Creating an Anorexia Treatment Plan for Your Clients in Therapy

Anorexia Nervosa, an eating disorder, has seen a rise in prevalence since the 1930s. It manifests in two subtypes: the restrictive type, marked by severe food intake limitations, and the bulimic type, where individuals binge and purge. Purging methods include self-induced vomiting, laxative use, excessive exercise, and other strategies.

At this time, researchers have not been able to pinpoint an exact cause for anorexia, but they have identified risk factors that can increase a person’s risk for developing anorexia, including:

  • A family history of weight concerns
  • Brain chemical imbalances
  • Developmental issues
  • Family attitudes
  • Genetics
  • Struggling with mental health, including depressive symptoms
  • Social attitudes

Anorexia often develops in a person’s teenage years, when they may engage in various sports and activities through their school or local recreational clubs. Examples of sports and activities that focus on a teen’s body shape and size include:

  • Ballet
  • Bodybuilding
  • Cheerleading
  • Finger skating
  • Gymnastics
  • Jockeying
  • Modeling
  • Wrestling

Anorexia presents severe health risks such as anemia, heart issues, low blood pressure, kidney complications, electrolyte imbalances, bone deterioration, and in extreme cases, fatality. Treatment for anorexia varies based on symptom severity, overall health, medical history, age, and other factors.

Severe cases often necessitate intensive, 24/7 care typically delivered in inpatient or residential treatment settings. These programs offer structured daily routines, supportive environments, meal plans, and medical oversight. Treatment components include medical supervision, nutritional guidance, psychotherapy, medications, and support groups.

Therapeutic approaches like Cognitive-Behavioral Therapy (CBT), Family-Based Treatment (FBT), and Interpersonal Therapy (IPT) are commonly used. Complementary modalities such as yoga, mindfulness meditation, art therapy, and body-based practices can enhance traditional treatments by fostering relaxation, self-awareness, and stress management.

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Setting Goals and Objectives With Clients in Your Treatment Plan for Anorexia

When you are ready to begin developing a treatment plan for anorexia, it is important to determine if the individual requires inpatient or residential treatment. As noted above, anorexia is associated with various health concerns and conditions, that often warrant medical attention and support. Individuals who are struggling with anorexia may also have co-occurring disorders, which is an important detail to be mindful of when developing your treatment plan. Treatment plans should be comprehensive and support the individual as a whole, rather than focusing solely on their eating disorder.

To help you determine the severity of your client’s condition, you may use assessments and screeners, such as:

  • Anorectic Behavior Observation Scale (ABOS)
  • Body Shape Questionnaire (BSQ)
  • Eating Disorder Examination-Questionnaire (EDE-Q)
  • SCOFF Questionnaire
  • Structured Clinical Interview for DSM-5 (SCID)
  • Weight and Height Measurements

What to Include in an Anorexia Treatment Plan + Example

Once your assessment has been completed, you should have the information you need to complete a treatment plan for treating anorexia. To outline the various components of a treatment plan, we will be following a sample treatment plan for anorexia counseling, modeled after the customizable treatment plan available at TherapyPatron. Continue reading for our case example:

Example for Megan:

Megan is a 19-year-old female who has been struggling with body image concerns for the past two years, including poor self-esteem, fear of gaining weight, and food restriction. She began decreasing her food intake at the beginning of her senior year of high school as a way to cope with the overwhelming stress and pressure from school, as well as the social pressure she felt about looking a particular way. As her stress continued, she continued restricting her eating and began eating ice chips when she was hungry.  Even though her weight decreased over her senior year, she remained unhappy with her body’s shape and appearance. Megan denied the use of laxatives and reported that she would run 3 to 5 miles more days than not.

Megan’s parents spoke to her about being concerned with the significant changes in her weight, and that they had noticed a change in her eating habits at home. Megan would become irritable and defensive when her parents brought up topics related to her body and eating habits. Megan becomes distressed when she hears remarks about needing to gain weight and finds herself obsessing over her weight to avoid this from happening. Megan’s parents brought her to the emergency department afterMegan got hurt running, which was later identified as a stress fracture. The medical doctors voiced concerns about Megan’s low body weight and visible signs of disordered eating. They noted that injuries like this are not uncommon when someone is struggling with an eating disorder because they often have nutrient deficiencies, particularly with calcium and vitamin D.

