Anorexia Treatment and the Unwilling Patient

Introduction to Anorexia Treatment:

Anorexia treatment has resulted in limited success since the 1970’s , when mental health professionals initially began to develop treatments. The mainstay of anorexia treatment has always been hospitalization to regain weight, sometimes followed by psychotherapy. Most of the more common anorexia treatment approaches have not been found to be especially effective in helping patients recover physically and psychologically over the long term. Traditionally, patients would present at an inpatient facility or outpatient center in a severely emaciated state, requiring basic nutritional needs to first be met to reduce starvation. Frequently this was done through the use of an IV, because of the individual’s refusal to eat, with the ultimate goal of restoring the body to a normal nutritional state. Obviously, this was not an ideal way to start psychotherapy or to build a trusting relationship with a patient, which is certainly needed in effective anorexia treatment. Also, the patient frequently has been found to be in need of immediate medical attention to ward off other medical complications associated with the starvation.

The most problematic aspect of successful anorexic treatment is probably due to the resistant nature of the patient. Most individuals who suffer from this disorder see no problem with their body weight, and actually perceive themselves as being overweight, resulting in their being very unwilling and uncooperative participants in treatment for anorexia. They are usually pressured by family, friends or other concerned individuals, and rarely initiate treatment for themselves.

Most successful anorexia treatments involve the restoration of a more healthy nutritional state along with psychotherapy, psychoeducation and assistance within the immediate family. As with most forms of psychotherapy, the immediate focus is on developing a trusting therapeutic relationship. Cognitive-oriented therapies, focusing on issues of self-image and self-evaluation are frequently some of the most beneficial. Cognitive techniques which recognize the importance of addressing distorted self-body images and perfectionist thinking are frequently used, and should be part of the initial focus of treatment. Psychoeducational materials are sometimes used to instruct patients on how to recognize the appropriate body weight and body fat proportions of a normal body, and how these images relate to their own. Obviously, obsessions with body image are powerful issues to be dealt with, and are very difficult to change.

Effective inpatient anorexia treatment sometimes uses behaviorally-oriented token economies which reward patients for eating regular meals, and ensuring that they do not purge afterwards, with additional hospital privileges or rewards then being granted. A specific target weight should be set as treatment goals upon which time a patient would then graduate from the hospital program to an outpatient program of individual therapy, and sometimes group therapy, family therapy and/or support groups.

Oftentimes additional psychiatric concerns must be addressed such as specific traumatic events or memories which may underlie the negative self-image associated with anorexia. Also, comorbid psychological issues such as depression and anxiety disorders commonly underlie anorexic symptoms and should also be addressed.

Families are usually involved in therapy and recovery from anorexia in various ways. Underlying relationship issues must be dealt with between the anorexic patient and family members. Also, specific relationships including those with parents, may play an important role in helping to inadvertently nurture a negative self-image in the anorexic individual, which needs to be considered and dealt with in family therapy. Family therapy may also be beneficial in uncovering the reinforcers an individual is receiving from significant others in their lives to remain thin. Therapy with the family can also be very helpful in educating the family about the disorder, and how to ensure the patient’s compliance with treatment recommendations. A healthy and adequate support system is absolutely essential to the healthy long-term recovery from anorexia.

Additional information and webpage by Paul Susic  MA Licensed Psychologist   Ph.D. Candidate  (Health and Geriatric Psychologist)  

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