Treating anorexia

The treatment for anorexia nervosa usually involves a combination of psychological therapy and supervised weight gain.

It's important for a person with anorexia to start treatment as early as possible to reduce the risk of serious complications of anorexia ,particularly if they've already lost a lot of weight.

The treatment plan

GPsare oftenclosely involved in ongoing treatment, although other healthcare professionals are usually involved, including:

• specialist counsellors
• psychiatrists
• psychologists
• specialist nurses
• dietitians
• paediatriciansin cases affecting children and teenagers

Before treatment starts, members of this multidisciplinary care team will carry out a detailedphysical, psychological and social needs assessment, and will develop a care plan.

Most people with anorexia are treated as an outpatient, which means they visit hospitals, specialist centres or individual members of their care team for appointments, but return home in between.

In more severe cases,a person may need tostay in hospital or a specialist centre for longer periods during the day (day patient), or theymayneed to be admitted as an inpatient.

Psychological treatment

A number of different psychological treatments can be used to treat anorexia. Depending on the severity of the condition, treatment will last for at least 6 to 12 months or more.

Cognitive analytic therapy (CAT)

Cognitive analytic therapy (CAT) is based on the theory that mental health conditions such as anorexia are caused by unhealthy patterns of behaviour and thinking developed in the past, usually during childhood.

CAT involves a three-stage process:

• Reformulation looking at past eventsthat mayexplain why the unhealthy patterns developed
• Recognition helping peoplesee how these patterns are contributing towardsthe anorexia
• Revision identifying changesthat can break these unhealthy patterns

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is based on the theory that how we think about a situation affects how we act and, in turn, our actions can affect how we think and feel.

In terms of anorexia, the therapist will attempt toshow how the condition is often associated with unhealthy and unrealistic thoughts and beliefsabout food and diet.

For example, these could be:

• "Putting on weight is the single worst thing that can happen in my life."
• "Everyone I know secretly thinks I'm fat."
• "If I finish the whole meal, people I'm eating with will think I'm greedy and worthless."

The therapist willencouragethe adoption ofhealthier, more realistic ways of thinking that should lead to more positive behaviour.

Interpersonal therapy (IPT)

Interpersonal therapy (IPT) is based on the theory that relationships with other people and the outside world in general have a powerful effect on mental health.

Anorexia may be associated with feelings of low self-esteem, Generalised anxiety disorder and self-doubt caused by problems interacting with people.

During IPT, the therapist will explore negative issues associated with your interpersonal relationships and how these issues can be resolved.

Focal psychodynamic therapy (FPT)

Focal psychodynamic therapy (FPT) is based on the theory that mental health conditions may be associated with unresolved conflicts that occurred in the past, usually duringchildhood.

The therapyencouragespeople with anorexia to think about how early childhood experiences may have affected them. The aim is to find more successful ways of coping with stressful situations and negative thoughts and emotions.

Family interventions

Anorexia doesn't just impact on one individualit can have a big impact on the whole family. Family intervention is an important part of treatmentfor young people with anorexia.

Family intervention should focus on the eating disorder, and involves the family discussing how anorexia has affected them.It canalso help the family understand the condition and how they can help.

Gaining weight safely

The care plan will include advice about how to increase the amount eaten so weight is gained safely.

Physical health as well as weight is monitored closely. The height of children and young people will also be regularly checked to make sure they're developing as expected.

To begin with, the person will be given small amounts of food to eat, with the amount gradually increasing as their body gets used to dealing with normal amounts.

The eventual aim is to have a regular eating pattern, with three meals a day, possibly with vitamin and mineral supplements.

An outpatient target is an average gain of 0.5kg (1.1lbs) a week. In a specialist unit, the aim will usually be to gain an average of around 0.5-1kg (1.1-2.2lbs) a week.

See treating malnutrition for more information about what gaining weight at home or in hospital may involve.

Compulsory treatment

Occasionally, someone with anorexia may refuse treatment even though they're severely ill and their life is at risk.

In these cases, as a last resort doctors may decide to admit the person to hospital for compulsory treatment under the Mental Health Act. This is sometimes known as sectioning or being sectioned.

Treating additional problems

As well as the main treatments mentioned above, other health problems caused by anorexia will also need to be treated.

If you make yourself vomit regularly, you'll be given dental hygiene advice to help prevent stomach acid damaging the enamel on your teeth.

For example, you may be advised not tobrush your teeth soon after vomiting to avoid further abrasion to tooth enamel, and torinse out your mouth with water instead.

Avoiding acidic foods and mouth washes may be recommended. You'll also be advised to visit a dentist regularly so they can check for any problems.

If you've been taking laxatives or diuretics in an attempt to lose weight, you'll be advised to reduce them gradually so your body can adjust. Stopping them suddenly can cause problems such asnausea and constipation .

Medication

Medication alone isn't usually effective in treating anorexia. It's often only used in combination with the measures mentioned above to treat associated psychological problems, such as obsessive compulsive disorder (OCD) or depression .

Two of the main types of medication used to treat people with anorexia are:

• Selective serotonin reuptake inhibitors (SSRIs) a type of antidepressant medication that can help people with co-existing psychological problemssuch as depression and anxiety
• Olanzapine a medication that can help reduce feelings of anxiety related to issues such as weight and dietin people who haven't responded to other treatments

SSRIs tend to be avoided until a person with anorexia has started to gain weight because the risk of more serious side effects is increased in people who are severely underweight. The drugs areonly used cautiously in young people under the age of18.

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