Treatment

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Most women don't realize how damaging eating disorders are to their health. Many think emaciation is normal and even attractive. Or they think that purging is the only way to avoid gaining weight. Even health care professionals sometimes fail to recognize the signs and the chance to intervene.

People fail to realize, however, that a potentially serious eating disorder may underlie their weight loss. Also, it is easy to confuse eating disorders with other emotional problems. Although women with depression may lose or gain weight, for example, that doesn't necessarily make them anorexic or mean they are binge eating. Unlike those with anorexia or bulimia, depressed women don't have a distorted body image, a drive to be thin or a compulsion to binge.

Eating disorders can be fatal and are not something you wait to treat. Fortunately, your risk of death or serious damage drops with prompt and aggressive treatment. The sooner you get help, the better your chances for a full recovery.

Still, treatment is no easy task. When an anorexic starves herself, she feels better. When a bulimic or binge eater binges, she feels less depressed. The eating disorder serves a purpose in the mind of the woman who has it. It becomes a kind of companion that it's hard to let go of.

Not surprisingly, relapses are common and success often comes only after trying several therapeutic approaches. A treatment team of dietitians, psychotherapists and physicians may use a variety of treatment methods in conjunction, including:

• psychological counseling or cognitive-behavioral therapy to help you replace negative attitudes about your body with healthier, more realistic ones

• medical evaluations to stabilize you physically

• nutritional counseling to teach you good nutritional habits

• medication such as antidepressants to address emotional health problems

• family therapy to establish the support system you need for full recovery

Treatment of anorexia is often approached as a three-step process:

1. Restoring weight loss due to severe dieting and purging
2. Treating psychological conditions such as distorted body image, low self-esteem and interpersonal conflicts
3. Long-term remission and rehabilitation or full recovery.

A one-year study published in the Journal of the American Medical Association determined, however, that there was no significant difference between those with anorexia who took antidepressants and those who receiving a placebo—evidence that there is no "magic pill" to make your disorder go away and keep it away.

The most common antidepressants prescribed for bulimia include tricyclic antidepressants such as imipramine (Tofranil) and desipramine (Norpramin), as well as selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil). Prozac is effective at higher doses (60 mg) but has little impact on the binge-purge cycle at low doses (20 mg). Some trials are using naltrexone or naloxone, medications that are used against drug addiction. Researchers hope that such drugs will reduce natural opioids that may be released during binges.

The antidepressants most commonly prescribed for anorexia are SSRIs such as fluoxetine (Prozac, Sarafem), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro) and fluvoxamine (Luvox). Other antidepressants prescribed may include venlafaxine (Effexor) and tricyclic antidepressants such as imipramine (Tofranil) and desipramine (Norpramin). Tricyclic antidepressants carry a greater risk of cardiac complications, however, and should be used with caution in people with anorexia.

With respect to bulimia and binge-eating disorder, research on interrupting the binge-eating cycle finds that once a structured pattern of eating is established, the two factors that increase the likelihood of bingeing—hunger and negative feelings—are reduced, which decreases the frequency of binges.

Another approach is called the Maudsley model. In this innovative family-centered treatment program, the family assumes responsibility for making the patient eat. No one is "blamed" for triggering the illness; rather, the eating disorder is treated as a medical condition and the family taught to care for the sick child. The power shifts back to the patient after he/she reaches an acceptable weight.

This method works best on younger patients and those who don't have chronic illnesses or practice binging/purging