What is the treatment for anorexia nervosa?

Treatment for Anorexia Nervosa

Eating disorder-focused psychotherapy combined with nutritional rehabilitation and weight restoration is the primary treatment for anorexia nervosa, as no medications are approved or routinely recommended for this condition. 1

Primary Treatment Approach

Psychotherapy is the cornerstone of treatment, not pharmacotherapy. 1 The American Psychiatric Association explicitly states that current evidence does not support routine pharmacologic treatment for weight restoration in anorexia nervosa. 1

For Adolescents and Emerging Adults

• Family-based treatment with caregiver involvement is strongly recommended as first-line therapy for adolescents and emerging adults who have an involved caregiver. 2
• This approach has the strongest evidence base in younger patients and should be initiated immediately upon diagnosis. 2

For Adults

• Eating disorder-focused psychotherapy that normalizes eating behaviors, restores weight, and addresses psychological aspects is the recommended treatment. 2
• Various psychotherapy modalities have demonstrated efficacy, though cognitive-behavioral approaches dominate the research literature. 3

Nutritional Rehabilitation and Weight Restoration

• Individualized goals for weekly weight gain and target weight must be established and monitored throughout treatment. 2, 4
• For severely malnourished patients (BMI ≤13.5 kg/m²), intensive inpatient treatment with a target BMI of at least 18 kg/m² is necessary. 5
• In cases of severe malnutrition with life-threatening conditions, nasogastric enteral feeding may be required until patients are no longer at immediate risk and begin cooperating with oral intake. 5

Multidisciplinary Team Requirements

All treatment requires coordination among medical, psychiatric, psychological, and nutritional expertise throughout the entire treatment duration. 1, 2 This is non-negotiable for optimal outcomes. 1

Initial Assessment Requirements

Before initiating treatment, the American Psychiatric Association mandates:

• Vital signs including orthostatic blood pressure 1, 4
• Complete blood count 1, 4
• Comprehensive metabolic panel 1, 4
• Electrocardiogram (especially critical as cardiac complications are common) 1, 4
• Quantification of eating behaviors 1, 4
• Height, weight, and BMI calculation 4

Level of Care Determination

• Severely malnourished patients (BMI ≤13.5 kg/m²) require intensive inpatient treatment with day-and-night hospitalization until medical stabilization and weight restoration occur. 5
• Patients with life-threatening vital sign abnormalities or severe electrolyte disturbances require emergent hospitalization for metabolic stabilization. 6
• Once medically stable and weight-restored, transition to outpatient care with continued multidisciplinary follow-up. 5

What NOT to Do: Critical Pitfalls

• Do not use oral contraceptives to "treat" amenorrhea in anorexia nervosa—they create false reassurance with withdrawal bleeding but do not restore spontaneous menses and may compromise bone health. 1
• Do not rely on pharmacotherapy as primary treatment—no medications have demonstrated efficacy for core anorexia nervosa symptoms or weight restoration. 1
• Do not use standard antidepressants expecting weight gain or symptom improvement in the acute phase. 1

Monitoring During Treatment

• Weekly weight measurements during active weight restoration phase 4
• Regular vital sign assessment throughout treatment 2
• Electrolyte monitoring, especially during refeeding to prevent refeeding syndrome 4
• Ongoing assessment of eating behaviors and psychological symptoms 2

Treatment Barriers to Address

Shame, stigma, and shortage of specialized providers can interrupt or prolong treatment and must be proactively addressed through patient education and care coordination. 2 For patients facing access barriers, guided computer-based interventions and videoconferencing show promise as adjunctive approaches. 1