Anorexia Treatment: Hospital Methods And Options

Anorexia nervosa is an eating disorder characterised by severe calorie restriction and a fear of gaining weight, often resulting in very low body weight. Treatment for anorexia is tailored to the individual and may include nutritional support, therapy, medication, and hospitalisation. Hospitalisation may be necessary for those with severe malnutrition or serious health complications. During hospitalisation, individuals receive medical care and supervision to ensure they regain physical and psychological well-being. This may include nutritional support, psychotherapy, and medication. Treatment aims to restore a healthy weight and normalise eating patterns, while also addressing the underlying psychological causes of the disorder.

Supervised weight gain and nutritional support

Inpatient treatment for anorexia nervosa may be necessary for those experiencing severe malnutrition or serious health complications. Hospitalisation allows for careful monitoring of a patient's weight and health, with the goal of helping them gradually reach and maintain a healthy weight. This process is supported by regular weight checks and nutritional education, empowering individuals to understand the importance of a healthy weight for their overall well-being.

Registered dietitians play a crucial role in providing nutritional support. They create individualised meal plans to ensure adequate calorie intake and balanced nutrition. These meal plans are designed to help patients gain weight in a healthy, supervised manner. Additionally, vitamin and mineral supplements are often recommended to compensate for any nutritional deficiencies resulting from anorexia.

The supervision aspect of weight gain is particularly important for patients who are very unwell or at risk of refusing treatment. In such cases, hospitalisation ensures that meal plans are closely monitored and followed. This supervision can be a critical factor in helping patients overcome their fear of weight gain and distorted thoughts about body image. It provides a structured environment where patients can gradually adjust to healthy eating patterns under the guidance of healthcare professionals.

Supervised weight gain is often complemented by concurrent therapy. Psychotherapy, including cognitive behavioural therapy, helps individuals address the underlying thoughts, feelings, and behaviours associated with their eating disorder. By combining supervised weight gain with therapy, individuals can work towards restoring a healthy weight while also developing healthier attitudes towards food, weight, and body image. This comprehensive approach addresses both the physical and psychological aspects of anorexia nervosa.

Psychotherapy and cognitive behavioural therapy

Anorexia nervosa is a complex eating disorder with mental, behavioural, and physical symptoms. Treatment for anorexia nervosa is tailored to the individual and may include nutritional support, therapy, medication, and more. Hospitalisation may be necessary to treat severe malnutrition or other serious health complications.

Psychotherapy, or talk therapy, is a cornerstone of anorexia treatment. It helps individuals identify and change thinking and behaviour patterns associated with eating disorders. It can help develop healthier attitudes toward food, weight, and body image. It can also aid in learning better coping mechanisms and techniques for dealing with stress and negative thoughts.

Therapists often use enhanced cognitive behavioural therapy (CBT) as a first-line treatment. CBT helps individuals identify and face distorted thoughts about body image and self-worth. It can help individuals recognise and accept that they have a serious illness, as many people with anorexia deny that they have an eating disorder. CBT can also be provided in a group setting, providing a supportive environment where individuals can address underlying issues and learn coping mechanisms.

Focal psychodynamic therapy is another form of psychotherapy that can be offered if other therapies are not suitable or effective. This therapy should include understanding how eating habits are related to thoughts and feelings about oneself and others. It typically involves weekly sessions for up to 40 weeks (9 to 10 months).

In addition to psychotherapy and CBT, family-based therapy can also be effective. This involves fostering a culture of open conversations, understanding, and support with loved ones, providing a consistent source of strength during the healing process.

Medication and supplements

Pharmacotherapy, or medication, should not be the only line of treatment and should be used with caution. Antidepressive and neuroleptic agents have limited use in patients with adequate nutrition and mood changes associated with anorexia nervosa. Selective serotonin reuptake inhibitors (SSRIs) have been shown to be beneficial in patients with bulimia nervosa but not anorexia. However, since many patients with anorexia have concurrent mood disorders, medication may be of benefit.

Randomized controlled trials have shown benefits from the use of medication in combination with cognitive-behavioural therapy (CBT). Fluoxetine was found to be generally helpful in patients with anorexia nervosa who had been stabilized with weight restoration. Psychotherapy with adjunctive low-dose olanzapine may be useful for anorexia nervosa during inpatient treatment, especially in the context of anxiety and obsessive eating-related ruminations.

