Anorexia Nervosa is a harrowing eating disorder diagnosis characterized by extreme restriction of nutritional intake that severely impacts the health, daily life, and relationships of an individual.
Left untreated, anorexia can result in a devastating loss of physical, emotional, and mental wellness.
The likelihood of an individual achieving long-term recovery increases greatly with early intervention, the use of effective treatment methods, and appropriate support from loved ones.
How to Help Someone with Anorexia
For those supporting a loved one engaging in anorexic behaviors, understanding what they are going through can be confounding. From the day we are born, infants have an awareness that they need to nourish. Yet, those struggling with anorexia nervosa withhold life-giving nourishment from themselves. It can be difficult for anyone on the outside to comprehend.
Even with this, it is possible to support your loved one even if you struggle to directly understand what they are going through. Begin with creating space for them to talk about what they are going through. This does not mean approaching bluntly with the assertion that they have anorexia nervosa and need help. Instead, point out the specific behaviors you are observing, express your concern, and ask your loved one what they are going through. While eating disorders are often secret in their nature, many individuals feel freedom when they have space to openly discuss the struggle they are facing.
If your loved one is willing to discuss their disorder, in addition to creating space through listening, practice responding with non-judgment. You do not need to directly understand your loved one’s behaviors or beliefs in order to support them. Approaching them non-judgmentally will help them to continue coming to you for support and models for them how they could approach themselves non-judgmentally as well.
From a more logistical perspective, you can help someone struggling with anorexia nervosa by educating yourself both on the disorder as well as on resources. It might be overwhelming to that individual to seek out support and navigate treatment resources and possibilities by themselves. Having someone assisting them in this reminds them that they are not alone in their fight and will likely help them find appropriate treatment sooner.
Recovery Steps for Anorexia
What treatment for anorexia nervosa looks like varies because anorexia nervosa does not present the same way in any two individuals. Often, the first step in receiving treatment is assessing what level of care is appropriate. An individual with moderate to severe anorexia nervosa is likely medically compromised and would be referred to Inpatient Hospitalization for medical stabilization. This would involve being admitted to a psychiatric hospital eating disorder inpatient unit where treatment focused on beginning appropriate nourishment, monitoring vitals, stabilizing medications, and beginning therapeutic work.
A step down from Inpatient Hospitalization involves Residential Treatment, wherein an individual lives in a home-like setting, engaging in continued refeeding while attending group, individual, and family therapy and meeting with a Dietitian and Psychiatrist.
Partial Hospitalization (PHP) is the next lowest level of care. In PHP, individuals live at home while attending 6 to 8 hours of individual and group therapy per day. Essentially, treatment becomes the individual’s job while they begin re-emerging into their home environment and daily life.
Intensive Outpatient follows PHP and is similar to PHP in many ways except that programming only occurs for 4 hours a day. Individuals may also have less individual therapy or dietary sessions to continue building their autonomy separate from their treatment team.
The lowest level of eating disorder treatment is Outpatient, where an individual will meet with an individual Therapist, Dietitian, and Psychiatrist less frequently while maintaining recovery.
To learn what level of care is appropriate, reach out to a treatment center and they will assess the struggling individual. One does not necessarily begin at the highest level of care, however, once beginning at a certain level of care, the clinical recommendation is most often to engage in every level of care on the way down to outpatient.
Effective treatment for anorexia nervosa does not simply involve receiving therapy or attending treatment as there are some therapies proven most effective in supporting an individual toward anorexia recovery.
Cognitive Behavioral Therapy (CBT) is the most evidence-based therapy to treat all eating disorder diagnoses. This treatment helps the individual to identify the beliefs and thoughts that influence eating disorder pathology and supports them in replacing these disordered thoughts and beliefs with recovery-focused thoughts and behaviors.
Dialectical Behavior Therapy (DBT) and Acceptance and Commitment Therapy (ACT) are types of CBT that are also effective in treating eating disorders. DBT teaches individuals to integrate numerous emotion-states that appear seemingly opposite at once while teaching skills to tolerate distressing situations and emotions, regulating emotions, engaging in mindfulness, and improving the communication of needs and thoughts.
ACT supports individuals in identifying their values and learning how to make choices that align with these.
Holistic therapies are also often incorporated into anorexia nervosa treatment. Therapies such as dance movement, yoga, somatic awareness, and art can support individuals in connecting with their bodies, engaging in mindfulness, and learning new outlets to communicate.
How Much Does Anorexia Treatment Cost?
The question of the cost of treatment is much more complicated than the question. The short answer is that it depends on the individual’s insurance. Some insurance companies will cover treatment in its entirety while others may require a copay. Regardless, all insurance companies often approve coverage on a short-term basis and are in consistent communication with the Treatment Team to learn whether an individual meets the criteria required for a specific level of care. If they meet the criteria, they will receive continued coverage. If an individual is declined coverage, they will often need to step down to a lower level of care. If an individual wishes to remain in their current level of care and their treatment team continues to recommend this level regardless of insurance coverage, the individual can self-pay. The cost of this varies depending on treatment facility and level-of-care.
While this might feel like a non-answer to the question, it might be comforting to hear that most treatment centers have Case Management teams that help to navigate insurance, treatment costs, and options that work for each individual’s finances.
Anorexia Treatment Programs: Selecting the Right One
For many, having the option to “choose” a treatment center is a luxury. Insurance often dictates what treatment centers are available to an individual. Within this there are ways to learn if a treatment center is right for your needs. Consider their therapeutic approach and don’t be afraid to ask any questions that arise. Further, ask about the program as treatment will likely be more effective in a program that is multidisciplinary and involves treatment from a therapist, dietitian, psychiatrist, and medical staff. You might also consider a treatment center’s philosophy on eating disorders, particularly how they approach Intuitive Eating and Health at Every Size concepts which are proven to be effective bases for eating disorder recovery.
Ultimately, the biggest predictor of effective treatment is the participation and engagement of the individual. Investing in your treatment and yourself is the most important aspect of your recovery.
Author: Margot Rittenhouse, MS, LPC, NCC
Page Last Reviewed and Approved By: Jacquelyn Ekern, MS, LPC / 12.6.21