Feeding and eating disorders are characterized by a persistent disturbance of eating or eating-

related behavior that results in the altered consumption or absorption of food and that
significantly impairs physical health or psychosocial functioning. Diagnostic criteria are
provided for pica, rumination disorder, avoidant/restrictive food intake disorder, anorexia
nervosa, bulimia nervosa, and binge-eating disorder. The diagnostic criteria for rumination
disorder, avoidant/restrictive food intake dis order, anorexia nervosa, bulimia nervosa, and binge-
eating disorder result in a classification scheme that is mutually exclusive, so that during a single
episode, only one of these diagnoses can be assigned. The rationale for this approach is that,
despite a number of common psychological and behavioral features, the disorders differ
substantially in clinical course, outcome, and treatment needs. A diagnosis of pica, However,
may be assigned in the presence of any other feeding and eating disorder. However, the relative
contributions of shared and distinct factors in the development and perpetuation of eating and
substance use disorders remain insufficiently understood.
Introduction
Anorexia

Anorexia nervosa is an eating disorder and a serious, potentially life-threatening, mental health
condition.People who have anorexia are very anxious about their weight and body shape. They
try to keep their weight as low as possible by strictly controlling and limiting what they eat.
Many people with anorexia will also exercise excessively. They may also use other methods to
try to control their weight, including using laxatives, vomiting after eating, and taking stimulant
drugs.Anorexia causes people who have it to be afraid of being ‘fat’. This fear is what causes the
other symptoms, leading to weight loss and potential health risks. Anorexia nervosa, often
referred to simply as anorexia, is an eating disorder characterized by low weight, food restriction,
body image disturbance, fear of gaining weight, and an overpowering desire to be thin.Anorexia
is a term of Greek origin: an- (ἀν-, prefix denoting negation) and orexis (ὄρεξις, “appetite”),
translating literally to “a loss of appetite”; the adjective nervosa indicating the functional and
non-organic nature of the disorder. Anorexia nervosa was coined by Gull in 1873 but, despite
literal translation, the feeling of hunger is frequently present and the pathological control of this
instinct is a source of satisfaction for the patients.
Globally, anorexia is estimated to affect 2.9 million people as of 2015. It is estimated to occur in
0.3% to 4.3% of women and 0.2% to 1% of men in Western countries at some point in their life.
About 0.4% of young women are affected in a given year and it is estimated to occur ten times
more commonly among women than men. Rates in most of the developing world are unclear.
Often it begins during the teen years or young adulthood. While anorexia became more
commonly diagnosed during the 20th century, it is unclear if this was due to an increase in its
frequency or simply better diagnosis. In 2013, it directly resulted in about 600 deaths globally, up
from 400 deaths in 1990. Individuals with anorexia nervosa also often deny that they have a
problem with low weight. They may weigh themselves frequently, eat small amounts, and only
eat certain foods. Some exercise excessively, force themselves to vomit (in the “anorexia
purging” subtype), or use laxatives to lose weight and control body shapes, and/or binge eat. In
extreme cases, patients with anorexia nervosa who continually refuse significant dietary intake
and weight restoration interventions, and are declared incompetent to make decisions by a
psychiatrist, may be fed by force under restraint via nasogastric tubeafter asking their parents or
proxies to make the decision for them.

Etiology

The success of many professions depends on a person’s weight. Models and actors portray a
level of thinness that is difficult to attain, and it is enhanced by make-up and photographic
alterations. Athletes in sports such as ballet, long-distance running, and martial arts are pressured
to maintain lean body weights to outperform the competition. Media outlets promote diet secrets
and weight loss tips in excess. Populations such as maturing females identify thin body types
with increased self-esteem and link weight loss with self-control.

Epidemiology

Anorexia nervosa is more common in females than males. Onset is late adolescence and early
adulthood. Lifetime prevalence is 0.3% to 1% (European studies have demonstrated a prevalence
of 2% to 4%), irrespective of culture, ethnicity, and race. Risk factors for eating disorders include
childhood obesity, female sex, mood disorders, personality traits (impulsivity and perfectionism),
sexual abuse, or weight-related concerns from family or peer environments.
Path physiology

Studies demonstrate biological factors play a role in the development of anorexia nervosa in
addition to environmental factors. Genetic correlations exist between educational attainment,
neuroticism, and schizophrenia. Patients with anorexia nervosa have altered brain function and
structure there are deficits in neurotransmitters dopamine (eating behavior and reward) and
serotonin (impulse control and neuroticism), differential activation of the corticolimbic system
(appetite and fear), and diminished activity among the front striatal circuits (habitual behaviors).
Patients have co-morbid psychiatric disorders such as major depressive disorder and generalized
anxiety disorder.

History and Physical

Patients will report symptoms such as amenorrhea, cold intolerance, constipation, extremity
edema, fatigue, and irritability. They may describe restrictive behaviors related to food like
calorie counting or portion control, and purging methods, for example, self-induced vomiting or
use of diuretics or laxatives. Many exercise compulsively for extended periods of time. Patients
with anorexia nervosa develop multiple complications related to prolonged starvation and
purging behaviors.

