How Anorexia Is Treated

Anorexia is an eating disorder in which a person has a distorted body image, an intense fear of gaining weight, and engages in activities contributing to more weight loss than is considered healthy for their height and age.

Anorexia can be hard to treat, particularly as people with anorexia (especially adolescents) often deny that they have a problem or do not see the dangers in their behaviors.

Fortunately, with the use of psychotherapy, nutritional counseling, and sometimes medication, recovery can be achieved. Learn more about anorexia treatment options.

In-Patient Hospital Care

Anorexia can lead to serious health complications, some life threatening. Before beginning therapy or other treatments, any acute health problems need to be addressed. While outpatient care is preferred, under some circumstances inpatient treatment in a hospital setting may be indicated.

Adolescents with eating disorders—including anorexia—may be hospitalized for concerns such as:

• BMI less than 75% for age and gender (meaning the person weighs only 75% of the expected body weight for a person of their height, gender, and age)
• Electrolyte disturbances, such as hypokalemia (blood potassium levels too low), hyponatremia (low sodium concentration in the blood), and hypophosphatemia (abnormally low level of phosphate in the blood)
• Acute food refusal
• Dehydration
• Physiologic instability, such as significant hypotension (low blood pressure), severe bradycardia (slower than normal heart rate), or hypothermia (dangerously low body temperature)
• ECG abnormalities, such as a prolonged QT interval (heart’s electrical system takes longer than normal to recharge between beats) or severe bradycardia
• Acute medical complications of malnutrition, such as syncope (fainting or passing out), seizures, heart failure, and pancreatitis (inflammation in the pancreas)
• Uncontrollable binge eating and purging
• Psychiatric or physical comorbidities—such as severe depression, suicidal ideation, obsessive-compulsive disorder (OCD), or type 1 diabetes—which make appropriate outpatient treatment difficult or impossible
• Unsuccessful outpatient treatment

Therapies

A meta-analysis published in The Lancet Psychiatry journal in 2021 showed that no one treatment for anorexia outperformed others, highlighting the need for treatment plans that are tailored to the individual.

The study, in which over 97% of the participants were female, also spotlighted the need for more research into how eating and feeding disorders manifest in males. This is especially important since males are less likely to report their distorted eating behaviors.

There are several options in therapies for anorexia, and multiple therapies can be undertaken at once, particularly nutritional therapy in combination with at least one form of psychotherapy (talk therapy).

Nutritional Therapy

Usually facilitated by registered dietitians, the goals of nutrition therapy include:

• Restoration and maintenance of body weight
• Redeveloping intuitive understandings of hunger, fullness, and satiety in order to develop neutrality toward food
• Regulation of health metabolic levels in the blood

The process of regaining weight is delicate for people who have anorexia. In addition to the psychological aspects, prolonged malnutrition can cause biochemical abnormalities such as deficiencies in proteins, micronutrients, and fatty acids.

Before weight gain is attempted, these balances need to be corrected with specialized dietary plans.

Registered dietitians who specialize in eating and feeding disorders are able to offer nutritional treatment while focusing on the psychological considerations that contribute to eating disorders.

While bringing weight back up to a measure that is necessary for health is a major goal of nutrition therapy, changing a person’s understand of and approach to food is a fundamental part of treatment with a dietitian.

Nutritional counseling covers topics such as:

• Food and drinks that are needed for a person to be healthy
• How the body uses the nutrients it gets from food
• Why vitamins and minerals are important, and how the body uses them
• Planning and preparing appropriate meals and snacks
• How eating habits can be linked to emotions
• How to recognize fears about certain food groups, and how even “feared” foods are important for staying healthy

While each individual plan will vary, basic recommendations regarding nutritional treatment for anorexia include:

• Start small: Begin by eating very small amounts of food, increasing intake very gradually over time.
• Check for and address imbalances: Nutritional experts need to correct any biochemical imbalances before beginning the weight gain process.
• Get into a routine: Eat regularly at particular times throughout the day (for example, three balanced meals per day).
• Set a goal: Determine a target weight as a goal to work toward. (A gain rate of about one to two pounds per week—but no more—is recommended and can be achieved by eating 3,500 to 7,000 extra calories per week).

Family-Based Treatment (FBT)/Maudsley Approach

Family-based treatment is usually the preferred choice in psychotherapies for adolescents and children.

FBT approaches a person with anorexia as part of a family unit and involves the whole family, particularly parents, in the treatment plan.

FBT posits that the adolescent with anorexia is not in control of their behavior, but rather the anorexia controls the adolescent. FBT shifts the control of the adolescent’s eating from the adolescent to their parents.

By separating the disorder from the adolescent, or externalizing it, parents are seen as attacking the disorder itself without being critical of the adolescent.

