EATING DISORDERS: TREATMENT

Eating disorders are most successfully treated when diagnosed early. Unfortunately, even when family members confront the ill person about his or her behavior, or physicians make a diagnosis, individuals with eating disorders may deny that they have a problem.

Thus, people with anorexia may not receive medical or psychological attention until they have already become dangerously thin and malnourished. People with bulimia are often of normal weight and are able to hide their illness from others for years. Eating disorders in males may be overlooked because anorexia and bulimia are relatively rare in boys and men.

Consequently, getting -- and keeping -- people with these disorders into treatment can be extremely difficult.

In any case, it cannot be overemphasized how important treatment is--the sooner, the better. The longer abnormal eating behaviors persist, the more difficult it is to overcome the disorder and its effects on the body. In some cases, long-term treatment may be required. Families and friends offering support and encouragement can play an important role in the success of the treatment program.

If an eating disorder is suspected, particularly if it involves weight loss, the first step is a complete physical examination to rule out any other illnesses. Once an eating disorder is diagnosed, the clinician must determine whether the patient is in immediate medical danger and requires hospitalization. While most patients can be treated as outpatients, some need hospital care.

Conditions warranting hospitalization include excessive and rapid weight loss, serious metabolic disturbances, clinical depression or risk of suicide, severe binge eating and purging, or psychosis.

The complex interaction of emotional and physiological problems in eating disorders calls for a comprehensive treatment plan, involving a variety of experts and approaches. Ideally, the treatment team includes an internist, a nutritionist, an individual psychotherapist, and a psychopharmacologist -- someone who is knowledgeable about psychoactive medications useful in treating these disorders.

To help those with eating disorders deal with their illness and underlying emotional issues, some form of psychotherapy is usually needed. A psychiatrist, psychologist, or other mental health professional meets with the patient individually and provides ongoing emotional support, while the patient begins to understand and cope with the illness. Group therapy, in which people share their experiences with others who have similar problems, has been especially effective for individuals with bulimia.

Use of individual psychotherapy, family therapy, and cognitive-behavioral therapy - -a form of psychotherapy that teaches patients how to change abnormal thoughts and behavior - -is often the most productive. Cognitive-behavior therapists focus on changing eating behaviors usually by rewarding or modeling wanted behavior. These therapists also help patients work to change the distorted and rigid thinking patterns associated with eating disorders.

NIMH-supported scientists have examined the effectiveness of combining psychotherapy and medications. In a recent study of bulimia, researchers found that both intensive group therapy and antidepressant medications, combined or alone, benefited patients. In another study of bulimia, the combined use of cognitive-behavioral therapy and antidepressant medications was most beneficial. The combination treatment was particularly effective in preventing relapse once medications were discontinued. For patients with binge eating disorder, cognitive-behavioral therapy and antidepressant medications may also prove to be useful.

Antidepressant medications commonly used to treat bulimia include desipramine, imipramine, and fluoxetine. For anorexia, preliminary evidence shows that some antidepressant medications may be effective when combined with other forms of treatment. Fluoxetine has also been useful in treating some patients with binge eating disorder. These antidepressants may also treat any co-occurring depression.

The efforts of mental health professionals need to be combined with those of other health professionals to obtain the best treatment. Physicians treat any medical complications, and nutritionists advise on diet and eating regimens. The challenge of treating eating disorders is made more difficult by the metabolic changes associated with them. Just to maintain a stable weight, individuals with anorexia may actually have to consume more calories than someone of similar weight and age without an eating disorder.

This information is important for patients and the clinicians who treat them. Consuming calories is exactly what the person with anorexia wishes to avoid, yet must do to regain the weight necessary for recovery. In contrast, some normal weight people with bulimia may gain excess weight if they consume the number of calories required to maintain normal weight in others of similar size and age.

5/28/98

Written by Lee Hoffman, Office of Scientific Information (OSI), National Institute of Mental Health (NIMH). An earlier version was prepared by OSI staff member Marilyn Sargent.

Scientific review was provided by NIMH staff Susan J. Blumenthal, M.D.; Harold Goldstein, Ph.D.; Harry E. Gwirtsman, M.D.; and Susan Z. Yanovski, M.D.

U.S. Department of Health and Human Services
Public Health Service

National Institutes of Health
National Institute of Mental Health

NIH Publication No. 94-3477 Printed 1993

 

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