Treatment

Treatment of persons with eating disorders can take place in an inpatient or
an outpatient setting. Hospitalization is indicated for patients with severe
malnutrition, serious medical complications, an increased risk of suicide,
and those who are unable to care for themselves or have failed outpatient
treatment.

The first step in the treatment of anorexics must be restoring their body
weight. This may require hospitalization. A system of carefully structured rewards
for weight gain is often successful. For example, the gain of a target
amount of weight may be tied to being allowed to go outside or having visits
from friends. Once the anorexic is nutritionally stabilized, individual, family,
cognitive-behavioral, and other therapies are indicated to address issues
specific to the individual.

The first step in the treatment of bulimics is a comprehensive medical evaluation.
Bulimics are less likely than anorexics to require hospitalization. As
with anorexia nervosa, treatment includes individual, family, and cognitivebehavioral
therapies. In addition, group therapy may be helpful. Cognitivebehavioral
therapies are effective in the treatment of bulimia nervosa.
Patients are taught to recognize and analyze cues that trigger the bingepurge
cycle. Once analyzed, they are taught to reframe these thoughts, feelings,
and beliefs to more adaptive and less destructive ones, thus altering the
cycle.

Outpatient care should be carefully coordinated among a multidisciplinary
team: an experienced health care practitioner to monitor the patient’s
medical condition, a therapist to address psychological and emotional
issues, a family therapist to deal with control and other issues within
the family, and a nutritionist to develop and monitor a sensible meal plan.
Medications may be a helpful adjunct in some cases, particularly in those
eating-disordered patients who have an additional psychiatric diagnosis
such as major depression or obsessive-compulsive disorder. Simply gaining
weight usually improves mood in anorexics, but antidepressants (particularly
the selective serotonin-reuptake inhibitors or SSRIs) may help not only
with depression but also with the obsessive-compulsive aspects of the anorexic’s
relationship with food.

Several different antidepressants (including monoamine oxidase inhibitors,
the tricyclics amitriptyline and desipramine, and high-dose fluoxetine,
an SSRI) are associated with fewer episodes of binge eating and purging in
bulimic patients, in addition to their use in treating anxiety and depression.
These drugs have not been studied extensively in the treatment of binge-eating
disorder, however.