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Treatment for anorexia nervosa
Medical expert of the article
Last reviewed: 04.07.2025
If anorexia is not treated, the mortality rate is about 10%, although undiagnosed mild disease rarely leads to death. With treatment, half of the patients regain all or almost all of the lost weight, their endocrine and other functions are restored. About 1/2 of the patients have a satisfactory treatment result, and relapses may be observed. The remaining 1/2 of the patients have unsatisfactory treatment of anorexia, exacerbations are observed, and mental and somatic complications persist.
Treatment of anorexia may sometimes require short-term life-saving intervention to restore body weight. All patients require long-term therapy to improve mental health and prevent relapse.
If anorexia is accompanied by significant or rapid weight loss or if body weight drops below 75% of the ideal, then urgent weight restoration is necessary, and hospitalization is considered. Nutrition begins with 30-40 kcal/(kg x day) and should lead to weight gain of up to 1.5 kg/week for inpatients, and 0.5 kg/week if anorexia is treated on an outpatient basis. If there are any doubts, the patient should be hospitalized.
Bone loss should be treated with the addition of the trace element calcium 1200-1500 mg/day, vitamin D 600-800 IU/day and, in severe cases, a bisphosphonate.
Once nutritional, fluid, and electrolyte status are stabilized, long-term therapy begins. Treatment of anorexia is complicated by the patient's negative attitude toward weight gain, denial of illness, and manipulative behavior. The physician should try to maintain a calm, stable, supportive relationship while explaining rational caloric intake. Individual psychotherapy, especially cognitive behavioral therapy, may be helpful, as may family therapy for younger patients. Second-generation antipsychotics (eg, olanzapine 10 mg once daily) may aid in weight gain and reduce the morbid fear of obesity. Fluoxetine, at an initial dose of 20 mg once daily, may be helpful in preventing relapse after weight gain.
Treatment of anorexia should be carried out under the supervision of psychiatrists in most cases in a specialized psychiatric hospital. General strengthening therapy is used, the purpose of which is to increase body weight. The main approach to therapy is to restore adequate nutrition. Along with this, specific treatment of anorexia is used using psychopharmacological drugs, psychotherapeutic methods of influence.
Patients should undergo long-term treatment of anorexia by a psychiatrist. Particular attention is paid to bringing the patient out of the state of cachexia (non-specific stage according to M. V. Korkina). Mandatory hospitalization in a psychiatric hospital is necessary - supervision of adequate nutrition, isolation from the family. The best effect is observed with adequate enteral nutrition with elemental mixtures. The next stage is specific treatment of anorexia with psychotropic drugs, and then - psychosocial adaptation.
According to research data, 30-40% of patients do not experience restoration of menstrual function after normalization of body weight to the initial level and maintaining it stable for 5-6 months against the background of discontinuation of psychotropic drugs. Thus, after restoration of body weight, treatment of anorexia by a gynecologist-endocrinologist is necessary. This risk group includes patients with late onset of menstruation, their high "weight threshold", onset of the disease in the pre-pubertal period and its long course.