Symptoms

The symptoms of anorexia nervosa are many, and these symptoms may differ between sufferers.

Below, we list some of the most common symptoms of anorexia nervosa:

 You label yourself as ‘fat’ even when you are not

 You experience a loss of menstrual periods and you lose the desire to have sex with your
partner
 You exercise specifically to burn off calories, even when this is detrimental to your health
 You severely limit the amount of food you eat to lose weight
 You experience significant weight loss over a short period of time
Physical symptoms

The physical symptoms of anorexia nervosa include:

 Brittle bones
 Infertility
 Kidney problems
 Heart problems

PREVENTION
If you know someone with anorexia, you may wonder if you could have prevented it. The simple

answer is probably not. Doctors don’t know what causes anorexia or how to stop someone from

getting it. What they do know is when someone has it, they don’t eat enough food because they’re

often trying to be perfect by being thin. They develop symptoms that make them sick and even

threaten their life.

Risk for Anorexia

 Being female (eating disorders also affect males, but are most common in young women)
 Higher childhood body mass index (body fat measure based on height and weight)
 Heredity and genes (eating disorders tend to run in families)
 An abnormal functioning of brain chemicals and circuits that control hunger and eating
 Social pressure to be thin
 Difficulty expressing feelings
 History of being teased because of weight or size
 History of sexual or physical abuse
 Perfectionism, or setting unrealistic standards
 Unhappiness with body image
 A lack of social or family support
 Low self-esteem
 Depression, anxiety, stress, anger, or loneliness
 Belief that a thinner body is ideal, sometimes because of social standards, such as pictures in
fashion magazines
 Dieting a lot
 Social problems in general, including withdrawal
 A history of psychiatric disorders
 Premature birth, low birth weight, or being part of a multiple birth
Can I Help Stop Anorexia?
There are many things that you, your friends, family, and teachers can do to help ease the pressures
that could lead your loved one developing anorexia, including the following:

 Tell them being extremely thin isn’t better

 Put more importance on their personality than their looks
 Encourage them to be honest about their feelings
 Build their self-esteem
 Teach them about the dangers of dieting
 Let them know that you don’t expect them to be perfect because perfection doesn’t exist

Detecting Anorexia Early

Before your loved one develops anorexia, they will likely start showing warning signs of the eating
disorder, such as dramatic weight loss, constantly complaining about being fat, avoiding mealtimes,
and excessively exercising. Here are ways you can help them from getting worse:
Get educated. Start by learning about anorexia, especially the differences between the myths
and facts.
Talk to them. Discuss your worries with them. And don’t wait until their symptoms become
severe. The sooner you talk about it, the sooner they can get help.
Get medical help. Encourage them to see a primary care doctor or a psychiatrist. They can
prevent their anorexia from getting worse.
Give them support. Tell them you love them. People with anorexia often have a hard time
trusting others. Go out of your way to show them that they can trust you.
Praise and compliment them. Tell them how wonderful they are, and remind them that true beauty
comes from inside. It’s good for them to hear that someone thinks they are great just the way they
are.
Build a support network. Share your concerns with other people who care about them. The best
thing for both of you is to have support.
Be their role model. Eat and exercise in positive ways. They need to see you practice strong habits.
They could inspire them to follow your lead.

1) Developing a Positive Body Image

Society often places a great deal of emphasis on outward appearance to the point of overlooking
other wonderful features about a person. One way to develop better self-esteem is to think
about all of your strengths. Make a list of all the qualities you feel describe you as a person.
Also, think about ways others have spoken highly of your personal traits in the past. Include
these compliments on the list as well.
  Tape this list on your bathroom mirror so whenever you find yourself judging your
physical appearance, you can immediately correct these judgments by focusing on
positive strengths you have in other areas of life.

2) Highlight the positives about your body. This method is not suggesting that you point out
specific aspects of your appearance like a slim nose or thighs. Instead, you need to direct your
attention on how awesome the human body is without regard to appearance. For instance, you
can pinpoint amazing abilities and functions that you are able to carry out because of your body.
 Whenever you catch yourself being nit-picky about any perceived flaws on your body, try
to correct yourself and declare positive affirmations like "My legs and arms allow me
to do cartwheels.", "My heart is so strong it delivers blood to my entire body." or "My
nose helps me to smell these beautiful flowers.

3) Developing a Healthy Relationship with Food

This may come as a surprise, but no food is bad. Yes, there are foods that nurture your body with
essential vitamins and minerals. On the contrary, there are foods that provide only empty
calories. These tend to be foods high in carbohydrates, fat, and sugar. Still, labeling these foods
as bad puts young people at risk of constantly denying themselves tasty foods that they enjoy
with the high likelihood of overeating them later.

Rehabilitation of Anorexia nervosa

Rehabilitation nutrition is defined as performing nutrition management that can

maximize the functions, activities, and participation of persons with disabilities
and elderly people after evaluation including nutritional status using International
Classification of Functioning, Disability and Health (ICF) guidelines.

