Psychiatric Support and Treatment for Anorexia, Bulimia, and BED

Eating disorders like anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) are serious mental health conditions which develop from a complex interplay of biological, psychological, and environmental factors.

Treating these conditions, especially alongside co-occurring mental health disorders, can be challenging. But recovery is always possible, especially with the help of psychiatric support and treatment.

Each patient’s treatment plan should be tailored to their particular needs, but psychiatric treatment can include talk therapy sessions, medical and psychiatric care and evaluations, and medication recommendations which may be able to help.

Types of Psychiatric Treatments for Eating Disorders

Psychiatry is a branch of medicine that focuses on treating mental, emotional, and behavioral disorders, though it often draws from a larger pool of treatment options than mental health therapy alone.

Psychiatrists are both medical doctors and mental health specialists, allowing them to treat both the physical and mental aspects of eating disorders and other mental health disorders. Some techniques often used by psychiatrists to treat eating disorders include: [1]

• Medical and psychological evaluations
• Psychotherapy sessions
• Pharmacological treatment (use of medicine to treat symptoms)

Depending on the specifics and severity of the case, one or all of these types of treatment may be necessary. Though, a psychiatrist will frequently work within a team of experts, including nutritional counselors, mental health therapists, nurses, pediatricians and other medical personnel, to help develop the best possible eating disorder treatment plan to address all of a patient’s physical and mental health concerns.

Psychotherapy for Eating Disorders

Psychotherapy—or, talk therapy—is often a crucial part of helping someone recover from an eating disorder, especially if they have co-occurring mood and anxiety disorders.

Someone can receive talk therapy from their psychiatrist, or a mental health therapist or counselor. (Generally, therapists and counselors are licensed to practice psychology but do not have a medical degree.)

And when it comes to eating disorders like AN, BN, and BED, there are a few types of psychotherapy that are more commonly recommended.

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy (CBT) is generally considered the leading evidence-based treatment for eating disorders. It’s been found particularly helpful for those with bulimia nervosa and, to a lesser but still strong extent, binge eating disorder, though people with AN respond about the same to CBT as other types of psychotherapy. [2]

At its core, cognitive behavioral therapy revolves around the idea that unhelpful behaviors come from unhelpful thoughts. As such, it focuses on helping patients first identify, then redirect, and, eventually, eliminate these thoughts. [3]

Patients undergoing CBT follow a highly-structured course of treatment, working through certain modules which are planned out beforehand. As a patient progresses, they’ll learn how to identify unhelpful thought and behavioral patterns and be given “homework assignments” to help them break free from these reactions. Toward the end of their treatment sessions, people in CBT are also taught healthier coping mechanisms and ways to monitor for triggers or backsliding moving forward. [3]

Acceptance and Commitment Therapy (ACT)

Acceptance and commitment therapy works in almost the opposite way as CBT. Rather than have a patient zero in on disordered thoughts in order to change disordered behaviors, it implores them to accept the pain behind these thoughts as just another part of the human experience.

Fostering this level of acceptance can help someone let go of their pain, diminishing its power and the unhelpful thoughts it might produce. [4] It can also help build mental flexibility, which can counteract the rigid thinking patterns that frequently uphold disordered eating behaviors. [5]

Instead of spending energy focusing on proactively changing one’s thoughts, ACT asks patients to spend that energy proactively getting involved in causes that are important to them and align with their morals. This can also help patients more naturally shift their thoughts toward subjects other than food and eating.

Importantly, ACT has also shown promise in helping people with anorexia nervosa, who historically have had mixed reactions to psychotherapy treatment. [6]

Interpersonal Psychotherapy (IPT)

Interpersonal psychotherapy takes a slightly different approach at treating eating disorders. Rather than examine childhood development or other facets that may have contributed to disordered eating behaviors, it focuses on someone’s social relationships in the present, and how they may affect thoughts and actions.

Like CBT, IPT is a highly-structured form of therapy that generally follows pre-set modules. In the beginning of treatment, a patient will describe what they’re going through, then, together with their therapist, they’ll choose a major area of focus. In the end, the patient will learn strategies for asserting their needs and wishes in a healthier way, to help maintain independence and higher self-esteem. [7]

While notably slower than CBT, IPT has been found effective for treating both BN and BED, especially in helping reduce binging and purging behaviors. And, when combined with CBT, it also had success at helping people with AN remain stable in recovery. [8]

Medication for Eating Disorders

Aside from attending to the mental health issues at play, a psychiatrist can also help treat physical complications of eating disorders. This can sometimes result in prescribing medication.

