Treatment of anorexia: complex, outpatient, inpatient + medication

Treatment for anorexia nervosa must be comprehensive:

1. weight adjustment
2. adjusting the somatic state
3. restoring eating habits
4. stabilising psychological complications
5. restoring social relationships

Treatment of anorexia nervosa can be done on an outpatient basis. In some cases, hospitalization is necessary.

Outpatient treatment is recommended only in the short term. It is used in simple cases or in cases where weight has not fallen below the minimum appropriate weight.

Hospitalisation is necessary when outpatient treatment fails or when there is a high risk of health complications.

High-risk medical complications include:

• weight - extremely low BMI
• behaviour - refusal of food
• impaired vital signs - very low heart rate
• psychiatric complications - risk of suicide
• external factors - negative family influence

During hospitalization, the patient's physical condition is monitored. During the process of nutritional restoration (refeeding) the following is monitored:

• diet and fluid intake
• electrolyte levels (potassium, phosphorus, magnesium)
• the development of oedema
• cardiac activity
• gastrointestinal symptoms (constipation, flatulence, dyspepsia)

What are the psychotherapeutic principles for the treatment of anorexia nervosa?

A good therapeutic relationship is important for the successful treatment of anorexia nervosa. The therapist communicates with patients in an age-appropriate manner.

Younger children are not able to describe inner feelings as well as an adolescent patient. Younger children express their feelings through their behaviour, non-verbal expressions and play.

One method used is cognitive remediation. It consists of mental exercises that focus on improving cognitive strategies and mind skills.

Multi-family therapy is increasingly used in psychotherapeutic treatment. It consists of joint meetings led by a therapist. Approximately 4 to 6 families spend ten days together over a period of 9 months.

Approximately 60-90% of patients are completely cured by this therapy.

Pharmacotherapy

Pharmacotherapy is symptomatic. Antidepressants are used in the treatment. They are applied in comorbid depressive or obsessive-compulsive disorders. Antipsychotics are used only in severe cases.

They are recommended in the pharmacotherapy of anorexia nervosa when necessary:

• supplementary multivitamins, iron, calcium
• prokinetics
• proton pump blockers, H2-receptor antagonists
• benzodiazepines (short-term)