Running head: TREATMENT OPTIONS FOR ANOREXIA NERVOSA

Treatment Options for Anorexia Nervosa Huda Abdulrahman Ivy Tech Community College

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Running head: TREATMENT OPTIONS FOR ANOREXIA NERVOSA

Treatment Options for Anorexia Nervosa Approximately 14 million women in the United States are battling with the disease anorexia nervosa (AN). Therefore, adolescent women struggling with AN need effective treatment, and today, after four decades of research, there is an increasing number of treatment options ranging from counseling, to nutritional therapy, to medication. Many of the victims of this disease will battle it for the rest of their lives. AN is described as one of the least understood and most intractable of all mental illnesses (Schindehette, Sandler, Nelson & Seaman, 2003, p. 136). However, if AN is diagnosed early, during the teen years, it is possible to cure it with appropriate treatment (Cooper, 2001). Yet, some researchers and victims still advocate that there is a need for further research in this area (Kaplan, 2002; Hendricks, 2003). Cooper advises that upon recognizing symptoms, such as strict dieting, weight loss, binge eating or fasting, feeling dizzy, weak, and/or depressed, in addition to insomnia, family members should seek out the advice of a health care provider. The health care provider will take a complete medical history as well as do a physical examination. After this process is complete, then the doctor can begin treating the patient with AN, which may include referrals to specialists in counseling, nutrition and other medical fields. One of the more traditional forms of treatment is counseling, which is also referred to as psychotherapy. The goal of psychotherapy is to work with the patient so that through therapy she will be able to control her eating and maintain her body weight. There are two primary types of psychotherapy, and they are individual therapy and family therapy. Individual therapy counsels one on one with the patient. Sometimes there is a team of medical specialists, yet the therapy sessions are between the patient and her doctor(s). This type of therapy has mixed results. According to Robin et al. (1999), an individual therapy is superior when used in treating older

Running head: TREATMENT OPTIONS FOR ANOREXIA NERVOSA

adolescents and those who have late-onset AN. Pike, Walsh, Vitousek, Wilson and Bauer (2003) report finding that concur with this finding. However, both Robin et al. and Pike et al. state that individual therapy is not the best treatment for young adolescents or those with early-onset AN. While individual therapy does not work well with young adolescents or patients with early-onset AN, family therapy seems to have made significant strides in treating this group of patients. In fact, without the involvement of the parents and family as the rapeuticallies, weight gain is extremely difficult to achieve (Geist, Heinmaa, Stephens, Davis & Katzman, 2000, p. 10). Family therapy may not only employ the assistance of parents and other family members, it can also call on schools and friends as part of the treatment strategy. One such strategy is a program called the Maudsley Method. This radically new treatment option was developed in the 1980s at the Institute of Psychiatry and Maudsley Hospital in London. This method coaches parents to help their kids gain weight by whatever means necessaryby preparing their favorite foods, with 24-hour monitoring to prevent purging and hours of cajoling at the dinner table (Schindehette et al., 2003, p. 136). An example of how involved the parents are in this treatment is seen in Abbies story. Abbie, at her low point, weighed only 68 pounds at 17 years old. Usually dinner was a struggle for the entire family as Abbie tried almost anything to avoid food. She would literally squeeze butter out of toast and wipe it on her hands like lotion; all so she could keep away from putting anything with caloric content into her mouth. Then Abbies parents learned of the Maudsley Method and started her in it. Shortly after starting the program, her parents had her wearing white gloves to dinner. The objective was that the food went in its entirety into her mouth not on or under the table or massaged into her skin. The gloves were to be clean at the end of the meal. Her parents said, If she slopped some milk on the table, shed lick it up. She knew that, no

