From the Guidelines
Treatment of anxiety in patients with anorexia nervosa (AN) should involve a comprehensive approach that includes eating disorder-focused psychotherapy, such as cognitive-behavioral therapy (CBT), as the primary treatment, with selective serotonin reuptake inhibitors (SSRIs) considered as an adjunct therapy in certain cases, as recommended by the American Psychiatric Association (1). When managing anxiety in AN, it's crucial to prioritize a multidisciplinary treatment plan that incorporates medical, psychiatric, psychological, and nutritional expertise (1). This approach ensures that the patient's overall health, including their eating disorder and anxiety, is addressed comprehensively.
Key Components of Treatment
- Eating disorder-focused psychotherapy: CBT is considered a first-line treatment for addressing anxious thoughts and behaviors related to food, weight, and body image in patients with AN (1).
- Medication: SSRIs, such as fluoxetine, may be considered for treating anxiety in AN, but their use should be carefully evaluated due to potential limitations in effectiveness and the need for lower starting doses due to the patient's compromised physical state (1).
- Nutritional rehabilitation and weight restoration: These are critical components of AN treatment and can help alleviate anxiety symptoms exacerbated by malnutrition (1).
- Multidisciplinary approach: Involving a team of professionals, including a psychiatrist, psychologist, and nutritionist, is essential for providing comprehensive care (1).
Considerations for Specific Populations
- Adolescents: Family-based therapy is particularly effective for this age group and should be considered as a primary treatment approach (1).
- Adults: Eating disorder-focused psychotherapy, such as CBT, is recommended, with the potential addition of medication like SSRIs if necessary (1). By prioritizing a comprehensive and multidisciplinary approach to treating anxiety in patients with AN, healthcare providers can help improve outcomes and reduce the risk of relapse (1).
From the Research
Treatment Options for Anxiety in Patients with Anorexia Nervosa (AN)
- Family-based treatment (FBT) has shown promising results for treating AN in adolescents, and may work via exposure (and habituation) to food and its consumption 2
- Cognitive-behavioural therapy (CBT) and specifically exposure in its various forms is most effective for treating anxiety disorders in youth 2
- A multidisciplinary approach to diagnosis and management, including nutritional rehabilitation, psychosocial support, and medical measures, can be effective in treating AN and its associated anxiety symptoms 3, 4
- Repetitive Transcranial Magnetic Stimulation (rTMS) has been used to treat depression and anxiety in patients with AN, but its effectiveness is still being researched and its results are inconsistent 5
- Comprehensive assessment and engagement of the family system are crucial in the treatment of AN, and can help stimulate patients and families to successfully engage in treatment 6
Specific Therapies
- Family-based therapy (FBT) involves the family in the treatment of adolescents with AN, and has been shown to lead to greater weight gain, shorter treatment duration, and reduced costs 4
- Exposure therapy, including exposure with response prevention, can be effective in treating anxiety disorders in youth, and may be adapted for use in patients with AN 2
- rTMS has been used to treat depression and anxiety in patients with AN, but its effectiveness is still being researched and its results are inconsistent 5
Multidisciplinary Approach
- A multidisciplinary approach to diagnosis and management, including nutritional rehabilitation, psychosocial support, and medical measures, can be effective in treating AN and its associated anxiety symptoms 3, 4
- Comprehensive assessment and engagement of the family system are crucial in the treatment of AN, and can help stimulate patients and families to successfully engage in treatment 6