Pediatric Eating Disorders

What treatments are available?

Eating disorder treatment typically requires a multidisciplinary approach. Most treatments involve a combination of psychotherapy, psychoeducation, nutritional counseling, and medical management (for a full review of treatment options for eating disorders see Garner & Needleman, 1995; for a review of treatments for Anorexia Nervosa see Lock, Le Grange et al., 2001).

The major treatment options for Eating Disorders include:

Hospitalization

  • Hospitalization is indicated in severe cases of eating disorders.
  • Some circumstances that justify hospitalization are:
    1. Medical danger from extreme emaciation
    2. Medical danger from excessive bingeing and purging
    3. Risk of self-harm
    4. Severe depression
    5. Substance abuse
  • Hospital treatments in the U.S. are typically limited to brief acute weight restoration and refeeding.
  • Inpatient treatment seems to be effective in the short and long term. Studies have found that 70% of patients with Anorexia Nervosa showed continued improvement at 3-year follow-up (Jenkins, 1987).
  • Because of increasing pressure to reduce use of inpatient treatment due to high cost and disruption to adolescent's usual life, outpatient alternatives have become important.

Day Treatment

Intensive day treatment programs seem to be effective for adults (Howard et al., 1999), although there is not much research for children and adolescents. These treatments provide structure around mealtime and during the day, and patients go home in the evening.

Outpatient Treatments

There are several outpatient treatments that have been shown to be effective in the treatment of eating disorders.

  1. Family Therapy

    There are different types of family treatments.

    1. Traditional family therapies: Therapies such as Structural Family Therapy focus on roles, alliances, conflicts, or interactional patterns within the family that are related to the eating disorder.
    2. Family-based treatments: Typically shorter than traditional family therapy (20 sessions) and instead of focusing on family dynamics, the initial focus is on putting parents temporarily in charge of helping to reduce control that the eating disorder has over their child's life. The first stage of treatment focuses on weight restoration and reduction of eating disorders symptoms.  Once the eating disorder is under control, parents return control over eating back to their child and help him/her with normal developmental tasks.

  2. Cognitive-Behavioral Approaches

    • Cognitive Behavior Therapy (CBT) is the treatment of choice for adults with Bulimia Nervosa whose symptoms are moderate to severe. 
    • CBT is also recommended for adults with Anorexia nervosa.
    • The therapy aims at correcting errors in thinking and perception that lead to negative self-perceptions and eating disorder symptoms. It is aimed at normalizing eating behavior and reducing restrictive eating by re-introducing ‘taboo' foods into diets and planning meals. The therapy involves self-monitoring of food intake, bingeing and purging episodes, and thoughts and feelings that trigger these episodes. CBT also involves regular weighing.
    • CBT for Bulimia Nervosa is short term (20 sessions) and for Anorexia Nervosa the length of treatment is longer.
    • Individual and/or group therapy formats exist for CBT.
    • Research has continually demonstrated the effectiveness of CBT for Bulimia Nervosa.  It is more effective than medication alone, supportive psychotherapy, behavior therapy, and is comparable to Interpersonal Psychotherapy (IPT; for a review see Wilson et al., 1997).
    • Research also suggests that CBT is effective for Anorexia Nervosa and Binge-Eating Disorder (Garner & Needleman, 1997).

  3. Interpersonal Psychotherapy

    • Interpersonal Therapy (IPT) typically involves identifying and working on interpersonal problems (relationship problems) that affect eating disorders.
    • Like CBT, IPT is typically a short-term treatment and goal oriented.
    • Individual and/or group therapy formats exist for IPT.
    • Research shows that IPT is equally effective as CBT in treating Bulimia Nervosa in the long-term, although CBT appears to have a faster effect (see Fairburn, 1997).
    • IPT and CBT appear to be superior to Behavior Therapy in the long-term (see Fairburn, 1997).
    • Many aspects of IPT are integrated in to longer term CBT treatment for Anorexia Nervosa.

  4. Psychodynamic Approaches

    • Psychodynamic approaches are typically longer than CBT and IPT.
    • They have not been as extensively studied as other treatments, and there are no controlled studies comparing psychodynamic therapy of eating disorders with other treatments.
    • There are several different types of psychodynamic therapies, some focus directly on eating disorders symptoms, while others focus on the underlying problems that give rise to the eating disorder symptoms.
    • Most of these treatments focus on understanding and resolving conflicts that often arise in childhood, which is believed to help free the individual from engaging and repeating negative behavioral patterns.

  5. Feminist Approaches

    • Feminist Therapy for eating disorders focuses on sociopolitical themes.
    • It addresses conflicts, identity confusion, and sexual abuse that are believed to be related to the development and maintenance of eating disorders.
    • The emphasis in therapy is on women's interpersonal relationships.
    • These treatments have not been extensively researched.

  6. Educational Approaches/Nutritional Counseling

    • Most treatments for eating disorders involve some aspect of psychoeducation.
    • Educational/Nutritional-specific treatments focus on the conflict between cultural pressures on women to diet and biological mechanisms that defend a person's natural weight. They offer recommendations for healthy eating, and often involve self-monitoring or meal planning.  They typically help patients to gradually re-introduce avoided foods into their diets, and provide specific suggestions for curbing binge eating and purging.
    • For individuals with mild symptoms of Bulimia Nervosa, research shows that educational therapies can be as effective as CBT (Olmsted, et al., 1991).

Self-Help Treatments

Self-help treatments can be quite effective for mild eating disorders symptoms. Self-help treatments are NOT sufficient for most cases of eating disorders, but can be a valuable adjunct to most treatments.  Self-help treatment can come in a variety of formats including books, self-help groups, and guided self-help groups (i.e. supportive groups that are lead by mental health professionals).

Pediatric Eating Disorders Links