Eating Disorders 463
P SN(CBT) is generally considered the method of choice. Regardless of the severity
of the eating disorder, frequent visits with an internist or family doctor are an
important additional component of treatment. The physician determines whether a
patient should be medically hospitalized and, if not, whether she is medically stable
enough to partake in daily activities. Let’s examine treatment options using the
neuropsychosocial approach.
Targeting Neurological and Biological Factors:
Nourishing the Body
Neurologically and biologically focused treatments are designed to create a pattern
of normal healthy eating and to stabilize medical problems that arise from the eat-
ing disorder. Treatments that focus specifi cally on these goals include nutritional
counseling to improve eating, medical hospitalization to address signifi cant medical
problems, and medication to diminish some symptoms of the eating disorder as well
as symptoms of comorbid anxiety and depression.
A Focus on Nutrition
For people with any type of eating disorder, increasing the nutrition and variety
of foods eaten—and not purged—is critical. A nutritionist will help develop meal
plans for increasing caloric intake at a reasonable pace. In the process of nutritional
counseling, the nutritionist may identify a patient’s mistaken beliefs about food and
weight; the nutritionist then seeks to educate the patient and thus help her correct
such beliefs.
When very low weight patients with anorexia increase their food intake tooaggressively, they can develop refeeding syndrome, in which rapidly shifting blood
electrolyte levels can cause congestive heart failure, mental confusion, seizures,
breathing diffi culty, and possibly death (Mehler, 2001; Pomeroy, 2004; Swenne,
2000). For such low weight patients, caloric intake should increase at a moderate
pace. Despite improved nutrition, menstruation may not restart (or begin) months
after a woman’s weight and body fat are in the normal range.
As people with anorexia begin to eat more, they may experience gastrointesti-nal discomfort. This may occur for two reasons: First, because of a lack of body fat,
eating more may compress a section of the duodenum (a part of the intestine) that is
on top of an important artery (Adson, Mitchell, & Trenkner, 1997). Second, when
people eat no fat (or very small amounts of it), their ability to produce bile, which is
necessary for the digestion of fats, diminishes. With reduced bile production, people
may feel uncomfortable after eating fats. To minimize this discomfort, nutritionists
suggest reintroducing fats slowly; bile production increases with increased fat con-
sumption over the course of a couple of weeks.
Medical Hospitalization
The bodily effects of eating disorders—particularly anorexia—can be directly life-
threatening. When medical problems related to eating disorders become severe, a
medical hospitalization rather than a psychiatric hospitalization may be necessary.
Medical hospitalization generally occurs in response to a medical crisis, such as
a heart problem, gastrointestinal bleeding, or signifi cant dehydration. The goal of
medical hospitalization is to treat the specifi c medical problem and stabilize the pa-
tient’s health.
Medication
Generally, various medications have not been found to help with the weight gain phase
of treatment for anorexia (Crow et al., 2009; de Zwaan, Roerig, & Mitchell, 2004;
Rivas-Vasquez, Rice, & Kalman, 2003; Walsh et al., 2006). However, once the patient’s
normal weight is restored, selective serotonin reuptake inhibitors (SSRIs) may help pre-
vent the person from relapsing (developing anorexia again; Barbarich et al., 2004).