Treatment of Eating Disorders
The treatment of eating disorders requires a comprehensive, multidisciplinary approach that includes psychiatric, psychological, nutritional, and medical expertise, with disorder-specific psychotherapies as the cornerstone of effective treatment. 1
Initial Assessment and Treatment Planning
- Comprehensive screening and evaluation are essential first steps, including assessment of height and weight history, eating patterns, compensatory behaviors, and psychosocial impairment 1
- Laboratory assessment should include complete blood count and comprehensive metabolic panel to detect complications like electrolyte abnormalities and liver dysfunction 2
- An electrocardiogram is recommended for patients with restrictive eating disorders, severe purging behaviors, or those taking medications that may prolong QTc intervals 1, 2
- A documented, comprehensive treatment plan should incorporate medical, psychiatric, psychological, and nutritional expertise, typically via a coordinated multidisciplinary team 1
Treatment Approaches by Disorder Type
Anorexia Nervosa
- Adults with anorexia nervosa should be treated with eating disorder-focused psychotherapy that normalizes eating behaviors, restores weight, and addresses psychological aspects like fear of weight gain and body image disturbance 1
- Adolescents and emerging adults with anorexia nervosa who have involved caregivers should receive eating disorder-focused family-based treatment 1, 3
- Individualized goals for weekly weight gain and target weight should be established for patients requiring nutritional rehabilitation 1
- No medications are currently FDA-approved specifically for anorexia nervosa 4
Bulimia Nervosa
- Adults with bulimia nervosa should be treated with eating disorder-focused cognitive-behavioral therapy 1, 5
- A serotonin reuptake inhibitor (specifically fluoxetine 60 mg daily) should be prescribed either initially or if there is minimal response to psychotherapy alone after 6 weeks 1, 6
- Fluoxetine is FDA-approved for bulimia nervosa at a dose of 60 mg/day, which has been shown to be statistically superior to placebo in reducing binge-eating and vomiting behaviors 6
- For adolescents and emerging adults with involved caregivers, eating disorder-focused family-based treatment is suggested 1
Binge-Eating Disorder
- Patients with binge-eating disorder should be treated with eating disorder-focused cognitive-behavioral therapy or interpersonal therapy, in either individual or group formats 1, 4
- For adults who prefer medication or have not responded to psychotherapy alone, either an antidepressant medication or lisdexamfetamine is suggested 1
- Cognitive-behavioral therapy and interpersonal psychotherapy remain the most established treatments for binge-eating disorder 5, 4
Special Considerations
- Treatment intensity (outpatient, partial hospitalization, or inpatient) should be determined based on the severity of the condition, medical stability, and psychiatric comorbidities 3
- For children and adolescents, family-based therapy is considered the first-line treatment for anorexia nervosa 3
- No medications have been FDA-approved specifically for children and adolescents with eating disorders 3
- Long-term maintenance treatment should be considered for patients who respond to initial interventions, with periodic reassessment to determine ongoing treatment needs 6
Treatment Challenges
- Many patients, particularly those with anorexia nervosa, do not derive sufficient benefit from existing treatments 4
- Limited progress has been made in developing effective pharmacologic options for eating disorders 4
- Widespread access to effective eating disorder treatments remains limited despite significant advances in treatment approaches 5
- Longer and combined treatments have generally not enhanced outcomes, suggesting the need for more complex and clinically relevant adaptive treatment designs 4