Anorexia is the rarest of the eating disorders. It is characterized by maintaining an extremely low body weight, often 20% to 30% below the ideal (or a Body Mass Index, or BMI, below 18.5), as well as amenorrhea (or not getting a regular period). Anorexia nervosa is often a chronic illness, usually beginning in early adolescence. If severe enough (i.e. a BMI of 16 or below and/or medical complications associated with malnourishment) an individual with anorexia nervosa may require a partial or full hospitalization program. Anorexia nervosa is among the most fatal psychiatric illnesses; about 5% of anorexic patients die from either complications of the disorder or from suicide. Nevertheless, with a motivated individual who is willing to seek concurrent medical supervision, anorexia nervosa can often be successfully treated on an outpatient basis.
Cognitive behavior therapy (CBT) forms the basis of modern treatment of anorexia nervosa. Since most patients with this disorder are worried about gaining weight, and perceive changes in body shape as frightening, treatment often entails learning how to identify, challenge, and replace maladaptive thoughts about weight, shape, and perfectionism.
Additionally, many individuals with anorexia nervosa may benefit from a type of cognitive behavioral therapy called dialectical behavior therapy, or DBT. DBT assumes that destructive eating behaviors are maladaptive attempts to avoid or diminish intolerable negative emotions. The focus of DBT for anorexia nervosa is to teach individuals to face, reduce, eliminate, and/or tolerate their painful emotions. This is accomplished by focusing on the following components:
- Mindfulness training (becoming aware of emotions)
- Emotional regulation (reducing or eliminating negative emotions)
- Distress tolerance (learning to tolerate painful emotions)
- Interpersonal effectiveness (interpersonal skills training)
Despite the potential severity of anorexia nervosa, research has shown that about three quarters of anorexics treated with some combination of CBT and DBT will gain a reasonable amount of weight, better manage their emotional states, and resume normal activities.