**7.3 Psychotherapy**

*Weight Management*

**7. Treatment**

also required for AN treatment.

**7.1 Medical nutritional therapy**

**7.2 Pharmacotherapy**

therapy has a value in the whole treatment process.

result of having an anorexic family member, as EDs affect families and caregivers [45]. Finally a wide range of traumatic experiences are prevalent in patients with AN. These include childhood neglect, every form of childhood abuse, witnessing violence, rape, loss of significant others, accidents, as well as interpersonal stress like bullying, humiliation, and body-related teasing [80]. The abovementioned factors may have neurodevelopmental effects on the HPA pathway and serotonergic

Evidence-based research in this area suggests promising results in treatment. At the same time, the treatment processes are reported to be long and especially expensive, almost like schizophrenia, yet full recovery is only possible for half of the patients [82]. A multidimensional treatment with a multidisciplinary team is necessary in AN treatment, as the disorder contains biopsychosocial elements in nature. Medical nutritional therapy for weight gain and nutritional counseling is important, especially in the case of severe weight loss. Pharmacotherapy has a limited role in the treatment and however can be beneficial in some cases. Nevertheless, there is certain evidence that psychotherapy is essential in AN treatment, although a multidisciplinary approach is required that includes nutritional therapy and psychiatric and medical evaluation as well [83]. Inpatient treatment is suggested in cases with a low BMI (<13.5), rapid decrease in weight, risk of suicide, social isolation, failure of outpatient treatment, and medical risk factors (e.g., cardiac problems and lowered blood sugars) [84]. Specialized units and clinics are

Medical nutritional therapy is an essential part of treatment in AN, especially

for inpatients. This form of therapy focuses on the evaluation of nutritional problems and risks, and after that nutritional counseling is provided to treat the nutritional disorder and to prepare the patient for the next stages of treatment. In medical nutritional therapy, the first choice is oral feeding (chewing and swallowing), but enteral/tube feeding (giving liquid food to the stomach or intestine) or, as a last resort, parenteral feeding (bypassing the digestive process) is also applicable [5, 83]. Refusals against weight gain are common in these treatments; the nutritional therapist also provides counseling to patients. In severely underweight patients, feeding may cause refeeding syndrome. Although weight gain is the first goal, weight maintenance is the ultimate goal in the long term. Hence, nutritional

Research has focused on the impact of several pharmacological agents on anorexia, as neurobiological factors are important in the etiology. Even so, antipsychotics and antidepressants have only a limited role in treatment [85]. However, there is some evidence about olanzapine, an atypical antipsychotic, whose mechanism of action is unclear, which is thought to block serotonin and dopamine, which may be effective in weight gain [86]. In addition, appetite regulators (e.g., dronabinol) and hormone (e.g., estrogen) drugs may contribute to both weight gain and anxiety reduction [87]. In the treatment of AN, antidepressants do not provide

system, which play a role in the brain's response to stress [81].

**74**

Psychotherapy is essential in anorexia treatment, and there is a range of psychotherapeutic approaches. The first psychological explanations of AN came from psychodynamic models, although psychodynamic treatments still have only limited effects [66]. Family therapy is the evidence-based psychotherapy type for younger AN patients, and some modifications are offered for adult patients [90]. CBT is the first step of treatment in BN and BED, and it also works for AN to some degree [91]. Other approaches include third wave behavioral therapies and eye movement desensitization and reprocessing (EMDR) therapy, which also show limited evidence of success in treatment.
