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And the entire suite of anorexia treatment options can be administered over several levels of care, adapted to suit the severity of the illness or where a person may be in their recovery journey.
There are several levels of care for those living with anorexia nervosa. A medical professional should be consulted to help determine the level of care that might be needed. For information sharing purposes, here are the various options to consider.
Inpatient care is usually required for people with anorexia whose disordered eating behaviors have left them psychologically or medically compromised.1
Inpatient treatment involves round-the-clock care and monitoring, which is usually provided in a hospital setting or a specialized facility for eating disorders.2
Patients in inpatient care may require medical management, such as tube feeding, intravenous fluids, vitals monitoring, and regular lab testing.2,16 Psychotherapy, supervised meals, and nutrition counseling are also usually part of the treatment plan.
Residential treatment also houses individuals with anorexia for 24 hours a day and provides multidisciplinary treatment. But it’s only for medically stable patients.
Still, eating disorder symptoms are usually severe at this stage. Residential treatment involves round-the-clock supervision to monitor patients' meals and eating disorder behaviors, which can include restriction, excessive exercise, and laxative and diuretic use.3
Residential treatment may also be suitable for those who:
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Partial hospitalization programs (PHPs) are day treatment programs that still provide a level of structure for people with anorexia, but do not require overnight stays.
Patients are required to attend several days a week, for many hours. PHP treatment can include nutritional counseling, monitored eating sessions, medical care, and individual, family, and group therapy.4
Intensive outpatient care (IOP) is usually for those with anorexia nervosa who are ready to step down from residential treatment or PHP but still need some structure and support to help maintain their recovery.5
A multidisciplinary team of therapists, nutritionists, and mental health professionals will continue with a treatment plan, which will include supported meals, nutritional counseling, and individual and group therapy.
No overnight stays are required. Instead, treatment is delivered at a specialist clinic for a few days a week, which allows patients to maintain a job or their education if they choose.
Outpatient treatment is the lowest level of care for those with AN and usually involves one-on-one sessions with a dietician and therapist once a week to monitor their progress.
Those in outpatient treatment tend to be able to control their disordered eating and compensatory behaviors, and are self-sufficient at weight gain.4
Proven therapy for anorexia nervosa include the following:
Acceptance and commitment therapy (ACT) helps people with AN to reduce their disordered eating behaviors, thoughts, and feelings.
By using metaphors, ACT teaches strategies to help those suffering from AN manage and cope with their maladaptive eating behaviors, like restriction and over-exercising. It helps a person move from rigid thoughts and behaviors to ones that are more flexible.
Six processes are involved in ACT for anorexia nervosa:6
Cognitive behavioral therapy (CBT) is a type of talking therapy that helps people living with anorexia nervosa understand the interaction between their thoughts, feelings, and behaviors. With a therapist’s help, CBT teaches a person to develop strategies to change their negative emotions and challenge their disordered eating behaviors.
Cognitive remediation therapy (CRT) for AN doesn’t necessarily target the condition itself or the disordered eating behaviors it results in, but rather works to alleviate other characteristics that may help maintain anorexia nervosa.8
Techniques are used to help break up rigid thinking for patients, and to create a greater balance between local and global information processing, or, in other words, to help someone move away from a hyper-focus on details. It’s thought that these changes can then make someone more open to change, and pave the way for them to incorporate positive change and treatment into their lives.8
Dialectical behavior therapy (DBT) is a type of talking therapy best suited to people with AN that feel emotions very intensely. During DBT, a therapist helps a person to accept themselves as they are, while also motivating them to change their disordered eating behaviors.9
Exposure therapy is a form of CBT that helps in the treatment of anxiety, which is often a significant psychological component of anorexia nervosa.10 Patients are exposed to situations that cause fear and distress, which are intensified over time, to increase the level of comfort with certain anxiety triggers.
The goal of exposure therapy is for those with AN to approach situations and behaviors that cause them anxiety in ways that are controlled and manageable. By confronting their fears, people living with anorexia can dispel the irrational beliefs they have about the dangers of food and certain eating situations.10
During family therapy, family members of an individual with anorexia learn how to support their loved ones in their eating disorder recovery. This form of therapy is particularly useful for parents of a child or teenager with anorexia and teaches them how to restore healthy eating behaviors and achieve a healthy weight.4
Group therapy gives patients with anorexia nervosa the opportunity to form deep connections and a strong support network with others in a similar situation.