When possible, it is best for the treatment team involved in FBT to be located in the same facility and have open communication with each other.

The FBT team might include:

• Primary clinician: Child and adolescent psychiatrist, psychologist, or social worker/family therapist
• Consulting team: Could consist of a pediatrician, nurse, and dietitian

FBT is administered in three phases.

Phase 1:

• Lasts about three to four months
• Sessions at weekly intervals
• Parents given the responsibility of correcting their adolescent’s disordered eating behaviors and low weight

Phase 2:

• Begins once eating disorder behaviors are significantly reduced
• Control over food consumption transferred back to the adolescent in an age-appropriate fashion
• Sessions gradually reduced from weekly to every second or third week

Phase 3:

• Begins once expected body weight (95% median BMI) and healthy eating behaviors have been achieved
• Sessions scheduled every third week or at monthly intervals
• More general issues of adolescent development addressed
• Focus on creating a healthy adolescent–parent relationship (which no longer requires the eating disorder as the basis of interaction)
• Includes efforts to increase the adolescent’s autonomy
• Establishes appropriate intergenerational family boundaries

FBT is considered an effective treatment for adolescents. One study showed that at the end of a course of FBT, two-thirds of adolescents with anorexia had recovered. At a five-year follow-up, 75% to 90% were weight-recovered.

FBT does not appear to be significantly superior to individual adolescent treatment at end of treatment, but it achieves greater symptom reduction by post-treatment follow-ups at six and 12 months.

While FBT is highly recommended, it is not appropriate or possible for all adolescents with anorexia. This can include:

• Those who do not have available parents
• Those with parents who are not accepting of an FBT model
• Those whose parents are unable to participate in a course of this treatment
• Lack of availability

For these adolescents, a different approach, such as cognitive-behavioral therapy, is recommended.

Parent-Focused Treatment (PFT)

PFT is similar to FBT, except that the parents and adolescent are seen separately. The same three phases outlined in FBT are worked through in PFT, but with separate sessions for parents and adolescents.

At the beginning of each session, a clinical nurse consultant weighs the adolescent, assesses medical stability as needed, and provides brief supportive counseling for up to 15 minutes.

The nurse then communicates any other pertinent information (such as weight) to the therapist, who then sees the parents for a 50-minute session.

The only direct contact between the therapist and adolescent is a brief introduction at the first session and a farewell to the family at the end of the final session.

A 2016 study showed that PFT was slightly more effective than FBT in bringing about remission in adolescents with anorexia at end of treatment, but the differences in remission rates at six- and 12-month follow-ups were not statistically significant between PFT and FBT.

Cognitive Behavioral Therapy (CBT)

CBT is a form of psychotherapy that focuses on changing distorted, problematic, and unhealthy thought patterns and replacing them with healthier ones. It involves a person facing their own fears, learning to understand their own behaviors and those of others, and learning problem-solving skills to help manage difficult situations.

Enhanced cognitive-behavioral therapy (CBT-E) is a form of CBT specifically aimed at addressing eating and feeding disorders. It is highly individualized.

While it was created for outpatient adults, it can be modified for younger people and for day patients or people in inpatient care.

CBT-E addresses the psychopathology of all eating disorders, instead of focusing on individual diagnoses such as anorexia or bulimia.

CBT-E is designed to treat the eating disorder as part of the person and places control in the hands of the individual, including for adolescents. The person with anorexia is an active participant in every aspect of the treatment and has the final say on decisions, such as which procedures to use and which problems to address. They are kept fully informed and are not asked to do anything they do not want to do.

With CBT-E, people with anorexia are encouraged to examine their concerns about shape, weight and eating, dietary restraint and restriction, low weight (if applicable), and extreme weight control behaviors.

By identifying the thought processes and behaviors that contribute to their eating disorder and how they play out in their lives, people with anorexia can make changes to their thinking and actions, leading to healthier outcomes.

CBT-E involves four stages.

Stage 1:

• Sessions usually 50 minutes long each, twice a week
• Focus on gaining a mutual understanding of the person’s eating problem
• Focus on helping them to modify and stabilize their pattern of eating
• Emphasis on personalized education
• Addressees concerns about weight

Stage 2:

• Brief “taking stock” stage
• Progress systematically reviewed
• Plans made for the main body of treatment

Stage 3:

• Weekly 50-minute sessions
• Focus on the processes that are maintaining the person’s eating problem
• Addresses concerns about shape and eating
• Focus on enhancing the ability to deal with day-to-day events and moods
• Addresses extreme dietary restraint

Stage 4:

• Future oriented
• Focus on dealing with setbacks and maintaining the changes that have been obtained

For people who are underweight, weight regain is part of the program, along with addressing eating disorder psychopathology. People with anorexia make the decision to regain weight rather than having this decision imposed upon them. This is encouraged through discussions about what happens if they do or do not regain weight.

