Mental health articles

anorexia nervosa Care and treatment

As mentioned above, the person with anorexia nervosa is frequently reluctant toseek help as they feel that they now have control over their body. Usually it isthe parent who brings their child to the doctor. The person with anorexia needs torecognise that they need help and have motivation to change their behaviour. Thiscan be a very frightening period for them; so they need support and empathy toenable them to accept help and treatment.

The National Institute for Health and Clinical Excellence (NICE) is an organisationthat provides guidelines on treatment and management for a range of physicaland mental health conditions. These guidelines have been formulatedby examining relevant research and talking to expert clinicians to ensure that arange of effective interventions are recommended. The NICE guidelines for eatingdisorders regarding appropriate care.

Most people with anorexia nervosa will receive out-patient treatment as long as their weight is not dangerously low. The treatment will be in the form of psychological treatments such as cognitive behavioural therapy (CBT), interpersonal psychotherapy or family therapies. Interpersonal psychotherapy focuses on the problems the person experiences and the effect on their current functioning. Cognitive behavioural therapy willaddress and challenge some of their beliefs about food and weight. Family therapy will help to address some of the underlying familial issues or conflicts that may have contributed to the person’s development of anorexia nervosa.

These psychological treatments should be of at least six months’ duration. Dietary counselling by a dietician will also occur and will help the person eat appropriatefoods to gain weight and also provide education about nutrition. NICE  doesnot recommend the use of drug treatments unless there is a clear indication of aseparate mental health condition that requires treatment, for example if the person has a depressive illness as well as anorexia nervosa. Also, owing to the anorexia nervosa and the effect of this condition on a person’s physical health, the side effects of the drug treatments may worsen their physical health. If there is no or limited improvement in the person’s condition, day care or in-patient care may berequired.

Some individuals with anorexia nervosa are so physically unwell due to malnutrition that they need in-patient care immediately. They may have rapid weight loss,and there may be a risk of suicide. Therefore, admission to an in-patient unit is required. This may be a specialist eating disorder unit or within an adolescent unit. The focus is on weight gain, carefully monitoring the person’sphysical condition, but equally psychological treatment should focus on addressingissues of their eating behaviour and their attitudes towards weight and size. Sometimes,a person has to be admitted compulsorily under the Mental Health Act and fed usually via a nasogastric tube against their will, as their condition is life threatening. This intervention is a last resort.The carers of the person with anorexia nervosa may feel guilty and upset,wondering what has happened to cause this disorder and trying to establish why they did not identify their child’s illness earlier. This is due to the fact that the person is able to conceal their weight loss and their behaviour from everybody, andit is often by accident that their condition is discovered. The carers may also feelanger and resentment, finding it difficult to understand why their child will not eat.Both parents/carers and siblings need to be fully involved in the treatment processof the person with anorexia nervosa and offered support and advice so they can understand the disorder but also in order for them to provide support for their child.

Overall, it is important to understand that treatment is a very frightening processfor the person with anorexia nervosa. They believe that they had gained controlof their lives by gaining control of their dietary intake and so, as that control isbeing removed from them, the future can now appear very bleak and they maybe at risk of attempting suicide. Although their thoughts and behaviour can bedifficult to understand (as their lives can be at serious risk due to malnutrition), thehealth-care practitioner needs to spend time listening to their concerns to understandwhat precipitated and is perpetuating this disorder. This will demonstrate to theperson with anorexia nervosa that the health care professional wishes to elucidatethe person’s perspective of their illness and will facilitate the development of a therapeutic relationship with them and their family. Therefore, the person can beginto trust the process and participate in the treatment.

If untreated, anorexia nervosa has one of highest mortality rates for a mental healthdisorder, 10–15% of people with anorexia nervosa die from either medical complicationsor suicide. Of those who receive care and treatment,one-third have a full recovery, one-third have a partial recovery (so they still havesome features of the illness) and one-third do not improve at all and have chronicdifficulties with food and their weight.

Tags: anorexia nervosa, prevention, treatment