Anorexia Nervosa Treatment
Do you struggle with anorexia? If so, then you probably know there’s a problem or someone has told you you have a problem you need to address. But you might be reluctant to change. That’s because anorexia nervosa is what we call an egosyntonic condition. What that means is you might have a certain level of desire in holding on to your symptoms because you feel that the person you are with those symptoms is who you truly want to be. Most other psychological disorders are egodystonic which means individuals feel unlike themselves and are eager to reduce or get rid of their symptoms.
Unfortunately, anorexia can cause significant damage to the body, can be extremely distressing psychologically, can cause significant issues in relationships, work and an overall difficulty in functioning on a day to day basis. Anorexia is also a psychological disorder with the greatest risk of mortality.
The good news is that all of this can be repaired through commitment to treatment (especially the physical consequences of anorexia). Nearly all the physical damage caused by restricting or overexercising in anorexia can be reversed through improved nutrition and dietary intake.
Using the gold standard, evidence-based treatment for anorexia, we will work with you as a team (a physician, psychologist, and dietitian) to help you recover.
Anorexia Treatment: The psychologist’s role
Our psychologists will help you cope with the distress you might feel going through the process of recovery from anorexia. They’ll help you identify what the eating disorder has taken away from your life to help you increase motivation and attach meaning to why it’s worthwhile for you to go through the recovery process. Our psychologists will be a voice of reason in a sea of overwhelming eating disorder thoughts convincing you that recovery is just wrong. Our therapists will eventually help you in adopting a stance of your own against the eating disorder to help empower you to be in charge of your own life instead of the anorexia eating disorder mindset dictating what your every move has to be. Psychologists on our staff draw upon cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), and dialectical behavioral therapy (DBT) to treat anorexia nervosa.
Anorexia Treatment: The registered dietitian nutritionist’s role
Our registered dietitian nutritionist will help you nourish yourself in a way that supports repairing your mind and body. Our dietitians on staff will have you track your food through an app called Recovery Record and encourage you to increase your food intake overtime. This is a slow and gradual process as to avoid refeeding syndrome. Refeeding syndrome can occur in individuals struggling with anorexia. It is a set of medical complications that can occur if you gain weight too quickly. Our dietitian nutritionists will help you begin to listen to, appreciate, and honor hunger/fullness cues again. They will help you learn to enjoy a variety of food and reintroduce forbidden foods that the anorexia mindset has not allowed you to. Exposure to these forbidden foods is a necessary part of anorexia treatment to help your mind overcome the initial fear of eating “bad” food once again.
Anorexia Treatment: The physician’s role
In the treatment of anorexia, we will ask that you be monitored by a physician. We are happy to work with a physician you’ve been seeing for quite some time and/or we have a few physicians we are happy to refer you to. The physician’s role is to ensure your safety in the recovery process to make sure you’re staying out of harms way. Some of the things medical doctors do in monitoring patients with anorexia is using an EKG to ensure your heart is safe, take bloodwork to ensure you’re not at risk for electrolyte imbalances which can lead to cardiac arrest, and use DEXA scans to determine if there is osteopenia or osteoporosis.
What about psychiatrists?
While we don’t have psychiatrists on staff, we are happy to refer you to psychiatrists in the area who can help you manage depression and anxiety symptoms that are often comorbid with anorexia and eating disorders. However, most psychological symptoms associated with anorexia are alleviated through weight restoration and proper nutrition.
More information about the treatment of anorexia:
What are the physical consequences of undereating and maintaining a low body weight?
Cardiac complications: When you are undereating and maintaining a low body weight with anorexia, you could potentially be losing heart muscle, blood pressure and heart rate may slow down (bradycardia), and you may have irregular heart beats (arrhythmia).
Bone Density: Many individuals struggling with anorexia will be diagnosed with osteoporosis or osteopenia. Hormonal and dietary changes create more fragile bones and often there are great risks of fractures with falls.
Skin & Hair Problems:
Lanugo is a condition where individuals with anorexia will begin to grow fuzz-like hair on their face and other parts of their body. This is the body’s way of trying to retain heat.
Individuals suffering from anorexia may also struggle with hair loss or thinning hair. When your body is at a low body weight, it tries to preserves what is essential in the body for survival. Hair isn’t important to survival.
Yellow-orange skin color can occur in those with anorexia because of elevated levels of beta carotene (primarily due to diet). This condition is called carotenosis.
Gastrointestinal Distress: Clients with anorexia will often complain of being constipated. This is a result of a gastroparesis or gastric delayed emptying due to muscle weakness in the digestive system. When you are undereating, your digestive system moves slower and it takes longer for food to move from the stomach to intestines. This can result in gas, bloating, constipation, and physical pain and discomfort.
