Chapter 6: Long-Term Recovery Stage Anorexia Nervosa in Adolescence

Long-Term Recovery: Role of the clinical nutritionist

The clinical nutritionist/dietitian on the therapeutic team provides nutritional care while working within the framework of mutually established psychotherapeutic goals. The focus of the adolescent's energy is directed away from food phobias toward recovery. Techniques developed by the social sciences and experience in modifying the disordered eating behaviors and attitudes help accomplish this. The nutritionist's knowledge of energy balance applied to an individual adolescent’s needs is required to establish dietary intake and nutritional rehabilitation goals throughout therapy.

Long-Term Recovery: Psychosocial issues

The adolescent with anorexia who has recovered from a starvation crisis will still have to overcome the developmental arrest that brought her to the crisis. Several years are usually required for recovery. The adolescent will need to solve problems concerning choice and preparation for a vocation, financial support, and relationships with peers (including the opposite sex), along with maintaining adequate nourishment and accepting her inherited physique.

Long-Term Recovery: Physical issues

Before fully recovering from anorexia, adolescents will often experience wide swings in weight from extreme thinness to obesity, and some may develop bulimia. An adolescent may see herself as somewhat detached from her body and experiment with extreme food habits before adopting a more reasonable perspective. By restricting food and experiencing stress she may not regain her menses as soon as expected. She may feel bloated and have bouts of edema as physical responses to starvation and re-feeding. Until she is fully nourished her skin may be yellow from time to time as result of carotenemia.

Long-Term Recovery: Intervention strategies

During recovery the psychotherapeutic goal will be to facilitate normal physical and psychological development, preparing the adolescent for a full healthy adult role in society. True psychological maturation will enable her to function without depending on unhealthy eating and exercise habits. Nutritional counseling will provide her with needed information and retraining about food and the physical aspects of life; education regarding healthy weight management techniques will also be useful. Issues such as the level of nourishment necessary to maintain the menstrual cycle will resurface from time to time, as cognitive and emotional development proceeds. Returning to such issues will enable her to deal more capably with them as she matures. Guided experiences in eating out, grocery shopping, cooking, and entertaining, prepare adolescents to manage food in the environment without over focusing on it. A team of psychological, nutritional and medical specialists will provide necessary care, and monitor her progress toward recovery.

Long-Term Recovery: Final outcome

Strong resistance to treatment and a high incidence of relapse and partial recovery are common outcomes of anorexia nervosa in adolescents. Many will retain symptoms into adulthood. Results of outcome studies reported to date indicate that although weight-for-height-for-age proportion improved in a majority of the adolescents, menstrual cycles were often unsatisfactorily maintained, ideas about food and weight remained disturbed, and psychosocial maladjustment was common. The relationship of depressed body weight to depressive symptoms, as well as to sex role and body image distortions, and the observation that fewer than the expected number of children are born to adolescents formerly diagnosed with anorexia nervosa, are equally disturbing.

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