Therapy for Anorexia: Understanding the Approaches and Proper Treatment

Eating disorders are serious conditions associated with extreme disturbances in eating behaviors and the emotions and thoughts related to eating. Anorexia nervosa is an eating disorder often characterized by severely restricting food intake. It can also include other emotional, behavioral, and physical symptoms, like being preoccupied with food or experiencing fatigue.

Sometimes colloquially called just ‘anorexia,” this disorder may cause serious health complications and even be life-threatening in extreme cases. But while this condition is serious, it’s important to note that it’s treatable with therapeutic support. Below, we’ll explore anorexia nervosa in greater detail — including the different therapeutic approaches used to treat it.

What is anorexia nervosa?

Anorexia nervosa eating disorder involves limiting food intake to an extreme degree. Those who have this condition might avoid eating, or they might only eat small amounts of food that aren’t enough to nourish their body. 

For those struggling with anorexia nervosa, worries about appearance or weight can have an immense impact on their eating habits. This can result in not eating enough food on a regular basis, or it can lead to patterns of binge eating or purging. 

How is this different from other eating disorders? With bulimia nervosa, people frequently eat food in large amounts, and then take steps to compensate for it, like using laxatives or forcing themselves to vomit. But as some with bulimia nervosa also restrict intake, it can be a gray area. However, the disorder isn't defined by it the way anorexia is.

Binge eating disorder also involves eating large amounts of food often. However, it typically doesn’t involve purging. 

The two subtypes of anorexia nervosa 

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes two subtypes of anorexia nervosa:

• Restricting type: This type mainly involves restricting food intake, but not engaging in any purging behaviors, like diuretics or vomiting. 
• Binge eating/purging type: This type involves limiting food intake and purging. People with this type have episodes of binge eating followed by purging to control their weight. 

Diagnostic criteria for anorexia nervosa: The signs 

When someone limits the amount of food they eat, it isn’t an immediate warning sign of anorexia nervosa. There could be a number of reasons for this behavior, and it’s always best to see a medical professional before assuming anything. 

To be diagnosed with this eating disorder means meeting the DSM-5’s criteria. In the following sections, we’ll give an overview of these criteria. As you read, keep in mind that this is informational only, and only a licensed practitioner can diagnose this eating disorder. 

Restriction of energy intake relative to requirements 

People need a certain amount of energy and nutrients in food to keep their bodies functioning properly. Those with anorexia nervosa don’t eat enough food to support energy intake requirements. This leads to a body weight that’s much lower than it should be based on age, physical health, and other factors. 

Not enough energy also has several effects on health and well-being. People who restrict intake to an extreme degree might feel exhausted and have trouble concentrating. They might also have a slow or irregular heartbeat, low blood pressure, and other physical signs. 

Intense fear of gaining weight 

Due to restricted food intake, people with anorexia nervosa usually are not at a healthy weight as determined by a physician. But this condition often goes hand in hand with strong fears of gaining weight. 

Those with anorexia nervosa might struggle with overpowering fears about gaining weight, or that their current weight is too much. It’s important to note that only a doctor can determine what a healthy weight range is, as this varies for every individual.

Disturbance in the way one’s body weight or shape is experienced 

A person with anorexia nervosa may experience body dysmorphia — a psychological symptom that causes people to have a distorted or inaccurate image of their body weight or shape. 

For example, they might think they have a very different body shape in a mirror compared to their actual shape. This disturbance in self-perception makes it hard to have a realistic sense of their actual body weight or shape. Seeing themselves this way can lead them to avoid eating or to only eat very small amounts. 

There is some overlap between anorexia nervosa and body dysmorphic disorder (BDD), but research is ongoing and there’s much to be understood about the relationship between the two conditions.

Undue influence of body weight or shape on self-evaluation 

For those with anorexia nervosa, body weight or shape becomes a huge influence on their lives. Without this condition, a person’s appearance or size might only play a small role in how they perceive themselves. 