Currently, there’s only a few medications that are specifically approved to treat eating disorders in the United States, including: [9, 10]

• Fluoxetine (Prozac): An antidepressant that’s been approved to treat bulimia nervosa and obsessive-compulsive disorder, which frequently co-occurs with eating disorders.
• Lisdexamfetamine Dimesylate (Vyvanse): A stimulant approved to treat binge eating disorder.

Depending on someone’s case, comprehensive psychiatric treatment may include the prescription of these medications. Certain types of antidepressants called selective serotonin reuptake inhibitors (SSRIs) are also often prescribed to help treat any co occurring depression. [9]

Still, in general, most psychiatrists don’t rely on medication as a primary treatment, and will instead supplement mental health care with these pharmacological options.

Other Types of Help for Eating Disorders

Psychiatric treatment for eating disorders is often a large part of someone’s treatment plan, but there are other methods that can be used to help patients overcome mental illness and establish healthy eating habits.

Nutritional counseling involves one-on-one meetings with a registered nurse and dietician. This professional is tasked with helping someone with an eating disorder better understand why their beliefs about food or eating habits may be harmful, and offer them advice on building healthy eating patterns. [11]

Still, a nutritional counselor often does address some psychiatric issues, as well, helping people with eating disorders work through any negative feelings they may have about food and helping them build an overall healthier relationship with food. [11]

Meal monitoring and medical monitoring are also often parts of eating disorder treatment. Those in higher-level programs, including residential treatment, partial hospitalization programs (PHPs), and, sometimes, intensive outpatient programs (IOPs), will regularly eat with nurses or other professionals, to benefit from the additional support at a difficult time.

And ongoing medical check-ins can help doctors keep track of important internal levels and measurements that can help them keep track of, and continually advise, a patient’s progress.

Finding Help for Eating Disorders

If you or a loved one are experiencing eating disorder behaviors, it’s important to seek out help. These conditions generally do not go away on their own and only get worse with time.

A psychiatrist can help by issuing an official eating disorder diagnosis or helping you determine your next best steps. But you can also reach out to your primary care physician, therapist, or another trusted medical professional to get the ball rolling.

A number of eating disorder hotlines can also help. These services offer additional information and resources on eating disorders and treatment options, often allowing a caller to remain anonymous throughout the process.

Remember, seeking help for an eating disorder is an act of courage, and one that can make all the difference. The right kind of care can help you restore healthy eating patterns, maintain a healthy weight, and foster a healthier and happier attitude about yourself, your life, and the future.

Resources

1. What is Psychiatry? American Psychiatric Association. Accessed August 2023.
2. Murphy R, Straebler S, Cooper Z, & Fairburn CG. (2010). Cognitive behavioral therapy for eating disorders. The Psychiatric Clinics of North America; 33(3):611–627.
3. Chand S, Kuckel P, Huecker M. (2023). Cognitive Behavior Therapy. StatPearls. Accessed August 2023.
4. Dindo L, Van Liew JR, & Arch JJ. (2017). Acceptance and Commitment Therapy: A Transdiagnostic Behavioral Intervention for Mental Health and Medical Conditions. Neurotherapeutics; 14(3):546–553.
5. Zickgraf H, Richard E, Zucker N, Wallace G. (2020). Rigidity and Sensory Sensitivity: Independent Contributions to Selective Eating in Children, Adolescents, and Young Adults. Journal of Clinical Child & Adolescent Psychology; 51(5):675-687.
6. Berman MI, Boutelle KN, & Crow SJ. (2009). A case series investigating acceptance and commitment therapy as a treatment for previously treated, unremitted patients with anorexia nervosa. European Eating Disorders Review; 17(6):426–434.
7. Markowitz JC, & Weissman MM. (2004). Interpersonal psychotherapy: principles and applications. World Psychiatry; 3(3):136–139.
8. Kass AE, Kolko RP, & Wilfley DE. (2013). Psychological treatments for eating disorders. Current Opinion in Psychiatry; 26(6):549–555.
9. Himmerich H, Kan C, Au K, Treasure J. (2021). Pharmacological treatment of eating disorders, comorbid mental health problems, malnutrition and physical health consequences. Pharmacology & Therapeutics; 271. 
10. Fala L. (2016). Vyvanse (Lisdexamfetamine Dimesylate): First FDA-Approved Drug for the Treatment of Adults with Binge-Eating Disorder. American Health & Drug Benefits. Accessed August 2023.
11. Stidwill, S., & Cook-Müller, I. (2019). Die Rolle der Ernährungsberatung bei der Behandlung von Anorexia nervosa und Bulimia nervosa [The Role of Nutritional Counselling in the Treatment of Anorexia Nervosa and Bulimia Nervosa]. Praxis; 108(14):931–936.

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The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published March 15, 2024 on EatingDisorderHope.com