Megan’s parents agreed with the recommendation that she receive mental health treatment for her disordered eating. Though Megan still does not see the concern that others have pointed out, she was willing to participate in treatment if it would help her heal her injury. The ER department provided Megan with a referral to her primary care physician, and an inpatient mental health treatment provider for assessment and evaluation. 

Agencies Involved and Plans for Care Coordination

Megan received a referral from the ER in addition to her primary care physician. Moving forward, it would be appropriate to coordinate care with her primary care physician, especially regarding her stress fracture. Open communication is key, considering the health conditions that are often associated with eating disorders.

Example for Megan:

Other Agency: Primary Care Physician, Doctor Smith

Plan to Coordinate: Contact to inform of assessment and evaluation, coordinate medical screenings and assessments commonly used with disordered eating, and maintain contact regarding Megan’s injury and  overall health to ensure comprehensive care

Clinical Diagnoses

Megan‘s symptoms indicate that she is struggling with anorexia nervosa. Due to the physical health concerns associated with this mental health condition, Megan needs to receive continued medical support to address the adverse health effects she has experienced. Diagnostic criteria that is indicated in Megan‘s case include:

  • Food restriction that has contributed to weight loss and malnutrition
  • A fear of gaining weight
  • Disturbances in the way she views her body

Example for Megan:

Clinical Diagnosis:

Anorexia Nervosa, F50.0

Supporting Assessments:

  • Eating Disorder Examination
  • SCOFF Questionnaire

Current Medications and Responses

There is no indication at this time that Jan has been given psychotropic medications to help manage her mental health symptoms.  Individuals living with anorexia nervosa could benefit from various medications including antidepressants, antipsychotics, mood stabilizers, and anti-anxiety medications, depending on their symptoms. Additional medications could be used to manage physical health concerns that have developed due to her mental health conditions. At this time, it does not appear that she is taking medications for her physical or mental health, which may be modified as she progresses through treatment.

Examples for Megan:

Medications:

None at this time

Presenting Problem and Related Symptoms

In the presenting problem and related symptoms section of your treatment plan, you will include a detailed clinical summary that would provide other healthcare professionals with a thorough understanding of Megan‘s presenting concerns, symptoms, and level of impairment. In an inpatient treatment facility, this can be helpful for the different healthcare providers working with Megan.

Examples for Megan:

Emily is a 19-year-old woman who has been struggling with anorexia nervosa, with symptoms tracing back two years. The initial trigger for her symptoms appears to be related to academic stress and body image concerns. Over time, her restrictive eating patterns intensified, leading to significant weight loss, physical complications, and social withdrawal. A stress fracture ultimately required her to seek out medical treatment, which led to the facilitation of a mental health treatment referral. Despite concerns from family and friends, Emily had been resistant to seeking help for her eating disorder until now, when her deteriorating health necessitated immediate intervention. Her diagnosis of anorexia nervosa is supported by her fear of gaining weight, food restriction, and disturbances in how she perceives her body.

Goals and Objectives

Goals and objectives will be unique to each client, reflecting their symptoms, coping skills, support, and other resources available to them. It is important to be mindful of their motivation for change and ensure that the identified goals and objectives are realistic based on their current mental health goals and insight into their concerns. Treatment plan goals are often long-term goals with several objectives that aim at helping clients accomplish their goals.

Example for Megan:

Goal 1: Improve Nutritional Health

  • Objectives 1) Implement a structured meal plan designed to increase caloric intake gradually and promote weight gain, with input from a registered dietitian.
  • Objective 2) Address maladaptive beliefs and fears about food and weight through cognitive restructuring techniques, challenging distorted thoughts, and promoting a balanced perspective on nutrition and body image.
  • Objective 3) Monitor nutritional status closely, including daily weights, vital signs, and laboratory parameters, to ensure safe and effective weight restoration.

Goal 2: Address Underlying Psychological Factors Contributing to Anorexia Nervosa

  • Objectives 1) Engage in individual and group therapy sessions focused on cognitive-behavioral techniques, such as identifying and challenging core beliefs about self-worth, perfectionism, and control.
  • Objective 2) Explore interpersonal dynamics and relationship patterns through interpersonal therapy (IPT), addressing conflicts, communication styles, and social isolation that may contribute to maintaining the eating disorder.
  • Objective 3) Develop coping strategies to manage emotional distress, including stress management techniques, relaxation exercises, and assertiveness training, to address underlying psychological vulnerabilities and improve emotional regulation.