With anorexia nervosa, they might base their entire self-esteem or self-worth on their body weight or shape and struggle to feel good about themselves if they see themselves as overweight. 

Denial of the seriousness of the current low body weight 

Having a low body weight can put individuals in danger of serious health consequences. Some of these may include heart problems, kidney problems, and serious electrolyte imbalances. 

In severe cases, anorexia nervosa can end up being fatal. But those with this condition often minimize or deny these risks. They may have a hard time understanding and accepting the potential dangers of continuing to have a low body weight. 

How is anorexia nervosa treated?

This eating disorder can cause a wide range of problems that affect physical and psychological well-being. However, there are multiple effective treatments used to help those with anorexia nervosa recover. 

Note that exact treatment plans vary based on each person’s specific needs and situation. We’ll explore a few main types of treatment for this condition below. 

Nutritional counseling and support 

Anorexia nervosa recovery focuses on helping ensure that individuals eat enough food and stay at a healthy weight. But this can often feel easier said than done. They might be used to eating very small amounts or only eating specific foods. 

Nutritional counseling and support provide guidance in learning to eat a well-balanced diet that includes adequate amounts of food. This typically involves getting a meal plan as part of this treatment. A nutritional counselor may also recommend taking supplements if signs of malnourishment are present.

This type of treatment happens alongside talk therapy, as nutritional support usually isn’t enough on its own to help treat anorexia nervosa. It’s important to make sure that the nutritional counselor is a qualified professional, as faux dieticians are very dangerous and many have established social media presences.

Family-based treatment 

Family can be a key part of the healing process. Family-based treatment involves therapy sessions with the affected individual and their loved ones. This therapeutic approach is commonly used for adolescents and younger individuals with anorexia nervosa. It involves having the individual and their family members participate in therapy sessions. Loved ones can learn ways to support them throughout recovery.

What does family-based therapy look like? Therapists first need to understand the current family dynamic. Are parents contributing to the restriction problem, for example? Once they have this information, they can focus on addressing specific issues affecting the family and supporting a healthy family dynamic overall.

This may include helping individuals with anorexia nervosa and their families make changes to eating behaviors at home. For example, parents might learn to make sure their child gets a high enough calorie intake. Then, the individual might work on handling their own food intake and eating behaviors. 

Psychotherapy 

Psychotherapy, or talk therapy, gives those with anorexia nervosa a chance to understand this condition. Working with a therapist can help with exploring emotions and managing symptoms. 

Therapy helps individuals understand how they feel about food and body weight. It also helps them make gradual changes to develop more positive feelings toward food and eating. It can also help prevent relapse, which can occur if symptoms return or if individuals begin to engage in disordered eating behaviors again. 

Different therapeutic approaches are used to treat this eating disorder. Some focus on helping people change their thoughts and behaviors during individual sessions, like cognitive behavioral therapy. Other approaches involve working on healing as part of a group or as a family. 

Inpatient treatment programs 

Many therapeutic approaches to anorexia nervosa are done in outpatient settings. However, hospitalization or inpatient treatment may be more suitable in some cases. 

Who might benefit from this approach? Inpatient treatment can be a great option for many with eating disorders — not just those whose conditions are acute. Doctors might also recommend inpatient treatment for those who are in danger of engaging in self-harm or suicidal behavior. 

Inpatient care may take place in hospitals, rehabilitation-style facilities, or general treatment centers. Individuals receive support around the clock from multiple providers, including medical and psychiatric care. For example, they might be treated for medical complications, get meal plans and nutritional counseling from a dietitian, meet with a therapist, and attend group therapy sessions. 

Group therapy 

Having support from others can encourage those with anorexia nervosa to focus on recovering. Group therapy provides an excellent source of support. These sessions involve meeting with peers who are also experiencing eating disorder symptoms. 