Treatment for anorexia nervosa

Each year, we meet people from various walks of life who undergo treatment for anorexia, and
then we help them restore their physical and mental health. Primrose Lodge provides an inpatient
rehab treatment programmed to guide you carefully toward long-term recovery; all the while, our
competent and compassionate team will keep you healthy, comfortable, and safe throughout the
process. Rehab for anorexia is essential for anyone battling anorexia as it takes a comprehensive
approach to recovery, encompassing diet and nutrition, therapy and holistic treatments. This way,
you can experience physical, mental, and emotional healing. Upon admission to rehab for
anorexia, you will be medically assessed and given a bespoke recovery plan tailored to your
specific needs.

It can be challenging to spot the symptoms of anorexia, and you may feel unsure about whether
you (or someone you love) need treatment for anorexia. Look at the following statements. If any
resonate with you, it may indicate that attending anorexia necessary.

.Physical signs:

I no longer menstruate.

My fingers have a bluish discoloration.

I frequently suffer from abdominal pain and constipation.

I often feel dehydrated.

I experience dizziness or fainting regularly.

I have dry or yellowish skin.

I have noticed extreme weight loss.

I am always tired.

My hair is either thinning or falling out.

Behavioral symptoms:

Now look at the following statements for the behavioral signs of anorexia nervosa; again, if you
identify with any of the following, it may mean you need to seek treatment.

 .I wear many layers of clothing or baggy clothes to conceal how thin I am.
 I make excuses to my loved ones about why I don’t eat.
  I tell people I am not hungry when am
 .I exerciseexcessively.
 I often look at my body in the mirror.
 I often weigh myself.
 My weight dictates my emotions.
 I count calories and severely restrict my food intake.
 I use the internet for inspiration to keep losing weight.
 I often feel depressed about my weight.

Indication:
Nutritional rehabilitation (nutritional support) is indicated as the first step of treatment for
all patients who are acutely ill with anorexia nervosa and underweight. This approach is
consistent with practice guidelines from the American Psychiatric Association, United
Kingdom National Institute for Health and Care Excellence, and the Academy for Eating
Disorder. In addition, some patients who are technically not underweight may
nevertheless require nutritional rehabilitation due to recent rapid weight loss that was
significant.

General principles
Goals and outcomes

The goals of nutritional rehabilitation (refeeding) for anorexia nervosa are to stabilize the
patient’s general medical status, reverse the medical complications that ensue from the
underweight state, and restore weight and normal eating patterns. Normalization of eating aims
to interrupt problematic behaviors, such as purging and other actions that are used to compensate
for eating, and can help patients regain the ability to perceive hunger an adolescent. Nutritional
replenishment often reverses the general medical complications that can occur in anorexia
nervosa due to starvation and malnutrition. As an example, weight restoration can ameliorate
electrolyte, cardiac, gastrointestinal, and endocrine disturbances. Nutritional rehabilitation can
also improve psychiatric symptoms such as mood and anxiety, cognitive function, apathy, and
lethargy. Although osteoporosis is less amenable to acute nutritional rehabilitation, achieving a
normal weight and the resumption of menses can improve osteoporosis, especially in adolescents
. The medical complications of anorexia nervosa and their management are discussed separately.

Treatment response is measured primarily as successful weight gain, and behavioral management
is the most successful approach for helping patients to achieve normal weight. Behavioral
therapy is used to reinforce healthy eating and weight gain, and to avoid reinforcing behaviors
that do not promote health. For patients who do not achieve expected weight gain, we suggest
prescribing more calories and/or decreasing physical activity.

Patient assessment

Assessment of the patient’s general medical status, including body mass index (BMI) (calculator
1), determines treatment recommendations. The evaluation should address:

●Current weight, and intakes- For adolescents, the growth chart and BMI percentile need to be
consulted.

●Current caloric intake.

●Weight history – Has weight recently been stable, declining, or increasing?

●Engagement in treatment – Does the patient accept the need for treatment? Is the patient
motivated? How ambivalent is the patient about increased energy intake?

●Behavioral reinforcements that will motivate healthy eating behaviors. (See ‘Behavioral
management’ below.)

Additional information about assessing patients with anorexia nervosa, as well as assessing the
dietary and nutritional status of primary care patients, is discussed separately.