Running head: TREATMENT OPTIONS FOR ANOREXIA NERVOSA

matter what, she had to eat it all (Schindehette et al., 2003, p. 136). Overall, in this family based therapy program the Maudsley Method, the parents are empowered to use food as medicine and many studies report significantly greater success with family based therapy. It is also reported that while the mortality rates for AN still average around 5 to 20percent, the Maudsley Method is reporting success rates as high as 90 percent five years after treatment was initially sought. Other studies agree that family therapy is one of the best treatments for young adolescents and those with early-onset AN (Robin et al., 1999; Geist et al., 2000). While individual and family therapy are two of the more traditional methods of treating AN, nutritional therapy which is called psycho educational therapy is also commonly used. The aim of psycho education is the process of giving information about the nature of the disease in hopes to cultivate behavioral and attitudinal changes in the patient. Furthermore, a study has reported that family based psycho education produces the same results as family therapy while costing less (Geist et al., 2000). However, these results may not be replicated with a group of older adolescents (Pike et al., 2003).Medication is another method used to treat AN. Using medication, pharmacological therapy, to treat AN also has some promising results. Recent evidence suggests a role for medication in the relapse prevention stage of the illness (Kotler & Walsh, 2000). Medication is commonly used along with another form of treatment, as are many of the treatments, too. This is referred to as a multidisciplinary approach. Pharmacological therapy uses medicines that help the patient reduce the fear of becoming fat, depression and anxiety as well as weight gain (Cooper, 2001).While each of these treatments reports success in various groups or when combined with other treatments, there are still individuals who do not feel that the treatments are effective. Hendricks stated that she did not feel that the treatments she was receiving were of any benefit (2003). Kaplan (2002) states:

Running head: TREATMENT OPTIONS FOR ANOREXIA NERVOSA

There is a significant need to find effective management that truly impacts on long-term outcome. There is also a need for the person to be convinced of what methods he or she should be using or exposed to in order for them to be cured.(p.236) Overall, there is a variety of treatments targeting a person with AN, ranging from individual and family therapy, to nutritional counseling to medicine; however, after reading through the literature, it can be noticed that there are still too many young women(and men) like Jennifer Hendricks who lose their battle with AN. Hopefully, the future will hold an increasing number of people whose stories are similar to that of Abbies who managed to beat her weakness.

Running head: TREATMENT OPTIONS FOR ANOREXIA NERVOSA

References Cooper, P. G. (2001). Anorexia nervosa.Clinical Reference Systems, 20, 107-108. Geist, R., Heinmaa, M., Stephens, D., Davis, R., &Katzman, D. (2000).Comparison of family therapy and family group psychoeducation.CanadianJournal of Psychiatry,45,173178.Retrievedfromhttp://allstate.libproxy.ivytech.edu/proxy.ivytech.edu/ Hendricks, J. (2003). Slim to none: A journey through the wasteland of anorexia treatment. New York, NY: McGraw-Hill. Hester, J. (2003, March). Never say die. British Medical Journal, 326(7391), 719. doi:10.1136/bmj.326.7391.719 Kaplan, A. (2002, April). Psychological treatments for anorexia nervosa a review of published studies and promising new directions. Canadian Journal of Psychiatry, 47(3), 235-242. Kotler, L. A., & Walsh, B. T. (2000). Eating disorders in children and adolescents: Pharmacological therapies.European Child & Adolescent Psychiatry, 9, 108-116. Retrieved fromhttp://allstate.libproxy.ivytech.edu/?url=http://search.ebscohost.com Pike, K. M., Walsh, B. T., Vitousek, K., Wilson, G. T., & Bauer, J. (2003, November). Cognitive behavior therapy in the posthospitalization treatment of anorexia.The American Journal of Psychiatry, 160 (11), 2046-2049.doi:10.1176/.ajp.160. 11.2046 Robin, A. L., Siegel, P. T., Moye, A. W., Gilroy, M., Dennis, A. B., &Sikand, A. (1999, December). A controlled comparison of family versus individual therapy for adolescents with anorexia nervosa. Journal of the American Academy of Childand Adolescent Psychiatry, 38(12), 1482-1491.

Running head: TREATMENT OPTIONS FOR ANOREXIA NERVOSA

Schindehette, S., Sandler, B., Nelson, M., & Seaman, D. (2003, December 15). Recipe for life. People, 60(24), 135-138. Retrieved

fromhttp://allstate.libproxy.ivytech.edu/?url=http://search.ebscohost.com.gary.libproxy .ivytech.edu.allstate.libproxy.ivytech.edu/