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Treatment
Strategies for Eating Disorders |
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Treatment Strategies
Eating disorders can be
treated and a healthy weight restored. The sooner these
disorders are diagnosed and treated, the better the
outcomes are likely to be. Because of their complexity,
eating disorders require a comprehensive treatment plan
involving medical care and monitoring, psychosocial
interventions, nutritional counseling and, when
appropriate, medication management. At the time of
diagnosis, the clinician must determine whether the
person is in immediate danger and requires
hospitalization.
Treatment of anorexia
calls for a specific program that involves three main
phases: (1) restoring weight lost to severe dieting and
purging; (2) treating psychological disturbances such as
distortion of body image, low self-esteem, and
interpersonal conflicts; and (3) achieving long-term
remission and rehabilitation, or full recovery. Early
diagnosis and treatment increases the treatment success
rate. Use of psychotropic medication in people with
anorexia should be considered only after weight
gain has been established. Certain selective serotonin
reuptake inhibitors (SSRIs) have been shown to be
helpful for weight maintenance and for resolving mood
and anxiety symptoms associated with anorexia.
The acute management of
severe weight loss is usually provided in an inpatient
hospital setting, where feeding plans address the
person's medical and nutritional needs. In some cases,
intravenous feeding is recommended. Once malnutrition
has been corrected and weight gain has begun,
psychotherapy (often cognitive-behavioral or
interpersonal psychotherapy) can help people with
anorexia overcome low self-esteem and address distorted
thought and behavior patterns. Families are sometimes
included in the therapeutic process.
The primary
goal of treatment for bulimia is to reduce or eliminate binge eating and purging
behavior. To this end, nutritional rehabilitation, psychosocial intervention,
and medication management strategies are often employed.
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Establishment of a pattern of
regular, non-binge meals, improvement of attitudes
related to the eating disorder, encouragement of
healthy but not excessive exercise, and resolution
of co-occurring conditions such as mood or anxiety
disorders are among the specific aims of these
strategies. Individual psychotherapy (especially
cognitive-behavioral or interpersonal
psychotherapy), group psychotherapy that uses a
cognitive-behavioral approach, and family or marital
therapy have been reported to be effective.
Psychotropic medications, primarily antidepressants
such as the selective serotonin reuptake inhibitors
(SSRIs), have been found helpful for people with
bulimia, particularly those with significant
symptoms of depression or anxiety, or those who have
not responded adequately to psychosocial treatment
alone. These medications also may help prevent
relapse. The treatment goals and strategies for
binge-eating disorder are similar to those for
bulimia, and studies are currently evaluating the
effectiveness of various interventions. |
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People with eating
disorders often do not recognize or admit that they
are ill. As a result, they may strongly resist
getting and staying in treatment. Family members or
other trusted individuals can be helpful in ensuring
that the person with an eating disorder receives
needed care and rehabilitation. For some people,
treatment may be long term.
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This information is
excerpted from material
written by Melissa Spearing,
Public Information and
Communications Branch,
National Institute of Mental
Health (NIMH). Expert
assistance was provided by
NIMH Director Steven E.
Hyman, M.D., and NIMH staff
members Bruce N. Cuthbert,
Ph.D., Regina Dolan-Sewell,
Ph.D., Benedetto Vitiello,
Ph.D., Clarissa K.
Wittenberg, and Constance
Burr. Editorial assistance
was provided by Margaret
Strock and Lisa D. Alberts,
also NIMH staff members.
All material
in this publication is in
the public domain and may be
copied or reproduced without
permission of the Institute.
NIH Publication No.
01-4901
Printed 2001
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