Setting :

Nutritional rehabilitation (refeeding) for anorexia nervosa is generally started during an inpatient
hospitalization, and completed on an inpatient or outpatient basis. Other settings that may be
available include intensive outpatient clinics (eg, two to three hours per weekday), partial
hospitals (eg, six hours of outpatient care per weekday), and residential care

Randomized trials suggest that after inpatients with anorexia nervosa are medically stabilized
with nutritional rehabilitation, ongoing refeeding and treatment in a partial (day) hospital or
outpatient clinic may be as effective as continued inpatient hospitalization:

●An open-label trial enrolled 172 female adolescents with anorexia nervosa who were initially
treated on an inpatient unit for three weeks, and then randomly assigned to continued inpatient
care or day hospital care (eight hours per day, five days per week). The inpatient hospitalization
represented the first lifetime admission to a hospital for anorexia nervosa; continued inpatient
hospitalization and day hospital care each provided the same multimodal specialized care
program of nutritional rehabilitation (including nutritional counseling), cognitive-behavioral
therapy (CBT), and family therapy. At the follow-up assessment 12 months after admission for
inpatient care, BMI in the group who received day hospital was comparable to continued
inpatient care .
●A second trial compared shorter inpatient hospitalization for the purpose of medical
stabilization with longer hospitalization for restoring weight to 90 percent of expected body
weight in 82 medically unstable adolescents with anorexia nervosa. In both groups,
hospitalization included nutritional rehabilitation and other specialist treatments; following
discharge, both groups received outpatient family therapy. Remission 12 months after treatment
was comparable for shorter and longer hospitalizations (30 and 33 percent of patients).

Behavioral management

Inpatient nutritional rehabilitation typically involves behavioral management, which includes.

●Regular structured meal plans :

Nutritional support staff should be consulted to determine caloric intake, help patients plan
meals, and establish regular eating patterns. (See ‘Nutritional counseling’ below.

●Monitoring

Meals :

Patients are observed as they eat to ensure that they do not surreptitiously discard their food, and
to interrupt abnormal eating behaviors (eg, cutting food into small pieces or refusing to mix
different types or colors of food on the plate) as they occur. For one hour after meals, patients are
observed to prevent compensatory behaviors such as exercise or vomiting, and access to the
bathroom is denied. In addition, fluid intake is monitored to prevent fluid loading.
•Exercise :.

During acute weight restoration, physical activity is generally restricted. As medical status
improves, mild exercise (eg, yoga and stretching) is often introduced. For patients who can
safely exercise, the activity should focus upon pleasure, rather than burning calories; group
activities and time-limited activities (eg, classes) are preferable to solitary exercises.

Behavioral reinforcement:.

Behavioral reinforcements increase the probability of desired responses:

•Positive reinforcements

It encourage healthy eating behaviors with desirable consequences such as off unit privileges or
increasing choice in meal selection.
•Negative reinforcements

It remove undesirable or aversive contingencies such as enforced bed rest, or restrictions of

exercise or off-unit privileges. If patients lose weight, privileges and autonomous control may
need to be reduced (eg, bed rest imposed) until weight gain is again achieved.

Nutritional counseling :

Nutritional rehabilitation for anorexia nervosa includes nutritional counseling provided by

registered dieticians who

●Assess the patient’s nutritional status, nutritional knowledge, and motivation to get better

●Determine the number of calories to administer

●Provide information about food, meal preparation, and eating behavior

●Supervise patients in selecting foods and planning meals

●Support patients in coping with eating and weight gain (eg, discourage dieting and reassure
patients that their weight gain is not out of control)
Although nutritional counseling is an important component of nutritional rehabilitation for
anorexia nervosa, dietary counseling is not sufficient as a stand-alone intervention for post
hospitalization management.

Weight gain targets :

The goal of nutritional rehabilitation for anorexia nervosa is to restore weight to a healthy range;
patients who do not fully restore their weight are at risk for relapse. Many patients can restore
weight to within normal limits in a structured treatment setting (eg, inpatient or partial hospital
program) that includes behavioral contingencies. The treatment team needs to discuss the target
weight with patients when they are capable of processing this information; for some patients the
ultimate weight goal is not a priority at the onset of treatment. There is no single standard for
what constitutes a minimally normal weight. The weekly target for controlled weight gain
generally varies according to the setting.

●Inpatient – 2 to 3 pounds (0.9 to 1.4 kg) per week

●Partial hospital – 1 to 2 pounds (0.5 to 0.9 kg)

●Outpatient – 0.5 to 1 pound (0.2 to 0.5 kg)

Early in the refeeding process, patients may gain weight rapidly because of fluid retention and a
low baseline metabolic rate.
Number of calories :

Caloric intake at the beginning of inpatient nutritional rehabilitation for anorexia nervosa is
typically 30 to 40 kcal/kg body weight/day (eg, 1500 to 1800 kcal/day) . Support for this
approach includes the following:

●A randomized trial compared higher-calorie refeeding with lower-calorie refeeding in 111

hospitalized adolescents and young adults with anorexia nervosa or atypical anorexia nervosa.
Participants had vital sign instabilities (bradycardia, hypotension, orthostatic hypotension, and/or
hypothermia) and low BMI. Higher-calorie refeeding commenced at 2000 kcal/day and increased
by 200 kcal/day, whereas lower-calorie refeeding started at 1400 kcal/day and advanced by 200
kcal every two days. Higher-calorie refeeding restored medical stability in less time (7 versus 10
days) and produced greater weight gain, compared with lower-calorie refeeding. Safety
(incidence of electrolyte abnormalities) and other adverse events were comparable between the
two groups. In addition, mean length of stay was shorter with higher-calorie refeeding than
lower-calorie refeeding (8 versus 12 days), indicating that higher-calorie refeeding is cost-
effective.

