Mental Health Care for Anorexia

Anorexia nervosa is a deadly mental illness usually occurring in teenage girls and less often in teenage boys and adult men or women. The condition is characterized by a morbid fear of being fat and an obsession with avoiding weight gain. Anorexics restrict their caloric intake by avoiding eating, excessive exercise or through vomiting, abuse of laxatives, enemas, diuretics or insulin. Despite losing weight, often to dangerous levels, the person experiences a distorted image of her own body, feeling fat despite evidence to the contrary.

Medical Care

• Anorexia has so many potential complications that patients require high levels of monitoring for signs of health damage caused by improper nutrition and hydration. Regular doctor visits include checks of vital signs, symptoms of dehydration, electrolyte levels and weight. The general physician often coordinates with other health care professionals, but it is the mental health provider who is in charge of the overall treatment plan.

Psychotherapy

• Mental health professionals may recommend family, group and individual therapy strategies to deal with with the distorted thoughts and maladaptive behaviors that are a feature of anorexia. Goals for psychotherapy include building healthier self-esteem, better coping skills and more effective emotional coping. Cognitive-behavioral therapy is the most frequently used form of treatment, though there's little evidence that it works better than anything else. Family therapy helps the patient build trust relationships with the most stable emotional support network in their lives. Group work with other anorexics can be risky because it can cause competitions over who is skinniest. If physical symptoms endanger the patient, hospitalization is recommended.

Nutritional Therapy

• Anorexia patients often work with dietitians to develop a healthy diet plan. Often, written meal plans with calorie goals are essential to help the person with anorexia to stick to weight gain plans. Written "contracts" with the patient help engage him, but the condition is so persistent that hospitalization and tube feeding may be the only way to get patient weight back up to a healthy level.

Medications

• The Food and Drug Administration in 2009 had not identified any medications that have shown more than limited effectiveness in treating anorexia. Sometimes, antidepressants, antipsychotics and mood stabilizers are given to help treat psychiatric disorders that may be exacerbating the anorexia nervosa. Antidepressants may help prevent the patient from relapsing, but nothing has been shown to help during critical initial treatment of the disorder.

Treatment Challenges

• The severity of anorexia varies depending on the course of the disease and how well the patient responds to treatment, especially in advanced stages. Those with anorexia are resistant to treatment and may actually promote behaviors such as purging, excessive exercise and use of laxatives and enemas as simply a lifestyle choice. Less severely affected anorexics may respond quickly to treatment, but serious cases may require years of treatment. Death can be a result of untreated anorexia nervosa, caused by what is essentially slow starvation.

Recovery

• Even patients who want to get better may find it difficult to remain "on the wagon." Many patients form friendships with other anorexics, and often people with anorexia don't consider it a disorder at all. There are even pro-anorexia websites that offer tips on living the anorexia "lifestyle." Anorexia may be an ongoing, lifelong battle for the recovered anorexic, with symptoms subsiding and then coming back. Even with a long period of remission, an emotional trauma or high-stress situation can trigger a relapse. To prevent this, mental health professionals may recommend ongoing therapy or periodic checkups, especially during times of stress.