Therapy for Anorexia Nervosa
Anorexia Nervosa, commonly referred to as anorexia, is a mental health condition characterised by a restrictive diet and/or compulsive exercise in the pursuit of low body weight. Body image and emotional regulation difficulties also feature as part of this mental health condition.
Anorexia Nervosa is a complex and deadly disorder. It currently claims the most number of lives of all psychiatric disorders (Auger et al., 2021). Early intervention for people suffering from Anorexia has been shown to improve their likelihood of recovery (Fukutomi et al., 2015).
Unlike depression or anxiety, where there is specific medication that might be helpful, there is no conclusive evidence suggesting strong support for pharmacology treatments for eating disorders (Vos et al. 2014; Zipfel et al., 2015).
Anorexia Nervosa treatments are largely psychological and nutritional (Zipfel et al., 2015). For adolescents, the evidence consistently suggests that ED-focused family therapy is more effective than individual therapy (Brockmeyer et al., 2018; Zipfel et al., 2015). While there is no leading psychotherapeutic treatment for adults suffering from Anorexia Nervosa, the existing psychological therapies have shown significant improvements in body weight, reductions in AN symptoms, and distress levels (Solmi et al., 2021).
Types of Psychological Therapies for Anorexia Nervosa
Family-Based Therapy (FBT)
What is Family-Based Therapy? It is a manualised outpatient therapy. This is the first-line treatment for adolescents and children struggling with Anorexia Nervosa. It has 3 phases.
Phase 1: Restoration of adolescents’ physical health by parents. As the adolescent has difficulties making healthy decisions about their food, parents are temporarily given responsibility for deciding what, how much, and when food is eaten. The goal of FBT is to allow the client to recover in their regular environment. This continues until there is steady weight gain.
Phase 2: Gradual transition of responsibility back to adolescent at an age-appropriate level. Parents might oversee meals and add portions for the adolescent where necessary.
Phase 3: Review or progress as well as identification and management of upccoming challenges as a family.
Enhanced Cognitive Behavioural Therapy (CBT-E)
What is CBT-E? Otherwise known as Enhanced Cognitive Behavioural Therapy, it is a psychological treatment model developed by Fairburn and colleagues. It was initially designed for people struggling with Bulimia Nervosa but later evolved to be applicable for all eating disorders (transdiagnostic). It has 4 stages and includes 20-40 weekly sessions.
Stage 1: Develop a mutual understanding of the eating problem and stabilising the pattern of eating
Stage 2: Review progress and made plans for treatment
Stage 3: Address processes maintaining eating problem (e.g., concerns about shape and eating, ED cognitions)
Stage 4: Address maintaining change, and relapse prevention.
Specialist Supportive Clinical Management (SSCM)
What is SSCM? SSCM is the provision clinical management for eating disorders with a supportive therapeutic style. This is likely to be the standardised form of outpatient treatment where clients with Anorexia Nervosa receive 30 weekly individual therapy sessions and 4 monthly follow-up sessions for clients with BMI under 15. Therapy content in SSCM might includes psychoeducation, assessment and review of target symptoms, establishing therapy goals (e.g., weight range), and nutritional education alongside any other client-specific needs.
Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA)
What is MANTRA? This is a modular psychological therapy for Anorexia Nervosa based on 4 factors underlying the psychopathology of Anorexia Nervosa - (1) thinking style characterised by inflexibility, excessive attention to detail and fear of making mistakes, (2) impairments in socio-emotional functioning, (3) positiive beliefs about Anorexia Nervosa, (4) unhelpful response of close others including over-involvement and criticism. The modular nature of MANTRA is reflective of its motivational and flexible nature, to best fit the needs of the client.
Where should I seek support for Anorexia Nervosa?
Seeking support from trained professionals is critical. Hospitals are most likely providers of SSCM and are also likely to offer outpatient psychotherapy services as well. If you have a dedicated eating disorders unit near you, that would be a great place to start as well.
Hospitals are likely to be the best place to go to if the person struggling with Anorexia Nervosa is:
severely ill (BMI is below 16; DSM-5, 2013)
has current and active medical complications (e.g., dizziness, difficulties walking)
suicidal or actively self-harming
If the person struggling with Anorexia Nervosa is medically stable and/or has medical support, seeking psychological from your local psychologist of choice would be important. When looking for a psychologist, ask if they have had experience or training in dealing with clients within this population. This is a complex mental health condition and not all psychologists practice within this scope. This is a question best asked during your free 15-minutes consultation prior to starting therapy formally. Ardelle Psychology provides in-person (Singapore) and virtual therapy (global) for eating disorder and offers a free consultation prior to starting.
When in doubt, reach out to your nearest mental health professional and start there! You do not need a diagnosis to seek support with a psychologist or a general practitioner. You can make an appointment to share your concerns with them, and they can direct you to the best possible professional within their network.
If you’re looking for treatment for Anorexia Nervosa in Singapore, here is a free brief guide to Eating Disorders that includes a list of local treatment providers.