Treatment For Eating Disorders: Approaches And Effectiveness

Eating disorders can be categorized as behavioral conditions that usually involve emotional distress and changes to eating habits. The long-term effects of eating disorders on physical health can be extensive and even deadly. Because there are multiple facets involved, treatment for eating disorders is often multidimensional. Early detection and individualized treatment, often including therapy, can promote recovery.

Types of eating disorders

According to the National Eating Disorders Association, 28.8 million people in the United States may experience an eating disorder at some point in their lifetimes. 

Early detection can be a key part of effective treatment. Below, learn about four common eating disorders and their symptoms to help you identify whether you or a loved one could benefit from professional support.

Anorexia nervosa

Anorexia nervosa generally involves restricting the amount of food eaten to avoid gaining weight. People with this condition may eat very little or nothing at all, and they may engage in excessive exercise or take laxatives or diet pills. 

Symptoms of anorexia can include significant weight loss, brittle nails and hair, muscle weakness, dry skin, or missed periods, and they may grow fine hair called lanugo all over their bodies. Lanugo typically grows when the body does not have enough fat to keep it warm.

Anorexia can have severe physical health complications, including kidney failure, anemia, and heart problems, and without effective treatment, the condition can be fatal.

Bulimia nervosa

In bulimia nervosa, people usually binge eat, consuming large amounts of food in a short amount of time and sensing that they cannot control how much they are eating. Binging is normally followed by purging to avoid gaining weight and typically takes the form of either self-induced vomiting or laxative use. 

It can be difficult to determine whether someone has bulimia. People with this eating disorder typically binge and purge secretly and are usually of average weight, so the signs may not be as obvious. Some potential behavioral changes associated with bulimia include going to the bathroom immediately after eating to purge or exercising excessively.

Purging can have long-term effects on the body, including broken blood vessels in the eyes, tooth decay, ulcers, and severe dehydration. In time, bulimia can lead to nutritional imbalances that can cause heart damage.

Binge eating disorder

Avoidant/restrictive food intake disorder (ARFID)

Selective eating disorder or ARFID typically develops in childhood, but it can occur at any age. People with this condition may significantly restrict the foods they eat. ARFID tends to be different from other eating disorders, as it normally isn’t tied to body image or a desire to lose weight. People with this condition may restrict their eating habits due to a fear of vomiting or choking or due to certain smells, colors, or textures.

People with ARFID may eat a few foods they have identified as “safe” and may have eating-related rituals, like eating foods in a particular order. In general, ARFID is not the same as picky eating. Picky eating generally only leads to the avoidance of certain foods, while ARFID can lead to nutrient deficiencies and malnourishment. In children, ARFID may impact development.

Eating disorders are often about more than just food

Researchers are still learning about the underlying causes of eating disorders, but they have identified various factors that may contribute to an individual developing these conditions.

Most eating disorders have a link to weight, food, and body image, but overall, they tend to involve much more than just food. Many people with eating disorders use food as a form of control or a way to cope with overwhelming emotions. Several mental health conditions can be associated with eating disorders, including mood disorders and anxiety disorders.

Researchers believe that some biological factors, like brain chemistry and genetics, may make someone more susceptible to developing an eating disorder, but many outside factors can contribute as well. 

For example, people who have a history of sexual or physical abuse or difficult family or personal relationships may have a higher risk of developing an eating disorder. Societal factors, such as cultural pressures to obtain the “ideal” body and narrow, unrealistic beauty standards, can also contribute to the development of eating disorders.

Co-occurring mental health conditions

Research suggests that multiple psychiatric comorbidities can occur alongside eating disorders, which can affect both the approach to treatment and its effectiveness. Below are several mental health conditions and mental states that can co-occur with eating disorders:

• Anxiety disorders, including generalized anxiety disorder and social anxiety disorder
• Obsessive-compulsive disorder
• Mood disorders, including major depressive disorder and bipolar disorder
• Personality disorders, specifically paranoid personality disorder, borderline personality disorder, avoidant personality disorder, and dependent personality disorder
• Substance use disorders
• Schizophrenia
• Psychosis
• Body dysmorphic disorder
• Attention-deficit/hyperactivity disorder
• Autism spectrum disorder
• Post-traumatic stress disorder
• Suicidality

Medical care for eating disorders

Depending on the severity of eating disorder symptoms, medical care may be a necessary part of treatment. Hospitalization may be needed if an individual is experiencing dehydration, refusal to eat, electrolyte imbalances, or medical complications like heart failure or seizures. Eating disorders that have been treated unsuccessfully in outpatient treatment may require hospitalization, residential treatment, or partial residential treatment.

Nutritional therapy

Nutritional therapy is often recommended treatment as part of eating disorder treatment. When oral feeding isn’t possible, feeding tubes inserted through the nose tend to be the preferred choice for nutritional support, although IV nutrition may be necessary for people with significant GI problems. Refeeding should generally start slowly, and electrolytes must be closely monitored, which is why this process usually occurs on an inpatient basis. 

Mental health support

Eating disorders can occur alongside many mental health conditions, and treatment typically involves addressing both co-occurring mental health disorders and the eating disorder in psychotherapy.

Multiple types of psychotherapy can be effective. For example, cognitive behavioral therapy (CBT) can help someone with an eating disorder learn how to overcome their thoughts about weight and replace disordered eating behaviors with more constructive habits. 

Research suggests that family-based therapy can be an effective first-line treatment for anorexia and bulimia, especially for young adults whose parents may play a key role in supporting recovery.

Medications

Some medications may be used for eating disorder treatment, particularly to address symptoms of co-occurring mental health conditions. Never start, stop, or change the way you take medication without consulting your doctor or psychiatrist.

Is treatment for eating disorders effective?

Most people with bulimia nervosa recover within nine to 10 years, and around half of those with anorexia nervosa recover within the same timeframe. Less information is available related to recovery from binge eating disorder and ARFID.

It can be important to note that anorexia is believed to have the highest mortality rate for all eating disorders and psychiatric disorders in general due to its potential physical health ramifications.

Several factors may contribute to poor treatment outcomes with eating disorder treatment, including low motivation, a low BMI, co-occurring depression, dysfunctional relationships, and a duration of symptoms for longer than six years. Early detection and treatment can improve the chances of a full recovery.

Therapy options

Some people may require inpatient or residential treatment to address eating disorders, while others may seek the help of a mental health professional on their own. In some cases, online therapy can be a viable alternative to in-person therapy, whether as a primary treatment or to provide additional support after completing a more intensive inpatient program.

With an online therapy platform like BetterHelp, you can attend sessions from the comfort of your home or any location with an internet connection. There are more than 30,000 providers on the platform, and you can change therapists at any time until you find a provider with whom you’re comfortable.

Research suggests that online treatment can be an effective option for eating disorders. For example, a 2021 study that looked at people with bulimia nervosa, binge eating disorder, and eating disorder not otherwise specified (EDNOS) found that web-based therapist-delivered CBT resulted in “large effect sizes for the reduction of ED (eating disorder) psychopathology and body dissatisfaction” and “small to moderate effect sizes for physical and mental health, self-esteem, social functioning, and quality of life.” The study also found that these effects were sustained for up to a year post-treatment.