Once appropriate regain has been achieved, the focus shifts to healthy weight management.

Four cohort studies of adolescents with anorexia showed that about 60% of those who finished the full treatment program achieved a full response.

A comparative study of 46 adolescents and 49 adults showed weight normalization occurred in 65.3% of adolescents and 36.5% of adults. On average, weight restoration was achieved approximately 15 weeks earlier by adolescents than by adults.

Support Groups

While not a treatment in and of themselves, support groups can be a helpful complement to more comprehensive treatments for anorexia.

Support groups provide a place to talk to others who understand your experiences and feelings, and are often a way to find contacts for other valuable resources.

Some places to look for or ask about support groups and other resources include:

• Your healthcare provider or therapist
• Local hospitals and universities
• Local eating disorder centers and clinics
• Your school’s counseling center

Other Potential Therapies

• Acceptance and commitment therapy: Focuses on developing motivation to change actions rather than thoughts and feelings
• Cognitive remediation therapy: Develops the capability of focusing on more than one thing at a time through the use of reflection and guided supervision
• Dialectical behavior therapy (DBT): Develops new skills to handle negative triggers; develops insights to recognize triggers or situations where a non-useful behavior might occur; involves building mindfulness, improving relationships through interpersonal effectiveness, managing emotions, and tolerating stress
• Interpersonal psychotherapy: Aims at resolving interpersonal problems
• Psychodynamic psychotherapy: Looks at the root causes of anorexia nervosa (the person’s true underlying needs and issues) as the key to recovery

Prescription Medications

No medication has been shown to be very effective as a treatment for anorexia, but some medications may help.

Antipsychotics

There is some indication that second-generation antipsychotics, especially olanzapine, may help with weight gain in anorexia, but these are not recommended as a standalone treatment.

Hormone Medication

Hormone medication and oral contraceptives are sometimes prescribed to people with anorexia to restore menstruation or to prevent or treat low bone mineral density, but there is no evidence to show that it is beneficial for people with anorexia.

Moreover, the use of estrogens might give a false impression that the bones are being protected against osteoporosis, lessening the motivation to adhere to treatments for anorexia. Restoration of menstrual periods and protection of bone density are better achieved by treating anorexia itself.

Antidepressants/Anti-Anxiety Medications

Antidepressants and anti-anxiety medications have not shown to be effective against anorexia directly, but they can help with mental health conditions that often occur alongside anorexia.

Conditions that commonly have a comorbidity with eating and feeding disorders such as anorexia include:

• Mood disorders, primarily major depressive disorder
• Anxiety disorders
• Obsessive-compulsive disorder
• Post-traumatic stress disorder
• Alcohol or substance use disorder

Lifestyle

While not a substitute for professional treatments of anorexia, self-help practices can help with recovery.

Some healthier ways to deal with emotional pain include:

• Calling a friend
• Writing in a journal
• Reading a good book
• Listening to music
• Playing with a pet
• Watching a movie or a favorite TV show
• Playing a game
• Going out into nature
• Doing something kind or helpful for someone else

Some food- and body-specific tips to help with anorexia recovery include:

• Let go of rigid eating rules, and don’t diet.
• Establish and adhere to a regular eating routine.
• Listen to your body, and look for hunger and fullness signals.
• Focus on your good qualities (make a list of all the great things about yourself).
• Resist the urge to engage in criticism of your own body and appearance, and that of others (including comparing yourself to others, or being critical of another person’s body/weight gain).
• Treat yourself with kindness, challenging negative self-talk.
• Choose your clothes based on what you like and what you feel comfortable in, not based on what others may think.
• Be kind to your body, pampering it with things that make you feel good like a massage, a manicure, or a warm bath.

To help stay on track during treatment and prevent a relapse:

• Develop and maintain a strong support system made up of people who help you in your recovery and want the best for you.
• Identify and try to avoid or learn to manage the things that trigger your disordered eating behaviors.
• Avoid groups and websites that glorify anorexia and eating disorders.
• Keep a journal of your thoughts, emotions, and behaviors (watch for negative patterns that indicate you need to seek help).
• Keep following your treatment plan, even if you are feeling better.
• Do things you enjoy, and engage in activities that make you feel happy.
• Be kind to yourself if you have a lapse, and continue with your treatment and recovery plan.

Summary

There are many different treatment options for anorexia. The best course of treatment for you can be determined through open communication with a healthcare provider.

A Word From Verywell

Anorexia is a serious condition that can be hard to treat, but recovery is possible.

If you believe you may have anorexia, see your healthcare provider. Together with eating disorder specialists, you can develop a treatment plan that puts you on the road to recovery.