The treatment of eating disorders is a highly individualized process. Sometimes an eating disorder requires months in the hospital. Sometimes an eating disorder only requires seeing a therapist once or twice a week. From the most intense to the least, here are four options for treating for anorexia nervosa, bulimia nervosa, binge-eating disorder, and eating disorders not otherwise specified, also known as EDNOS.
Inpatient treatment (hospitalization)
The psychiatric indications for hospitalization for an eating disorder include a suicide attempt or repeated expressions of intent to commit suicide. Eating disorder patients may also be hospitalized when their psychological symptoms are rapidly getting worse.
The medical indications for hospitalization for an eating disorder include unstable vital signs, complications such as dehydration or diabetes, and laboratory tests that indicate severe metabolic issues. The kinds of medical changes that indicate an immediate need for hospitalization include:
- An drop in blood pressure of more than 20 mm Hg,
- An in pulse of less than 40 beats per minute or more than 110 beats per minute,
- An inability to maintain a core temperature of at least 97° F (36.1° C).
The benefit of residential care is the structure it provides for diet. The limitation of residential care is that it is not designed for patients whose symptoms are rapidly getting worse. They usually have to hospitalized. Both hospitals and residential care link patient "privileges" for personal choices to improvement in symptoms.
People who live with eating disorders may stay in their homes and come in for medical appointments if they are sufficiently stable that they do not require regular monitoring. Usually people in outpatient care are given easier goals than those in hospital or residential care. For instance, the doctors may set a goal of gaining 2 pounds (about a kilogram) of body weight every week in the hospital for an anorexia patient, but lower that goal to half a pound (about 250 grams) per week in outpatient care.
Most doctors in hospitals, residential care centers, or doing outpatient also rely on "evidence-based therapy". Rather than strictly following set psychiatric principles, doctors will offer "whatever works best". Even therapists who primarily offer one kind of treatment may not offer it for every patient in every setting. No single type of psychotherapy is best for every patient or for every situation.
Among the schools of psychotherapy used to treat eating disorders are:
- Acceptance and commitment therapy. This therapeutic technique attempts to get patients to change their actions rather than changing their feelings.The goal isn't to feel good. It's to live with integrity.
- Cognitive behavioral therapy. This is a relatively short-term therapy that focuses on talking through values, beliefs, and thought processes that sustain unhealthy eating habits. The goal is to change distorted beliefs about shape, weight, and personal value that stand in the way of changing eating habits.
- Cognitive remediation therapy. The goal of this kind of therapy is breaking through perfectionism or narcissism that structures rigid thought. Currently, this therapy is mostly used in treating anorexia.
- Dialectical behavior therapy. This therapy centers on mindfulness. The therapist attempts to guide the patient to replace dysfunctional behaviors in eating, relationships, and dealing with stress with functional ones. Dialectical behavior therapy was first developed to help people who live with borderline personality disorder.
- Family-based therapy. This method of psychotherapy focuses on healthy eating rather than on disordered eating. The therapist works with the patient and all family members to establish not just healthy eating habits but healthy reward patterns and interactions to enable sustained improvement. This form of therapy is also known as the Maudsley Approach.
- Interpersonal psychotherapy. This approach to therapy treats bulimia and binge-eating disorder as occurring in a broader context. In interpersonal psychotherapy, the therapist works on issues of grief, interpersonal roles, interpersonal deficits, and transitions in roles as the patient recovers and establishes new kinds of relationships.
- Psychodynamic psychotherapy. This method of therapy looks for the root causes of an eating disorder. If behaviors are discontinued without dealing with the issues driving them, the patient will relapse. In this approach to treatment, the therapist aims to help the patient achieve a stable recovery.