Treatment of Anorexia Nervosa and Bulimia Nervosa: A Multidisciplinary Team Approach
Patients with anorexia nervosa and bulimia nervosa should be treated by a coordinated multidisciplinary team that incorporates medical, psychiatric, psychological, and nutritional expertise to optimize outcomes related to morbidity, mortality, and quality of life. 1
Core Treatment Team Components
The multidisciplinary team for eating disorders typically includes:
- Primary care or sports medicine physician: Responsible for medical monitoring, physical examinations, laboratory assessments, and coordination of care 1
- Mental health practitioner: Delivers specialized eating disorder-focused psychotherapy, which is the cornerstone of treatment 1
- Registered dietitian/nutritionist: Provides nutritional rehabilitation, meal planning, and education on healthy eating patterns 1, 2
Additional specialists may be required depending on individual needs:
- Psychiatrist (for medication management and complex psychiatric comorbidities) 1, 3
- Endocrinologist (for hormonal complications) 1
- Cardiologist (for cardiac complications) 1
- Exercise physiologist (for appropriate physical activity guidance) 1
Treatment Approaches by Disorder Type
Anorexia Nervosa
- For adults: Eating disorder-focused psychotherapy is recommended, focusing on normalizing eating behaviors, weight restoration, and addressing psychological aspects like fear of weight gain and body image disturbance 1
- For adolescents and emerging adults: Family-based treatment is recommended when caregivers can be involved, with emphasis on caregiver education to normalize eating behaviors and restore weight 1
- Nutritional rehabilitation: Individualized goals for weekly weight gain and target weight should be established 1
- Medication: Limited evidence supports medication as primary treatment for anorexia nervosa, but may be considered for comorbid conditions 1, 4
Bulimia Nervosa
- For adults: Eating disorder-focused cognitive-behavioral therapy (CBT) is the first-line treatment, with the addition of a serotonin reuptake inhibitor (typically fluoxetine 60mg daily) either initially or if minimal response to psychotherapy alone after 6 weeks 1, 5
- For adolescents and emerging adults: Family-based treatment is suggested when caregivers can be involved 1
- Nutritional counseling: Focus on establishing regular eating patterns and reducing dietary restraint 2, 3
Emerging Treatment Modalities
- Technology-based interventions (TBIs): Including computer and internet-based interventions show promise, especially for:
Important Clinical Considerations
- Early intervention is critical: Early diagnosis and treatment are associated with improved outcomes and reduced mortality 3
- Regular monitoring: Patients require ongoing assessment of vital signs, weight, laboratory values, and cardiac function 1
- Comprehensive treatment plans: Should be documented, culturally appropriate, and person-centered 1
- Treatment barriers: Many patients face barriers to accessing care, including shame, stigma, long waiting times, and shortage of specialized providers 1
Common Pitfalls to Avoid
- Focusing solely on weight restoration: Treatment must address both physical and psychological aspects of eating disorders 1, 4
- Inadequate medical monitoring: Regular assessment of vital signs, laboratory values, and ECG is essential, especially in restrictive eating disorders and severe purging behaviors 1
- Underestimating severity: Eating disorders have among the highest mortality rates of any psychiatric condition, particularly anorexia nervosa 3
- Fragmented care: Lack of coordination between team members can lead to inconsistent messages and suboptimal outcomes 1
- Delayed specialist referral: Complex cases or those not responding to initial treatment should be promptly referred to higher levels of care 1, 3