In-Depth Notes on Treatment of Eating Disorders

Treatment of Eating Disorders

Overview of Treatment Efficacy

• Treatments designed for eating disorders include both medical and psychological interventions.
• Medical complications of eating disorders necessitate comprehensive treatment plans, especially for anorexia nervosa (AN).
• Cost of treatment is substantial:
  • AN: Female patients average 26 days inpatient, costing $19,728 annually.
  • Bulimia Nervosa (BN): Female patients average 15 days inpatient, costing $10,970 annually.

Treatment Use Statistics

• Many patients do not seek treatment:
  • Only 8% of individuals with binge eating disorder (BED) receive treatment in England compared to 40% for BN.
  • 66% of patients in Germany received treatment post-inpatient for BED.
• Underutilization of services is linked to:
  • Lack of disorder recognition.
  • Financial barriers.
  • Lack of healthcare access.

Inpatient Treatment

• Most intensive and costly treatment.
• Rationale: Medical safety and stabilization for patients with severe health risks caused by eating disorders.
  • Commonly employed for dangerously underweight individuals with AN.
• Case Study of Emily:
  • Initially resistant to treatment but gradually improved while hospitalized.
  • Treatment included monitored meals and psychological support.

Residential Treatment Programs

• Provides structure for medically stable patients.
• Example: Renfrew Center, established in 1985, focuses on a non-institutional environment.
• Costs are similar to inpatient treatment, averaging $79,348 for 83 days of treatment.

Outpatient Treatment

• Less intensive and costly than inpatient care; can include various formats such as day programs and individual therapy.
  • Day Treatment Programs: 40 hours/week of therapy while allowing the patient to return home at night.
  • Outpatient care is suitable for patients who have achieved medical stability.

Types of Psychological Treatments

1. Psychodynamic Therapy:
   • Focuses on underlying emotional struggles contributing to disordered eating behaviors.
   • Less empirical support compared to other treatments.
2. Cognitive-Behavioral Therapy (CBT):
   • Focus on present thoughts and behaviors; structured and directive.
   • Proven effective for both BN and BED.
3. Interpersonal Therapy (IPT):
   • Addresses interpersonal problems associated with eating disorders.
   • Comparable success to CBT over time but slower initial improvements.
4. Dialectical Behavior Therapy (DBT):
   • Incorporates mindfulness and distress tolerance techniques.
   • Shows promise for treating BN and BED.

Family-Based Therapy for Adolescents

• Particularly effective for treating AN in adolescents living at home.
• Involves parents actively in the treatment process to support refeeding and improve family dynamics.

Non-Psychotherapy Interventions

• Nutritional Counseling:
  • Focuses on understanding nutritional needs and normalizing eating behaviors.
  • Helps combat misinformation surrounding dieting and food choices.
• Medication:
  • SSRIs such as Fluoxetine are FDA-approved for BN.
  • Atypical antipsychotics like olanzapine show promise for AN treatment.

Conclusion

• Variety of effective treatment modalities exists for BN and BED; family-based therapy is most effective for adolescents with AN.
• Significant barriers to accessing these treatments persist, underscoring the need for increasing awareness and training for healthcare providers.
• Multidisciplinary approaches combining therapy, nutrition, and medical supervision are recommended for successful treatment outcomes.