How is anorexia treated?

Anorexia nervosa is an eating disorder and mental illness that impacts millions of people worldwide. It is much more than simply trying to be slim; it is an illness that involves a person’s intense fear of gaining weight, Distorted body image, and severely restricting food intake, rendering them alarmingly underweight. It can be life-threatening if left untreated because it has serious implications for a person’s health and well-being, both physically and mentally.

The good news is that it is possible to successfully treat anorexia. Recovery from this eating disorder is completely possible; however, it is not necessarily easy. In fact, it is a process that requires professional assistance. What is most important to understand is that successfully treating someone with anorexia is much more complicated than simply telling them to “eat more.”

In this complete guide, we will walk you through how anorexia is treated, step by step. The goal of this piece is to educate you on how anorexia is treated, de-mystify the entire process, and give those affected hope.

The Core Principle: A Holistic Approach

When we refer to anorexia treatment, we refer to it as “holistic.” What does that mean? That is to say, the whole person, physically, mentally, emotionally, and socially. Anorexia does not just affect one part of a person; it affects everything. Therefore, treatment should simultaneously address all these areas.

In building a house, a solid foundation should be laid, then walls that are strong and supported, a roof that securely covers the inside structures of the house, internal systems such as plumbing and electrical work, and so on. If everything is not considered and taken into account, then any one deficiency will cause the entire house to become unstable. With anorexia treatment, the foundation of physical health is first established, followed by the construction of walls of psychological support, and the building of internal systems for emotional regulation in daily life and long-term recovery.

Key Pillars of Anorexia Treatment

Let’s dive into the main components that make up a successful anorexia treatment plan.

1. Medical Stabilization and Nutritional Rehabilitation: Healing the Body First

In order for any sort of psychological work to be effective, it is necessary that the individual’s physical well-being is addressed. The body is subjected to incredible amounts of pressure due to this eating disorder. Some rather life-threatening complications can arise. This is why it is necessary that the body is stabilized first.

Why is it first? Because malnutrition can lead to life-threatening situations. The body is starting to shut down, critical organs such as the heart and brain may become damaged, and the levels of essential minerals will get imbalanced. To try and take care of the psychological part of the problem when the body is on the brink is as effective as trying to have an intellectual conversation with someone who has dehydration and is running a high fever – they are not going to do very well.

What does it involve?

• Hospitalization or Inpatient Care:
  • When is it needed? This level of care is required if someone is severely underweight, their vital signs (heart rate, blood pressure, temperature) are unstable, they’ve experienced rapid and significant weight loss, or they have serious medical complications (like heart problems, electrolyte imbalances, or fainting spells). If someone is at risk of self-harm or suicide due to their illness, inpatient care is also crucial.
  • What happens there? In a hospital or specialized inpatient eating disorder unit, the person receives round-the-clock medical monitoring. Doctors and nurses regularly check their heart, blood, and other bodily functions. The main goal here is to safely restore the person to a stable medical state. This often involves a careful, controlled process of refeeding.
• Outpatient Medical Monitoring:
  • For less severe cases, or after a period of inpatient care, medical monitoring might happen through regular visits to a doctor or primary care physician. These visits involve checking weight, vital signs, and ordering blood tests to ensure the body is recovering and staying healthy.
• Nutritional Support and Refeeding:
  • The Gradual Process: This is key. Refeeding someone who has been malnourished for a long time must be done very gradually and carefully. Why? Because rapid refeeding can lead to a dangerous condition called refeeding syndrome, which happens when the body’s metabolism suddenly shifts, causing severe imbalances in electrolytes (important minerals in the body). This can be life-threatening.
  • Role of Dietitians/Nutritionists: A registered dietitian (RD) or nutritionist specializing in eating disorders is absolutely vital here. They work closely with the medical team and the individual to create a personalized meal plan. This isn’t just about calories; it’s about introducing a balanced range of nutrients, helping the person re-establish normal eating patterns, and often challenging long-held food fears.
  • Developing a Meal Plan: The dietitian helps the person understand what a healthy portion looks like, introduces foods they might have cut out, and gradually increases food intake to support healthy weight gain. It’s about nourishment, not punishment.
  • Education about Food: Part of this process involves educating the person about the body’s need for different types of food, dispelling myths about “good” and “bad” foods, and helping them understand the link between nutrition and overall well-being.
  • Challenging Food Fears and Rituals: Many people with anorexia develop very specific food rituals (e.g., cutting food into tiny pieces, eating only certain foods, chewing food excessively). The dietitian and therapy team help to gently challenge and break these patterns, making eating a more normal and less anxiety-provoking experience.

