NEDA TOOLKIT for Parents
Treatments available for eating disorders
Standard treatments include medications (prescription
drugs), various psychotherapies, nutrition therapy,
other nondrug therapies, and supportive or adjunct
interventions such as yoga, art, massage, and
movement therapy. Some novel treatments are
currently under research, such as implantation of a
device called a vagus nerve stimulator implanted at
the base of the neck. This stimulator is currently in use
to treat some forms of depression, and it is under
research for treating obesity.
The most commonly used treatments—psychotherapy
and medication—are delivered at various levels of
inpatient and outpatient care, and in various settings
depending on the severity of the illness and the
treatment plan that has been developed for a
particular patient. Bulimia nervosa and binge eating
disorders can often be treated on an outpatient basis,
although more severe cases may require inpatient or
residential treatment. The levels of care and types of
treatment centers are discussed in separate documents
in the tool kit. The treatment plan should be developed
by a multidisciplinary team in consultation with the
patient, and family members as deemed appropriate by
the patient and his/her team.
Medication Biochemical abnormalities in the brain and body have
been associated with eating disorders. Many types of
prescription drugs have been used in treatment of
eating disorders; however, only one prescription drug
(fluoxetine) actually has a labeled indication for one
eating disorder, bulimia nervosa. (This means that the
manufacturer requested permission from the U.S. Food
and Drug Administration (FDA) to market the drug
specifically for treatment of bulimia nervosa and that
FDA approved this request based on the evidence the
manufacturer provided about the drug’s efficacy for
bulimia nervosa.)
Most prescription drug therapy used for treatment of
the disorder is aimed at alleviating major depression,
anxiety, or obsessive-compulsive disorder (OCD), which
often coexist with an eating disorder. Some
prescription drug therapies are intended to make
individuals feel full to try to prevent binge eating.
Generic and brand names of prescription drugs that
have been used to treat eating disorders are listed in
the chart. Some of these antidepressants also can exert
other effects. Selective serotonin reuptake inhibitors
alleviate depression, but may also play a role in
making an individual feel full and possibly prevent
binge eating in patients with bulimia or binge eating
disorder. FDA has issued a warning and labeling to
prevent prescription of one particular antidepressant
for eating disorders Wellbutrin, which is available in
several brand and generic formulations— because it
leads to higher risk of epileptic seizures in these
patients. Psychological Therapy
Several types of psychotherapy are used in individual
and group settings and with families. Patients must be
medically stable to be able to participate meaningfully
in any type of psychological therapy. Thus, a patient
who has required hospitalization for refeeding and to
stabilize his/her medical condition will ordinarily not
be able to participate in therapy until after he/she has
recovered sufficiently to enable cognitive function to
return to normal.
A given psychologist or psychiatrist may use several
different approaches tailored to the situation. The
types of psychotherapy used are listed here in a chart
and defined below. Cognitive behavior therapy (CBT)
and behavior therapy (BT) have been used for many
years as first-line treatment, and they are the most-
used types of psychotherapy for bulimia. CBT involves
three overlapping phases. The first phase focuses on
helping people to resist the urge to engage in the cycle
of behavior by educating them about the dangers. The
second phase introduces procedures to reduce dietary
restraint and increase eating regularity. The last phase
involves teaching people relapse-prevention strategies
to help prepare them for possible setbacks. A course of
individual CBT for bulimia nervosa usually involves 16-
to 20-hour-long sessions over a period of 4 to 5 months.
BT uses principles of learning to increase the frequency
of desired behavior and decrease the frequency of
problem behavior. When used to treat bulimia nervosa,
BT focuses on teaching relaxation techniques and
coping strategies that individuals can use instead of
binge eating and purging or excessive exercise or
fasting. Self-help groups are listed here because they may be
the only option available to people who have no
insurance. However, self-help groups can also have
negative effects on a person with an eating disorder if
they are not well-moderated by a trained professional.
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