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Getting Help--The Sooner the Better
Eating disorders can be treated and a healthy
weight restored. However, the longer abnormal eating behaviors persist,
the more difficult it can be to overcome the disorder and its effects
on the body. Many treatment plans are comprehensive due to the complex
interaction of emotional and psychological problems in eating disorders.
Treatment Strategies
Treatment of anorexia calls for a specific program that involves three main phases:
(1) restoring weight lost to severe dieting and purging; (2) treating psychological
disturbances such as distortion of body image, low self-esteem, and interpersonal
conflicts; and (3) achieving long-term remission and rehabilitation, or full
recovery. Early diagnosis and treatment increases the treatment success rate.
Use of psychotropic medication in people with anorexia should be considered only
after weight gain has been established. Certain selective serotonin reuptake
inhibitors (SSRIs) have been shown to be helpful for weight maintenance and for
resolving mood and anxiety symptoms associated with anorexia.
The acute management of severe weight loss is usually provided in an inpatient
hospital setting, where feeding plans address the person's medical and nutritional
needs. In some cases, intravenous feeding is recommended. Once malnutrition has
been corrected and weight gain has begun, psychotherapy (often cognitive-behavioral
or interpersonal psychotherapy) can help people with anorexia overcome low self-esteem
and address distorted thought and behavior patterns. Families are sometimes included
in the therapeutic process.
The primary goal of treatment for bulimia is to reduce or eliminate binge eating
and purging behavior. To this end, nutritional rehabilitation, psychosocial intervention,
and medication management strategies are often employed. Establishment of a pattern
of regular, non-binge meals, improvement of attitudes related to the eating disorder,
encouragement of healthy but not excessive exercise, and resolution of co-occurring
conditions such as mood or anxiety disorders are among the specific aims of these
strategies. Individual psychotherapy (especially cognitive-behavioral or interpersonal
psychotherapy), group psychotherapy that uses a cognitive-behavioral approach,
and family or marital therapy have been reported to be effective. Psychotropic
medications, primarily antidepressants such as the selective serotonin reuptake
inhibitors (SSRIs), have been found helpful for people with bulimia, particularly
those with significant symptoms of depression or anxiety, or those who have not
responded adequately to psychosocial treatment alone. These medications also
may help prevent relapse.
The treatment goals and strategies for binge-eating disorder are similar to those
for bulimia, and studies are currently evaluating the effectiveness of various
interventions.
People with eating disorders often do not recognize or admit that they are ill.
As a result, they may strongly resist getting and staying in treatment. Ongoing
emotional support is necessary for the individual, as recovery can be a long
process and relapse is common.
Assessing the risk of Immediate Danger
At the time of diagnosis, the clinician must determine whether the person is
in immediate danger and requires hospitalization.
Conditions warranting hospitalization include
excessive and rapid weight loss, serious metabolic disturbances, risk
of suicide, severe binge eating and purging, and psychosis. |
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