2. Psychotherapy (Talk Therapy): Addressing the Mind

And once the physical condition has been stabilized or concurrently alongside primary medical care in non-critical situations, therapy becomes the backbone of treatment. Anorexia is a mental condition, and one of its main treatments must be talking therapies that target the ideas, emotions, or behavior initiatives that drive this condition.

Why is this so important? Simply getting healthy physiologically is not sufficient. Without dealing with the distorted cognitions and severe fears evident in these patients, a quick return to unhealthy eating is assured.

Some of the types of therapies that work well are as follows:

• Cognitive Behavioral Therapy (CBT) – Enhanced (CBT-E):
  • What it is: CBT is a very practical type of therapy. “Cognitive” refers to your thoughts, and “behavioral” refers to your actions. The idea is that our thoughts, feelings, and behaviors are all connected. If we change our unhelpful thoughts and behaviors, we can improve our feelings. CBT-E is a specific version of CBT developed for eating disorders.
  • How it works for anorexia:
    • Identifying and Challenging Distorted Thoughts: People with anorexia often have very harsh, critical thoughts about their body, weight, and eating. For example, “If I eat that, I’ll become fat,” or “I’m only valuable if I’m thin.” CBT-E helps identify these “maladaptive” (unhelpful) thoughts and teaches the person how to challenge them, replacing them with more realistic and helpful ways of thinking.
    • Changing Unhealthy Behaviors: The therapist works with the person to change the specific behaviors associated with anorexia, such as extreme food restriction, compulsive exercise, vomiting, or misuse of laxatives. This might involve setting specific goals, like eating a particular food item, or reducing the amount of time spent exercising.
    • Self-Monitoring: Often, people are asked to keep a food diary and note their thoughts and feelings around eating. This helps them and the therapist identify patterns and triggers.
    • Problem-Solving: The therapist helps the person develop better ways to cope with difficult emotions or stressful situations, instead of turning to eating disorder behaviors.
• Family-Based Treatment (FBT) – Maudsley Approach:
  • Who it’s for: FBT is highly effective, especially for adolescents and younger individuals (under 18) who have had anorexia for a shorter period. It’s often the first-line treatment for this age group.
  • How it works: FBT recognizes that parents are a powerful resource in their child’s recovery. Instead of blaming parents, it empowers them to take an active role in helping their child regain healthy weight and eating habits at home.
  • Phases of FBT:
    • Phase 1: Weight Restoration: Parents are given the authority and support to manage their child’s eating. They plan and supervise all meals and snacks, ensuring their child gets adequate nutrition. The therapist acts as a coach and supporter to the parents. This can be very challenging for families, but it’s effective because it provides a consistent, loving, and firm environment for refeeding.
    • Phase 2: Gradual Return of Control: Once the child’s weight has been significantly restored, and some of the eating disorder behaviors have reduced, control over eating is gradually handed back to the adolescent in an age-appropriate way. This phase focuses on helping the child learn to eat independently and make healthy choices.
    • Phase 3: Addressing Developmental Issues: The final phase deals with any underlying developmental or family issues that may have been masked by the anorexia, helping the adolescent transition back to a normal life and preventing relapse.
• Dialectical Behavior Therapy (DBT):
  • What it is: DBT was originally developed for people with intense emotional regulation difficulties. “Dialectical” means balancing opposites, like accepting yourself as you are while also working to change.
  • How it works for anorexia: DBT helps individuals learn skills in four key areas:
    • Mindfulness: Being present and aware, without judgment.
    • Distress Tolerance: Learning to cope with intense emotions and difficult situations without resorting to harmful behaviors (like restricting or purging).
    • Emotional Regulation: Understanding, accepting, and changing intense or overwhelming emotions.
    • Interpersonal Effectiveness: Improving communication and relationships with others, setting boundaries.
  • DBT can be particularly helpful for those with anorexia who also struggle with intense emotional swings, self-harm, or other impulsive behaviors.
• Psychodynamic Therapy (or variations):
  • This type of therapy explores how past experiences, relationships, and unconscious conflicts might contribute to the eating disorder. It aims to gain insight into the deeper emotional roots of the illness. While not typically a first-line therapy for the acute phase of anorexia, it can be very helpful for some individuals later in their recovery to address underlying issues.
• Support Groups:
  • These are not a substitute for professional therapy but can be a valuable addition. Connecting with others who understand what you’re going through can reduce feelings of isolation, provide encouragement, and offer different perspectives on recovery.

