Eating disorders: Treatment

Psychoeducation

Learning about eating disorders and strategies for coping with them can inform and motivate clients and their families. Primary care providers can provide this support in various ways:

  • Offer self-help books and guided self-help, such as regular visits with a primary care provider.
  • Assume responsibility for monitoring the client's weight at regular visits and encourage the client to get rid of the scale at home.
  • Ask the client to keep a diary of eating and associated behaviour so the client can begin to see the connections.
  • Help the client understand that weight gain of .5–1.0 kg per week is appropriate in anorexia nervosa.
  • Direct clients and families to the National Eating Disorder Information Centre, which provides information about prevention and health promotion.

Psychotherapy

Cognitive-behavioural therapy (CBT) and interpersonal psychotherapy (IPT) are the most validated treatments for eating disorders, especially bulimia nervosa and binge eating disorder.

  • Cognitive-behavioural therapy (CBT) is a common-sense approach that requires clients to challenge their assumptions and focuses on behavioural change. It is structured, goal-oriented and time-limited. CBT involves a skill set that primary care providers can use for treating other mental health issues, including depression and anxiety. Clients can also be referred to other professionals who practise CBT, such as social workers, psychologists and occupational therapists.
  • Interpersonal psychotherapy (IPT) is a structured, time-limited therapy that is based on psychodynamic and interpersonal models. IPT sees problems as rooted in insecure attachments and early life experiences. It focuses on grief, interpersonal disputes, role transitions and interpersonal deficits, and helps clients make changes in their interpersonal lives that may be causing or exacerbating their eating disorder.
  • Mindfulness training increases self-awareness, acceptance and non-judgment. It is taught through meditation and focus on a specific object, such as the breath. Mindfulness training requires a daily time commitment. Evidence suggests that mindfulness is a promising treatment for binge eating disorder. The approach is generally beyond the scope of primary care and requires dedicated professionals in the community.
  • Family therapy has shown the best results for treating anorexia nervosa and should be made available to children and adolescents with the eating disorder. The Maudsley model involves the family without blaming the family or client. It includes three stages of treatment: re-feeding the client, giving the client more control over eating and exploring identity and relationships.
  • Motivational interviewing. Early assessment of client motivation to engage in treatment is key to success. Motivational interviewing assesses clients' ambivalence, confidence and readiness for change.

Pharmacotherapy

  • For anorexia nervosa, there is no high-quality evidence that antidepressants are effective in treating the mood disturbance component of the disorder. For people who have recovered weight, medications may help with mood and anxiety.
  • Drugs that induce weight gain or stimulate appetite should not be used because the evidence shows they do not work.
  • For bulimia nervosa, the only drug approved in Canada is the antidepressant fluoxetine.
  • For binge eating disorder, there is evidence supporting the use of SSRI antidepressants such as fluoxetine, fluvoxamine, sertraline and citalopram.

Evidence summary

Courbasson, C. & Shapira, L. (2012). In A. Khenti, J. Sapag, S. Mohamound & A. Ravindran (Eds.), Collaborative Mental Health: An Advanced Manual for Primary Care Professionals (pp. 143–178). Toronto, ON: Centre for Addiction and Mental Health.

Goldbloom, D. (2011). The patient with an eating disorder. In D. Goldbloom & J. Davine (Eds.), Psychiatry in Primary Care: A Concise Canadian Pocket Guide (pp. 129–144). Toronto, ON: Centre for Addiction and Mental Health.

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Eating disorders quick reference:

Overview

Guidelines

Treatment

Tools and resources