Treatment Plan for Anorexia Nervosa Following Sexual Trauma
The recommended treatment for a 20-year-old female with anorexia nervosa resulting from sexual trauma should include eating disorder-focused psychotherapy to normalize eating behaviors and restore weight, combined with trauma-informed care addressing the underlying sexual trauma. 1
Initial Assessment
Comprehensive psychiatric evaluation including:
- Weight measurement and quantification of eating/weight control behaviors
- Assessment of vital signs (temperature, heart rate, blood pressure, orthostatic measurements)
- Physical appearance evaluation for signs of malnutrition
- Complete review of systems 1
Laboratory assessment:
- Complete blood count
- Comprehensive metabolic panel (electrolytes, liver enzymes, renal function)
- Electrocardiogram (especially important with restrictive eating disorders) 1
Trauma assessment:
- Detailed history of recent and past sexual trauma
- Evaluation for dissociative symptoms, which are common in eating disorder patients with trauma history 2
- Screening for PTSD symptoms related to sexual trauma
Treatment Components
1. Psychotherapy
Primary approach: Eating disorder-focused psychotherapy that addresses:
- Normalizing eating and weight control behaviors
- Weight restoration with individualized weekly goals
- Fear of weight gain and body image disturbances 1
Trauma-specific therapy:
- Trauma-focused cognitive behavioral therapy (TF-CBT)
- Consider interpersonal therapy (IPT) as it addresses relationship issues that may be particularly relevant given the sexual trauma history 3
2. Nutritional Rehabilitation
- Set individualized goals for weekly weight gain and target weight 1
- Implement structured meal planning with gradual increase in caloric intake
- Regular monitoring of weight and nutritional status
3. Family/Support System Involvement
- Family-based treatment (FBT) is recommended for adolescents and emerging adults with involved caregivers 1
- Educate caregivers on normalizing eating behaviors and supporting weight restoration
- Provide guidance on appropriate trauma support without retraumatization
4. Medication Considerations
- For comorbid depression/anxiety: Consider fluoxetine (60mg daily) which has evidence for eating disorders 3
- For sleep disturbances: Extended-release melatonin may help with sleep initiation and reduce nighttime awakenings 3
- For binge-eating components: Consider duloxetine which modulates serotonergic and noradrenergic pathways involved in mood regulation and impulse control 3
5. Technology-Based Interventions
- Consider guided computer/internet-based CBT interventions as adjuncts to treatment 1
- These may be particularly helpful for patients with trauma history who experience shame or fear of stigmatization 1
Addressing Sexual Trauma
Sexual trauma history significantly impacts treatment outcomes for eating disorders. Research shows that:
- Patients with eating disorders and sexual abuse history often show impaired sexual functioning that may not improve with standard CBT alone 4
- Sexual trauma creates a profound uneasiness with body perception that requires specialized attention 4
- Discussion of sexual problems should be integrated into treatment 5
Monitoring and Follow-up
- Regular assessment of vital signs and weight
- Ongoing evaluation of eating behaviors and trauma symptoms
- Adjustment of treatment plan based on progress
- Multidisciplinary team approach including medical, psychiatric, psychological, and nutritional expertise 1
Common Pitfalls to Avoid
- Focusing solely on weight restoration without addressing trauma history
- Discontinuing treatment prematurely (before 12 weeks) 3
- Neglecting to create a comprehensive treatment plan that addresses both eating disorder and trauma symptoms 3
- Failing to address sexual functioning issues which are common in patients with eating disorders and sexual trauma history 4, 5
The connection between sexual trauma and anorexia nervosa is well-documented 2, 6, 7, making trauma-informed care essential for effective treatment. The treatment plan must simultaneously address both the eating disorder symptoms and the psychological impact of sexual trauma for optimal outcomes.