From the Guidelines
Treatment for adolescent anorexia nervosa should prioritize family-based treatment (FBT), also known as the Maudsley approach, as the first-line therapy. This approach involves parents taking an active role in managing their child's eating and weight restoration, typically over 15-20 sessions spanning 6-12 months, with an initial focus on weight restoration followed by gradual return of eating control to the adolescent 1. Medical monitoring is essential and should include regular weight checks, vital signs, and laboratory tests to manage complications such as electrolyte abnormalities and cardiac issues. Nutritional rehabilitation aims for weight gain of 0.5-1 kg per week for inpatients and 0.2-0.5 kg per week for outpatients, with caloric intake starting at 1,200-1,500 calories daily and increasing gradually to 3,000-4,000 calories.
Key Components of Treatment
- Family-Based Treatment (FBT): Parents are actively involved in managing their child's eating and weight restoration.
- Medical Monitoring: Regular checks for complications such as electrolyte abnormalities and cardiac issues.
- Nutritional Rehabilitation: Aimed at achieving a healthy weight through a gradual increase in caloric intake.
- Psychological Support: Addressing the psychological factors maintaining the disorder.
Adjunctive Treatments
Medications like olanzapine (2.5-5 mg daily) or fluoxetine (20-60 mg daily) may be used as adjuncts but are not primary treatments 1. Hospitalization is necessary for severe cases with medical instability, rapid weight loss, or failed outpatient treatment. The multidisciplinary approach, incorporating medical, nutritional, and psychological interventions, is crucial as it addresses both the physical consequences of malnutrition and the psychological factors maintaining the disorder, with early intervention significantly improving recovery rates.
Considerations for Treatment
- Individualized Goals: Setting individualized goals for weekly weight gain and target weight is recommended for patients with anorexia nervosa who require nutritional rehabilitation and weight restoration 1.
- Eating Disorder-Focused Psychotherapy: Recommended for adults with anorexia nervosa, which should include normalizing eating and weight control behaviors, restoring weight, and addressing psychological aspects of the disorder 1.
- Technology-Based Interventions: While showing promise, especially guided computer- and Internet-based interventions, more research is needed to fully recommend their use in treatment 1.
From the Research
Treatment Options for Adolescent Anorexia Nervosa
- Family-based treatment has been shown to have the best evidence of efficacy and cost-effectiveness for adolescents with anorexia nervosa 2
- Other treatment options for adolescents include adolescent focused therapy, cognitive behavioral therapy, systemic family therapy, and psychopharmacologic treatments 2
- The true value of family-based treatment for adolescents has yet to be fully established, with some studies suggesting that new forms of treatment are needed 3
Effectiveness of Treatment Options
- Family-based treatment has been found to be beneficial for youth with anorexia nervosa 4, 5
- For adults, no specific approach has shown superiority, and a combination of renourishment and psychotherapy such as specialist supportive clinical management, cognitive behavioral therapy, or interpersonal psychotherapy is recommended 4, 5
- Selective serotonin re-uptake inhibitors have been found to be effective in preventing relapse in anorexia nervosa, especially in adolescents and young adults 6
Future Directions in Treatment Research
- Future research should focus on establishing the true value of family-based treatment for adolescents and exploring new forms of treatment for adults with anorexia nervosa 2, 3
- There is a need for more research on the treatment of anorexia nervosa in ethnically diverse populations and on the effectiveness of multidisciplinary treatment approaches 4