The Treatment and Outcomes of Chronic Anorexia

The last few posts summarized new directions for diagnosis and treatment of eating disorders, primarily around concomitant psychiatric and medical illnesses. Treating these issues can enhance and improve overall outcome.

However, I don’t want to be misleading. The treatment of anorexia remains prolonged and difficult for many people. Recognizing new ideas for treatment is promising, but research into chronic anorexia in particular has not led to any options that vastly improve outcome.

Of all the eating disorders, anorexia is the hardest to treat with the lowest success rate. Research into these diagnoses tends to focus on anorexia just for this reason.

The improvement in treating anorexia is likely to uncover a variety of causes of the illness from trauma to autoimmune disorders to hormonal dysregulation and more. No one diagnosis or treatment is likely. Anorexia will much more likely be an umbrella for various illnesses and causes.

A significant percentage of people with anorexia seek treatment early and find that the persistent thoughts to restrict food dissipate quickly enough to lead to significant recovery. The increased access to diagnosis and care has helped these patients enormously.

However, there is also a significant percentage of patients who don’t respond to initial stages of care. Often residential treatment only hardens the resolve of the thoughts to restrict and the anorexia becomes chronic.

These patients need an outpatient team which typically involves a doctor, therapist and dietitian and often other group treatment or outpatient programs to maintain stability and build towards a slower recovery.

Fundamentally, recovery for this group involves setting a meal plan and following it. The eating disorder thoughts for some people only get louder and stronger when following a meal plan so often much more individualized care is necessary.

For these patients, recovery inevitably means pushing through a prolonged period of internal struggle between the desire to be well and have a larger life and the extreme internal pressure of the eating disorder to follow the rules of restriction.

This battle between these two sides often feels like an internal war that can be excruciating.

This treatment plan can and often does work over a period of years. The question is not whether this plan is successful but whether each person can tolerate the distressing process. Support from a dedicated and caring team makes all the difference, but the process remains difficult and lonely.

Hope and care are the foundation of success in recovery from chronic anorexia. People absolutely do get well. Continued understanding of the underlying causes will, hopefully sooner than later, offer other options for treatment.