Treatment for anorexia nervosa (often called anorexia) usually involves a combination of talking therapy and supervised weight gain.
It's important to start treatment as early as possible to reduce the risk of serious complications, particularly if you've already lost a lot of weight.
If a GP thinks you may have anorexia, or another eating disorder, they’ll usually refer you to a specialist eating disorder team or community mental health team.
Treatment for anorexia is slightly different for those under 18 years old. Young people are usually referred to children and young people’s mental health (CYPMH) services, or to a children’s health team in hospital (paediatrics).
If you’re very unwell, you may need hospital treatment.
A number of different talking therapies are available to treat anorexia. The aim of these treatments is to help you understand your eating problems and feel more comfortable with food so you can begin to eat more and reach a healthy weight.
You may be offered any of the following types of talking therapy. If you feel one is not right for you or is not helping, you can talk to your doctors about trying a different kind of therapy.
Cognitive behavioural therapy (CBT)
If you are offered CBT, it'll usually involve weekly sessions for up to 40 weeks (9 to 10 months), and 2 sessions a week in the first 2 to 3 weeks.
CBT involves talking to a therapist who'll work with you to create a personalised treatment plan.
They'll help you to:
- cope with your feelings
- understand nutrition and the effects of starvation
- make healthy food choices
They'll ask you to practise these techniques on your own, measure your progress, and show you ways to manage difficult feelings and situations so you stick with your new eating habits.
Maudsley anorexia nervosa treatment for adults (MANTRA)
MANTRA involves talking to a therapist in order to understand your eating disorder and its effects.
It focuses on what's important to you and helps you to change your behaviour when you're ready.
You can involve your family or carers if you think it would be helpful.
You should be offered 20 sessions. The first 10 should be weekly, with the next 10 scheduled to suit you.
Specialist supportive clinical management (SSCM)
SSCM involves talking to a therapist who'll help you understand your eating disorder, any problems it's causing and what to do about them. You'll learn about nutrition and how your eating habits cause your symptoms.
You should be offered 20 or more weekly sessions. Your therapist will set you a target weight and, over the course of the 20 weeks, will help you reach it.
Focal psychodynamic therapy
Focal psychodynamic therapy is usually offered if you do not feel any of the above therapies are right for you or if they do not work.
Focal psychodynamic therapy should include trying to understand how your eating habits are related to what you think, and to how you feel about yourself and other people in your life.
You should be offered weekly sessions for up to 40 weeks (9 to 10 months).
Nutritional support
During your treatment you'll get specialist dietary advice and a meal plan to help you get to a healthy weight.
However, this advice alone will not help you recover from anorexia, so you'll need to have talking therapy as well as a meal plan.
Your doctors will probably also advise you to take vitamin and mineral supplements so you get all the nutrients you need to be healthy.
You'll usually have regular check-ups to see how you're getting on.
If you’re very unwell, your meal plan may need to be supervised more closely. For some people this might mean a stay in hospital.
Children and young people will usually be offered family therapy.
You may also be offered adolescent-focused psychotherapy or cognitive behavioural therapy (CBT). CBT will be very similar to the CBT offered to adults but also includes some family sessions.
Family therapy
Family therapy involves you and your family talking to a therapist, exploring how anorexia has affected you and how your family can support you to get better.
Your therapist will also help you find ways to manage difficult feelings and situations to stop you from relapsing into unhealthy eating habits once your therapy ends.
You'll have sessions together with your family, and the option to have some sessions on your own with the therapist. Family therapy is sometimes offered in a group with other families.
You'll usually be offered 18 to 20 sessions over a year, and your therapist will regularly check that the schedule is still working for you.
Adolescent-focused psychotherapy
Adolescent-focused psychotherapy will usually involve up to 40 one-to-one sessions, and normally lasts between 12 and 18 months. You'll have sessions more often in the beginning to give you more support.
The therapist will help you:
- cope with your fears about gaining weight
- understand nutrition and healthy eating, and the effects of undereating
- understand your feelings about your identity and how you see yourself
- build your confidence and help you manage stressful situations
You can also have 8 to 12 therapy sessions with your family.
Nutritional support
If you have anorexia, you may not be getting all the vitamins and energy that your body needs to grow and develop properly, which is especially important as you reach puberty.
During your treatment, your doctor will give you advice about the best foods to eat to stay healthy. They'll probably also advise you to take vitamin and mineral supplements.
They'll also talk to your parents or carers about your diet so they can support you at home.
You’ll usually have regular check-ups to see how you’re getting on.
If you’re very unwell, your meal plan may need to be supervised more closely. For some people this might mean a stay in hospital.
Anorexia can make your bones weaker, which can make you more likely to develop a condition called osteoporosis. This is more likely if your weight has been low for a year or more in children and young people, or 2 years or more in adults.
Because of this, your doctors may suggest you have a bone-density scan to check the health of your bones.
Girls and women are more at risk of getting weak bones than men, so your doctor may prescribe you medicine to help protect your bones against osteoporosis.
Antidepressants are not used to treat anorexia. But you may be offered an antidepressant, such as fluoxetine (Prozac), in combination with therapy, to help you manage other mental health conditions such as:
Antidepressants are very rarely prescribed for children or young people under 18.
Most people with anorexia will be able to stay at home during their treatment. You'll usually have appointments at your clinic and then be able to go home.
However, you may be admitted to hospital, or have day care in a hospital or at home, if you have serious health complications. For example, if:
- you're very underweight and still losing weight
- you're very ill and your life is at risk
- you're under 18 and your doctors believe you do not have enough support at home
- doctors are worried that you might harm yourself or are at risk of suicide
Your doctors will keep a careful eye on your weight and health. They'll help you to reach a healthy weight gradually, and either start or continue any therapy.
Once they're happy with your weight, as well as your physical and mental health, you should be able to return home or to stop having day care.
Compulsory treatment
Occasionally, someone with anorexia may refuse treatment even though they're seriously ill and their life is at risk.
In these cases, doctors may decide, as a last resort, to admit the person to hospital for compulsory treatment under the Mental Health Act. This is sometimes known as "sectioning" or "being sectioned".
It's important that you receive ongoing support after your treatment is finished.
You should have checks of your weight at least once a year, as well as of your mental and physical health. This will usually be done by your GP, but it may be with an eating disorder specialist.
There are many organisations that support people with anorexia and their families, including:
Joining a self-help support group, such as the Beat online support groups (called swan groups) for people with anorexia, may also be helpful.
