How Eating Disorders Are Treated

Treatment for eating disorders may include various types of therapy, prescription medications, and alternative therapies. As eating disorders have one of the highest mortality rates of any mental illness, treatment is essential.

There is not necessarily a "cure" for these conditions. Like many mental health conditions, a person will likely cope with their eating disorder throughout their life. The focus of treatment will be on working toward recovery and preventing relapse in the future.

Levels of Treatment

Eating disorders are treated in a variety of different settings, based on a person's unique factors such as preferences, family involvement, and medical or psychiatric severity of their condition.

Levels of treatment for eating disorders can include:

• Self-help: A person pursues treatment themselves through alternative methods or self-help resources. The person will either have good insight into their condition, be in the long-term recovery phase, or is still coming to terms with their condition and how to seek help from other sources.
• Community: The person lives at home and receives outpatient treatment services in their community, such as teletherapy, visits with their primary care provider, and more.
• Intensive outpatient: Treatment is offered in an outpatient clinic the person visits on a regular basis, perhaps several times a week.
• Partial hospital: This involves regular hospital monitoring for people who are medically and psychiatrically stable but may need daily monitoring of vital signs and eating disorder behaviors. A person in partial hospitalization treatment still lives in the community but attends the program for several hours a day.
• Residential: A person who is medically stable but requires significant psychiatric and behavioral support may benefit from residential treatment. They will live in a residential treatment center for a set period of time and generally receive comprehensive treatment.
• Inpatient: The person receives treatment in a secure inpatient facility if the patient is either medically or psychiatrically unsafe or unstable.

Prescription Medications

Prescription medications are used to treat eating disorders but are not usually the sole treatment method. Medications including antipsychotics, mood stabilizers, and antidepressants can have some benefit in eating disorders when used in conjunction with therapy or to help treat co-occurring conditions such as anxiety or depression.

Antidepressants are the primary medication used to treat bulimia nervosa. Of these, selective serotonin reuptake inhibitors (SSRIs) are well-tolerated and have the most evidence but are most effective when used in combination with psychotherapy.

For people with binge eating disorder, lisdexamfetamine, a derivative of amphetamine, is FDA-approved and well-tolerated. Antidepressants are also effective in binge eating disorder treatment and are shown to reduce distressing binge eating behaviors.

Anorexia nervosa is sometimes treated with second-generation antipsychotics, including olanzapine and transdermal hormones. These treatments can aid in weight gain and bone density gain but should not be the sole treatment used.

Therapies

Psychotherapy is the foundation of eating disorder treatment. The type a person chooses will vary based on the severity of their condition; their personal culture, background, and preferences; their age; and more. In most cases, a combination of therapies will be the most effective treatment.

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy (CBT) is the most widely-studied psychotherapy for treating eating disorders. In CBT, a person is taught to identify their thought patterns, learn awareness, and change their thinking and subsequently their behavior.

In CBT for eating disorders, a person may first learn to identify their destructive thought patterns around food, emotions, control, and body image. They will then learn coping mechanisms to deal with these negative thought cycles. Eventually, the therapist and client work together to alter the disordered eating behaviors.

Research shows that cognitive behavioral therapy can begin to improve eating disorder symptoms in just six sessions, with early reduction in restrictive behaviors being the best indicator of a positive outcome.

A 2017 systematic review also found that cognitive behavioral therapy is effective at treating all types of eating disorders and is either equally or more effective than other types of psychotherapy.

Other Psychotherapies

In addition to cognitive behavioral therapy, there are other evidence-based psychotherapy methods used in eating disorder treatment. These include:

• Compassion focused therapy (CFT-E)
• Dialectical behavior therapy
• Emotion focused therapy
• Cognitive remediation therapy
• Enhanced cognitive behavioral therapy (E-CBT)
• Acceptance and commitment therapy

Family-Based Therapy

Family-based therapy (FBT), also referred to as the Maudsley approach, was developed in London in the late 1900s. It is now a leading eating disorder treatment method for children and adolescents with eating disorders.

FBT is a behavioral therapy that does not address the root cause of the eating disorder or blame the condition on the family, as previous methods have done. Instead, it treats the family as a unit and empowers parents to assist their child through recovery in what is treated as a battle against the eating disorder as an external force.

In the beginning stage of family-based therapy, a certified therapist helps the parents feed the child or teen, as the parents take full control of the child's nutrition at home. Throughout FBT, control is gradually transitioned back to the child.

A central benefit of family-based therapy is that the child or teen gets to remain living at home with their family. FBT is typically offered in outpatient or occasionally partial hospitalization settings.

A systematic review found that FBT is not more effective than individual therapy at the end of treatment. However, FBT does have longer-term results with significant benefits maintained six to 12 months after treatment.

