Recovery may seem impossible if you are deeply embedded in a relationship with anorexia nervosa. You might be strictly adhering to food rules and rituals and feel unable to let go. The thought of eating something outside of your comfort zone or gaining weight absolutely terrifies you. You may feel very physically weak and your health may be suffering from malnourishment. Your life might feel out of control as you’re trapped in a toxic cycle. When you are in such a distressed state, you may not be able to imagine what treatment would even entail, or whether there is help for what you are experiencing. Fortunately, various levels and components of treatment are available to address your individual needs.
A Holistic Approach
If you’re struggling with anorexia – regardless of how your symptoms manifest – you will benefit most from a holistic treatment approach: physical, making sure you are not at an acute health risk and that any complications from anorexia are addressed; psychiatric, ensuring that your psychological symptoms related to anorexia and other mental disorders are attended to through psychotherapy and psychiatric treatment; and nutritional support, helping you repair dysfunctional eating patterns and ensuring adequate nutritional intake.
A System of Stages
Different stages of treatment are available based on how your anorexia might present and the associated complications you are facing.
Inpatient: The highest level of care involves hospitalization, which is appropriate if you exhibit life-threatening physical and mental symptoms, such as severe malnourishment or a dangerous weight for your particular shape/size. You may present with alarming vital signs, lab findings, or medical complications that put you at an acute health risk. Moreover, if you are experiencing very high-risk psychological symptoms, such as suicidality and self-harm, inpatient treatment is imperative to ensure your safety by providing around the clock medical and psychiatric care. At this point, you won’t engage in intensive psychotherapy but focusing on recovering your physical and mental health.
Residential: At this next level of care, you still live in the safety of a treatment setting, but not in the hospital. You can benefit from this type of treatment if you are very active in your eating disorder but are medically stable (i.e. you don’t present with acute health risks). If you are still experiencing psychological impairment, you would benefit from this level of care as it provides comprehensive mental health support in a secure setting. The goal of this type of treatment is to disrupt restriction and other weight-management techniques and build adaptive coping skills in therapy. At this level, you will have a comprehensive treatment team, including medical and mental health professionals, as well as caregivers to help you with residential life and make sure you are engaging in actions conducive to your recovery.
Partial Hospitalization: At this level of care, you are not as engulfed in the treatment setting but continue to benefit from the structure of the program. This type of care is appropriate if you are medically and psychologically stable, but are still engaging in restriction or other weight-control techniques that interfere with your functioning, but do not imminently threaten your physical or psychological health. You may still struggle to function in your daily social, occupational, or educational pursuits. At this point, your treatment team will monitor your health status (vitals, weight) and mental functioning to determine whether you are progressing or require a higher level of care. The goal at this stage is to continue halting your restrictive behaviors, increase your adaptive coping skills, and slowly begin to scratch the surface of the issues underlying your anorexia in therapy.
Intensive Outpatient: This level of care provides less frequent or thorough treatment and is helpful if you are medically and psychologically stable and demonstrate consistency in controlling your symptoms of anorexia. In therapy, you will continue delving into and resolving concerns underlying your disorder and applying healthy coping skills. You may be ready to start reintegrating into your social, educational, or occupational circumstances. Intensive outpatient treatment still provides a structured, nurturing environment; as you are ready to leave this stage, you will receive help in creating structure and consistency in your life, and setting up goals to make your transition smoother. Following this type of treatment is regular outpatient, in which you can continue seeing a therapist, psychiatrist, and/or dietician but also have more flexibility to apply recovery in your daily life. Seeing these professionals helps maintain foundational support in your recovery.
Meeting You Where You Are
The most intensive levels of treatment for anorexia ensure that you are fully engaged in a secure, structured treatment setting with consistent support and monitoring for your physical and mental stability. As you begin to recover, you continue to receive support in reducing your restrictive behaviors and learn how to normalize your relationship with food and body image. Such support includes individual and group therapy, meal support, and other activities beneficial to recovery.
The more stable you are, the more you are ready to engage in therapeutic work regarding your eating disorder and underlying concerns. As you progress, you will be given more flexibility and discretion in your eating and behavioral patterns so you can develop self-sufficiency and trust in your recovery. At the later stages of treatment, you will have support to create a relapse prevention plan and receive support in how to integrate back into your daily life and society at a pace that is comfortable and in line with your recovery.
Bahar Moheban, M.A. is a clinical psychology doctoral candidate and registered psychological assistant in Torrance under the supervision of Dr. Nazanin Moali. She provides individual therapy and facilitates a Body Image Group for adults and adolescents with disordered eating, body dissatisfaction, and comorbid disorders. If you are struggling with bulimia nervosa or any other type of disordered eating, contact Bahar for a counseling appointment to repair your relationship with food and body image.