●A review of observational studies in hospitalized adolescents found that lower calorie

refeeding, starting at 1000 to 1200 kcal/day, was associated with weight loss at the beginning of
treatment, followed by slow weight gain of 0.7 to 0.9 kg/week
Administration :

Nutritional rehabilitation can be achieved by:

●Oral refeeding – typically indicated

●Enteral (nasogastric) refeeding – occasionally indicated

●Total parenteral nutrition – rarely indicated

Oral refeeding

Nutritional rehabilitation (refeeding) of anorexia nervosa is typically accomplished solely

through oral intake of regular food, which helps patients resume healthy eating patterns (eg, three
meals and one or two snacks per day). Energy dense liquid dietary supplements may be
prescribed if patients cannot consume enough food to meet their caloric goals Supplements are
commonly required at the peak of weight gain, when nutritional requirements are high. These
supplements can be consumed during or between meals. After patients restore their weight and
transition to a weight maintenance diet, supplements are discontinued.

Enteral refeeding
Enteral (nasogastric tube) feeding is occasionally indicated for extremely underweight patients
(eg, BMI <15 kg/m2) or highly refractory patients who are unable to eat a sufficient amount of
food to gain weight . Enteral feeding is preferable to parenteral feeding because enteral feeding
normalizes gastrointestinal function (comparable to oral intake).

Parenteral nutrition:

It is a treatment of last resort when no other alternatives exist, including cases in which enteral
feeding is precluded (eg, following gastrointestinal surgery) or patients with acute hepatitis or
pancreatitis. The benefits of parenteral feeding almost never outweigh the risk of serious
complications, which include catheter related infection and air embolism if patients disconnect
the parenteral solution from the indwelling catheter, as well as the risks of disseminated
intravascular coagulation and death.

Monitoring general medical status :.

The general medical status of patients with anorexia nervosa who are receiving nutritional
rehabilitation should be monitored, and more severely underweight patients (eg, body mass index
<16 kg/m2) require more intensive monitoring.

Vital signs :

For inpatients, vital signs are monitored one to three times daily, for partial hospital patients once
each day, and for outpatients, vital signs are monitored each visit. Patients with anorexia nervosa
are at high risk for orthostatic hypotension. In addition, patients are usually bradycardic, and a
sudden, sustained, increased pulse greater than 70 beats per minute may be a sign of cardiac
overload and harbinger of the refeeding syndrome.

Weight :

For inpatients and partial hospital patients, weight is measured several (eg, three) times per week
or on a daily basis, and for outpatients at each visit. Weighing is preferably conducted at the
same time each day with the same scale, typically in the morning, post voiding, with patients in
hospital gowns (when appropriate). These procedures can increase the reliability and validity of
recorded weights by preventing patients from falsely elevating their weight through water
loading, wearing heavy clothing, or surreptitiously carrying extra weights in pockets. Weight
gain targets are discussed separately.

Physical examination:

The physical examination focuses upon the cardiovascular (including signs of lower extremity
edema), gastrointestinal, and pulmonary systems. Early in the refeeding process (eg, first two
weeks), clinicians should examine inpatients and partial hospital patients daily and outpatients at
each visit, looking for signs of the refeeding syndrome.

Laboratory tests :.
Once nutritional replenishment commences, clinicians should regularly check serum electrolytes,
glucose, phosphorous, magnesium, and liver function tests. The frequency of laboratory testing
depends upon the severity of the patient’s general medical status. We usually perform tests on
hospital days 1, 3, 7, and 10, and weekly thereafter.

Medication

Some healthcare providers may prescribe medication to help manage anxiety and depression that
are often associated with anorexia. The antipsychotic medication olanzapine (Zyprexa®) may be
helpful for weight gain. Sometimes, providers prescribe medications to help with period
regulation.

Outpatient Nutritional Rehabilitation

Recent research has shown that for patients not at risk for refeeding syndrome, more aggressive
and faster-refeeding protocols lead to faster recovery and better overall outcomes. It is not
uncommon for daily caloric needs of people recovering from anorexia to reach 3,000 to 5,000
daily calories for a sufficient ½ pound to 2 pounds per week weight gain until achieving goal
weight. This is especially true for adolescents who are still growing and young adults.
Adolescents participating in Family-Based Treatment with parents in charge of nutritional
rehabilitation support are usually able to be safely started at an intake of 2,000 to 2,500 calories
per day.2 With an outpatient team supporting and monitoring, parents are often encouraged to
increase meal plans to 3,000 to 5,000 calories per day for weight restoration.

