Treatment of anorexia nervosa should be disorder-oriented and take into account the physical aspects of the disease. The healing process usually requires many months, usually several years. For indications for inpatient therapy, see “Drug therapy” below. In the context of inpatient treatment, the goal should be a weight gain of 500 g to a maximum of 1,000 g per week; for outpatient treatment, the goal is 200 to 500 g per week. In this context, a higher initial caloric intake does not seem to be associated with an increased risk of refeeding syndrome (group of sometimes life-threatening symptoms that can be caused by rapid intake of normal amounts of food after a long period of malnutrition), as long as close monitoring of electrolytes (blood salts), water balance, and cardiovascular parameters (cardiac and vascular parameters) is ensured [S-3 guideline]. High-calorie refeeding, in which anorexia patients received the amount of calories of a healthy person from the beginning, has shortened inpatient treatment time without causing the dreaded refeeding syndrome. Day hospital treatment can be considered an alternative to inpatient treatment: Patients in the day hospital had no less weight gain than anorexics who were treated as inpatients. It should be noted as particularly positive that patients in the day clinic showed fewer psychological problems and better psychosexual development. Therapeutic goal: A healthy weight exists when body weight remains stable without restriction and counterregulation within the range established by WHO between a BMI of 18.5-24.9 kg/m2.
General measures
- Involvement of the key caregiver in the therapeutic process.
- Structured daily routine
- Regular weight checks
- Psychosocial integration: this is mainly understood as the (re)integration into school. In addition, the integration in groups of peers counts to lift the social isolation.
- Review of permanent medication due topossible effect on the existing disease.
- Avoidance of psychosocial stress:
- Fear of obesity
- Fear of being overworked
- Experiences of loss and rejection
- Emotional neglect
- Family factors such as overprotection and conflict avoidance.
- Family problems or conflicts with peers.
- Lack of self-esteem
- Physical abuse in the past
- Low self-esteem
- Perfectionism
- Psychiatric disorders such as depression in the family environment.
- Sexual abuse
- Dissatisfaction with one’s appearance (self-esteem issues).
- Compulsive, perfectionist character
Regular checkups
- Regular medical checkups
Nutritional medicine
- Maintenance of a nutritional protocol by patients → nutritional analysis.
- Nutritional counseling with the aim of dietary change and weight gain.
- Dietary recommendations according to a mixed diet taking into account the disease at hand. This means, among other things:
- A total of 5 servings of fresh vegetables and fruit daily (≥ 400 g; 3 servings of vegetables and 2 servings of fruit).
- Once or twice a week fresh sea fish, i.e. fatty marine fish (omega-3 fatty acids) such as salmon, herring, mackerel.
- Observance of the following specific dietary recommendations:
- Assistance with eating by caregivers – this means creating a diet plan (4-6 meals), monitoring food intake, etc.
- In the context of daily energy intake, for every 10 kg of underweight, an excess intake of 20% of the daily energy requirement is recommended, based on the size-dependent normal weight.
- The diet should be high-calorie – fat content of daily food energy: up to 40% of energy intake.
- At each meal, eat only enough until satiety sets in. Too much food at once stresses the digestive system and leads to a reduced appetite at the next meal.
- After getting up, breakfast should be eaten immediately.
- Overly coarse whole grain products and some legumes can cause severe bloating and other digestive problems and should be avoided. To meet the need for fiber, fiber concentrates can also be used.
- A liquid intake should always be between meals, so that the stomach is not filled too quickly. Attention: Avoid strongly carbonated drinks.
- Selection of suitable food based on the nutritional analysis.
- In life-threatening situations with total food refusal, artificial nutrition may also be necessary to save the patient from fatal complications.
- See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
- Detailed information on nutritional medicine you will receive from us.
Sports Medicine
- Keeping an exercise log
- Endurance training (cardio training)
- Preparation of a fitness or training plan with suitable sports disciplines based on a medical check (health check or athlete check).
- Detailed information on sports medicine you will receive from us.
Psychotherapy
- Psychotherapy can be carried out only after an acute hunger situation has been compensated. Before that, mainly supportive talks (motivational work) are necessary. The following measures of psychotherapy can be used:
- Cognitive behavioral therapy (KVT) – discussion of the psychological problems such as fear of weight gain or lack of self-esteem.
- Interpersonal psychotherapy (IPT) – short-term psychotherapy; it draws on cognitive-behavioral approaches, among others.
- Psychodynamically oriented therapy (PT) – reappraisal of conflicts and crises; best long-term success.
- Family therapy
- Parental counseling
- Social skills training
- Relaxation methods
- Detailed information on psychosomatic medicine (including stress management) is available from us.
Aftercare
- Medical aftercare: after inpatient as well as outpatient psychotherapy, the success of therapy must be checked at least once a week for at least one year.
- Further measures in the context of aftercare are: Relapse prophylaxis, crisis intervention, reintegration of those affected and social counseling.
