Medications (medicines) are not part of the standard treatment for anorexia nervosa because there is not strong enough evidence that they are effective.
For people with bulimia nervosa or binge eating disorder, if you also have another mental health condition such as depression, anxiety, impulse control or substance use disorder, your doctor may prescribe antidepressant or mood-stabiliser medications. These medications may also be useful alongside psychological treatment, even if you don’t have one of these conditions.Research shows that antidepressant medications can help people with bulimia nervosa reduce their uncontrolled overeating, as well as improve their mood.
Your doctors may suggest a low dose of an antipsychotic or antidepressant medication if you have symptoms of anxiety or obsessive thinking. People with a very low body weight have a higher risk of unwanted side effects from these medications, so they are prescribed only when necessary.
Tell your health-care team immediately if you think you may be having side effects from a medication.
In addition to nutrition and medical treatment, to recover and stay well you must also make changes in your thinking and behaviour. Psychological treatment is an essential part of treatment for everyone with an eating disorder. It provides a chance to find out what triggers a person’s eating problems and to work out how to deal with them.
There are many different types of psychological treatments, but all involve talking with a therapist (a psychologist or psychiatrist). These treatments are designed to help you understand your thinking, actions and relationships, so that you can make changes that will make you less distressed and make everyday living easier.
Some of the main psychological treatments used to help people with eating disorders are:
- family therapy (family members work together as a team to directly manage a child’s behaviour)
- cognitive behavioural therapy (works by teaching you to recognise your negative thoughts and beliefs and to challenge them, so that you can change your behaviour)
- interpersonal psychotherapy (focuses on the link between when and how your symptoms started and on problems you have relating to other people)
- psychodynamic psychotherapy (focuses on uncovering what’s on your mind that you are not normally aware of).
For children and teenagers with anorexia nervosa, family therapy is usually the best choice. Other types of psychological treatment are considered if family therapy is not possible or has not been successful.
If you are severely underweight, you will need to begin your physical recovery before you start psychological treatment, so you are strong enough and your brain is working properly.
Whichever therapy you and your health-care team decide on, three things will always be true:
- You will play an important role in your own treatment.
- You will need to be patient and keep persisting.
- You must be committed to the treatment.
Challenging the way you think, feel and behave is very hard work. This may be distressing as you work through issues and problems with your therapist, and begin to make changes that affect the way you live your life.
It takes time and persistence to achieve real change. Learning new ways of thinking, feeling and behaving will involve trial and error, and may be very frustrating. This process may take many months before you discover subtle changes in the way you think about yourself and the world around you. The goal for you is to be in control of your thinking and feeling – and therefore in charge of your behaviour.
It is important for everyone involved in your treatment to be committed to it. For example, family therapy would not be the best choice of treatment if a key person in your family is not supportive or is not always available.
Other practical help
Adults with long-term anorexia nervosa may need help with nutrition, housing, financial issues, and recreational and occupational activities. If substance use is a problem, your health-care team will arrange treatment.