From the Guidelines
Treatment for anorexia nervosa should involve a comprehensive approach combining psychological therapy, nutritional rehabilitation, and medical monitoring, with the most effective treatment typically involving a team of specialists including psychiatrists, psychologists, dietitians, and medical doctors, as recommended by the American Psychiatric Association (1). The most effective psychological therapies for anorexia nervosa are Cognitive Behavioral Therapy (CBT) and Family-Based Treatment (FBT, also called the Maudsley approach), with FBT being particularly effective for adolescents, involving parents in the refeeding process (1). Some key points to consider in the treatment of anorexia nervosa include:
- Nutritional rehabilitation focusing on gradual weight restoration, typically aiming for 0.5-1 kg per week for inpatients and 0.2-0.5 kg per week for outpatients (1)
- Medication alone is not a primary treatment, but selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (20-60 mg daily) may help with co-occurring depression or anxiety once weight has been partially restored (1)
- Olanzapine (2.5-5 mg daily) sometimes helps reduce anxiety around eating and weight gain (1)
- Treatment settings vary from outpatient care to partial hospitalization to inpatient treatment, depending on medical stability, suicide risk, and treatment response (1)
- Recovery takes time, often 1-3 years or longer, and relapse prevention strategies are essential (1)
- Early intervention significantly improves outcomes, as anorexia becomes more entrenched and difficult to treat the longer it persists (1)
From the Research
Anorexia Treatment Approaches
- Family-based treatment (FBT) is an empirically supported treatment for anorexia nervosa, particularly for adolescents, as noted in 2.
- FBT is a highly focused approach that initially targets weight restoration under parental management at home, but its broader aim is to promote adolescent development without anorexia nervosa thoughts and behaviors interfering, as discussed in 2.
- Cognitive behavioral therapy (CBT) is also a beneficial approach, with studies showing its effectiveness in outpatient treatment of anorexia nervosa, as seen in 3 and 4.
Treatment Outcomes
- A study comparing CBT and behavioral family therapy found that 60% of the total sample and 72% of treatment completers had a "good" outcome, defined as maintaining weight within 10% of average body weight and regular menstrual cycles, as reported in 3.
- Another study found that outpatient individual CBT and combined family/individual therapy resulted in significant improvements, with high effect sizes, and a recovery rate of 76% in both groups at post-treatment, as noted in 4.
Multidisciplinary Treatment
- A multidisciplinary team approach, involving social work, medicine, and nursing, is also important in treating anorexia nervosa, as emphasized in 5.
- This approach recognizes the importance of each role in treating the disorder and highlights the need for a comprehensive treatment plan, as discussed in 5 and 6.
Emerging Interventions
- The evidence base for anorexia nervosa treatment is advancing, with emerging interventions and a growing understanding of the importance of addressing the full range of psychopathology, as noted in 6 and 2.
- Further research is needed to fully understand the effectiveness of different treatment approaches and to address methodological challenges that hinder progress in controlled research, as discussed in 6.