3. Medication Management: Supporting the Journey, Not Curing the Illness

It is essential to note that there is no particular drug that “treats” anorexia nervosa per se. Nonetheless, certain medications may offer supplemental relief from anorexia, particularly when it comes to associated disorders that frequently occur alongside anorexia.

Role of Medications: Medications are usually employed to help deal with symptoms like depression, which is very common in individuals suffering from anorexia, as well as obsessive-compulsive disorder (OCD). Such symptoms tend to hinder the recovery process for individuals suffering from eating disorders, which is why treating them helps greatly in terms of being able to cooperate in therapy sessions.

Types of Medications:

• Antidepressants (SSRIs – Selective Serotonin Reuptake Inhibitors):
  • How they help: These medications are commonly prescribed for depression and anxiety. Many people with anorexia experience severe depression and anxiety, especially as a result of starvation.
  • Important Note: Antidepressants are generally not effective for depressive symptoms during active malnutrition. The brain needs adequate nutrition to function properly and respond to these medications. Therefore, they are usually introduced once some weight restoration has occurred and the body is more stable.
  • Examples: Fluoxetine (Prozac) is sometimes used, particularly after weight restoration, to help with mood and obsessive thoughts.
• Antipsychotics (low dose):
  • How they help: In very specific cases, a low dose of an antipsychotic medication might be prescribed. This isn’t because the person is psychotic, but because these medications can sometimes help reduce severe anxiety, obsessive thoughts (especially about food or body image), or delusional beliefs related to being fat, which can be part of anorexia. They can also help with sleep and appetite stimulation in some instances.
  • Examples: Olanzapine (Zyprexa) is sometimes considered, but its use is carefully weighed against potential side effects.
• Mood Stabilizers:
  • These are rarely used unless there is a clear diagnosis of a co-occurring bipolar disorder or severe mood swings that are not managed by other treatments.

Important Considerations for Medication:

• Always Supervised: Any medication use must be carefully supervised by a psychiatrist or a medical doctor specializing in mental health and eating disorders. They will assess the benefits and risks for each individual.
• Part of a Larger Plan: Medication is always an adjunct (an addition) to therapy, not a standalone treatment for anorexia. It works best when combined with psychotherapy and nutritional support.

4. The Team Approach: Who’s on Your Side?

One of the most defining characteristics of effective anorexia treatment is that it’s almost never done by just one person. It’s a team effort. Imagine trying to solve a complex puzzle with only one piece – you’d never see the full picture. A team brings different pieces of the puzzle together, offering comprehensive support.

A typical eating disorder treatment team might include:

• Medical Doctor/Physician: This could be a primary care doctor, an internist, or a hospital physician. They manage physical health, monitor vital signs, order tests, and address any medical complications (e.g., heart issues, bone density loss).
• Psychiatrist: A medical doctor who specializes in mental health. They are responsible for diagnosing and managing mental health conditions, including prescribing and monitoring medications.
• Therapist/Psychologist: A mental health professional who provides individual, group, or family therapy (like CBT-E, FBT, DBT). They help the person address the psychological roots of the eating disorder, develop coping skills, and change unhealthy thought patterns.
• Registered Dietitian (RD): A nutrition expert specializing in eating disorders. They create personalized meal plans, provide nutrition education, challenge food fears, and help normalize eating behaviors.
• Nurses: Especially important in inpatient or residential settings, nurses provide daily care, monitor vital signs, administer medications, and offer emotional support.
• Social Workers/Case Managers: These professionals can help coordinate care across different providers, assist with practical issues (like school or work accommodations), and connect families with resources.
• Family Members: For younger individuals, family members are an integral part of the treatment team, especially in FBT. For adults, supportive family and friends can be a crucial part of the support system, even if not directly involved in therapy sessions.

This multidisciplinary team communication is vital to ensure that all aspects of the person’s physical and mental health are being addressed in a coordinated and consistent way.

Levels of Care: Finding the Right Support

Anorexia treatment isn’t one-size-fits-all. The intensity of care needed depends on the severity of the illness, the person’s medical stability, their support system, and how well they are able to function in their daily life. This is often referred to as a “continuum of care,” where people can move between different levels as they recover.

