When treating anorexia nervosa What is the first step that should be taken?

Eating disorders are very serious illnesses. They can result in severe health complications and even death. The thought of treatment can be quite frightening for someone with an eating disorder because their disorder is essentially their “identity.” Patients often wonder, “what would I be without this eating disorder?” and “how will I cope?” These are all very common questions.

Eating disorders are not only about eating and weight. They are also about anxiety, depression, self-esteem, and other negative thoughts and feelings. Sometimes patients know what triggered (or led to) the eating disorder while other patients do not.

There is not one cause of eating disorders, however.  It is a combination of genes and environment.  This means that there is a genetic vulnerability to the development of an eating disorder, but not everybody with these genes will develop an eating disorder. That is where environmental protectors or triggers play a role (that is, the nature-nurture interaction). As said by renowned eating disorder expert, Dr. Cynthia Bulik, genes load the gun, and the environment pulls the trigger.

Eating Disorders are Not a Choice

If you are considering seeking treatment, congratulations! That is the first step to your recovery. Depending on your own individual situation and needs, your provider will discuss your options which may include hospitalization, residential treatment, day treatment, or outpatient therapy. You may benefit from individual therapy, family therapy, group therapy, and/or dietitian services. Research has shown that if the patient is medically stable, then outpatient therapy is just as effective as higher levels of care.

Below is a page extracted from the National Eating Disorders Association about what to look for and questions to ask when seeking a treatment provider. When you find a therapist that you want to meet, just commit to an initial meeting and see how it goes. It may take a few sessions to know if you will both work well together so don’t give up right away.

Some facts about Eating Disorders (taken from www.aedweb.org):

1. Eating disorders are serious mental illnesses. They are treatable, and the sooner someone gets the treatment he or she needs, the better the chance of a good recovery.
2. Prevalence of Eating Disorder: Between 0.3 and 1% of young women have anorexia nervosa and 1%-3% have bulimia nervosa. About 3% of the population has binge-eating disorder. Between 4% and 20% of young women practice unhealthy patterns of dieting, purging, and binge-eating. About one in 20 young women in the community has an eating disorder and an estimated 30% to 40% of people seeking weight loss treatments can be clinically diagnosed with BED.
3. Anorexia Nervosa can occur in men and women, children and adults, and across various races and ethnicities.
4. Treatment guidelines and recommendations can be found here: https://www.nice.org.uk/guidance/ng69/chapter/Recommendations

In Summary: Anorexia nervosa: The critical first step in the treatment of anorexia nervosa is re-nutrition (carefully monitored feeding, often with the assistance of a medical team) and weight restoration back to the healthy weight range. There is no consensus on the best approaches to treating anorexia nervosa, but family therapy appears to be helpful for younger patients who have recently developed an eating disorder. CBT may be helpful after weight restoration. Bulimia nervosa: A review of research studies concluded that bulimia nervosa can be treated effectively with cognitive behavioral therapy (CBT). CBT is a type of psychotherapy that addresses an individual’s thoughts and feelings to make changes in her behavior. Improvement in symptoms over a short period of time are also seen with the only FDA approved medication for bulimia nervosa fluoxetine (i.e., Prozac). Binge-Eating Disorder: Binge-eating disorder also responds to cognitive-behavioral therapy, behavioral weight loss therapy and a variety of medications (e.g., selective serotonin reuptake inhibitors, tricyclic antidepressants) have also been shown to lead to improvement.

Eating Disorders can be life-threatening. For women aged 15-24, eating disorders are among the top four leading causes of burden of disease in terms of years of life lost through death or disability.

Many people worry about gaining too much weight. But in some people the worry becomes obsessive, resulting in a condition called anorexia nervosa. Anorexia nervosa is an eating disorder that can result in severe weight loss. A person with anorexia is preoccupied with calorie intake and weight.

People with anorexia nervosa eat an extremely low calorie diet and have an excessive fear of gaining weight. They often feel better about themselves when they lose weight. They may also exercise excessively. Anorexia is most commonly diagnosed in adolescent women, but it’s been diagnosed in older and younger women and in men.

