Anorexia nervosa is a mental health disorder in which a person restricts food intake. This results in reduced weight, emotional challenges, an unrealistic body image, and an exaggerated fear of gaining weight.

Doctors base the disorder’s severity on body mass index (BMI) and will either diagnose a person with acute or severe anorexia.

The treatment for anorexia may include a combination of medications, therapy, hospital care, and additional support.

This article examines the treatment for severe anorexia and how doctors define severe anorexia. It also looks at treatment for adults, children, and adolescents and explores options such as therapy, medications, food advice, and additional support.

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Treatment for anorexia involves helping people normalize their eating habits and control behaviors to help restore their weight. Doctors will diagnose and treat any additional mental or physical conditions as part of their personalized treatment plan.

In severe cases, a person may develop serious health conditions that require hospital care. People may also need inpatient or residential programs to restore their weight.

Healthcare professionals and individuals may face challenges as the individual with anorexia may have a fear of gaining weight. Doctors will try to overcome barriers by adopting various bespoke methods according to a person’s needs.

Doctors define extreme anorexia nervosa as a BMI below 15, and a person must meet the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) diagnostic criteria for the disorder. Symptoms usually include:

  • intentional calorie restriction
  • significant weight loss
  • intense fear of gaining weight
  • body image distortions

Extreme anorexia can lead to serious medical complications, including:

Learn more about anorexia nervosa.

Doctors may propose talking and behavioral therapies that aim to help adults understand the causes of their eating disorders. They help make people feel more comfortable with food so they can begin to eat more and start to gain weight.

The following are examples of the therapy for adults:

  • Cognitive behavioral therapy (CBT): This involves talking with a therapist to:
    • discuss feelings
    • challenge rules surrounding food
    • focus on negative thought patterns
    • behavioral strategies to help with food
    • understand the drive behind eating disorders
    • understand nutrition
    • understand the effects of starvation
  • Maudsley anorexia nervosa treatment for adults (MANTRA): This therapy involves talking about the possible causes of a person’s eating disorder and using an integrative approach to help people find healthier coping strategies. This may also involve family or carers and will generally consist of 20 sessions.
  • Specialist supportive clinical management: This type of therapy will also involve discussing what is causing the anorexia. People will also learn about nutrition and how their eating habits have a causal effect on their symptoms. There is a focus on clinical symptoms as well as offering supportive therapy.
  • Focal psychodynamic therapy: This therapy helps people understand how their eating habits relate to their thoughts and feelings about themselves and others.

Doctors will usually offer children and young people family therapy. In addition to this, they may have CBT and adolescent-focused psychodynamic therapy.

Research suggests the most effective treatments for adolescents involve helping parents and caregivers to support and monitor their child’s meals. Doctors also recommend addressing body dissatisfaction as an important part of treatment.

Family therapy

Family therapy involves the person and their family talking with a therapist about how anorexia has affected the individual and how their family can support them. Therapists will help people manage difficult situations and triggers to help people avoid relapse.

Therapists can run these sessions with or without family members, and the sessions tend to last for a full year.

Adolescent-focused psychotherapy

Adolescent-focused psychotherapy will usually last between 12 and 18 months and can be with or without the family.

The therapist will help people:

  • manage their fears about gaining weight
  • understand what lifestyle changes can lead to a moderate weight
  • understand the effect of undereating
  • understand the cause of their anorexia and how to stop it

In addition to general CBT, newer interventions include acceptance and commitment therapy and dialectical behavioral therapy. These therapies emphasize how it is important for people to accept and practice mindfulness in tolerating distress to reduce maladaptive behaviors.

Doctors aim to treat symptoms relating to anorexia, such as depression and anxiety, with antidepressant and antipsychotic medications.

They may prescribe antidepressants, in combination with therapy, to help manage mental health disorders.

During a person’s treatment, a doctor may give advice on foods and vitamin and mineral supplements, as those with anorexia will likely be deficient. They will also speak with family members to determine how they can support a person at home.

Healthcare professionals will devise a nutritional plan to ensure an individual is eating a more balanced diet and consuming a wider range of calories across more regularly spaced meals.

People will receive ongoing support after their treatment plan or therapy has finished. A general practitioner may assess a person’s weight regularly and run checks of their physical and mental health. Various organizations support people with anorexia and their families, including:

Doctors may diagnose a person with severe anorexia if they have a BMI below 15 and meet the DSM-TR-5 diagnostic criteria for the disorder.

To treat severe anorexia, healthcare professionals will recommend talking therapies such as CBT and MANTRA for adults. They may suggest family therapy and adolescent-focused therapy for younger people.

In addition to therapy, doctors may prescribe antidepressants and provide food advice and psychological support for individuals and their families.

In severe cases, people may also require hospital care for complications or residential specialty care.