Achieving High-Calorie Intake Requirements

Parents and patients are often perplexed at such high caloric needs as renourishing progress. Why
are they so high? Individuals with anorexia nervosa often become hyper metabolic, which means
their metabolism has kicked into high gear as the body tries to rebuild all the tissue lost during
starvation. Individual commonly experience elevated body temperature as energy intake may be
converted into heat, rather than solely used to build tissue. This paradoxical symptom makes
recovery even harder. Additionally, many patients with anorexia nervosa engage in excessive
exercise despite severe emaciation. Such exercise may be hidden and can further undermine
attempts at weight gain by increasing calorie expenditure. Exercise is usually not medically
advised in the initial stages of nutritional rehabilitation, but patients may need monitoring to
prevent it. It Is important to note that because increased caloric intake generates significant
anxiety in those with anorexia nervosa, achieving these caloric goals may be very challenging
even with additional support. However, it is imperative to allow enough caloric intake for the
body to fully recover. Weight goals should always be calculated by your medical team. The
return of menses in females is critical.3 Again a medical team is advised to calculate your
specific individual calorie needs as they shift during the recovery process.

Improve Eating behavior

All the weight restoration in the world will count for little if the individual does not relearn how
to view food in a healthy, not harmful, fashion. Normalized food consumption can begin with
mechanical eating with an eye toward eventual mindful eating. An exchange system can be
utilized to follow normalized eating patterns. The ultimate goal is to embrace intuitive eating; in
this, the person eats when hungry and stops when full. Nutritional rehabilitation is a key
component of eating disorder recovery. Once weight is restored and the individual embraces a
new, positive relationship with food, it is possible for anyone to recover from an eating disorder,
and go on to have a life of health and a restoration.

Nutrition counseling
Nutrition counseling is a strategy to help treat anorexia that involves the following:

• Teaching a healthy approach to food and weight.

• Helping restore normal eating patterns.

• Teaching the importance of nutrition and a balanced diet.

• Restoring a healthy relationship with food and eating

Group and/or family therapy

Family support is very important to anorexia treatment success. Family members must
understand the eating disorder and recognize its signs and symptoms.People with eating
disorders might also benefit from group therapy, where they can find support and openly discuss
their feelings and concerns with others who share common experiences.

Hospitalization
Hospitalization might be needed to treat severe weight loss that has resulted in malnutrition and
other serious mental or physical health complications, such as heart disorders, serious depression
and suicidal thoughts or behaviors.

.Family support anorexia treatment

It recognize the crucial role your loved ones play in the recovery process and have designed a
programmed to get them involved in your treatment and recovery from start to finish. Our family
support programmed will help you and your family make sense of your thought processes and
understand how to help you on your journey to recovery. The therapy sessions will be aimed at
healing the past and preparing the ground for a better, healthier future.

Benefits of rehab for anorexia treatment

Several benefits can be gained by opting for anorexia treatment in a rehabilitation facility. For
one, we create a comfortable but controlled environment, so you will have people to turn to
whenever you feel the need to check your weight or induce vomiting. Furthermore, you’ll be in a
highly supportive atmosphere where you’ll receive encouragement and share experiences with
others going through the same experiences. You’ll be invited to attend holistic treatments such as
meditation, yoga and art therapies. These can help you express yourself and access a place of
inner calm. When you reach a certain level of peace, you can begin physically, emotionally and
mentally rejuvenating. Rehab for anorexia leads to significantly strong recovery rates and can
help you learn the skills you need to live a long, healthy life.
Therapies for anorexia treatment:

Several counselling and therapy approaches may be used, depending on the specific case we’re
dealing with. These are typically referred to as talking therapies. They include:

 Cognitive analytic therapy (CAT)

 Cognitive behavioral therapy(CBT)
 Focal psychodynamic therapy (FPT)
 Interpersonal psychotherapy (IPT)

Cognitive analytic therapy (CAT):

Cognitive Analytic Therapy is an accredited structured psychological therapy that is usually

offered an an individual therapy, but can be done as a couple or in a group. CAT can be used to
treat the spectrum of eating disorders from anorexia nervosa to bulimia nervosa, OSFED to binge
eating disorder, because eating disordered behaviors can be tackled alongside the underlying
intra- and interpersonal factors maintaining the eating difficulties. CAT takes a very
collaborative stance (therapist and client working together towards a shared understanding to
meet shared goals). Unhelpful patterns in experiences and relationships are identified through
open discussion about issues, and through patterns that may reoccur within the therapeutic
relationship. It is therefore a good choice for people who find relationships, including the
therapeutic relationship, challenging, or who experience high ambivalence towards change. CAT
is becoming more popular in the treatment of eating disorders. CAT is a time limited therapy and
the number of sessions (16, 24 or 32) will usually be agreed at the start of treatment. Following
regular therapy a number of less frequent follow up session will usually be offered.

There are four distinct phases of CAT:

Reformulation

Recognition

Revision

Ending.

