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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
Complexity of family relationships
Influence of other psychiatric disorders that may be present
Provide formal psychotherapy once weight gain has started.
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 approachesor a combination of these approacheshave 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.
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.