Eating Disorders Anorexia Treatments

While anorexia nervosa can affect men as well as women, the eating disorder is primarily a woman’s health issue. As such, most anorexia treatments and counseling focus on women’s health. However, anorexia counseling, nutritional therapy, and the use of antidepressants such as fluoxetine are as valid for both men and women.

Goals of Anorexia Treatment

The goals of anorexia treatment are simple in theory. Successful treatment teaches the anorexic to maintain a healthy body weight, change unrealistic perceptions of body image, and prevent relapse. In practice, these goals are difficult to achieve, as anorexics often resist treatment and must be convinced that their health or life is at risk.

A good prognosis for anorexia treatment requires the anorexic to admit to hunger, and to accept that their health is at risk. A gradual increase in self-esteem during treatment is a positive sign.

Treatment can be less effective and sometimes fails due to severely low weight at the start of treatment or a failure to respond to previous anorexia treatments. Treatment is more difficult if the anorexic has a history of laxative or self-induced vomiting. Finally, a dysfunctional family environment or relationship problems decreases the chance of effective treatment.

Psychological Counseling for Anorexic Patients

Psychological counseling is the cornerstone of anorexia treatment. Counseling aims to educate the anorexic about the seriousness of anorexia and its possible consequences. Anorexics must come to terms with their disorder, and accept that they have a problem. This step alone often requires extensive counseling.

In addition to educating the patient about the risks of starvation and anorexia, counseling also helps the anorexic examine her perception of body image, and develop a more realistic image. Counseling helps anorexics develop areas other than body image and weight loss for self-worth and self-esteem.

Family Counseling and Anorexia Nervosa

Anorexia nervosa is rarely treated without addressing family relationships. Family counseling may be necessary to change family attitudes about weight, body image, and attitudes that can trigger anorexia. Often family members are as unwilling to admit to the presence of anorexia as the anorexic herself. Marital therapy is also essential to strengthen relationships and prepare spouses to assist with treatment.

Group Counseling and Women’s Health

Group counseling can be a powerful tool for anorexics, allowing them to share experiences with fellow anorexia sufferers and survivors. Most group counseling sessions are geared towards women’s health. Male anorexics may have a difficult time locating a group in which they feel comfortable.

Group counseling varies in its goals. Some support groups focus on determining the emotional and psychological motivations behind anorexia, while others prefer to focus on meal planning, monitoring weight, and providing support for daily life.

One word of warning: With the development of the Internet, a number of anorexia support groups have appeared online, for both men and women. Many of these support groups are well run and well monitored, but some are questionable. Some actually proclaim anorexia as a lifestyle choice — an attitude that runs counter to anorexia treatment and which could have a negative affect on both treatment and health.

Improving Nutrition in Anorexia Treatment

Nutritional treatment for anorexics is essential to counteract the effects of weight loss and starvation. If the anorexic is hospitalized, nutritional treatment aims to increase weight by two to three pounds a week. If the patient is being treated through an outpatient center, an increase of half a pound to a pound a week is considered optimum.

As the anorexic gains weight, her health must be carefully monitored. Regular doctor’s visits are required to watch for symptoms of circulatory overload, swelling, and bloating, all of which can occur if nutrition is reintroduced too suddenly after starvation. Vitamins and supplements are administered if needed.

Constipation is common as anorexics begin eating more, and should be treated with stool softeners, rather than laxatives, which could be abused by the anorexic in order to lose weight. Close supervision of the anorexic during mealtimes is essential to ensure that food is consumed. After eating, access to bathrooms or solitary locations should be controlled for at least two hours, to prevent the possibility of self-induced vomiting.

Antidepressants and Other Anorexia Medications

No medication exists that treats anorexia nervosa directly. However, a number of medications can improve the health of anorexics by treating secondary complications. Chief amongst these are the SSRI antidepressants. The SSRI medications, or serotonin-specific reuptake inhibitors, increase the levels of the neurotransmitter serotonin.

Fluoxetine is one of the SSRI medications used to treat depression in anorexics. Like any other SSRI, fluoxetine takes up to a month before health benefits are felt. Fluoxetine is used to treat both depression and obsessive compulsive disorder, two mental health disorders commonly found in combination with anorexia.

Serotonin imbalances have been linked to anorexia, so the use of SSRI medications such as fluoxetine may help anorexics recover.

More study is required to assess the value of SSRI antidepressants in anorexia treatment. Some studies have suggested that anorexics whose depression or obsessive compulsions are treated with fluoxetine are less likely to suffer relapses after treatment.

In addition to antidepressants, some anorexics benefit from anti-anxiety medication, if they become anxious or panic-stricken at the thought of eating.

Hospitalization and Anorexia Nervosa

Not all anorexics are hospitalized due to their condition: many patients can be treated through outpatient visits. If health complications are severe, however, anorexia treatment may require hospitalization. Health factors that may lead to hospitalization include:

  • a weight of less than 75 percent normal
  • clinical depression or other mental health concerns
  • dangerous metabolic imbalances
  • extremely low body temperature
  • serious electrolyte imbalances
  • suicidal tendencies.

Hospitalization may also be necessary if an anorexic’s health has deteriorated to the point she can no longer care for herself, or if dysfunctional family dynamics are likely to sabotage treatment. If outpatient treatment has no effect, and weight loss continues to progress, hospitalization may also be required.

Hospitalization may also be used as a precaution. If previous anorexia treatment efforts became ineffective after the anorexic gained back a certain amount of weight, a hospital stay may be recommended until the patient has passed that weight level.

Anorexia Treatment and Relapse

Anorexia treatment results vary. Studies of long-term recoveries suggest between 44 to 75 percent of anorexics respond well to treatment, but relapses are common. A woman’s health is never quite the same after anorexia nervosa. A preoccupation with food is likely to continue past treatment, and most recovered anorexics often retain distorted perceptions of body image.

Recovery from anorexia nervosa may be compared to recovery from alcohol or other substance abuse — the disorder is never fully cured, but can be controlled.

Resources

Beers, M.H.