Anorexia nervosa: treatment for children and young people

Anorexia nervosa: treatment for children and young people

Family therapy

Many children and young people with anorexia find it helpful to have a talking therapy that family members or carers can take part in too. This is known as family therapy. It involves working with a practitioner (for example a therapist), and allows you to explore how anorexia has affected you and how your family can support you to get better.

You should be able to choose whether to have therapy sessions together with your family or separately (you can also have a mixture of both). Sometimes family therapy is offered together with other families.

Family therapy usually involves between 18 and 20 sessions over a year. After the first 4 weeks, your practitioner should check if you are happy with how often you have sessions and how long they last. You can make changes if you want to. Your practitioner should ask you about this every 3 months after that, to make sure the therapy suits you.

What does family therapy involve?

To start with, your practitioner will want to get to know you and your family and build up a good relationship with you all. Your therapy will involve:

  • thinking about ways your family can help you to get better – it is not about blaming anyone for your anorexia

  • learning about what happens to your body when you are starving

  • supporting your parents or carers to help you manage your eating until you feel ready to be fully in control again

  • working with your family to make sure they give you independence when you need it and are ready for it

  • preparing for the end of your treatment and showing you how to cope at times when you are finding it hard to stick to your new eating habits (this is called relapse prevention)

  • making sure you know how you can get support if you need it after your treatment finishes.

Other talking therapies

If family therapy is not right for you, your practitioner might suggest cognitive behavioural therapy (CBT) or adolescent-focused psychotherapy. Ask your practitioner if you would like to know more about these.

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 also usually have some sessions with your parents or carers.

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).

Adolescent-focused psychotherapy

This therapy involves up to 40 sessions with a practitioner. The sessions will be regular early on when you need the most help, and less regular when you start to feel better. You can also have some sessions with your parents or carers if you think this might help. The therapy normally lasts between 12 and 18 months. It should include:

  • helping you cope with fears about weight gain

  • understanding nutrition and starvation

  • helping you understand what causes your anorexia, and how to change your behaviour to stop it.

Eating a healthy diet

Food gives you the energy and vitamins you need to grow and develop properly. This is important as you reach your teenage years when your body is changing quickly. If you have anorexia, you might not be getting everything you need from your diet, so your doctor should encourage you to take vitamins and minerals. They should also give you advice about the best foods to eat to stay healthy and grow.

If you are having therapy separately from your parents or carers, your practitioner will need to tell them about any eating plans you have agreed so that they can support you at home.

Growth and development

Anorexia has physical effects on your body and your growth. If your body weight is low for a long time it can delay your puberty (the time when your body becomes more adult-like, when you are about 13). For girls and women, it can also make your periods stop.

If your doctor thinks anorexia might be causing problems with your growth and development they might make an appointment for you to see a specialist to help with this.

Bone health

Anorexia can also interfere with building strong bones. Because of this, you may be offered a special type of X-ray called a bone density scan to check if your bones are healthy. You might be offered this if you have been underweight for a year or more, but it might be offered sooner if you have pain in your bones or have had lots of fractures (broken bones). Your doctor should talk to you about bone scans and whether having one might be useful.

Bone problems can be worse in girls and women. Because of this, you may be offered medicine to help with your body's growth if you are underweight or have bone problems.