To prevent bone loss, a daily dietary intake of calcium (1000-1500 mg) and vitamin D (400 IU) is recommended. Electrolyte supplements and fat-soluble vitamins are also used. Estrogen replacement (e.g. oral contraceptives) has been recommended for the treatment of osteopenia, although the benefits and minimal effective dose are still being explored.

Hospital admission and residential care

Hospitalization may be required for individuals with severe malnutrition or other serious physical complications resulting from anorexia. It provides a safe and supervised environment where individuals can receive the necessary medical care and monitoring until their health stabilizes. During hospitalization, individuals are closely monitored by medical professionals, including doctors and nurses, who ensure their physical health is maintained and may provide nutritional support to help them regain a healthy weight.

Residential care, on the other hand, is often suitable for those who require consistent support and a structured environment but do not need the intensive medical care provided in a hospital setting. Residential treatment centers offer a range of therapeutic interventions, including individual, group, and family therapy, as well as nutritional counseling and educational programs focused on anorexia and its treatment. These programs aim to address the underlying issues contributing to the eating disorder and provide individuals with the necessary tools and coping mechanisms to manage their thoughts, feelings, and behaviors related to food, weight, and body image.

The decision to admit someone to hospital or residential care is made on a case-by-case basis, taking into account the individual's physical and mental health, the severity of their eating disorder, and their home environment. In some cases, individuals may refuse treatment despite being at serious risk, and hospitalization may be necessary to provide compulsory treatment under the Mental Health Act.

The overall goal of both hospital admission and residential care is to stabilize the individual's health, ensure their safety, and provide them with the necessary tools and support to continue their recovery journey. This may include ongoing therapy, nutritional support, and regular check-ups to monitor their progress and maintain their physical and psychological well-being.

Support from family and friends

Anorexia nervosa is a complex eating disorder with mental, behavioural, and physical symptoms. Treatment for anorexia in hospitals involves nutritional support, therapy, medication, and more. The treatment is specific to the person being treated and aims to restore a healthy weight and normalise eating patterns.

Family and friends play a pivotal role in the healing process of individuals with anorexia nervosa. Here are some ways in which they can provide support:

• Open conversations and understanding: Creating a culture of open and honest communication is essential. It involves expressing concern about the individual's health without focusing on body size, shape, weight, or eating habits. For example, saying, "I am worried about your health, and I want you to have energy and be healthy," is more appropriate than commenting on their appearance.
• Educating themselves about anorexia: By learning about the different modalities of treatment, such as medical care, medication, therapy, and dietary counselling, family and friends can better understand what their loved one is going through. They can also seek educational resources from reputable organisations like the National Association of Anorexia Nervosa and Associated Disorders.
• Encouraging professional help: Getting professional help from a doctor, nurse, or another qualified healthcare provider is crucial. However, this step can be challenging for individuals with anorexia. Family and friends can play an essential role in encouraging their loved ones to seek professional help and even offering to accompany them to appointments.
• Participating in therapy: Family therapy is often recommended as part of the treatment plan. It helps address underlying issues, improve family dynamics, and provide a supportive environment for the individual. Therapy may also involve close friends, as their support and understanding can be invaluable to the recovery process.
• Supporting nutritional goals: Family and friends can work with registered dietitians to understand the nutritional needs of their loved one. They can help create and support a meal plan that ensures adequate calorie intake and balanced nutrition. Additionally, they can set a positive example by adopting healthy attitudes, eating habits, and activities that align with the individual's nutritional goals.
• Providing consistent support: Recovery from anorexia is a long-term process, and consistent support from loved ones is crucial. This includes continuing to invite the individual to social activities and maintaining communication, even if they decline. It also means being understanding of the time-intensive nature of treatment and recovery, as clinic visits, therapy sessions, and health checks can be frequent and lengthy.
• Managing physical activity: Supporting recommended limits on physical activity is an important aspect of helping someone with anorexia. This may include reducing or eliminating extracurricular sports, exercise, or school attendance. In some cases, bed rest may be advised.
• Seeking support for themselves: It is important for family and friends to recognise the impact of the disorder on their own lives and to seek support for themselves. They can find support groups specifically for friends and family members of individuals with eating disorders, where they can openly discuss their feelings, fears, and experiences. Connecting with others who have gone through similar situations can bring hope and encouragement during challenging times.

Frequently asked questions