What is the recommended treatment for anorexia nervosa?

Recommended Treatment for Anorexia Nervosa

The recommended treatment for anorexia nervosa is eating disorder-focused psychotherapy, with family-based treatment strongly recommended for adolescents and emerging adults who have involved caregivers. 1, 2

Initial Assessment and Evaluation

• A comprehensive psychiatric evaluation must include weighing the patient, quantifying eating behaviors, and identifying co-occurring psychiatric disorders 1, 2
• Physical examination should assess vital signs (including orthostatic measurements), height, weight, BMI, and signs of malnutrition or purging 1, 2
• Laboratory assessment should include complete blood count, comprehensive metabolic panel, electrolytes, liver enzymes, and renal function tests 1
• An electrocardiogram is essential for patients with restrictive eating disorders or severe purging behaviors 1, 2

Treatment Approach by Age Group

For Adults with Anorexia Nervosa:

• Eating disorder-focused psychotherapy is the primary treatment, which should include:
  • Normalizing eating and weight control behaviors
  • Restoring weight
  • Addressing psychological aspects (e.g., fear of weight gain, body image disturbance) 1
• Individualized goals for weekly weight gain and target weight should be established 1
• No medications are specifically approved for anorexia nervosa treatment 3

For Adolescents and Emerging Adults:

• Family-based treatment is strongly recommended when caregivers are involved 1, 2
• This approach should include caregiver education aimed at normalizing eating behaviors and restoring weight 1
• Family therapy supports parents, provides psychoeducational guidance, and helps the family develop new ways of understanding the eating disorder 4

Treatment Setting and Intensity

• Most patients can be treated on an outpatient basis 4, 5
• Inpatient care is necessary when:
  • Severe medical complications are present
  • Significant psychiatric comorbidities exist
  • Weight is dangerously low (BMI <16 kg/m²) 2, 5
• A coordinated multidisciplinary team approach is essential, incorporating medical, psychiatric, psychological, and nutritional expertise 1

Treatment Escalation for Resistant Cases

• If initial outpatient treatment is unsuccessful, consider:
  • More intensive outpatient programs
  • Day treatment programs
  • Inpatient treatment 5
• For severe and enduring anorexia nervosa that has not responded to multiple treatments, consider:
  • Specialized residential treatment
  • Novel approaches such as neurostimulation techniques in appropriate clinical settings 5
• Nutritional interventions may need escalation from counseling to more intensive approaches like nasogastric feeding in severe cases 5

Common Pitfalls and Caveats

• Failure to recognize the seriousness of anorexia nervosa, which has the highest mortality rate among psychiatric disorders 6
• Inadequate weight restoration goals that don't support proper growth and development, especially in younger patients 2, 4
• Premature return to athletic activities before adequate treatment and weight restoration 2
• Focusing only on weight restoration without addressing psychological aspects of the disorder 1
• Treating comorbid conditions without adequately addressing the eating disorder itself 6

Emerging Treatment Approaches

• Technology-based interventions (including computer/internet-based and mobile interventions) show promise, especially for:
  • Prevention of eating disorders
  • Support for patients with bulimia nervosa
  • Support for carers of eating disorder patients 1
• Videoconferencing appears to be a promising approach for delivering therapy when in-person treatment is not accessible 1