A18.png
There are basically three goals as a treatment of anorexia nervosa. First is to regain weight till normal weight; second is to treat any other psychological mental illness, such as depression; and finally the third is to resolve behaviors or thoughts that led to anorexia nervosa.


Regaining weight through eating is an important step to treat anorexia nervosa.
5466572894_63c4183254_n.jpg
Tolcher, Steve. Beat ..... (83/365). 2011. Photograph. Flickr - Photo Sharing! Yahoo!, 21 Feb. 2011. Web. 20 Mar. 2012. <http://www.flickr.com/photos/stegsie/5466572894/>.


Biomedical approach
Drugs/medication
Because depression is apparent in people diagnosed of anorexia nervosa, antidepressant may help them. This is " the usual drug treatment and may speed up the recovery process" (Grohol). Another drug, "chlorpromazine may be beneficial for those individuals suffering from severe obsessions" (Grohol). On rare occasion the patients are allowed and need to use electronvulsive therapy (ECT). This "is never appropriate treatment option for a person suffering from an uncomplicated eating disorder" (Grohol). Estrogen may also help women patients, particularly due to the absence of periods while they are at this eating disorder. However, as there are no specific and precise medication "designed to treat anorexia because they haven't been found to work very well," the efficiency of these drugs may be limited to some extent, such as treating depression and anxiety (Staff).
Hospitalization
This is the very last option as treatment for anorexia nervosa. Only certain patients chooses this option due to financial issues. It is not recommended very much by researchers. In research study conducted by Andrea Garber et al., they re-examined the efficiency and conditions of hospitalization for people diagnosed of anorexia nervosa. The participants included "adolescents aged 13.1 - 20.5 years" diagnosed of anorexia nervosa (Garber). They were hospitalized and measured "weight, vital signs, electrolytes, and 24-hour fluid balance" daily and calories for their food were "prescribed on admission and were increased every other day" (Garber). They were hostpilized for average 16.7 days (Garber). The result showed that all the patients went through initial weight loss even though they are supposed to be gaining weight, but there was "slow weight gain on a recommended feeding protocol" (Garber). Despite this result, there needs to be more research about hospitalization and its safety.

Individual approach
Cognitive behavioral (CBT)
This type of individual therapy approach "helps a person understand how their thinking and negative self-talk and self-image can directly impact their eating and negative behaviors" (Grohol). In other words, this is like a battle between oneself for the patients. Through this, the patients are able to change and alternate "dysfunctional thought patterns, attitudes and beliefs" that usually are the cause of anorexia nervosa. In 1980s, Chris Fariburn developed this with finishing touch with addition of "behavioral interventions (such as promoting health eating behaviors through goal setting, rewards, etc.)" (Grohol). Compared to other therapies, this cognitive behavioral therapy lasts for specific duration "with specific goals in mind" (Grohol).
In research study conducted by Kathleen M. Rike et al., they investigated the effectiveness of cognitive behavioral therapy as a treatment for anorexia nervosa. The participants included 33 people whom just finished hospitalization and diagnosed of anorexia nervosa accord ing to DSM-IV. 18 women were "randomly assigned to 1 year" (Pike) to cognitive behavioral therapy and another 15 women were assigned to nutritional counseling. This therapy specifically involved The result which was shown through Eating Disorder Examination showed that the decline in the patients' weight was significant in the group receiving cognitive behavioral therapy than nutritional counseling. Cognitive behavioral therapy is one of the effective treatment to anorexia nervosa, especially because the patients can come to understanding of their diagnosis, specifically the cause, and suggests treatment to solve the problem.
Yoga
There is also a possibility of yoga as a treatment of anorexia nervosa. By occupying one's mind with physical activity where one can relax and sooth their mind, a person with anorexia nervosa may regain their weight and additionally their anxiety and depressive symptoms.
This is proven by a randomized controlled research study conducted by Tiffany Carei et al. to measure the efficiency of "individualized yoga treatment on eating disorder outcomes among adolescents" (Carei et al.). The participants were "50 girls and 4 boys, aged 11-21 years", and "27 were randomized to standard care and 26 to yoga plus standard care" (Carei et al.). Yoga lessons were facilitated one hour "semi-weekly for 8 consecutive weeks" (Carei et al.). This standard care involved "every other week of physical or dietician appointments" as to meet ethical guidelines (Carei et al.). There was also 9 week of post intervention and then "1-month follow-up" that was 12th week (Carei et al.). The result showed that yoga group had significantly "greater decreases in eating disordered symptoms" according to Eating Disorder Examination (EDE) (Carei et al.). The control group also showed drop in the participants' weight; however, their weight returned to the critical state at 12th week.
Individualized yoga treatment could possibly be an efficient treatment for anorexia nervosa, as well.

