What Is the Treatment for Eating Disorders?

By:
iVillage Health & Well-Being Staff Writer

Common Questions about Eating Disorders
Craig Johnson, Ph.D.
Laureate Psychiatric Clinic and Hospital, Tulsa, OK

What Is the Treatment for Eating Disorders?
There is hope and help for eating disorders. Early intervention is vital. A team of professionals, specifically trained in eating disorders, can evaluate a patient and set up an individualized treatment plan. This should include a comprehensive multidimensional assessment and a coordinated care plan.

The comprehensive, multidimensional assessment includes a full physical exam and laboratory studies to determine the patient's physical status and risk of death. The assessment should also include a meeting with a nutritionist to help establish a safe diet plan and provide ongoing nutritional counseling. In addition, the assessment should include a complete mental health evaluation. This psychiatric evaluation should include a review of the patient's symptoms, current life situation, treatment history, personal and family history, and a thorough examination of the patient's thoughts, feelings and behaviors. The mental health evaluation is extremely important to making a proper diagnosis. Research shows that nearly 50 percent of individuals with eating disorders suffer from at least one other psychiatric disorder, and these co-occurring disorders must be identified and treated.

After the assessment, the next step is to establish a coordinated care plan tailored to the individual. A team of experienced professionals will work together to assist the patient in recovery. The team may include an internist, nutritionist, psychopharmacologist, one or more therapists (for individual, group or family therapy).

Treatment interventions are first aimed at restoring normal eating patterns and correcting the physical and psychological effects of malnutrition. The long-term goals are to diagnose and help resolve the associated psychological, family, social and behavioral problems so that relapse does not occur. For this part of the process, both psychotherapy and medication can help.

Psychotherapy. Although many types of psychotherapy or "talk therapy" are used in the treatment of eating disorders, two types -- cognitive behavioral therapy and interpersonal therapy -- are proving particularly effective.
* Cognitive behavioral therapy is designed to help the patient gain control of unhealthy behaviors and to alter the distorted thinking that perpetuates the syndrome. The treatment uses a combination of procedures to change the patient's behavior, attitudes about shape and weight, and any other cognitive distortions such as low self-esteem and extreme perfectionism.
* Interpersonal therapy focuses on the patient's current circumstances and relationships. Initial sessions are typically devoted to a detailed analysis of the interpersonal context in which the eating disorder developed and was maintained.

These types of therapy can take place in individual, family or group sessions, and it is likely that a combination of the three will be recommended.
* Individual psychotherapy can help the patient regain physical health, reduce symptoms, increase self-esteem and proceed with personal and social development.
* Family therapy attempts to establish more appropriate eating patterns, facilitate communication and permit family members to feel more connected to one another.
* Group therapy allows the patient to feel less alone with symptoms, to get feedback from peers and to enhance social skills.

Typically, therapy is on an outpatient basis. However, hospitalization may be necessary when an eating disorder has led to physical problems that may be life-threatening or when associated with severe emotional distress.

Medication. In addition to therapy, medication may be helpful in the treatment of eating disorders. Patients with severe eating disorders appear to have abnormalities in brain neurotransmitter systems, as do patients with depressive, obsessive-compulsive or anxiety disorders. Because these illnesses are thought to have biological roots, they respond well to medications that work by affecting brain chemistry.

Although the use of medication is more common for patients with bulimia than with anorexia, there is evidence that some medications do assist with recovery in both illnesses. Antidepressants are helpful for patients with significant symptoms of depression, anxiety or obsessions. They may also have a specific role in reducing the binge-purge cycle in bulimia. In anorexia, use of medication is usually best assessed after weight regain, when the psychological effects of starvation are resolving, although some antidepressants appear to help stabilize weight recovery. In addition to antidepressants, other drugs may be used as well.

Medication is generally used in conjunction with psychotherapy, as part of a coordinated treatment plan. Before prescribing medication, a psychiatrist or physician will discuss any co-existing medical problems, review current medications being taken and assess the patient's physical health. Sometimes it's necessary to try several medications to establish the proper dosage or minimize side effects. It is important for the patient to continue seeing a psychiatrist or other physician to monitor medication use.

Whether with therapy, medication, or a combination of both, eating disorders can be successfully treated. As much as 80 percent of people respond to treatment. Relapses can occur, but the sooner treatment begins, the better the chances for recovery and a return to a healthy life.