Principles of managing anorexia nervosa

Managing anorexia nervosa can be challenging; patients may deny the presence or the severity of their disorder, which makes it difficult for the clinician and the patient to agree on the management approach. Patient engagement is key to successful management of anorexia nervosa.

Comprehensively assess patients with anorexia nervosa to identify comorbid physical or psychiatric disorders, and any physical complications. Identify and address family and personal problems that may have contributed to the development of the condition.

The Eating Disorders Examination Questionnaire (EDE-Q) (available via the Centre for Research on Eating Disorders at Oxford (CREDO) website) assesses severity of symptoms, which is relevant to accessing care through the Medicare Benefits Schedule, see here for current information.

The treatment goals for anorexia nervosa are to first restore body weight to an appropriate body mass index (BMI); then to help the patient have a positive relationship with food and eating, by focusing on good psychosocial function and mental wellbeing. A multifaceted approach is required to manage anorexia nervosa, led by an eating disorder–informed therapist (ie a psychologist who is competent in using evidence-based therapies as funded by Medicare for eating disorders) with other health care professionals involved (eg dietician for nutritional restoration). Assessing for and managing medical complications can be lifesaving—barriers and delays in accessing care can have significant impact. Anorexia nervosa can lead to a range of severe cardiac, metabolic, endocrine and bone-related sequelae that may require hospitalisation; hypokalaemia and dehydration are common complications of purging and laxative misuse and can lead to cardiac dysrhythmia.

Note: Assessing patients for medical complications, dehydration and metabolic disturbances is mandatory and may be lifesaving.

Treatment of anorexia nervosa is usually initiated in an outpatient setting unless the patient:

Because of the high levels of morbidity and mortality, consult a specialised eating disorder unit within 6 weeks of diagnosis to initiate an Eating disorder treatment plan (EDTP), even if the patient’s weight loss is not yet marked. Outpatient care is led by a general practitioner, in collaboration with a dietician and psychologist, using an EDTP.

Engaging with the community-based healthcare providers is key to ensuring successful management.

Use nutritional replenishment and psychological therapies to manage patients with anorexia nervosa. There is no evidence to support the use of pharmacological treatment for anorexia nervosa itself. Pharmacological treatment may be required for the management of medical complications associated with anorexia nervosa and psychiatric comorbidities.

The principles of managing atypical anorexia nervosa are similar to those described here, see Atypical anorexia nervosa for differences.

For considerations in managing anorexia nervosa in:

  • females of childbearing potential, see here
  • pregnancy, see here
  • the postpartum, see here.

Outcomes are better for patients with anorexia nervosa who receive treatment early. After receiving treatment, approximately 40% of patients are symptom-free after 5 years. The remainder continue to be symptomatic, and up to 20% of patients are severely affected, with their psychosocial functioning impacted.

Family, carers or significant others may have to assume a large burden of care when a patient is diagnosed with anorexia nervosa. Useful resources are available from:

1 If involuntary treatment is required, it must be undertaken in accordance with relevant mental health legislation—see the Royal Australian and New Zealand College of Psychiatrists website.Return