Reformulation

The initial sessions of CAT are termed the ‘reformulation phase’. Here clients are encouraged to
speak openly about what they are experiencing in their life. Clients will share their own personal
history and life experiences. As well as things going wrong in your life there are always some
things that have gone right. The therapist will encourage you to name what works well and what
areas have given you happiness and satisfaction so that you are able to recognise your strengths,
as well as your challenges

Recognition

The second phase of therapy is known as recognition. The focus shifts to more recent
experiences, exploring where patterns you’ve identified might be being played out. Many of
these patterns will involve relationships – either with others or with yourself. This stage of
therapy is about compassionately noticing what is going on rather than trying to make changes. A
CAT diagram is always used in therapy, which serves as a map of the difficulties you are
experiencing; how these are developed and maintained; and the patterns you tend to fall into
which serve to keep you stuck in your current difficulties.
REVISION

As therapy progresses, the focus moves to trying out new ways of relating, thinking, acting, and
seeing how these work. These are often described as “exits”, as they are a way of breaking free
of the patterns that you have previously felt stuck in. Time is taken to practice these new ways of
being, using the CAT diagram to notice when you have slipped back in to the old familiar
patterns, and thinking about how you can do things differently the next time.

ENDING

CAT recognizes that finishing therapy can be difficult, especially if endings in your life have
been difficult in the past. The last three or four sessions are used to think back over the course of
therapy and the ending of this therapy relationship. The therapist will write a ‘goodbye letter’ and
will invite you to do the same, sharing them in the last session. This goodbye letter, as well as the
CAT diagram and the reformulation letter, serve as written reminders of therapy that you can take
with you to continue working once therapy has finished.

CAT can be used to treat the spectrum of eating disorders from anorexia nervosa to bulimia
nervosa, OSFED to binge eating disorder, because eating disordered behaviors can be tackled
alongside the underlying intra- and interpersonal factors maintaining the eating difficulties. CAT
takes a very collaborative stance (therapist and client working together towards a shared
understanding to meet shared goals). Unhelpful patterns in experiences and relationships are
identified through open discussion about issues, and through patterns that may reoccur within the
therapeutic relationship. It is therefore a good choice for people who find relationships,
including the therapeutic relationship, challenging, or who experience high ambivalence towards
change. CAT is becoming more popular in the treatment of eating disorders.

Cognitive behavioral therapy(CBT):

This therapy’s goal is to address distorted views and attitudes about weight, shape and
appearance and to practice behavioral modification (if “X” happens, I can do “Y” instead of
“Z”). CBT is a psychotherapeutic approach that involves a variety of techniques. These
approaches help an individual to understand the interaction between his or her thoughts, feelings,
and behaviors and develop strategies to change unhelpful thoughts and behaviors in order to
improve mood and functioning. The cognitive model of eating disorders posits that the core
maintaining problem in all eating disorders is over concern with shape and weight. The specific
way this over concern manifests can vary. It can drive any of the following: Therapists
conducting CBT aim to introduce behavioral change as early as possible. Research has shown
that patients who are able to make early behavioral changes such as establishing more regular
eating and reducing the frequency of purging behavior are more likely to be successfully treated
at the end of treatment. CBT for acute weight gain is designed to restore weight on an outpatient
basis. CBT for anorexia nervosa, designed for late adolescents and adults with this disorder, is
typically conducted on an individual basis over the course of one year. This treatment is
explicitly focused on the achievement and maintenance of a healthy weight, particularly one at
which (for females) return of menses is possible. CBT for anorexia nervosa employs behavioral
strategies including the establishment of a regular pattern of eating and systematic exposure to
forbidden foods, while simultaneously addressing cognitive aspects of the disorder such as
motivation for change and disturbance in the experience of shape and weight. CBT for anorexia
nervosa also emphasizes schema-level change and challenges the seemingly inextricable tie
between personal identity and the illness

Focal psychodynamic therapy (FPT)

Focal Psychodynamic Therapy (FPT) is a specialized form of psychodynamic therapy that

targets specific issues related to eating disorders, providing patients with an opportunity to gain
insight into their emotions, thoughts, and behaviors. Focal psychodynamic therapy (FPT) is
based on the theory that mental health conditions may be associated with unresolved conflicts
that occurred in the past, usually during childhood. The therapy encourages people with anorexia
to think about how early childhood experiences may have affected them. The aim is to find more
successful ways of coping with stressful situations and negative thoughts and emotions. FPT is
long-term therapy looking at what your symptoms mean to you, how they affect you and how
they affect your relationships with other people. It examines the beliefs, values and feelings you
have about yourself, and helps you to take what you learn into everyday life.

Interpersonal psychotherapy (IPT)

Interpersonal psychotherapists at anorexia nervosa treatment centers also help clients reconstruct
negative and positive aspects of past relationships to further examine their emotions associated
with important relationships. Often, eating disorder clients come to realize how their unhealthy
idealization of certain relationships may have contributed to their anorexia nervosa. As therapists
teach clients to focus less on the past and more on their future by encouraging them to develop
new relationships and interests, clients in anorexia nervosa treatment ultimately begin
understanding how their eating disorder affects their relationships and how some relationships
intensify their anorexia nervosa symptoms. Interpersonal psychotherapy is being used more often
in anorexia nervosa treatment centers because of its effectiveness and associated with cognitive
behavioral therapy. It is similarly structured like CBT and utilizes homework, a time-limited
design, assessment tools, and formatted interviews. Principles of social and attachment theory
are implicated in interpersonal psychotherapy as well, with emphasis placed on the positive
impact social support networks have on anorexia nervosa recovery. Unlike standard
psychotherapy, interpersonal psychotherapy does not try to conceptualize personality disorders
but remains focused on humanistic applications of mindful awareness of elements vital to
healthy, meaningful relationships.

