13.3 Treatment for Eating Disorders

Early treatment is important for individuals with eating disorders because of increased risk for suicide, self-injury behaviors, and medical complications. People with eating disorders may also have other mental health disorders (such as depression or anxiety) or problems with substance use. There are a variety of treatments that have been shown to be effective in treating eating disorders. Generally, treatment is more effective before the disorder becomes chronic, but even people with long-standing eating disorders can recover.^[1] It is important to note that treatment can be difficult for some individuals to obtain due to limited options and scarce resources in many rural areas.

The choice of treatment depends on the specific type of eating disorder, the severity of the condition, and the individual’s needs. Treatment plans may include one or more of the following:

• Individual, group, and/or family psychotherapy
• Medications
• Nutritional counseling
• Medical care and monitoring

Psychotherapy

Cognitive behavioral therapy (CBT) is used to reduce or eliminate binge eating and purging behaviors. Therapy focuses on modifying dysfunctional thoughts and behaviors related to eating, body image, and weight.^[2] Limited provider availability may require individuals to complete therapy virtually.

Family-based therapy is a type of psychotherapy in which parents take an active role in managing their child’s eating behaviors and weight restoration. This approach involves parents carefully monitoring all of the client’s eating and activities to prevent excessive exercise and purging. The goal is to promote healthy eating behaviors and weight restoration, with parents providing structure and support to reduce parental distress and anxiety. As treatment progresses, autonomy in feeding is gradually shifted back to the adolescent, and the focus shifts to improving family communication and independence. This therapy has been found to be very effective in helping adolescents gain weight and improve eating habits and moods.^[3]

Interpersonal psychotherapy (IPT) is another effective treatment, focusing on improving interpersonal functioning and reducing eating disorder symptoms.

Medications

Evidence also suggests that medications such as antidepressants, antipsychotics, or mood stabilizers may also be helpful for treating eating disorders and other co-occurring mental illnesses such as anxiety or depression.^[4] Fluoxetine, a selective serotonin reuptake inhibitor (SSRI), is FDA-approved for the treatment of bulimia nervosa (BN) and has demonstrated efficacy in reducing binge-purge behaviors. Lisdexamfetamine, approved for binge eating disorder (BED), effectively decreases the frequency of binge eating episodes. Although not FDA-approved for anorexia nervosa (AN), olanzapine has shown potential benefits by promoting weight gain and alleviating anxiety symptoms in individuals with AN.^[5]

Nutritional Rehabilitation & Counseling

Nutritional rehabilitation is essential for all eating disorders because it aims to restore healthy eating patterns and address malnutrition. Registered dietitian nutritionists play a crucial role in this aspect of treatment. Nutritional counseling by a dietician with specialized training is necessary for individuals with eating disorders. The counseling should incorporate education about nutritional needs, as well as planning and monitoring healthy food choices.^[6]

Medical Care and Monitoring

Medical treatments for eating disorders can be delivered in a variety of settings and are guided by the severity and chronicity of the illness, medical stability, insurance coverage, and available community resources. The following characteristics apply to the setting selected for an individual’s treatment^[7]:

• Outpatient Treatment: This is suitable for clients who are medically stable and can maintain their daily activities. It includes regular visits to a health care team comprising a physician, therapist, and dietitian.
• Intensive Outpatient: The client is medically and psychiatrically stable and does not need daily medical monitoring. Symptoms are under sufficient control for the individual to be able to function in normal social, educational, or vocational situations and continue to make progress in recovery.
• Partial Hospitalization:
  • The client is medically stable. The eating disorder impairs functioning but is without immediate risk. The client requires daily assessment of physiologic and mental status.
  • The client is psychiatrically stable but is unable to function in normal social, educational, or vocational situations. They engage in daily binge eating, purging, fasting, restricted food intake, or other pathogenic weight control techniques.
• Residential: The client is medically stable and requires no intensive medical intervention. They are psychiatrically impaired and unable to respond to partial hospital or outpatient treatment.
• Inpatient:
  • The client is medically unstable as determined by the following:
    • Unstable or depressed vital signs
    • Laboratory findings presenting acute health risk
    • Complications due to coexisting medical problems such as diabetes

• • The client is psychiatrically unstable as determined by the following:
    • Rapidly worsening symptoms
    • Suicidal ideation with a plan and unable to contract for safety