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Treatment varies according to type and severity of eating disorder, and usually more than one treatment option is utilized.[210] However, there is lack of good evidence about treatment and management, which means that current views about treatment are based mainly on clinical experience. Therefore, before treatment takes place, family doctors will play an important role in early treatment as patients suffering from eating disorders will be reluctant to see a psychiatrist and a lot will depend on trying to establish a good relationship with the patient and family in primary care.[211] That said, some of the treatment methods are: Cognitive behavioral therapy (CBT),[212][213][214] which postulates that an individual's feelings and behaviors are caused by their own thoughts instead of external stimuli such as other people, situations or events; the idea is to change how a person thinks and reacts to a situation even if the situation itself does not change. See Cognitive behavioral treatment of eating disorders. Acceptance and commitment therapy: a type of CBT[215] Cognitive Remediation Therapy (CRT), a set of cognitive drills or compensatory interventions designed to enhance cognitive functioning.[216][217][218][219] Dialectical behavior therapy[220] Family therapy[221] including "conjoint family therapy" (CFT), "separated family therapy" (SFT) and Maudsley Family Therapy.[222][223] Behavioral therapy: focuses on gaining control and changing unwanted behaviors.[224] Interpersonal psychotherapy (IPT)[225] Cognitive Emotional Behaviour Therapy (CEBT) [226] Music Therapy Recreation Therapy Art therapy[227] Nutrition counseling[228] and Medical nutrition therapy[229][230][231] Medication: Orlistat is used in obesity treatment. Olanzapine seems to promote weight gain as well as the ability to ameliorate obsessional behaviors concerning weight gain. zinc supplements have been shown to be helpful, and cortisol is also being investigated.[232][233][234][235][236][237] Self-help and guided self-help have been shown to be helpful in AN, BN and BED;[214][238][239][240] this includes support groups and self-help groups such as Eating Disorders Anonymous and Overeaters Anonymous.[241][242] Psychoanalysis Inpatient care There are few studies on the cost-effectiveness of the various treatments.[243] Treatment can be expensive;[244][245] due to limitations in health care coverage, patients hospitalized with anorexia nervosa may be discharged while still underweight, resulting in relapse and rehospitalization.[246] Total costs in USA for hospital stays involving eating disorders rose from $165 million in 1999-2000 to $277 million in 2008-2009; this was a 68% increase. The mean cost per discharge of a person with an eating disorder rose by 29% over the decade, from $7,300 to $9,400. Over the decade, hospitalizations involving eating disorders increased among all age groups. The greatest increases occurred among those 45 to 65 years of age (an 88% increase), followed by hospitalizations among patients younger than 12 years of age (a 72% increase). The majority of eating disorder inpatients were female. During 2008-2009, 88% of cases involved female patients, and 12% were male patients. The report also showed a 53% increase in hospitalizations for males with a principal diagnosis of an eating disorder, from 10% to 12% over the decade.[247] Prognosis estimates are complicated by non-uniform criteria used by various studies, but for AN, BN, and BED, there seems to be general agreement that full recovery rates are in the 50% to 85% range, with larger proportions of patients experiencing at least partial remission.[241][248][249][250] |
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