• Programs for Eating Disorders

    Anorexia Nervosa

    We Can Help You Recover from Anorexia!

    We offer Anorexia treatment as well as treatment for other eating disorders.

    In order to receive help for Anorexia Nervosa, the first step is to contact our Intake Coordinator at 314-289-9411. Our Intake Coordinator will match you to one of our clinicians who will evaluate your concerns and make recommendations to you. Your insurance coverage will also be reviewed by the intake coordinator.

    The first step is an important one and only you can place the call.

    Anorexia Nervosa (Food Restriction and Avoidance)

    “I will never let myself get fat.”iStock_19213450XSmall_ED_anorexia

    “No one will like me if I gain weight.”

    “Weight loss shows that I am independent and have self-discipline.”

    Anorexia Nervosa is a psychiatric disorder that frequently begins in adolescence and is characterized by an intense pursuit of thinness that results in losing to an unhealthy weight. Often the person is absolutely convinced that she is obese or in immediate danger of becoming fat, when she is actually very thin. Sometimes dangerous methods of weight control are used such as semi-starvation, which is eating very limited amounts of food, exercising excessively, avoiding foods believed to be fattening, or purging via vomiting or laxative abuse.  Often the condition worsens and accelerates quickly as increasing categories and types of foods, or amounts of food are avoided. 

    When present, exercise requirements tend to become increasingly demanding.  Excessive exercise without allowing proper rest and in extreme excess of consumed calories creates a serious and traumatic burden to physical health.

    While the amount of weight loss can be striking and methods used to achieve weight loss can be very dramatic, the core of the disorder is the obsessive preoccupation with thinness as the primary, if not exclusive basis for judging one’s worth. The affected individual is never satisfied with the amount of weight loss, no matter how great. The perception of one’s own appearance is typically extremely distorted.

    Anorexia Nervosa may initially go unnoticed because it is masked by accomplishments in school and sports.   Individuals who develop anorexia are often people pleasers who avoid conflict and, therefore, may not be readily identified by parents or teachers as having problems.  Socio-cultural influences that promote a thin ideal contribute to a diet mentality.  What becomes a relentless pursuit of weight loss may start initially as a response to learning about weight management and nutrition as part of a healthy lifestyle.  However, applying expectations of perfection associated with high achievement in other areas to the goal of weight loss may quickly turn into life threatening behaviors, especially in younger adolescents.

    Weight loss methods may also serve psychological functions of perceived control and coping strategies for uncomfortable emotions such as anxiety and anger.  Anorexia Nervosa is commonly associated the tendency to have other obsessive-compulsive behaviors, other anxiety disorders, and depression.  Neurobiological factors can also produce and exacerbate symptoms.  Disturbances in the serotonin system and changes in brain structure and functioning are associated with semi-starvation and nutritional deficiencies.

    Medical Complications

    Weight loss and reliance upon unhealthy methods of weight control can result in serious medical complications. The most common complications are amenorrhea (loss of menstruation), dry skin, and intolerance to cold temperatures. Sometimes, there is downy hair on the face or limbs, called lanugo. Heart irregularities, dizziness and low blood pressure can occur. Chronic low weight can lead to infertility and osteoporosis (thinning of the bones). The longer the person is low weight and persists at using unhealthy weight control methods, the more serious the medical problems are likely to be. Without treatment, it is estimated that up to 20% of individuals with Anorexia Nervosa are likely to die, either from medical complications or from suicide.  The risk of making a suicide attempt is higher than in the general population as well as in other eating disorders.

    Anorexia Nervosa Treatment

    Anorexia Nervosa, like other eating disorders, can be treated effectively. Many individuals with Anorexia Nervosa will eventually recover although it may require a year or more of treatment. Effective Anorexia treatment consists of four components:

    1.)  Assessing and managing medical problems that may be present.

    2.) Addressing eating behavior directly in order to achieve a healthy meal pattern and healthy weight restoration.

    3.) Medication: When medication is considered, a positive response may require a longer time period at higher doses of medication, typically SSRIs (Serotonin reuptake Inhibitors) for symptom reduction and sometimes low dose antipsychotics are administered.  

    Weight restoration is often a painful and difficult process that requires empathy and support from loved ones and care providers.  Sometimes medications are administered to initially help manage anxiety associated with eating so as to facilitate weight restoration.  It is often argued that SSRIs or other forms of antidepressants and outpatient therapy are most effective once a client has restored weight to within 90% of Ideal Body Weight (IBW).

    Psychological treatment:

    • Important components of psychological treatment are assessing a client’s readiness to change and addressing resistance.

    • Food avoidance and restricting behaviors are treated utilizing research supported behavioral exposure therapy with anxiety management techniques.   The necessity of restoring nutrition and weight that often dictates the pace of exposure work.

    • Family Based Treatment (FBT- also known as the Maudsley Approach) has been demonstrated in controlled research studies to be highly effective in treating adolescents with Anorexia Nervosa.  Controlled research studies report success rates as high as 80-90% within the home environment, thereby reducing costly admissions to residential or inpatient treatment facilities.  The focus of FBT is empowering parents to be actively iStock_11221660XSmall_ED_Anorexiainvolved with their child’s weight restoration and the return to their normal developmental trajectory.  Medical evaluation and ongoing monitoring by a physician is required, especially during weight restoration.

    There is still relatively little research about the use of Cognitive Behavior Therapy (CBT) for Anorexia but research suggests that CBT appears more helpful than family therapy in adult populations.  CBT is generally offered for a longer period of time than for Bulimia Nervosa (link) and in different ways than for other conditions.

    Additional therapeutic interventions are aimed at developing behavior plans to prevent and respond to urges to restrict and/or purge; identifying and changing cognitive distortions about appearance and self-worth; developing better means of demonstrating independence; developing adaptive coping skills for stress and anxiety; learning to balance self-care with achievement; improving personal relationships; and communicating more clearly with family and friends. Weight gain is the first goal of treatment, but the more difficult treatment goal of addressing serious psychological issues must be accomplished if the person is to avoid relapse.

    When a family is unable to achieve success in the home environment due to the severity of the condition, other family obligations and/or due to high conflict in the home, intensive programming can help alleviate some of the stress.  Furthermore, when medical concerns are present, inpatient medical hospitalization is often the first step of recovery.  Obtaining the right level of care and combination of treatment services is critical for effective recovery.  When clients are under treated, there is a risk of discrediting treatment and creating a cycle of blaming and hopelessness.  Our assessment will determine an individualized treatment plan that represents the best match between symptom severity and effective interventions.

    No single professional can provide all of the care an individual with an eating disorder requires. We believe a multidisciplinary approach is the best way to treat eating disorders.

    If you suspect that you or someone you know is struggling with Anorexia Nervosa, please contact our anorexia treatment center in St. Louis, MO at 314-289-9411.