Eating Disorders:
Treatment Overview

Eating disorders CAN be treated:

Eating disorders are most successfully treated when diagnosed early. 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.

When an eating disorder is suspected, particularly if it involves severe weight loss, the first step is a complete physical examination to rule out any other illnesses. Once an eating disorder is diagnosed, the physician must determine how to treat the patient. While most patients can be treated as outpatients, some may be in immediate medical danger and require hospitalization.

Eating disorder conditions that often require hospitalization include:

• excessive and rapid weight loss

• serious metabolic disturbances

• clinical depression or risk of suicide

• severe binge eating and purging

• psychosis

An eating disorder treatment plan:

The complex interaction of emotional and physiological problems in eating disorders calls for a comprehensive treatment plan that can involve a variety of experts and approaches. Ideally, the treatment team includes:

• an internist -- usually acts as the manager of the team

• a dietitian or nutritionist

• an individual psychotherapist

• a psychopharmacologist -- a health professional who is knowledgeable about psychoactive medications useful in treating these disorders

Psychotherapy

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.

Medication

Scientists have examined the effectiveness of combining psychotherapy and medications.

A recent study of bulimia 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.

For anorexia, preliminary evidence shows that some antidepressant medications may be effective when combined with other forms of treatment.

Antidepressants may also treat any co-occurring depression.

Nutritional Therapy

Nutritionists or dietitians advise on diet and eating regimens. The challenge of treating eating disorders is made more difficult by the metabolic changes associated with them.

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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. 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.

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