Anorexia Nervosa is considered a fatal psychological disorder among young people, with up to 20% of people dying within 20 years of receiving the diagnosis1. However, most patients do respond positively to treatment, making at least partial recovery2.
In this article, we'll look at the available treatments for people with anorexia and answer the questions of how and why they work.
- First, we'll introduce the topic of anorexia nervosa treatment.
- Next, we'll outline the evidence-based treatment for anorexia nervosa.
Then, we'll explore the types of psychological treatments for anorexia nervosa.
Moving along, we'll dive into the cognitive treatments for anorexia nervosa.
Finally, we'll discuss the biological treatment for anorexia nervosa.
Fig. 1 - Anorexia can have fatal consequences; this is why effective treatment interventions are so important.
Anorexia Nervosa Treatment
Let's start with defining anorexia.
Anorexia nervosa is a severe eating disorder involving food restriction and can result in severe malnutrition and low body weight.
One of the possible symptoms of anorexia is body dysmorphia. Body dysmorphia is a mental health condition characterised by people viewing their bodies differently from how they actually look.
People with anorexia often see themselves as much larger than they are and can become preoccupied with their weight or what they perceive as 'flaws' in their body image.
There are different ways a person can seek help if they are suffering from anorexia. If one seeks help and support early, the chances are higher that the condition will be treated properly. For instance, the patient is more likely to recover with the least negative side effects of a long-lasting condition.
If a person believes they are suffering from anorexia but is unsure, they should see their doctor as soon as possible. This can help with getting an early diagnosis, which is made based on the criteria included in diagnostic manuals like the ICD-11.
However, anorexia can be difficult to diagnose because people with anorexia often deny their condition and its severity and may be reluctant to seek help.
Evidence-Based Treatment for Anorexia Nervosa
Anorexia treatments are based on the psychological and biological explanations of the disorder. So, let's start with a summary of these.
Biological Explanations of Anorexia
Biological explanations of anorexia focus on the role of genes, brain structure and neurotransmitters like serotonin and dopamine.
The genetic explanation of anorexia has been proposed based on twin studies. Moreover, gene-sequencing studies have identified EPHX2 gene variants as common in people with anorexia (Scott-Van Zeeland et al. 2014).
Researchers have found a 56% concordance rate in identical twins and 5% in fraternal twins with anorexia nervosa (Holland, Sicotte & Treasure, 1988), indicating a genetic contribution to the disorder.
The neuroanatomical explanation suggests that anorexia is linked to the levels of serotonin and dopamine in the body.
- High serotonin levels are associated with anxiety, and since food produces serotonin, eating less food may reduce anxiety in anorexic people.
- High levels of the neurotransmitter dopamine have also been linked to anorexia; dopamine activity can be triggered by food deprivation, motivating and rewarding individuals for engaging in restriction.
Drug therapies used in anorexia treatment are based on the neuroanatomical explanation of anorexia.
The dual centre theory of anorexia has highlighted the role of hypothalamic dysfunction in anorexia patients. As a result, patients with anorexia may experience abnormal signals of hunger and satiety.
The neurodevelopmental explanation proposes that childbirth complications like a low birth weight have been linked with anorexia.
Psychological Explanations of Anorexia
There are multiple psychological perspectives on understanding anorexia. The main explanations include Minuchin's family systems theory, the social learning theory and the cognitive theory.
According to the family systems theory, a certain type of dysfunction, where another family member, often the parent, is enmeshed with the child, exerts too much control over them and prevents them from developing autonomy.
Enmeshment occurs when there are no clear boundaries between family members. As a result, a child may be overly concerned with the needs or feelings of a parent (or vice versa), which stops them from developing a sense of their own needs and emotions.
In this family dynamic, the child can develop anorexia to exert some control of their life.
Family-based anorexia treatment roots partially stem from family systems theory.
The cognitive theory of anorexia focuses on the cognitive distortions that maintain the disorder. These include distortions (e.g. about one's body image), irrational beliefs, rigid schemas and black and white thinking.