Goal 3: Enhance Social Support

  • Objective 1) Involve family members in therapy sessions to provide education, support, and communication skills training, fostering a supportive environment conducive to recovery.
  • Objective 2) Address interpersonal difficulties and conflicts within the family system using IPT techniques, focusing on improving communication, resolving conflicts, and rebuilding trust and connection.
  • Objective 3) Facilitate peer support and socialization through group therapy, experiential activities, and recreational therapy, promoting a sense of belonging, camaraderie, and mutual support among peers in treatment.

Specific Interventions to Be Used

Detailed within your treatment plan, you should have incorporated interventions that will be used to help your client work towards accomplishing their goals. Using evidence-based interventions and approaches for treating anorexia is ideal in Megan’s case, and will likely have the greatest impact on her recovery. This section of your treatment plan can be a great reference before future sessions, reminding you of interventions that you could utilize in session.

Example for Megan:

Intervention/Action 1:

Use cognitive-behavioral approaches to identify and dispute irrational beliefs

Responsible Person: Counselor A and Megan

Intervention/Action 2:

Identify additional irrational beliefs about perfectionism and control

Responsible Person: Counselor A

Intervention/Action 3:

Introduce mindfulness and relaxation skills that can be used to cope with psychological distress

Responsible Person: Counselor A

Intervention/Action 4:

Explore and utilize emotional regulation skills that can be used to manage stress and emotional distress

Responsible Person: Counselor A and Megan

Family Involvement

Family members can be a valuable source of support and encouragement for individuals experiencing eating disorders. Adolescents and young adults experiencing eating disorders often have family therapy and counseling incorporated into their treatment plan so that everyone in their family unit can learn the best ways to provide support to their loved ones. Since Megan is 19, it would be up to her to involve her family. If she declines, she can always change her mind, and you can make the appropriate adjustments to her treatment plan. 

Example for Megan:

Family counseling and education for her parents

Estimation for Completion

Several factors influence the duration of programming for an individual receiving inpatient psychiatric care for anorexia nervosa. One study found that on average, inpatient treatment programs are just shy of 12 weeks.  This duration can, of course, be modified based on individual progress and the use of additional treatment and supportive services.

Example for Megan:

Duration of 12 weeks of inpatient psychiatric treatment, focusing on treating anorexia nervosa with the use of counseling and therapy, supportive services, nutritional services, and medical supervision and support. Time is to be adjusted as needed.

Aftercare Plans

Aftercare plans should be a consideration at the time of assessment because there are cases where clients do not complete their treatment program. This can be because the treatment offered is not the right fit, the client is leaving against medical advice or any number of other reasons. Your aftercare plans and referrals should reflect recommendations that would be appropriate if your client were discharged today. Because of this, you will likely need to adjust your aftercare plans as your client progresses in their treatment plan.

Example for Megan:

Aftercare plans:

  • Continue in therapy and counseling services to address underlying mental health concerns  
  • Continue receiving medical assessment and supervision
  • Family counseling and therapy

Final Thoughts On Creating a Treatment Plan for Anorexia

Crafting a comprehensive treatment strategy for anorexia nervosa is crucial to supporting individuals on their path to recovery. It’s vital to address the disorder’s physical, psychological, and behavioral dimensions, equipping them with tools and encouragement for sustained well-being. Counselors play a pivotal role, offering guidance, advocacy, and empathy throughout the therapeutic process.

Therapists utilizing worksheets in their sessions can access eating disorder and body image worksheets on TherapyPatron, along with the treatment plan outlined in this article.

TherapyPatron.com helps mental health professionals better serve their clients. Our (editable, fillable, printable PDF) therapy worksheets can help you streamline your practice, effectively deliver different types of therapy, and support your clients be the best version of themselves.

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    Eating Disorder Worksheets Bundle (Editable, Fillable, Printable PDFs)

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Download the counseling treatment plan associated with this resource

Resources:

  • “Anorexia Nervosa.” Johns Hopkins Medicine, January 31, 2023. https://www.hopkinsmedicine.org/health/conditions-and-diseases/eating-disorders/anorexia-nervosa.  
  • Kästner, D et al. “Factors influencing the length of hospital stay of patients with anorexia nervosa – results of a prospective multi-center study.” BMC health services research vol. 18,1 22. 15 Jan. 2018, doi:10.1186/s12913-017-2800-4
Anthony Bart
Author: Anthony Bart

Anthony Bart is a huge mental health advocate. He has primarily positioned his marketing expertise to work with mental health professionals so that they can help as many patients as possible.

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