Anorexia nervosa: treatment for adults

If you have anorexia you should usually be offered a talking therapy. This kind of therapy helps you to understand the causes of your eating problems and learn new ways of thinking and behaving. You may be offered cognitive behavioural therapy (CBT), the Maudsley Anorexia Nervosa Treatment for Adults (MANTRA) or specialist supportive clinical management (SSCM). Treatment aims to help you feel comfortable around food, so you can eat enough to stay healthy. It is also likely to involve helping you reach a healthy weight.

What does cognitive behavioural therapy involve?

If you have CBT you should be offered weekly therapy sessions for up to 40 weeks (9 to 10 months). For the first 2 or 3 weeks you should be offered 2 sessions a week. You will work with a practitioner (for example a therapist) to make a personal treatment plan and start making changes in your behaviour. This should involve:

  • coping with your feelings

  • understanding nutrition and starvation

  • helping you to make healthy food choices and manage what you eat.

You should be given simple 'homework' to help you put into practice what you have learned. You should also be taught how to monitor your own progress, and how to cope with times when you find it hard to stick to your new eating habits (this is called relapse prevention).

What does the Maudsley Anorexia Nervosa Treatment for Adults involve?

You should be offered 20 sessions with a practitioner. The first 10 should run weekly, and the next 10 can be on a flexible schedule based on what works best for you. Some people will have extra sessions, depending on how severe their problems are.

MANTRA helps people to understand what causes their anorexia. It focuses on what is important to you personally, and on encouraging you to change your behaviour when you are ready. Your family and carers can be involved in the therapy too if you think it could help.

What does specialist supportive clinical management involve?

You should be offered 20 or more weekly sessions. At these sessions your practitioner will help you to explore the main problems that cause your anorexia. You will learn about nutrition and how your eating habits cause your symptoms. Your practitioner will help you set a target weight and encourage you to reach it.

You can also include other things as part of the therapy if you want to (such as improving relationships with other people, or getting back into work or education).

Changing to a different therapy

If you are offered a therapy and you don't think it is right for you, or you try one and it doesn't help, you should be able to have a different therapy. Talk to your practitioner if you think you would like to try something different. It could be another of the therapies above, or a treatment called focal psychodynamic therapy.

What does focal psychodynamic therapy involve?

You should be offered weekly sessions over 40 weeks (9 to 10 months). Your therapy should include looking at how your eating habits are related to your thoughts, beliefs and self-esteem. It helps you to discuss feelings you have about yourself and other people in your life, and how these influence your eating behaviour.

Diet advice

During your treatment you may be given some advice about healthy eating by a dietitian. Although a healthy diet is important and will help you get to a healthy weight, dietary advice on its own does not work as a treatment for anorexia so you should be offered other therapies too.

While you are recovering you should take a multivitamin and mineral supplement, to make sure you get the vitamins and minerals you need.

Bone health

If you have anorexia your bones can become weaker, especially if your weight has been very low for a long time. Losing bone strength makes you more likely to develop osteoporosis, a condition where your bones become fragile and break (fracture) easily, even from a minor knock or fall.

If you have osteoporosis or another bone disorder you will need to be careful about what types of exercise you do. To avoid broken bones you should avoid high-impact physical activities like running, and other activities that might increase your chance of falling. The best way to protect your bones is to work towards reaching a healthy weight or BMI.

Tests and treatment for low bone strength

Your doctor may offer you a special type of X-ray called a bone density scan to check the health of your bones. This is normally for adults who have been underweight for 2 years, but it may be offered earlier if you have pain in your bones or have had a lot of fractures. Your doctor should talk to you about bone scans and whether having one might be useful.

Women with anorexia are at particular risk of low bone strength. Because of this, if your bone strength is very low you might be offered a medicine called a bisphosphonate, which is used to treat osteoporosis. Before you start taking this medicine it's important to discuss with your doctor the pros and cons (including side effects), so you can decide if it's right for you.