CAW must be taken seriously and treated as quickly as possible, as they are associated with significant psychological distress. Suicide attempts are not uncommon in people with ACT. Anorexia is the disorder associated with the highest mortality rate: some studies estimate that 10% of people with anorexia die within 10 years of diagnosis.
CAW must be taken seriously and treated as quickly as possible, as they are associated with significant psychological distress. Suicide attempts are not uncommon in people with ACT.
Anorexia is the disorder associated with the highest mortality rate: some studies estimate that 10% of people with anorexia die within 10 years of diagnosis9.
The management of CAW is based on psychological interventions (individual, family or group) that target abnormal behaviour, but which should also improve self-esteem. Among young people, family involvement is often necessary. There is no real codified psychological treatment (although several learned societies have made recommendations) and the treatment is often accompanied by relapses.
In addition, CAWs have similarities with addictions such as alcoholism. Food compulsions have an addictive potential, which often alters the willingness to get out of it. However, it is possible to recover completely, especially if the diagnosis and management are done quickly.
The objectives of treatment differ according to the disease. In the case of anorexia nervosa, the urgent need is to regain and stabilize a normal weight (the recommended body mass index is at least 18.5 kg/m²).
In all cases, the treatment aims to normalize eating behaviour. No study shows the superiority of one therapy over another. Treatment must continue for several months to be fully effective. The most recognized therapies are the following10,11 :
Cognitive and Behavioural Therapies (CBT)
Cognitive-behavioural psychotherapies have been shown to be effective in most eating disorders.
They are not intended to understand the causes of the disorder, but rather to establish new ones.
eating habits and to change beliefs about weight and food. By confronting the patient with situations that cause him/her to feel anxious, particularly through practical exercises such as role-playing or role-playing, CBTs gradually help to desensitize the person to his/her own fears and restore eating behaviour focused on physiological sensations (hunger, satiety, satiety).
In general, the therapy is based on weekly sessions, alone or in groups, for 3 to 4 months. It is often required to keep a diary that helps to define and control bad behaviour.
Interpersonal therapy (IPT)
Interpersonal therapy is a form of psychotherapy originally developed to treat depression. Several studies show that it is also effective in some people with CAW12.
This type of therapy focuses on identifying the person’s current social conflicts and interpersonal relationships, rather than focusing on eating disorders.
It is a short therapy (12 to 16 sessions), which is unfortunately still not very widespread in Europe.
Psychotherapy, whose purpose is to work deeply on oneself, has an interest in the treatment of ACT, usually in addition to the therapies mentioned above. Taking place over a long period of time, it allows a better understanding of the causes of the disorder, and thus to profoundly modify the beliefs and fears that can fuel the eating problem.
It is important to choose a therapist who is familiar with this type of pathology.
Self-help groups supervised by a therapist have proven their effectiveness, especially if the damage is not too severe, or as a complement to personal therapy. These groups allow you to feel supported, understood and motivated to follow the treatment over time.
When the eating disorder involves a child or adolescent, family therapy is strongly recommended. This type of disorder affects all family members, with parents struggling to understand and communicate with their child. The objective of this type of therapy is to mobilize the whole family and optimize the chances of recovery, and to increase vigilance against possible relapses.
In severe cases of anorexia or bulimia, when the person is severely malnourished or at risk of suicide or self-attack, hospitalization is sometimes necessary. If possible, hospitalization should be in an institution or service specialized in the management of CAW, which will benefit from a multidisciplinary team (psychiatrist, nutritionist, psychologist).