Group therapy allows participants to share their experiences with each other. Listening to others’ experiences may help those struggling with anorexia nervosa to learn from those experiences, all while receiving guidance from a therapist. These sessions can help with finding the motivation needed to heal

Group therapy is among the best treatment options for eating disorders. Research shows how effective it can be for anorexia nervosa. For example, in an Eating and Weight Disorders study on outpatient group therapy for this disorder, 70% of cases achieved good Eating Attitudes Test (EAT) scores after treatment.     

What therapeutic approaches are used for anorexia nervosa?

Therapy for anorexia nervosa can take many forms. Some people find it helpful to work on changing thought patterns and behaviors. Others might do better with an approach that focuses on clinical management and supportive therapy.

Below, we’ll go over some of the different therapeutic approaches that are used for treating anorexia nervosa. 

Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)

MANTRA was developed specifically as a treatment approach for anorexia nervosa. It involves helping people work on recovering at their own pace — and with help from others, such as family members. 

MANTRA has several components. It helps individuals explore their motivation to recover and receive support to improve nutrition. Other components include exploring and challenging thinking styles and building an identity that isn’t related to anorexia nervosa. 

This approach may be effective for those who have a rigid thinking style that makes it hard to change their behavior. It may also be helpful for those who tend to regard anorexia nervosa in a positive light. 

Cognitive Remediation and Emotion Skills Training (CREST)

Managing emotions is an important part of anorexia nervosa recovery. CREST helps people learn to regulate challenging emotions and develop adaptive coping skills. For example, they might restrict their food intake as a way to handle intense emotions. With CREST, they learn to manage these emotions more adaptively. 

CREST also helps with developing cognitive flexibility. This means people are able to shift their thinking in order to adapt to changes or handle stress. This ability helps with switching from rigid or maladaptive thinking that may contribute to anorexia nervosa. 

Specialist Supportive Clinical Management (SSCMI)

This approach to treating anorexia nervosa offers more flexibility. Individuals can address specific behaviors related to anorexia nervosa, along with other aspects of their lives, such as interpersonal issues. 

SSCMI aims to help people understand the connection between their behaviors, symptoms, and body weight. It also helps them return to a healthy weight and healthy eating patterns gradually. 

This involves the use of clinical management for body weight restoration and getting back to eating the right amounts of food. It also involves supportive psychotherapy to help individuals work through or address issues that might affect or contribute to their condition.

ERP (Exposure and Response Prevention)

Anorexia nervosa may cause people to feel an enormous amount of distress about gaining weight. Or they might feel discomfort when looking at themselves in a mirror due to distorted self-perception. This may lead to binge eating and purging episodes or restricted food intake. 

ERP therapy is an effective form of treatment that helps people learn to cope with these feelings without engaging in disordered eating behaviors. This involves slowly being exposed to things that cause distress — rather than avoiding them. In addition to exposure, people learn how to gradually adjust their response to these triggers. 

Cognitive behavioral therapy (CBT)

This type of therapy involves learning to recognize certain thought patterns that may contribute to anorexia nervosa — and challenging them. For example, someone with anorexia nervosa might have “all or nothing” thinking that convinces them that they should avoid food to prevent weight gain.

Cognitive behavioral therapy (CBT) helps with developing a more adaptive mindset when it comes to eating and body image. This, in turn, can help people change their behavior. For example, they can learn to eat the right amounts of food rather than eating only small quantities. 

Experience the right therapeutic support with SonderMind 

Anorexia nervosa can affect people’s lives in many ways and may feel all-consuming. But with the right help and therapeutic support, they can enjoy a full recovery. 

Seeking therapy is a brave and commendable first step on the road to a healthier relationship with food. It may feel overwhelming, but SonderMind can simplify the matter of finding a therapist who meets each individual’s needs. 

SonderMind makes it easy to connect with therapists online or in person who can help those with anorexia nervosa navigate symptoms.

Start the path toward better wellness with SonderMind today.