• Inpatient Hospitalization: The highest level of care, as discussed earlier. This is for medical stabilization and close monitoring when a person is critically ill or medically unstable.
• Residential Treatment: After medical stabilization, some individuals move to a residential treatment center. This is a non-hospital setting where individuals live for an extended period (weeks to months). They receive 24/7 support, structured meal plans, daily therapy (individual, group, family), and medical monitoring, but in a less restrictive, more home-like environment than a hospital.
• Partial Hospitalization Programs (PHP) / Day Treatment: Individuals attend treatment for most of the day (usually 6-8 hours) for several days a week, but they return home in the evenings. This level provides intensive therapy, meal support, and medical monitoring while allowing some reintegration into daily life.
• Intensive Outpatient Programs (IOP): This is a step down from PHP. Individuals attend treatment for a few hours a day, a few days a week. It offers structured support, group therapy, and meal support, but with more flexibility.
• Outpatient Therapy and Support: This is the most common and often the long-term level of care. It involves regular appointments with individual therapists, dietitians, and psychiatrists, while the person lives independently and manages their daily life. Many people continue outpatient support for months or even years as they solidify their recovery.

The treatment team will assess and recommend the most appropriate level of care, and it’s common for individuals to move through several levels as they progress.

Relapse Prevention and Long-Term Recovery

Recovery from anorexia is a journey, not a destination reached overnight. For many, it’s a chronic illness, meaning symptoms can return, and vigilance is needed. Relapse prevention is a critical part of treatment from the very beginning.

• Ongoing Support: Even after reaching a healthy weight and feeling better psychologically, continued therapy (e.g., maintenance CBT-E sessions) and dietitian follow-ups can be invaluable.
• Developing Coping Skills: Learning healthy ways to manage stress, difficult emotions, and life challenges is key to preventing a return to eating disorder behaviors.
• Identifying Triggers: Understanding what situations, emotions, or thoughts might trigger a relapse helps individuals develop strategies to manage them proactively.
• Building a Fulfilling Life: Recovery is not just about stopping eating disorder behaviors; it’s about building a life that is meaningful, joyful, and healthy. This involves pursuing interests, building strong relationships, and finding purpose beyond the illness.

Challenges in Treatment

Treating anorexia is complex, and there are several common challenges:

• Denial and Resistance: A core feature of anorexia is often a lack of insight into the severity of the illness. The person may not believe they are sick or underweight, or they may be terrified of giving up their eating disorder, viewing it as a part of their identity or a source of control. This phenomenon is sometimes called “ego-syntonic,” meaning the illness feels “right” to the person, making them resistant to change.
• Fear of Weight Gain: This is one of the most powerful fears associated with anorexia and can make accepting nutritional rehabilitation incredibly difficult.
• Co-occurring Conditions: As mentioned, depression, anxiety, OCD, and trauma are very common alongside anorexia. These can complicate treatment and require additional support.
• Stigma: The stigma associated with mental illness and eating disorders can make it difficult for individuals to seek help or openly discuss their struggles.

Getting Started: How to Seek Help

If you or someone you know is struggling with anorexia, taking the first step to seek help is the most important thing you can do.

1. Talk to a Trusted Professional: Start by speaking with a doctor, a school counselor, a therapist, or a trusted adult. They can provide initial assessment and guidance.
2. Contact Eating Disorder Organizations: Many national and local organizations specialize in eating disorders and can provide information, resources, and referrals to treatment centers and professionals.
3. Be Patient and Persistent: Finding the right treatment team and program can take time. Don’t get discouraged if the first option isn’t the perfect fit. Keep advocating for yourself or your loved one.

Conclusion

Anorexia Nervosa is a tragic illness, but it is by no means a death sentence. It should be noted that with the proper professional assistance and help, complete recovery can be realized. This process, however, is not a walk in the park but rather a brave and trying experience, but in any case, the end result is a life free from the grasp of this eating disorder, and a life of health, happiness, and true bliss.

Remember, you are not alone and there are people out there to guide you through the process. Look forward to the healing process and take the first step towards living free and healing with courage.

Disclaimer: This blog post is for informational purposes only and does not constitute medical advice. If you suspect you or someone you know has anorexia nervosa, please consult with a qualified healthcare professional immediately. Eating disorders are serious medical conditions that require specialized treatment.