Why Drugs Don’t Work to Treat All Eating Disorders

By Mandy Parsons

The Harvard T.H. Chan School of Public Health reports that 10,200 deaths each year are the direct result of an eating disorder (ED) — that’s one death every 52 minutes. 

Among the most common eating disorders, anorexia nervosa has the highest case mortality rate and second highest crude mortality rate of any mental illness, according to the National Association of Anorexia Nervosa and Associated Disorders (ANAD).

Fortunately, medications for eating disorders have been successful in treating bulimia and binge eating disorder; however, there is still no proven drug therapy for anorexia. 

Why not? The answer is complex. It involves a number of psychological, emotional, and social factors — all pointing to the critical need for continued clinical research and optimization of therapeutic approaches in ED treatment.  

Drug Testing for Eating Disorder Treatment

We are living in what many consider a golden age of medicine with scientific breakthroughs on the horizon for diseases, viruses, and conditions that were once considered untreatable.

So why such little progress in drug therapy research for anorexia? A major obstacle to testing drugs for anorexia treatment lies in the unique nature of the disorder. 

Those suffering from anorexia have a debilitating fear of gaining weight. One significant measure of a drug’s success in anorexia clinical trials is weight gain. This goal makes it challenging to recruit and retain patients for scientific study. As a result, there have been few controlled trials and little evidence that current medications are effective in the treatment of anorexia, says Psychiatry (Edgemont).

An anorexia nervosa trial of the antipsychotic drug olanzapine corroborates this claim. Published by the Journal of Child and Adolescent Psychopharmacology, the study, which comprised 20 female adolescents — five of whom dropped out — did not find support for adjunctive olanzapine in patients receiving standard ED care.

What then is the alternative? Experts like Dr. Guido K.W. suggest a multidisciplinary approach. In Expert Opinion on Pharmacotherapy, he recommends evidence-based psychotherapy, safe experimental treatments, and treatment of comorbid conditions improve overall quality of life.

Let’s Talk Psychotherapy

What clinical research does support is the critical role of psychotherapy in eating disorder recovery. Cleveland Clinic defines psychotherapy as “a variety of treatment techniques that aim to help you identify and change unhealthy emotions, thoughts, and behaviors through having conversations with a mental health professional.”

There are many types of psychotherapy used in anorexia treatment. The following examples are among the most common: 

Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy assumes that maladaptive (or faulty) thinking patterns cause maladaptive behavior and negative emotions. The treatment focuses on changing your thoughts in order to change your behavior and emotional state.

Dialectical Behavior Therapy (DBT)

The goal of Dialectical Behavior Therapy is to help you increase your emotional and cognitive regulation by learning about your triggers. It will also help you to discern which coping skills to apply in a sequence of events, thoughts, feelings, and behaviors to help avoid undesired reactions.

Acceptance and Commitment Theory (ACT)

Acceptance and Commitment Theory uses mindfulness and behavioral activation to increase your psychological flexibility — your ability to engage in values-based, positive behaviors — while experiencing difficult thoughts, emotions, or sensations.

Exposure Therapy

Exposure therapy is a form of psychological treatment that helps you overcome fears by exposing you to them in a safe and controlled environment. Over time, those fears are reduced as you learn how to interact with the object or situation you are afraid of.

Family-Based Treatment (FBT)

FBT is explained by the Child Mind Institute as treatment in which parents are guided by a mental health professional in showing empathy while enforcing strict eating rules with their child. “Parents choose, prepare, and serve all of the child’s foods. They require the child to eat and offer lots of support.”