Group approach
Family therapy (also known as the "Maudsley Method")
This therapy involves not only the person diagnosed of anorexia nervosa, but also with their family. This, in other words, is "were parents assume responsibility for feeding their anorexic teen to help them gain weight and improve the teen's eating habits" (Grohol).
But sometimes only the family members are involved in this therapy; this deepens their understanding of anorexia nervosa, particularly their "often-times dysfunctional role they play within the family, and how their eating behaviors maintain that role" (Grohol). Through this, it also allows therapists to give suggestions to the family about how they can help the patient. It can be said that there is more reliable and trusted supports available compared to individual therapy, where good relation with the patient and therapist is important to establish at first, and group therapy, where there is possibility of occurrence of competition.
A research study conducted by Jennifer Couturier et al. investigated in the effectiveness of family therapy with participants diagnosed of anorexia nervosa aged between 12 to 17 years old. The participants' and their parents went over three phases of family therapy with professional therapist which lasted for a year. The result showed that each participants' weight increased by average of 7.8 kg and 9 out 8 participants regained their menstrual cycle, as well. Furthermore, the result revealed that this therapy also improves "some psychological symptoms including dietary restraint, interceptive deficits, and maturity fears" (Couturier et al.) . Supported by the result and agreement over its acceptable methodology by the participants and their parents, family therapy is an effective treatment particularly for the adolescents.


One treatment does not exceed another in anorexia nervosa. In a randomized clinical trial conducted by James Lock et al., they examined the effectiveness of "family-based treatment (FBT) and adolescent-focused individual therapy (AFT) for adolescents with anorexia nervosa in full remission" (Lock et al.). The participants included 121 adolescents, aging from 12 to 18 years old and diagnosed of anorexia nervosa according to DSM-IV "excluding the amenorrhea requirement" (Lock et al.). They all received "twenty-four outpatient hours of treatment over 12 months of [either] FBT or AFT" and they were further assessed at the end of the treatment with follow up of "6 months' and 12 months'...posttreatment" (Lock et al.). The result showed that no significant differences were seen "in full remission between treatments at" end of the treatment; however, "FBT was significantly superior to AFT" at the 6 and 12 month's follow-up posttreatment. Furthermore, participants who received FBT showed "greater changes in Eating Disorder Examination score...than those in AFT" (Lock et al.). On the other hand, AFT was superior over FBT near the end of the treatment. For these results, one cannot tell which treatment is absolutely better than the another. This may actually dependent on the severity of the anorexia that a person has. A person with family environment that values physical appearance the most may be likely to be treated better with family therapy for the family to gain more knowledge about their role in etiology and development of anorexia nervosa.

Here is a video about a woman previously diagnosed of anorexia nervosa and now treated:


http://youtu.be/i1ObXHHEY2Y


HOW ARE THE ETIOLOGIES AND TREATMENTS CONNECTED??


<Works Cited>
Carei, Tiffany R., Amber L. Fyfe-Johnson, Cora Collette Breuner, and Margaret A. Marshall. "Randomized Controlled Clinical Trial of Yoga in the Treatment of Eating Disorders." PubMed Central. US National Library of Medicine National Institutes of Health, 1 Apr. 2011. Web. 29 Feb. 2012. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2844876/?tool=pmcentrez>.
Couturier, Jennifer, Leanna Isserlin, and James Lock. "Family-Based Treatment for Adolescents with Anorexia Nervosa: A Dissemination Study." PubMed Central. US National Library of Medicine National Institutes of Health, 2010. Web. 29 Feb. 2012. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3012128/?tool=pmcentrez>.
Garber, Andrea K. "Prospective Examination of Weight Gain in Hospitalized Adolescents With Anorexia Nervosa on a Recommended Refeeding Protocol." Journal of Adolescent Health. 26 Aug. 2011. Web. 1 Mar. 2012. <http://www.jahonline.org/article/S1054-139X(11)00232-1/abstract>.
Grohol, John M. "Psych Central: Anorexia Nervosa Treatment." Psych Central. 6 Apr. 2011. Web. 29 Feb. 2012. <http://psychcentral.com/disorders/sx2t.htm>.
Grohol, John M. "Treatment for Anorexia." Psych Central. 7 Apr. 2011. Web. 29 Feb. 2012. <http://psychcentral.com/lib/2006/treatment-for-anorexia/>.
Lock, James, Daniel Le Grange, W. Stewart Agras, Ann Moye, Susan W. Bryson, and Booil Jo. "Randomized Clinical Trial Comparing Family-Based Treatment With Adolescent-Focused Individual Therapy for Adolescents With Anorexia Nervosa." Arch Gen Psychiatry. American Medical Association, 29 Mar. 2010. Web. 29 Feb. 2012. <http://archpsyc.ama-assn.org/cgi/content/full/67/10/1025>.
Pike, Kathleen M., Timothy Walsh, Kelly Vitousek, Terence Wilson, and Joy Bauer. "Cognitive Behavior Therapy in the Posthospitalization Treatment of Anorexia Nervosa." The American Journal of Psychiatry. American Psychiatric Publishing. Web. 1 Mar. 2012. <http://ajp.psychiatryonline.org/article.aspx?articleid=176504>.
Staff, Mayo Clinic. "Anorexia Nervosa." Mayo Clinic. Mayo Foundation for Medical Education and Research, 05 Jan. 2012. Web. 29 Feb. 2012. <http://www.mayoclinic.com/print/anorexia/DS00606/METHOD=print>.

A7.png