Before your treatment begins, you will probably have an overall assessment of your health. This may be carried out by your GP or another healthcare professional, such as a specialist in eating disorders.

The assessment will help your healthcare professional put together a plan for your treatment and care. For example, they may assess:

• your health and medical needs,
• your social needs, such as support from family and friends,
• any risks that affect you, such as whether you are at risk of harming yourself, and
• how mild or severe your condition is, in case any urgent action is needed.

Who is involved with treatment?

If you are diagnosed with anorexia nervosa, your GP will probably be involved in your ongoing treatment and care. Other healthcare professionals may also be involved in your treatment, such as:

• a specialist counsellor,
• a psychiatrist,
• a psychologist,
• nurses, and
• a dietician or nutritionist (specialists in nutrition).

If a child or teenager has anorexia, a paediatrician may also be involved in their treatment.

Where will treatment be given?

Where you are treated may depend on how mild or severe your condition is. For example, you may be treated:

• as an outpatient - this is most common,
• as a day patient or in a day unit, or
• as in inpatient in hospital, if your weight loss or symptoms are severe.

In some parts of England, eating disorders like anorexia are treated by community mental health teams. In others, there are units that specialise in treating eating disorders. Some services that treat eating disorders also specialise in treating young people.

Treating anorexia

It is important to start treatment as early as possible, especially if someone has already lost a lot of weight.

Treatment for anorexia usually includes:

• psychological treatment - talking to a therapist or counsellor, and
• advice on eating, your diet and nutrition, to help you gain weight safely.

These treatments work better when combined, rather than on their own.

Your physical health will be monitored closely during your treatment. For example:

• your weight will be checked regularly, and
• you may have regular health checks with your GP or another healthcare professional.

In children and young people with anorexia, their growth and development will be monitored closely, as well as their weight. Their height will also be checked regularly against the average for their age and sex.

Other health problems caused by your anorexia will also be treated. For example:

• If you vomit regularly, you will be encouraged to stop doing so. You will be given advice on dental hygiene, to help prevent acid from your stomach causing damage to the enamel on your teeth. You will also be advised to visit a dentist regularly.
• If you take laxatives or diuretics, you will be advised to reduce them gradually, so your body can adjust. Stopping them suddenly can cause problems.

Gaining weight safely

Your healthcare professional will give you advice about how to increase the amount you eat, so you can gain weight safely.

They will probably ask you about your current eating habits and how much fluid you drink, as well as lifestyle issues like smoking and alcohol. This will help them to advise you on how to change what you eat. It will also help to identify any deficiencies, such as a lack of vitamins in your diet.

Your healthcare professional will help you to re-establish or develop healthy eating habits, so that you can:

• eat more food,
• eat more healthily, and
• increase the nutrients and calories you get from the food you eat.

You may need to start by eating small amounts of food, and gradually increasing what you eat. Your body will not be used to dealing with normal amounts.

You may need to take supplements, such as multivitamins or multiminerals, to help adjust the chemical balance in your body. Some experts think this should be done before you start gaining weight.

You should work towards developing a regular pattern of eating, with three meals a day. A target weight may be set, so you can aim for a minimum healthy weight.

If you are treated as an outpatient, you should aim to gain an average of 0.5 kg a week. Most people can achieve this by eating around 3,500 to 7,000 extra calories each week. This level of weight gain helps to avoid complications that can arise with gaining weight more quickly. For example, the chemical balance in your body can be disturbed.

If your weight loss is severe, treatment in hospital may be needed to help you start to gain weight. Sometimes this is called refeeding. Your health will be closely monitored, particularly in the first few days. People treated as inpatients should aim to gain an average of around 0.5-1.0 kg (1-2 lbs) a week.

Types of psychological treatment

Various types of psychological treatment can be used to treat anorexia. For example:

• cognitive analytic therapy (CAT),
• cognitive behavioural therapy (CBT),
• interpersonal therapy (IPT), also used in treating bulimia and
• focal psychodynamic therapy.

Your views should be taken into account, when deciding which type of treatment is best for you.

Psychological treatment for anorexia as an outpatient usually lasts for at least six months. If you have had treatment in hospital for anorexia, your psychological treatment will usually last for at least 12 months after you leave hospital.

A healthcare professional will meet with you, to help you with your eating problems. They will help you try to find out what has caused your condition and support you in trying to overcome it. They will talk to you about:

• how you feel about your weight and shape,
• gaining weight, and
• your eating habits.

You may meet your healthcare professional:

• on your own,
• with a group of other people who have similar conditions, or
• together with your family.

Treatment for the family

Support from family and friends is important in treating anorexia. They should receive support and information to help them understand and deal with the problems that anorexia can cause.

In some cases, the whole family may be involved in treatment. This is sometimes called family therapy. However, the person affected will also have their own individual meetings with a healthcare professional.

For example, if a child or teenager has anorexia, this type of therapy can help all members of the family to support each other.

Medication

Research studies have shown that medication used on its own is not effective in reducing anorexia symptoms.

If medication is prescribed for you, such as antidepressants, this will therefore be alongside the types of treatment described above.

However, there are some medicines that doctors usually try to avoid when treating people with anorexia. For example:

• antipsychotic medicines,
• some medicines used to treat depression, such as
• tricyclic antidepressants,
• some types of antibiotics, such as macrolides, and
• some antihistamines.

This is because of their possible side effects. People with anorexia can have other health problems, such as a heart condition, and this can make side effects worse.

Anorexia can cause other health problems, and you may need medication to treat those problems - see the 'complications' section.

Compulsory treatment

Occasionally, someone with anorexia may refuse treatment even though they are severely ill and their life is at risk.

In such a situation, doctors may decide it is necessary to admit the person to hospital for compulsory treatment under the Mental Health Act. This is sometimes called 'sectioning' or being 'sectioned'.

NICE guideline on treating eating disorders

The National Institute for Health and Clinical Excellence (NICE) has published a clinical guideline for healthcare professionals on treatment of eating disorders.

The guideline covers eating disorders in adults and children from the age of eight. It includes anorexia, bulimia and other eating disorders such as binge eating disorder.

NICE has also published a booklet for people with eating disorders and their families or carers.

Private treatment

Private treatment for anorexia may be available in some areas.

It is important to choose someone appropriately qualified, with expertise in eating disorders. It is recommended that you choose someone who is accredited by the UK Council for Psychotherapy (UKCP).

The British Association of Behavioural and Cognitive Psychotherapies (BABCP) also holds a register of accredited practitioners.