Eating disorders - Treatment
This section gives information on:
What treatment should I be offered?
You can check what treatment and care is recommended for eating disorders on the National Institute for Health and Care Excellence (NICE) website. NICE produce guidelines for how health professionals should treat certain conditions. You can download these from their website. But the NHS does not have to follow these recommendations. They should have a good reason for not following them.
Medication should not be offered as the only treatment for any eating disorder.
Physical treatments like acupuncture, weight training and yoga should not be offered as treatment for eating disorders.
There are different types of psychological treatments for eating disorders, and you may be offered a combination of these. All of the treatments will include guide self help and psycho-education.
Guided self help programme
This is a self-help programme. You will look at the thoughts, feelings and actions that you have in relation to your eating. You should also have some short support sessions to help you follow the programme.
Psycho education means that you will learn about your symptoms and how to manage them.
What is the treatment for anorexia?
When treating anorexia a key goal is for you to reach a healthy weight. Your weight will be monitored. Doctors may share your weight with your family members or carers.
There are different psychological treatments for anorexia in adults. Your doctor should talk to you about different treatments. You should be given your preferred treatment if it is available.
Individual eating-disorder-focused cognitive behavioural therapy (CBT-ED)
This is a long term therapy. You will have individual sessions with your therapist. You will usually have 40 sessions over 40 weeks. At the beginning of your therapy you will usually have 2 sessions a week.
The therapy aims to help you to:
- reduce the risks to your physical health,
- learn about nutrition and how you can change the way you think,
- think about your body image concerns and self-esteem, and
- monitor what you are eating and how this makes you think and feel.
Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
This usually consists of 20 sessions. For the first 10 weeks you have weekly sessions. After that the sessions are more flexible. If you have a more complex problem you may get up to 10 extra sessions.
- covers nutrition, how to manage your symptoms and how to change your behaviour once you are ready,
- helps you to develop a ‘non-anorexic identity’, and
- involves your family members and carers to help you to:
- understand your condition and the problems it causes, and
- change your behaviour.
Specialist supportive clinical management (SSCM)
This therapy will usually be 20 or more weekly sessions. This will depend on the severity of your anorexia. Its aims to:
- help you to recognise the link between your symptoms and your eating behaviour,
- give you nutritional education and advice, and
- allow you to decide what else should be included as part of your therapy.
Eating-disorder-focused focal psychodynamic therapy (FPT)
You will only be offered FPT if individual CBT-ED, MANTRA or SSCM hasn’t worked. Or if your doctor thinks that the other therapies shouldn’t be used.
FPT is a long term therapy. You will have individual sessions with your therapist. You will usually have 40 sessions over 40 weeks.
FPT looks at:
- what your symptoms mean to you, how they affect you and how they affect your relationships with other people,
- the beliefs, values and feelings that you have about yourself,
- your relationships with other people and how they affect your eating behaviour, and
- helping you to take what you have learned into everyday life.
What is the treatment for bulimia?
Psychological treatments for bulimia have a limited effect on body weight.
Individual eating disorder-focused cognitive behavioural therapy (CBT ED)
You should be offered individual CBT-ED if the self-help programme hasn’t worked. Or your doctor doesn’t think it should be used.
Individual CBT-ED for adults with bulimia nervosa is usually 20 sessions over 20 weeks. At the very beginning of your therapy you may have 2 sessions a week. Its aims are to help you to:
- begin a regular pattern of eating,
- think about your concerns around body shape and weight,
- find other ways to deal with difficult thoughts and feelings, and
- involve your family members and carers, if this is appropriate.
What is the treatment for binge eating disorder (BED)
Psychological treatments for BED have a limited effect on body weight. Weight loss isn’t the aim of the therapy. Doctors can give you advice on weight loss.
Group eating disorder-focused cognitive behavioural therapy (CBT-ED)
You should be offered group CBT-ED if the self-help programme hasn’t worked, or your doctor doesn’t think it should be used.
Group CBT-ED is usually 16 sessions over 4 months. It aims to help you to:
- monitor your eating behaviour,
- think about your problems and goals,
- identify your binge eating triggers,
- identify and change any negative beliefs you have about your body, and
- avoid relapses and identify ways to cope with your triggers.
Individual CBT-ED for adults with BED
Your doctor could offer you individual CBT-ED if group CBT-ED may not be available in your area. Or you may decide that you do not want group therapy.
You will have individual sessions with your therapist. You will usually have 16-20 sessions over 40 weeks. You will work with your therapist to understand what makes you binge eat.
What is the treatment for Other Specified Feeding and Eating Disorder (OFSED)?
There is no specific treatment for OFSED. You should be offered the treatments recommended for the type of eating disorder your symptoms are most similar to.
What if I am not happy with my treatment?
If you are not happy with your treatment you can:
- talk to your doctor about your treatment and ask for a second opinion,
- get an advocate to help you speak to your doctor,
- contact Patient Advice and Liaison Service (PALS) and see whether they can help, or
- make a complaint.
There is more information about these options below:
If you are not happy with your treatment you should talk to your doctor and see if you can resolve the situation with them. You can refer to the NICE guidelines if you feel your doctor is not offering you the right treatment. See here for more about this.
You may feel that your treatment should be changed. If your doctor does not agree you could ask for a second opinion. You are not legally entitled to a second opinion but your doctor might agree to it if it would help with treatment options.
An advocate is independent from the NHS. This means that the NHS doesn’t employ them. Advocacy services are free to use. Usually a charity will run an advocacy service. An advocate is there to support you.
They can help to make your voice heard when you are trying to sort problems. They may be able to help you to write a letter to the NHS or go to a meeting with you.
There may be a local advocacy service in your area which you can contact for support. You can search online for a local service. You can also call our advice service on 0300 5000 927 or email us at firstname.lastname@example.org and we can look for you.
The Patient Advice and Liaison Service (PALS) at your NHS trust are there to help you sort problems with a local service.
You can find your local PALS’ details here.
You can make a formal complaint. Your GP practice or mental health trust should be able to give you a leaflet about their complaints procedure.
If you need help to make a complaint you can get help from a complaints advocate.
You can click on the following to find more information about them:
What can I do to manage my symptoms?
You can learn to manage your symptoms through self-care. Self-care is how you manage your daily routine, relationships and feelings. The healthcare professional who is working with you should give you advice about self-care.
The following website links have information about how you can deal with symptoms of anorexia, bulimia and BED:
Can I be detained in hospital under the Mental Health Act?
Eating disorders are mental disorders. Your life may be at risk if your eating disorder is very bad. You may need treatment in hospital. If you refuse treatment you can be sent to hospital. You can be treated against your will under the Mental Health Act.
How will doctors decide if I should be detained under the Mental Health Act?
Doctors will look at risk to decide if you need to be sent to hospital. They should not base their decision on your weight or body mass index (BMI) alone. Other things they will look at include:
- your pulse, blood pressure and core temperature,
- muscle power,
- blood tests for things like your sodium, potassium and glucose levels, and
- your heart rate.
Can I be force-fed?
Feeding is recognised as treatment for anorexia under the Mental Health Act.
The person in charge of your care under the Mental Health Act is called the responsible clinician. This person will be a psychiatrist or another professional who has had specialist training.
A responsible clinician must be appointed to look after your care if you are detained on a medical ward.
You can find more information about the ‘Mental Health Act’ here.
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