An example of black-and-white thinking would be, "Carbs are bad, so I can never eat carbs". An example of an irrational belief includes "if I have a bit of chocolate, I will never stop eating and gain a lot of weight".
The trait perfectionism has also been associated with anorexia. Fairburn et al. (1999) proposed that anorexia is maintained by individuals' strong need for self-control, which comes from perfectionism.
Cognitive-behavioural anorexia treatments are based on the cognitive theory of anorexia.
Finally, the social learning approach highlights the role of culture and the environment in promoting restrictive diets and behaviours associated with anorexia. According to this approach, anorexia can result from imitating role models and the body image presented in media.
Moreover, culture is likely to reinforce restriction and weight loss as slimmer figures are preferred and often praised. This encourages individuals to maintain their restrictive behaviours.
Fig. 2 - Family therapy can improve family dynamics reducing an individual's distress, which can contribute to anorexia.
Psychological Treatments for Anorexia Nervosa
For adolescents, family-based treatment or family therapy is often recommended.
Family therapy aims to look at the individual's behaviour in the context of their role in the family system. Dysfunction is assumed to exist not only in the individual but also on the systemic level; therefore, it also needs to be addressed on that level.
The purpose of family therapy is not to place blame on any family member but to improve relationships in the family.
Family therapy may explore the relationship between family members, their roles, the boundaries between the members, and patterns around control or conflict.
Family-based treatments aim to engage the family in the individual's recovery. This approach aims to promote recovery without hospitalising the individual.
It recognises that individuals struggling with anorexia may be unable to change their behaviour due to the effects of starvation. Instead, it puts parents in charge of the adolescent's food decisions (when what and how much they eat) to help the adolescent gain weight.
Next, the adolescent is gradually given back control over their food decisions while any indications of relapse are monitored.
Once improvement is achieved, and the adolescent's healthy eating patterns are restored, the therapist will discuss upcoming challenges with parents and how they can prevent relapse in the future.
Cognitive Treatments for Anorexia Nervosa
The main goal of Cognitive behavioural therapy (CBT) is to help the patient achieve and maintain a healthy weight. It is primarily used to prevent relapse once weight restoration has been achieved. It helps maintain healthy eating behaviours and addresses one's beliefs and rigid thinking patterns around food.
Various behavioural methods are used to gradually increase the patient's food intake with gradual exposure and reduce the anxiety associated with behavioural change.
In addition, the patient's positive and negative beliefs related to food and weight that promote disordered behaviours are identified and challenged using various cognitive techniques.
By identifying dysfunctional coping mechanisms, professionals can use treatment to identify where problem-solving is deficient and help the patient develop and work with new problem-solving and coping skills.
The main goal of Cognitive behavioural therapy (CBT) is to help the patient maintain a healthy weight; it is primarily used to prevent relapse once weight restoration has been achieved. It helps maintain healthy eating behaviours and addresses one's beliefs and rigid thinking patterns around food.
Various behavioural methods are used to gradually increase the patient's food intake with gradual exposure and reduce the anxiety associated with behavioural change.
In addition, the patient's positive and negative beliefs related to food and weight that promote anorexic behaviours are identified and challenged using various cognitive techniques.
The professionals can use treatment to identify where problem-solving is deficient and then help the patient develop and work with new problem-solving and coping skills.
Phases of CBT for Anorexia | Description |
| Behavioural phase | The therapist works with the patient to create a plan to stabilise eating behaviours. They identify dysfunctional thoughts. The therapist teaches the patient various coping strategies and tools to help them with overwhelming emotions. |
| Cognitive phase | As therapy progresses, cognitive restructuring techniques are introduced. Problematic thoughts and beliefs are identified and challenged, like, 'I will only be happy if I lose weight.' New thoughts and beliefs are introduced, like, 'My self-worth does not depend on my weight'. |
| Maintenance and relapse prevention phase | This final phase is about maintaining progress and preventing relapse by reducing triggers. The patient can return to a happy, fulfilling life, which is the goal of CBT. Even if symptoms are not eliminated, therapy will move to other problem areas and work on holistic emotional well-being once stabilised. |
Enhanced CBT (CBT-E) is a personalised treatment approach suitable for all eating disorders. It aims to develop an understanding of the root cause of one's eating problems, what maintains them, and what plan would address a person's needs.
