Persons with eating disorders often have difficulty admitting that they have a serious problem, and in many cases, particularly with anorexia, family or friends must persuade the individual to seek treatment.

In treating anorexia nervosa, the first step is the restoration of normal body weight. The greater the patient’s weight loss, the more likely the individual is to require hospitalization to ensure adequate food intake. Outpatient programs have become common in recent years; some centers have day programs where patients may spend eight hours a day, five days a week.

Anorexic patients are given a carefully prescribed diet, starting with small meals and gradually increasing the caloric intake. Each patient is given a goal weight range, and as she or he approaches the ideal weight, more independence in eating habits is allowed. If, however, she or he falls below the set range, greater supervision may be reinstated.

As they begin to gain weight, each patient usually will begin individual, as well as group, psychotherapy. Counseling usually involves education about body weight regulation and the effects of starvation, clarification of dietary misconceptions, and working on the issues of self-control and self-esteem. Follow-up counseling for anorexia may continue for six months to several years after healthy weight is restored.

Eating Disorder Treatment of bulimia nervosa first involves the management of any serious physical complications. In some cases, when the binge-purge cycle is so severe that the patients cannot stop on their own, hospitalization may be necessary. In such instances, individual counseling, sometimes combined with medication, is the standard treatment.

Counseling involves issues similar to those discussed in the treatment of anorexia and usually lasts for about four to six months.

In addition, group therapy has been found especially effective for bulimics. Antidepressant medications also may be an effective way of treating bulimia.

In outpatient treatment, bulimic patients are often asked to keep a food intake diary, making sure they eat three meals a day of moderate caloric intake, even if they are still binge eating. Exercise is limited, and if the patient becomes compulsive about it, it is not permitted at all.

In the eating disorder treatment of both anorexia and bulimia nervosa, family support is extremely important, especially in helping the recovering anorexic or bulimic with everyday tasks, such as grocery shopping.

In many cases, anorexic and bulimic patients and their families will attend family counseling sessions. Even after the eating disorder has been controlled, follow-up counseling for the patient, as well as the patient’s family, may be recommended.

While many people with an eating disorder will recover fully, relapse is common and may occur months or even years after treatment. An estimated 5 to 10 percent of anorexics will die from the disorder; their deaths most commonly result from starvation, suicide or electrolyte imbalance. More favorable outcomes for anorexics have been associated with a younger age of onset of the disorder, less denial, less immaturity, and improved self-esteem.

The outcome for bulimia nervosa is not as well documented, and mortality rates are not yet known. It is a chronic, cyclic disorder. Of those bulimics who are treated for the disorder, fewer than one-third will be fully recovered three years after treatment, more than one-third will show some improvement in their symptoms at a three-year follow-up, and about one-third will resume chronic symptoms within three years.

Finding a Health Care Provider

The treatment of eating disorders may be provided by a variety of specialists, including internal medicine physicians, psychiatrists, psychologists, clinical social workers, nurses and dietitians.