Treating eating disorders is not a one time or a short term process. There is a high risk of relapse and recurrence. Another difficulty is that an anorexic patient believes that the emaciation is normal and attractive and bulimic patient feels that purging is the only way to prevent obesity.
Anorexics may be reinforced in their beliefs by their coaches and teachers at times to maintain a low body fat and often family refuses to perceive eating disorders in their children.
Who treats eating disorders?
Treatment involves a multidisciplinary team approach with continued support and counselling. Team members include:
- doctors
- dentists
- oral pathologists
- dieticians and nutritional advisors
- cognitive-behavioral therapists
- Psychotherapists
- occupational therapists
- social workers
- nurses
Aims of treatment
The major aims of treatment of eating disorders are:
- Normal body weight needs to be restored particularly in anorexia
- Physical complications such as bad teeth and gums, digestive problems, vitamin deficiencies need to be addressed
- Binge eating needs to be stopped or reduced
- Purging needs to stop
- Psychiatric illnesses that occur concurrently need to be treated
- Patient needs to be educated on proper nutritional habits and development of healthy eating patterns and meal plans
- Improvement of self-control, self-esteem, and behavior
- Family counselling
- Prevention of relapse
- Prevention of unrealistic expectations from treatment
Counselling
Patient is counselled before enrolling into therapeutic sessions that it is painful and requires hard work on the part of the patient and family. They are explained that quite a few therapeutic methods are likely to be tried until the patient succeeds and that relapse is common but needs to be tackled with will power and support.
Outcome
Research shows that about 70% of people with bulimia and 27 - 50% of patients with anorexia nervosa are free from eating disorders within 10 years of treatment.
Treatment approaches
Treatment approaches include:
Psychotherapies
This is the mainstay of therapy. Depending on the problem, certain psychologic approaches may work better than others. Cognitive behavioural therapy is the most used and best approach.
Medications
These are usually prescribed to treat co-existing psychiatric ailments.
Nutritional counselling and diet plans
These help patients to gain weight and learn healthy eating plans and patterns.
Recommendations for anorexia nervosa
- Place of treatment (on an outpatient basis or in the hospital) is determined based on physical aspects of the disease
- Patient is explained that healing may take many months if not years
- Forced treatment of anorexia nervosa should only take place when all other measures have been exhausted
- With children and adolescents still living with their family, other members of the family need to be involved
- Attempts should be made to restore normal weight
- In the hospital set up a weight gain of between 500 g and a maximum of 1000 g per week should be aimed at. In the outpatient setting, the goal should be a gain of 200 to 500 g per week. Patients should be weighed at the same time regularly in the morning wearing light clothing
- Guidance regarding adequate nutrition should be given
Recommendations for bulimia nervosa
- Psychotherapy is the treatment of choice for bulimia nervosa
- For children, adolescents, and young adults, Cognitive behavioral therapy (CBT) is regarded as the treatment of choice
- Usual course lasts at least 25 sessions at a frequency of at least 1 session per week
- Management of physical symptoms is important
- Patients with co-morbidities like borderline symptoms need psychiatric support as well
- With children and adolescents still living with their family, other members of the family need to be involved
- Administration of selective serotonin reuptake inhibitors (SSRIs) is the drug therapy of choice
Recommendations for binge eating disorder
- Usually patients may be overweight or obese and may need therapy
- Those with existing psychological complaints and disorders like depression, social phobia etc. need therapy
- Relapse prevention is an important measure as well.
Criteria for admission
- Lack of efficacy or failure on outpatient based therapy
- Lack of adequate outpatient care facilities near the patient’s home
- Presence of severe psychological and physical co-morbidity like type I diabetesmellitus and self harm.
- Those with severe disease and poor motivation
- Presence of suicidal tendencies
- Conflicts in social and family environment
- Requirement of intensive care – severe dehydration, electrolyte imbalance, severe malnutrition etc.
