Treatment
The first major difficulty in treating eating disorders is often the resistance by everyone involved:
- The anorexic patient often believes that the emaciation is normal and even attractive.
- The bulimic patient may feel that purging is the only way to prevent obesity.
- Even worse, the anorexic condition may be encouraged by friends who envy thinness or by dance or athletic coaches who encourage low body fat.
- The family itself may deny the problem and be obstructive or manipulative, adding to the difficulties of treatment.
It is very important that the patient and any close friends and relatives be informed about the serious potential of these conditions and the importance of receiving immediate help.
Getting Rid of Unrealistic Expectations
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Patients may drop out of programs if they have unrealistic expectations of being "cured" simply through the therapists' insights. Before a program begins, the following possibilities should be made clear:
- The process is painful and requires hard work on the part of the patient and family.
- A number of therapeutic methods are likely to be tried until the patient succeeds in overcoming these difficult disorders.
- Relapse is common but should not be greeted with despair. (In one study, about 90% of bulimic patients responded to treatments after 6 years.)
Although the outcome for bulimics is generally more favorable than for anorexics, long-term studies are showing recovery in most people treated for anorexia.
General Treatment Approaches
Psychotherapies. All eating disorders are nearly always treated with some form of psychiatric or psychologic treatment. Depending on the problem, different psychologic approaches may work better than others. A 2001 study reported that patients at greater risk for not completing therapy are those with a history of childhood trauma (for example, divorce and abuse). Dropout rates were not related to the severity or duration of the disorder.
Medications. A number of medications may be valuable for these patients depending on the type of eating disorder, psychiatric state, and severity of the condition.
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