Some research indicates that family-based therapy may actually be more effective than CBT at treating bulimia nervosa among adolescents.

Nutritional Therapy

Nutritional counseling by a registered dietitian (RD) is a core aspect of eating disorder treatment. Eating disorders carry the highest mortality rate of all mental illnesses due to the physical impacts on the body, including constipation, significant weight gain or loss, loss of menstrual period, cardiovascular problems, weakened bones, and more.

Returning to a healthy body weight is an essential part of the recovery process, although this may be physically and emotionally painful for the person in recovery.

Nutritional counseling can help a person develop a meal plan, normalize eating patterns, reach a stable and healthy body weight, alter their relationship with food and eating, and develop motivation for recovery and a relapse plan.

Occupational Therapy

Occupational therapy (OT) is increasingly becoming a part of eating disorder treatment in both residential and inpatient settings. Occupational therapists approach health and rehabilitation through the lens of a person's meaningful activities and routines.

People with eating disorders may struggle to engage in occupations involving food, socializing, self-care, and other activities. Occupational therapy can help a person relearn to engage in self-care, eating alone or with others, meal preparation, grocery shopping, leisure, and more.

Occupational therapy can also help with sensory modulation and integration, particularly among people with anorexia nervosa who experience sensory over-responsiveness during the acute stages of recovery and weight gain.

Physical Therapy

Physical therapy (PT) has an emerging role in eating disorder treatment. A person might see a physical therapist in a residential treatment program or an outpatient clinic to work on rebuilding muscle mass and body awareness.

A 2013 systematic review found that of physical therapy treatment modalities, aerobic exercise, and resistance training most significantly increased muscle strength and body mass index (BMI) among people with anorexia nervosa.

Aerobic exercise, therapeutic yoga, massage, and body awareness therapy also helped reduce depressive symptoms and eating disorder behaviors among people with both anorexia and bulimia nervosa.

Medical Treatments

Medical monitoring and treatment may be essential for some people with eating disorders, depending on the severity. It is important to seek medical treatment for eating disorders due to the life-threatening impacts and long-term health implications of disordered eating.

Medical treatment may include:

• Weight monitoring
• Vital sign monitoring
• Parenteral nutrition
• Bone density scanning
• X-rays
• Blood tests to monitor organ function, electrolytes, and blood counts
• Cardiovascular monitoring
• Dental evaluations and treatment

Complementary and Alternative Medicine (CAM)

Alternative treatments for eating disorders may have a positive impact and be very meaningful to people. However, they should still be treated with caution and used in conjunction with the above medical, nutritional, and therapeutic treatments.

Yoga

Yoga is a popular alternative treatment for eating disorders that is receiving increasing attention in research in recent years. Yoga is now often incorporated into mainstream treatment in residential or outpatient settings.

One preliminary study found that a 12-week yoga program reduced binge eating disorder severity. A randomized controlled trial found that in a residential setting, yoga reduced negative emotions before mealtime among participants with eating disorders.

However, more research is needed on the benefits of yoga for various eating disorders. A 2019 systematic review found that yoga is effective at treating eating disorders, but the quality of evidence is low and more research is needed to make conclusions on treatment recommendations.

Recovery

Aspects of recovery may include weight, body image, emotions, eating behavior, independence in eating disorder management, physical health, psychological well-being, and feelings of life worth living.

Using those aspects of recovery, a 2020 survey found that only 20% of parents felt their child had achieved full recovery from their eating disorder. Other research, however, has found that people with eating disorders themselves have a different definition of recovery than the medical community.

For many people, recovery is not synonymous with complete remediation of all eating disorder symptoms; insight and self-management may be more meaningful than a complete lack of psychopathology.

Like many mental health conditions, eating disorders can be chronic. It may be more realistic to think of your eating disorder recovery as a lifelong process, with natural ups and downs. Through consistent treatment, trigger identifications and relapse plans can help maintain your quality of life and mental and physical health.

A Word From Verywell

It can be very challenging for someone with an eating disorder to seek treatment. People with certain eating disorders notably have low insight into their condition. In some, this is because anosognosia, or lack of insight into a health condition, is a side effect of starvation on the brain.

For many others, the idea of gaining weight during treatment and subsequently losing that control over their body and life is truly terrifying. In the face of this fear, motivation to seek treatment can be very low.

For many people, especially children and adolescents, treatment is encouraged or even forced by family members. Adults over the age of 18 legally cannot be forced into treatment by their families. However, caring relatives and friends still have an important role in raising awareness and respectfully encouraging treatment.

Ultimately, though, change comes down to the individual. If you have an eating disorder and are considering your treatment options, know that there is help available. Recovery is a difficult process, but there are many evidence-based options out there to help you on your road to recovery.