0
1

  • Establish goals, including to help the patient

    • understand and cooperate with nutritional and physical rehabilitation,

    • understand and change the behaviors and dysfunctional attitudes related to the eating disorder,

    • improve interpersonal and social functioning, and

    • address comorbid psychopathology and psychological conflicts that reinforce or maintain eating disorder behaviors.

  • Establish and maintain a psychotherapeutically informed relationship with the patient.

    This includes understanding the following:

    • Psychodynamic issues, including deficits in sense of self and interpersonal and intrapsychic conflicts

    • Cognitive development

    • Psychological defenses

    • Complexity of family relationships

    • Influence of other psychiatric disorders that may be present

    • Patient preferences

  • Provide formal psychotherapy once weight gain has started.

+
Table Reference Number

Therapy

Indication/Notes

Individual psychotherapy

Is usually required for at least 1 year and may take many years because of the enduring nature of the illness and the need for support during recovery.

Cognitive-behavioral, interpersonal, and psychodynamic approaches—or a combination of these approaches—have the most evidence and consensus for use in adults.

Family and couples therapy

Is useful when family or marital problems are contributing to the maintenance of the disorder.

Family approaches are most effective with children and adolescents, particularly with illnesses lasting less than 3 years.

Group psychotherapy

Typically has a cognitive-behavioral, interpersonal, and/or psychodynamic focus.

Care must be taken to help patients avoid competition to be the thinnest or the sickest and cope with demoralization from observation of the difficult, chronic course of the illness.

Self-help, online resources, 12-step models

Can be helpful adjuncts for some and patients.

Lack of professional supervision can sometimes perpetuate misinformation or unhealthy dynamics.

Table Reference Number

Therapy

Indication/Notes

Individual psychotherapy

Is usually required for at least 1 year and may take many years because of the enduring nature of the illness and the need for support during recovery.

Cognitive-behavioral, interpersonal, and psychodynamic approaches—or a combination of these approaches—have the most evidence and consensus for use in adults.

Family and couples therapy

Is useful when family or marital problems are contributing to the maintenance of the disorder.

Family approaches are most effective with children and adolescents, particularly with illnesses lasting less than 3 years.

Group psychotherapy

Typically has a cognitive-behavioral, interpersonal, and/or psychodynamic focus.

Care must be taken to help patients avoid competition to be the thinnest or the sickest and cope with demoralization from observation of the difficult, chronic course of the illness.

Self-help, online resources, 12-step models

Can be helpful adjuncts for some and patients.

Lack of professional supervision can sometimes perpetuate misinformation or unhealthy dynamics.

References

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