Biological Treatment for Anorexia Nervosa
Anorexia patients may be prescribed antidepressant medication in addition to their psychological treatment. However, according to guidelines, medication should not be their sole treatment.
One common class of psychiatric drugs prescribed for anorexia are selective serotonin reuptake inhibitors (SSRIs). Anorexia often co-occurs with depression and anxiety; the purpose of using SSRIs is to decrease psychological distress to make it easier for a person to participate in their treatment.
Research has found an association between low serotonin levels and depression.
SSRIs work by increasing the availability of serotonin in synapses, enhancing serotonin transmission.
One limitation of using SSRIs in anorexia treatment is that they can sometimes cause weight gain, which can be highly distressing for anorexia patients and set them back in their recovery.
Antipsychotic medication like Olanzapine can also be prescribed in anorexia treatment. The purpose of it is to reduce anxiety and obsessive thinking to help with patients eating disorder recovery. It also slows metabolism, increases appetite, and alters homeostatic physiological functions.
However, empirical support for using drug therapy in anorexia recovery is lacking.
Bodell and Keel (2010) noted that drug therapy offers limited overall benefits in treating anorexia nervosa. In contrast, the review of Tortorella et al. (2014) found mixed results for the effects of antidepressants on anorexia.
Drug therapy is more often aimed at improving the depressive and anxious symptoms of anorexia nervosa but not so much for the cognitive and behavioural aspects of anorexia.
Fig. 3 - Medication is used in anorexia treatment to help reduce the anxiety individuals may feel around food.
Treatments for Anorexia - Key takeaways
- Anorexia nervosa is a severe eating disorder involving food restriction and can result in severe malnutrition and low body weight.
- Both biological (genes, neuroanatomy, neurotransmitters, birth complications) and psychological (perfectionism, cognitive mechanisms, dysfunctional family systems) explanations for anorexia nervosa have been proposed.
- Psychological treatments for anorexia nervosa include family therapy, family-based treatment, cognitive behavioural therapy (CBT) or Enhanced CBT.
- Biological treatment for anorexia can include SSRI or antipsychotic medication.
- The anorexia nervosa treatment can sometimes use the conjunction of biological and cognitive treatments for anorexia nervosa.
References
- Eating Disorder Statistics. South Carolina Department of Mental Health. https://www.state.sc.us/dmh/anorexia/statistics.htm. Accessed July 2022.
- Accurso, E. C., Sim, L., Muhlheim, L., & Lebow, J. (2020). Parents know best: Caregiver perspectives on eating disorder recovery. The International journal of eating disorders, 53(8), 1252–1260. https://doi.org/10.1002/eat.23200
- Scott-Van Zeeland, A. A., Bloss, C. S., Tewhey, R., Bansal, V., Torkamani, A., Libiger, O., Duvvuri, V., Wineinger, N., Galvez, L., Darst, B. F., Smith, E. N., Carson, A., Pham, P., Phillips, T., Villarasa, N., Tisch, R., Zhang, G., Levy, S., Murray, S., Chen, W., … Schork, N. J. (2014). Evidence for the role of EPHX2 gene variants in anorexia nervosa. Molecular psychiatry, 19(6), 724–732. https://doi.org/10.1038/mp.2013.91
- Bodell, L. P., & Keel, P. K. (2010). Current treatment for anorexia nervosa: efficacy, safety, and adherence. Psychology research and behavior management, 3, 91–108. https://doi.org/10.2147/PRBM.S13814
- Tortorella, A., Fabrazzo, M., Monteleone, A.M., Steardo, L., Monteleone, P., 2014. The role of drug therapies in the treatment of anorexia and bulimia nervosa: A review of the literature. J. Psychopathol. 20.
Explanations 
Exams 
Magazine 
