Treating chronic restrictive anorexia remains difficult and greatly unchanged in recent decades. Other eating disorders morph over years of an illness into new iterations of symptoms with varying types of treatment and leading to more successful outcomes. Chronic anorexia seems like a different illness altogether.
The disorder only really has one symptom: severe food restriction. These people continue to restrict over many years and decades. For some people, the long period of being malnourished leads to extreme hunger that takes over and leads to binging or eating/purging over time. A small percentage of these patients—the ones I’m talking about—only restrict and can’t stop no matter the severity of the medical illness and even when faced with imminent death.
There is no sense of vanity about weight or size but simply an inability to overcome the thoughts to restrict which function more like commands than how one perceives typical daily thoughts. The thoughts are to be obeyed.
Over the years, numerous studies focused on a wide variety of medications and treatments without benefit. Doctors have studied procedures as well such as Transcranial Magnetic Stimulation and ketamine infusions alone others. Nothing works.
Recently, links between this type of Anorexia and Autism, PTSD, ADHD, mast cell activation syndrome and metabolic disorders have been suggested. There is no research yet definitively connecting any of these disorders and no treatment options known to be helpful. However, new ideas about restrictive anorexia have spawned theories about the underlying causes and possible treatments.
My approach with people with this type of chronic anorexia is to create highly individualized treatment plans. The plan is to work with a team of clinicians who are right for this person, address any medical issues that come from chronic anorexia, clarify goals and above all create treatment based on medical knowledge, understanding, kindness and compassion.
A plan that incorporates all these facets ensures that the progress is appropriate for each person and focuses on the needs and goals of each individual. No plan can prioritize other ideas such as legal protection for the clinicians, the punitive approach of residential treatment or unrealistic goals. The purpose of treatment needs to center on the person’s life and well-being.
The approach to help people with restrictive chronic anorexia is different from other eating disorders. I suspect one day there will be a clearer medical explanation for this illness and new types of treatment. However, there is enough knowledge now to often help these patients get a lot better.
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