Treatment:

Treatment goals for eating disorders include:

• Restore normal weight for anorexia nervosa
• Reduce, and hopefully stop, binge eating and purging for bulimia nervosa
• Treat physical complications and any associated psychiatric disorders
• Teach patients proper nutritional habits and how to develop healthy eating patterns and meal plans
• Change patientsâ ' dysfunctional thoughts about the eating disorder
• Improve self-control, self-esteem, and behavior
• Provide family counseling
• Prevent relapse

The first major difficulty in treating eating disorders is resistance by everyone involved:

• The anorexic patient often believes that the emaciation is normal and even attractive.
• The bulimic patient may feel that purging is the only way to prevent obesity.
• Even worse, the anorexic condition may be encouraged by friends who envy thinness or by dance or athletic coaches who encourage low body fat.
• The family itself may deny the problem and be obstructive or manipulative, adding to the difficulties of treatment.

It is very important that the patient and any close friends and relatives be informed about the serious potential of these conditions and the importance of receiving immediate help.

A multidisciplinary team approach with consistent support and counseling is essential for long-term recovery from all severe eating disorders. Depending on the severity and type of disorder, team members may include:

• Doctors specializing in relevant medical complications
• Dietitians
• Cognitive-behavioral therapists
• Psychotherapists
• Nurses

All should be skilled in treating eating disorders. Studies have found that people treated by such specialists have a lower mortality rate than those treated only as psychiatric patients.

Getting Rid of Unrealistic Expectations

Patients may drop out of programs if they have unrealistic expectations of being "cured" simply through the therapists' insights. Before a program begins, the following possibilities should be made clear:

• The process is painful and requires hard work on the part of the patient and family.
• A number of therapeutic methods are likely to be tried until the patient succeeds in overcoming these difficult disorders.
• Relapse is common but should not be greeted with despair.

Although the outcome for bulimics is generally more favorable than for anorexics, long-term studies are showing recovery in many people treated for anorexia. Studies indicate that about 70% of people with bulimia and 27 - 50% of patients with anorexia nervosa are free from eating disorders within 10 years of treatment.

General Treatment Approaches

Psychotherapies. Eating disorders are nearly always treated with some form of psychiatric or psychologic treatment. Depending on the problem, certain psychologic approaches may work better than others.

Medications. Various medications may be helpful for patients depending on the type of eating disorder, psychiatric state, and severity of the condition.

Nutritional Rehabilitation. Nutritional counseling can help patients regain weight and learn normal expectations concerning hunger and eating patterns.

Choosing a Treatment Site

The patientâ ' s condition, social circumstances, and health insurance coverage determine the type of treatment facility -- inpatient hospitalization, residential hospitalization, partial hospitalization, or outpatient care. Weight is not the sole determining factor. The patientâ ' s overall physical condition, psychological state, behavior patterns, and family support are all factors. Patients and their families should discuss with their doctors the various options available and how structured and intense the treatment should be.