Recognizing the Symptoms of Anorexia Nervosa

Those with anorexia nervosa lose weight and maintain their extremely low weight in different ways. While some put severe restrictions on their calorie intake, others exercise excessively. Some employ a binge and purge method similar to that used by those with bulimia. Others use laxatives, vomiting, or diuretics to rid themselves of calories. If you have anorexia nervosa, your symptoms may include:

• inability to maintain a normal weight
• fatigue
• insomnia
• skin that is yellow or blotchy and covered with soft, fine hairs
• hair thinning or falling out
• constipation
• more than three cycles without a period
• dry skin
• low blood pressure

You may also notice behaviors such as:

• excessive exercise
• pushing food around the plate instead of eating it, or cutting food into small pieces
• irritability
• withdrawal from social activities
• depressed mood
• hunger denial
• use of diuretics, laxatives, or diet pills

What Causes Anorexia Nervosa?

The exact cause of anorexia nervosa isn’t known. People who develop anorexia may have a negative body image. They may be focused on being “perfect.” They may be looking for ways to control their lives. Other factors like biology, environment, and psychology are believed to play a role.

Biology

Genetics and hormones might have an effect on the development of anorexia nervosa. Some evidence suggests a link between anorexia and serotonin, a chemical produced in the brain.

Environment

Pressure from society to look thin may also contribute to the development of anorexia nervosa. Unrealistic body images from media outlets like magazines and television can greatly influence young people and spark the desire to be thin.

Psychology

Someone with obsessive-compulsive disorder (OCD) might be more predisposed to maintaining the strict diet and exercise regimen that those with anorexia nervosa often maintain. That’s because people with OCD are prone to obsessions and compulsions.

How Is Anorexia Nervosa Diagnosed?

Your primary care provider will perform a physical exam to check your blood pressure and heart rate. They will also do a psychological exam or refer you to a mental health professional who will ask about your eating habits and feelings. They will look for any criteria that show:

• you are restricting food intake
• you have fear of gaining weight
• you have problems with body image

Your primary care provider may also order certain laboratory tests. Blood tests may be ordered to check your electrolyte levels and liver and kidney function. In addition, your primary care provider may check your bone density and look for heart irregularities.

Your primary care provider may also order other laboratory tests to rule out other possible causes for weight loss, such as celiac disease and inflammatory bowel disease.

What Treatment Is Available for Anorexia Nervosa?

One of the biggest obstacles in the treatment of anorexia nervosa is realizing that you need help. Many with anorexia nervosa don’t believe they have a problem. That can make treatment difficult.

The main goal of treatment is to restore your body to a normal weight and establish normal eating habits. A dietitian will help you learn how to eat properly. It might also be recommended that your family take part in therapy with you. For many people, anorexia nervosa is a lifelong challenge.

Therapy

You and your family must work hard to overcome anorexia nervosa. Individual, family, and group therapies are often an integral part of treatment.

Individual Therapy

A form of therapy called cognitive behavioral therapy is often used to treat anorexia nervosa. CBT helps change unhealthy thoughts and behaviors. Its goal is to help you learn to cope with strong emotions and build healthy self-esteem.

Family Therapy

Family therapy gets family members involved in keeping you on track with your healthy eating and lifestyle. Family therapy also helps resolve conflicts within the family. It can help create support for the family member learning to cope with anorexia nervosa.

Group Therapy

Group therapy allows people with anorexia nervosa to interact with others who have the same disorder. But it can sometimes lead to competition to be the thinnest. To avoid that, it’s important that you attend group therapy that is led by a qualified medical professional.

Medication

While there is no medication at this time that is proven to treat anorexia nervosa, antidepressants may be prescribed to deal with the anxiety and depression common in those with anorexia. These may make you feel better. But antidepressants do not diminish the desire to lose weight.

Hospitalization

Depending on the severity of your weight loss, your primary care provider may want to keep you in the hospital for a few days to treat the effects of your anorexia nervosa. You may be put on a feeding tube and intravenous fluids if your weight is too low or if you’re dehydrated. If you continue to refuse to eat or exhibit psychiatric issues, your primary care provider may have you admitted into the hospital for intensive treatment.

Online therapy options

Read our review of the best online therapy options to find the right fit for you.

What Is The Long-Term Outlook?

Many people recover from anorexia. But a small percentage of people don’t. In some the condition can be deadly. Still others may go on to develop other eating disorders. For some people, overcoming anorexia takes lifelong treatment and maintenance. Joining a support group for anorexia can help increase your likelihood of recovery.

Can Anorexia Nervosa Be Prevented?

There is no proven method to prevent anorexia nervosa. But looking out for symptoms of the disorder can help with quick diagnosis, treatment, and recovery. If you find yourself or a loved one obsessing about weight, excessively exercising, or being dissatisfied with their appearance, you may want to seek professional help.

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