Treatment and the Unwilling Patient
Introduction to Anorexia Treatment:
treatment has resulted in limited success since the 1970ís , when mental
health professionals initially began to develop treatments. The mainstay of
anorexia treatment has always been hospitalization to regain weight, sometimes
followed by psychotherapy. Most of the more common anorexia treatment approaches
have not been found to be especially effective in helping patients recover
physically and psychologically over the long term. Traditionally, patients would present at an
inpatient facility or outpatient center in a severely emaciated state, requiring
basic nutritional needs to first be met to reduce
starvation. Frequently this
was done through the use of an IV, because of the individualís refusal to eat,
with the ultimate goal of restoring the body to a normal nutritional state.
Obviously, this was not an ideal way to start psychotherapy or to build a
trusting relationship with a patient, which is certainly needed in effective
anorexia treatment. Also, the patient frequently has been found to be in need of
immediate medical attention to ward off other medical complications associated
with the starvation.
The most problematic aspect of successful
anorexic treatment is probably due to the resistant nature of the patient. Most
individuals who suffer from this disorder see no problem with their body weight,
and actually perceive themselves as being overweight, resulting in their being
very unwilling and uncooperative participants in treatment for anorexia. They
are usually pressured by family, friends or other concerned individuals, and
rarely initiate treatment for themselves.
Anorexia Treatment and
Most successful anorexia treatments involve the
restoration of a more healthy nutritional state along with psychotherapy,
psychoeducation and assistance within the immediate family. As with most forms
of psychotherapy, the immediate focus is on developing a trusting therapeutic
relationship. Cognitive-oriented therapies, focusing on issues of self-image and
self-evaluation are frequently some of the most beneficial. Cognitive techniques
which recognize the importance of addressing distorted self-body images and
perfectionist thinking are frequently used, and should be part of the initial
focus of treatment. Psychoeducational materials are sometimes used to instruct
patients on how to recognize the appropriate body weight and body fat
proportions of a normal body, and how these images relate to their own.
Obviously, obsessions with body image are powerful issues to be dealt with, and
are very difficult to change.
Effective inpatient anorexia treatment sometimes
uses behaviorally-oriented token economies which reward patients for eating
regular meals, and ensuring that they do not purge afterwards, with additional
hospital privileges or rewards then being granted. A specific target weight
should be set as treatment goals upon which time a patient would then graduate
from the hospital program to an outpatient program of individual therapy, and
sometimes group therapy, family therapy and/or support groups.
Oftentimes additional psychiatric concerns must
be addressed such as specific traumatic events or memories which may underlie
the negative self-image associated with anorexia. Also, comorbid psychological
issues such as depression and anxiety disorders commonly underlie anorexic
symptoms and should also be addressed.
Anorexia Treatment and the
Families are usually involved in therapy and
recovery from anorexia in various ways. Underlying relationship issues must be
dealt with between the anorexic patient and family members. Also, specific
relationships including those with parents, may play an important role in
helping to inadvertently nurture a negative self-image in the anorexic
individual, which needs to be considered and dealt with in family therapy.
Family therapy may also be beneficial in uncovering the reinforcers an
individual is receiving from significant others in their lives to remain thin.
Therapy with the family can also be very helpful in educating the family about
the disorder, and how to ensure the patientís compliance with treatment
recommendations. A healthy and adequate support system is absolutely essential
to the healthy long-term recovery from anorexia.
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