Feeling Cold: Individuals with anorexia often experience feeling cold all the time, especially in the hands and feet. This is due to malnutrition and not maintaining a healthy body weight.
Restless, Non-Refreshing Sleep/Insomnia: Because of starvation and being malnourished, individuals with anorexia often describe difficulty falling asleep and having restless sleep. There are decreases in slow wave sleep, sleep efficiency, and overall less hours sleeping amongst those with anorexia.
Loss of Libido: Sex hormones and fertility are non-essential for survival. So many individuals with anorexia will lose their sex drive and have difficulty getting pregnant if their body weight is too low.
What are the psychological/social consequences of undereating and maintaining a low body weight?
Cognitive: When individuals are malnourished, we see a pattern of very rigid thinking. It becomes harder for individuals with anorexia to make decisions as well. Concentration and ability to focus are also reduced. Clients with anorexia often describe a preoccupation with thinking about food all the time as well.
Mood: Individuals with anorexia often are very irritable and depressed.
Personality: Many individuals with anorexia will not always see this clearly, but loved ones will see that the individual is just not the same in terms of their personality. Individuals’ true personality tends to be restored with weight restoration.
Relationship stressors: Individuals not only become very rigid in their thinking patterns, but in their behaviors as well. They often must do things a certain way or else they will become quite irritable. They may only be able to eat at certain restaurants where they feel there is something “safe” to eat on the menu. Because socializing often involves food, individuals with anorexia may become increasing isolated. Individuals with anorexia may not have an interest in sex and can become more focused on themselves vs. others. All of these behaviors can significantly impact relationships with loved ones.
But I’m getting my period, so I must be okay, right?
When do you determine if there is a need for a higher level of care?
We are happy to try outpatient treatment with individuals who struggle with eating disorders. However, if it is medically unsafe for you to be in an outpatient setting, we will recommend a higher level of care where you can be closely monitored by medical staff to ensure your safety.
At Mind Body Health, our dietitians and psychologists use the American Psychiatric Association’s Guidelines for Higher Level of Care. These guidelines factor in suicidality, percentage of ideal body weight, motivation, severity of obsessive thinking patterns, severity of co-occuring psychological disorders, ability to complete meals and follow through on nutrition recommendations, ability to follow exercise recommendations provided by the team, and ability to abstain from laxative and purging behaviors, and family/environmental stressors that may stand in the way of recovery.
But I’m purging, so that means I have bulimia, right?
Anorexia nervosa has two subtypes: restricting type and binge/purge type. It is not uncommon for individuals with anorexia to not only restrict their food intake to reach a low body weight, but also to be exercising excessively and compulsively and/or vomit, use laxatives or diuretics.
Who is affected by anorexia?
Anorexia can affect individuals of all ages, ethnicities, genders, races, and sexual orientation. Anorexia is more common amongst women, but there are adolescent boys and adult men who also suffer from anorexia nervosa. There are heightened prevalence rates of eating disorders amongst the LGBTQ population. Because there is less awareness about the prevalence of eating disorders amongst men and individuals of various sexual orientations or ethnicities, there can be a reluctance to discuss symptoms and seek treatment. We strongly encourage you to reach out to us! We are well trained in the treatment of eating disorders as it pertains to very specific populations.
What is the typical age of onset for anorexia?
Teenage and early adulthood years are typically what we see in regard to the onset of anorexia. Puberty and changes in the body can often be a trigger for the onset of anorexia in adolescence.
Is family involved in treatment?
For adolescents and very young adults, we use Family Based Treatment for Anorexia. You can read more about this treatment here. For adults, we often encourage involving supportive family members in treatment so that in between sessions, you’re having someone hold you accountable and help you through what can be a difficult recovery process.
What causes anorexia?
As with most psychological disorders, it’s complex! At Mind Body Health, we use a biopsychosocial model in understanding the etiology of psychological disorders. Essentially the answer is often a mix of nature and nurture (biological and environmental factors).
Individuals with anorexia typically have a genetic predisposition. Often there will be another family member in the immediate or extended family that has suffered from an eating disorder. The likelihood of having an eating disorder if a family member has had an eating disorder is significantly higher.
That combined with certain personality traits and environmental stressors can cause anorexia to manifest within an individual.Personality traits often associated with anorexia are perfectionism, neuroticism, harm avoidance, and being an overachiever.
Environmental triggers can include perceived cultural, peer, or familial pressures to be thin, dieting or unhealthy weight control efforts, professions or recreational activities that promote weight loss or being thin (modeling, ballet/dancing/gymnastics, wrestling), sexual abuse, trauma, past history of bullying/teasing.