Treatment Summary for Eating Disorders

There are many different treatments available for eating disorders. Treatment options may be recommended based on the person’s age, the severity and type of eating disorder they are experiencing, and the length of illness. 

A treatment plan will generally involve a mix of medical, psychological and nutritional support. It should also recognise and address the different phases of the illness, target specific symptoms and provide ongoing support to reduce the risk of relapse. 

Involving families and carers in treatment is important for maximising the effectiveness of any treatment plan. Wherever possible, every effort should be made to include family and carers in the treatment of an individual with an eating disorder and especially children and adolescents. 

Treatments for Anorexia Nervosa 

Different treatments are likely to be beneficial at different stages of the illness. 

For children and adolescents, the first line treatment recommendation is: 

• Family Based Treatment, commonly referred to as FBT or Maudsley Family Therapy.  

• If FBT is not appropriate or ineffective then a combination of nutritional rehabilitation and psychological therapies is recommended. Psychological therapies recommended for adolescents include: Adolescent Focused Individual Therapy (AFT) or Cognitive Behaviour Therapy Enhanced for Eating Disorders (CBT-E) 

For adults, the best evidence for treatment is a combination of nutritional rehabilitation and psychological therapies. Recommended psychological therapies include: 

• Cognitive Behaviour Therapy Enhanced for Eating Disorders (CBT-E) 

• Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA)  

• Specialist Supportive Clinical Management (SSCM) 

Hospital-based treatment may be required when a person needs medical stabilisation, nutritional rehabilitation and intensive support to manage disordered eating behaviours. Hospitalisation is also a possibility if there is a risk of self-harm or suicide. Hospitalisation is usually always followed by community-based treatment. 

Treatments for Bulimia Nervosa (BN) and Binge Eating Disorder (BED) 

Ongoing medical monitoring by a GP and nutrition support with a Dietitian is important. 

For children and adolescents with bulimia nervosa, bulimia nervosa focused family therapy (FT-BN), FBT or CBT-E are recommended. For children and adolescents with binge eating, CBT is recommended.  

For adults, Guided self-help has also been shown to be effective for BN and BED. In guided self-help, the person works with a trained clinician to implement a CBT based self-help program. Cognitive Behaviour Therapy enhanced for eating disorders (CBT-E) has been shown to be the most effective for treatment of bulimia nervosa and binge eating. Dialectical Behaviour Therapy (DBT) and Interpersonal Therapy (IPT) are also effective.  

Treatment may be provided individually, in groups or through guided self-help programs. 

Some people benefit from more intensive community-based day programs, which involve treatment for a number of hours a day, one or more days each week. Hospital-based treatment may be required if symptoms are very severe or if there are any medical complications that need immediate treatment. Hospitalisation is also a possibility if there is a risk of self-harm or suicide. 

Treatments for Other Specified Feeding and Eating Disorders (OSFED) 

The best treatment for individuals experiencing OSFED will depend on their symptoms and DSM-5 specific designation. For example, if the specific designation is ‘atypical anorexia nervosa’ then treatment should be the same as for someone with anorexia nervosa. Similarly, if the symptoms are more like bulimia nervosa or binge eating disorder, then treatment should follow those approaches 

Treatments for Avoidant Restrictive Food Intake Disorder (ARFID) 

A specific CBT program, Cognitive Behavioural Therapy for ARFID (CBT-AR) is currently being studied. Though it is important to note that at this time there is a limited evidence base for the treatment approaches to ARFID and so clinicians are encouraged to use a formulation based approach (Willmott et al, 2024). 

NICE. Eating disorders: recognition and treatment. NICE guideline NG69. Published May 23, 2017. Available from: https://www.nice.org.uk/guidance/ng69 

Thomas JJ, Wons OB, Eddy KT. Cognitive-behavioral treatment of avoidant/restrictive food intake disorder. Curr Opin Psychiatry. 2018 Nov;31(6):425-430. doi: 10.1097/YCO.0000000000000454. PMID: 30102641; PMCID: PMC6235623 

Willmott, E., Dickinson, R., Hall, C., Sadikovic, K., Wadhera, E., Micali, N., Trompeter, N., & Jewell, T. (2024). A scoping review of psychological interventions and outcomes for avoidant and restrictive food intake disorder (ARFID). The International journal of eating disorders, 57(1), 27–61. https://doi.org/10.1002/eat.24073