Dialectical behavior therapy (DBT):

This therapy helps you not just develop new skills to handle negative triggers but also helps you
develop insight to recognize triggers or situations where a non-useful behavior might occur.
Specific skills include building mindfulness, improving relationships through interpersonal
effectiveness, managing emotions and tolerating stress.

Family-based therapy:

This therapy involves family-based refeeding, which means putting the parents and family in
charge of getting the appropriate nutritional intake consumed by the person with anorexia. It’s
the most evidence-based method to physiologically restore health to an individual with anorexia
who is under 18 years of age.
Psychodynamic psychotherapy:

This therapy involves looking at the root causes of anorexia as the key to recovery.

Interpersonal psychotherapy:

This therapy is aimed at resolving an interpersonal problem area. Improving relationships and
communications and resolving identified problems may reduce eating disorder symptoms.

Psychodynamic psychotherapy:

This therapy involves looking at the root causes of anorexia as the key to recovery.

Functional Family Therapy (FFT)

Itis an intensive, short-term therapeutic model that offers in-home family counseling designed
specifically to address the referring behaviors (i.e., curfew violations, running away, and truancy)
and juvenile delinquency from a relational, family-based perspective.
Medication
Some healthcare providers may prescribe medication to help manage anxiety and depression that
are often associated with anorexia. The antipsychotic medication olanzapine (Zyprexa®) may be
helpful for weight gain. Sometimes, providers prescribe medications to help with period
regulation.

Family Therapy

The best-studied treatment approach for anorexia is a specific form of family

therapy called the Maudsley model. This intervention involves 10-20 family
sessions over 6-12 months. Ideally, the whole family needs to be seen
together for all sessions. In the first phase, parents are directed to take control
over their child’s eating and weight and are taught effective means to do so.
As the child starts to comply with parental authority, parents’ control is slowly
faded. In the later stages, the adolescent gets back their age-appropriate
authority if their eating disorder has been resolved (Lock, le Grange, Agras, &
Dare, 2001).
Research on the Maudsley method has found that for younger patients with a
more recent onset of symptoms, this method has produced impressive
recovery rates that were maintained even 5 years later. Furthermore, the
method was found to be far more effective than psychodynamically-oriented
individual therapy. Unfortunately, patients with a later onset of symptoms or
longer history of illness neither treatment proved to be beneficial (Eisler et al.,
1997).

Individual Therapy

The most thoroughly studied treatment model for individual therapy for
anorexia nervosa is cognitive-behavioral therapy. CBT for anorexia is similar
to CBT used for bulimia with some key differences: emphasis for anorexia
being shaped by the importance of motivational issues, the effects/problems
related to semi-starvation, and often the need for weight gain (Garner et al.,
1997). It is also important to focus on enhancing patients’ motivation for
change and engaging them as active collaborators (Vitousek, Watson, &
Wilson, 1998).

Studies that compared nutritional counseling alone with CBT found that most
patients assigned to only nutritional counseling drop out and refuse to
participate in sessions, while those in the CBT group complete treatment
(Serfaty, Turkington, Heap, Ledsham, & Jolley, 1999). Also, CBT patients
were slower to relapse after treatment and achieved better outcomes overall
(Pike, Walsh, Vitousek, Wilson, & Bauer, 2003). Other studies also reveal that
the use of nutritional counseling or medication in the absence of
psychotherapy is not recommended for anorexia patients (Wilson, Grilo, &
Vitousek, 2007).

Inpatient Treatment

In the US today, about 50% of all anorexia patients end up hospitalized at

least once during the course of their illness. Some of these admissions are
necessitated by medical crises but often patients are hospitalized because
outpatient therapy proves to be ineffective. Besides the incredibly high costs
of inpatient treatment, there are many other reasons why this might not be the
best option for many. The benefits of rapid weight gain in inpatient treatment
must be balanced against the disadvantages of disrupted continuity of care,
separation from one’s family and natural environment, and increased
identification with the disorder (Gowers et al., 2000). Anorexia patients often
experience residential treatment as demeaning; and often being exposed to
other, more experienced patients can prompt patients to want to become the
“best anorexic” in the unit (Colton & Pistrang, 2004).

In summary, most anorexia patients should be treated on an outpatient basis

using CBT and family therapy. Hospitalization can be considered when there
is substantial medical or suicide risk or after repeated failures of improvement
despite going through evidence-based treatment modalities. Inpatient units
need to provide structured regimens focused on refeeding and weight gain
along with psychosocial interventions. If possible, residential treatment should
occur near the patient’s home and community followed by at least 12 months
of outpatient care (Wilson, Grilo, & Vitousek, 2007).