Nutritionists work with other professionals whether treatment is inpatient or outpatient. The patient sees a nutritionist, sometimes weekly, sometimes less frequently (some people go for a one-time consultation), who will review a person's food intake, suggest things to add to balance nutrition and perhaps increase weight, and educate the person about how food affects the body in an effort to dispel any distorted thoughts they may have. The psychonutritional approach to the treatment of eating disorders is one in which psychotherapy and medical nutrition therapy carry through the entire recovery process.
Sometimes, medication is an important adjunct to psychotherapy, certainly if there is another illness like depression or OCD, and sometimes just to help manage symptoms better. The effectiveness of pharmaceutical treatment for eating disorders is still under study, but antidepressants or a serotonin reuptake inhibitor have been shown to have some effectiveness. Seroquel, or quetiapine, is a drug under investigation for use as a treatment for anorexia nervosa.
Seroquel is approved for use in schizophrenia and has been used with some success in anorexia. Certain selective serotonin reuptake inhibitors (SSRIs) have been shown to be helpful for weight maintenance and for resolving mood and anxiety symptoms associated with anorexia. Evaluation and treatment may begin during hospitalization, or during outpatient treatment with a psychotherapist.
Also, people with anorexia have symptoms in common with certain forms of depression. They both tend to have higher than normal levels of cortisol, a brain hormone released in response to stress. These connections may help to explain why those with eating disorders often suffer depression, and treatments for depression can help.
Different eating disorders require slightly different treatment programs. Treatment of anorexia calls for a specific program that involves three main phases: (1) restoring weight lost to severe dieting and purging; (2) treating psychological disturbances such as distortion of body image, low self-esteem, and interpersonal conflicts; and (3) achieving long-term remission and rehabilitation, or full recovery.
The primary goal of treatment for bulimia is to reduce or eliminate binge eating and purging behavior. Nutritional rehabilitation, psychosocial intervention, and medication management strategies are used to establish a pattern of regular, non-binge meals, improve attitudes related to the eating disorder, encourage healthy but not excessive exercise, and resolve co-occurring conditions such as mood or anxiety disorders.
Individual psychotherapy (especially cognitive behavioral or interpersonal psychotherapy), group psychotherapy that uses a cognitive-behavioral approach, and family or marital therapy have been reported to be effective. The treatment goals and strategies for binge-eating disorder are similar to those for bulimia.
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