A psychologist or other mental health professional leads these sessions, encouraging intimate conversations that can help relieve emotional distress, provide healing, bring positive changes to a person’s thoughts, and provide the realization that they’re not alone.
Interpersonal psychotherapy (IPT) is based on the principle that how you relate to others impacts your mental health. Therefore, problems in relationships can result in emotional issues, such as eating disorders.
A treatment plan for anorexia nervosa should strongly consider including some form of nutrition counseling. In nutrition counseling, someone with anorexia learns about the body’s nutritional needs and how much food someone of their age, size, and sex should eat to stay healthy. Patients with anorexia are also taught how to recognize the body’s hunger cues, work on repairing their relationship with food, work on body image, and address emotional dysregulation.
Meal support ensures those with AN are eating meals that meet the requirements of their individual meal plan. If a meal falls short, it can be supplemented, and the patient is advised on how to make sure their meals meet their dietary requirements going forward.
During supervised mealtimes, staff watches for disordered eating behaviors or rituals, which will be redirected. Light-hearted conversation and games during meals helps take the focus off food.
Art therapy, such as painting, drawing, and sculpture, can help people with anorexia to express their feelings and emotions when it’s difficult to find words. This form of creative self-expression provides a way to engage with difficult feelings and externalize them visually, which can give much-needed perspective.
Psychodrama is a form of group therapy where people with anorexia can explore their issues and feelings by acting out events, with role-playing and dramatic self-presentation. It can help a person living with anorexia to gain a greater understanding of thoughts and emotions that come to the surface during the session.13
The experienced team at Within Health recognizes that no two people with anorexia nervosa are the same. Therefore, we formulate personalized treatment plans for each client with the goal of helping our clients embrace weight neutrality and flexibility around food and eating.
Our AN treatment program consists of three levels of care:
At Within Health, we evaluate and assess each client to determine the appropriate level of treatment, which will depend on the severity of the illness, overall health, and needs of the individual seeking treatment.
We use an intuitive eating model to counteract diet culture and rigid food rules, and to recognize internal cues of hunger and satiety.
Furthermore, we don't discuss numbers, any numbers. This includes calorie counting, weight, clothing size, and more. We believe fixating on numbers is counterproductive to treatment, and we want our clients to recognize they’re more than a number on a scale.
We know how difficult it is to seek help for anorexia nervosa and treat each patient with empathy, understanding, and compassion. We care about our clients and pride ourselves on providing a safe space where anyone of any ethnicity, gender identity, sexuality, shape, and size, can feel safe.
Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.
Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.
Unlike other eating disorders, such as bulimia nervosa and binge eating disorder, which respond particularly well to specific treatments, anorexia nervosa does not seem to be treated especially effectively by any one type of therapy.14 Though teens respond well to treatment, adults can have a less significant response to treatment.
Still, a number of treatment types have been found useful, including cognitive behavioral therapy, exposure and response prevention, supportive psychotherapy, and certain acceptance-based treatments.14 Family-based therapy has also been especially effective for younger people struggling with anorexia nervosa.15
The first step in treatment depends on a number of factors, including the severity of symptoms and someone's personal history and needs, but it should include a thorough evaluation from a mental health or medical professional.
In more severe cases, the first step is generally a focus on gaining weight and/or alleviating any immediately harmful medical complications. Once someone is considered medically stable, other facets of treatment can begin, including psychotherapy and nutritional counseling.
If someone enters treatment already medically stable, their first step will most likely be consulting with a primary care physician and a psychiatrist, and starting on a regimen of medical check-ins and mental health treatment.
If you or a loved one are struggling with anorexia nervosa, it's important to seek out help.
You can reach out to your primary care physician or therapist as a first step. These medical professionals may be able to help you get an official diagnosis—usually the first step in finding a treatment program—or help you dictate your next best steps.
There are also a number of online options which may be able to offer help, including Within Health. Our program is tailored to cater to the needs of each individual patient, and you can get started today without even having to leave home.
