severity and risks of the condition.
The first step toward treatment is a comprehensive medical examination. Ideally, parents should seek out a physician who is experienced in the treatment of eating disorders and works with a multi-disciplinary team of experts. A thorough diagnosis and ruling out of medical issues, as well as identification of possible co-morbid psychiatric conditions, is essential. Eating disorder specialists are often not available locally, and families often need to travel to specialized clinics. It is also helpful to interview a number of clinicians before choosing a team, and doing extensive research about the treatment options and variety of approaches. Keep in mind that there is great controversy within the field between approaches and clinics are unlikely to offer information about approaches they don't offer. Many of those offering treatment for anorexia are not familiar with recent research or treatment methods. Parents should seek evidence-based care and ask for the research basis for any treatment they are offered.
The psychological symptoms of anorexia can include body dysmorphia, fixed beliefs about body size, irrational food beliefs, a compulsion to exercise, an obsessive interest in food and nutrition, and social isolation. (These symptoms should not be confused with cause. For more information on cause: CLICK HERE.) In addition, anorexia also carries all the symptoms associated with chronic malnutrition such as heart and bone damage, digestive dysfunction, hair loss, and the growth of lanugo (a fine layer of hair appearing all over the body).
Anorexia, unlike bulimia, is often called "ego-syntonic." This means the patient finds many symptoms of the illness are desired ones: loss of weight, numbing of emotions, loss of reproductive and hormonal function, and positive feedback from peers and society for moral values like restraint and self-control.
The first and primary goal in anorexia treatment is the restoration of medical health. Regaining (or in the case of developing children and adolescents: reaching) a metabolically normal and healthy weight as soon as medically possible, and retaining that healthy status for a period of time, is the single best predictor of long-term recovery. Anorexia nervosa is a brain disorder, not simply a measure of weight status, and the mental symptoms can be present when the patient is at average weight and take many months to repair.
"We know too much about the mental symptoms of malnutrition to continue treating patients without complete nutritional restoration. Our loved ones deserve the best chance at recovery, and Food is Medicine." Laura Collins, F.E.A.S.T. Executive Director.
Although it is common for patients to feel what they are doing is normal and in fact positive, it is very important that parents and caregivers listen to their instincts if they see behaviors or attitudes that are worrying. Caregivers should avoid shame, blame, and anger and remember that the patient feels in an intolerable mental trap and is not choosing to behave in this way. Anorexia is a real illness, not a choice, and recovery is painful and difficult. It takes courage and support and expert care to face this illness. Parents and caregivers play a key role in creating a home environment conducive to recovery by participating in evidence-based care with well-trained clinicians, reducing stress and conflict in the home, and creating a well-ordered plan around food and monitoring after meals.
The key to successful treatment is early, long-term, well-informed intervention. Family Based Maudsley Treatment: [FBT] to help patients recover from anorexia is well-established as the most effective treatment for adolescent anorexia, and is currently being studied as an intervention for adults. A treatment manual for clinicians is available: “Treatment manual for anorexia nervosa: A family based approach.”Cognitive Behavioral Therapy (CBT) is considered more effective with adult and chronic patients but should be pursued with a specialist in adapting CBT principles to eating disorders.
There are currently no pharmaceutical interventions for the treatment of anorexia, but several medicines are used in treating symptoms during the recovery process.