recommends a team approach to treatment of eating disorders. the members of the team are usually a psychiatrist, therapist, and registered dietitian, but other clinicians may be included. that said, some treatment methods are: cognitive behavioral therapy (cbt), which postulates that an individual's feelings and behaviors are caused by their own thoughts instead of external stimuli such as other people, situations or events; the idea is to change how a person thinks and reacts to a situation even if the situation itself does not change. see cognitive behavioral treatment of eating disorders. acceptance and commitment therapy: a type of cbt cognitive behavioral therapy enhanched (cbt-e): the most widespread cognitive behavioral psychotherapy specific for eating disorders cognitive remediation therapy (crt), a set of cognitive drills or compensatory interventions designed to enhance cognitive functioning. exposure and response prevention: a type of cbt; the gradual exposure to anxiety provoking situations in a safe environment, to learn how to deal with the uncomfortableness the maudsley anorexia nervosa treatment for adults (mantra), which focuses on addressing rigid information processing styles, emotional avoidance, pro-anorectic beliefs, and difficulties with interpersonal relationships. these four targets of treatment are proposed to be core maintenance factors within the cognitive-interpersonal maintenance model of anorexia nervosa. dialectical behavior therapy family therapy including "conjoint family therapy" (cft), "separated family therapy" (sft) and maudsley family therapy. behavioral therapy: focuses on gaining control and changing unwanted behaviors. interpersonal psychotherapy (ipt) cognitive emotional behaviour therapy (cebt) art therapy nutrition counseling and medical nutrition therapy self-help and guided self-help have been shown to be helpful in an, bn and bed; this includes support groups and self-help groups such as eating disorders anonymous and overeaters anonymous. having meaninful relationships are often a way to recovery. having a partner, friend or someone else close in your life may lead away from the way of problematic eating according to professor cynthia m. bulik. psychoanalytic psychotherapy inpatient care there are few studies on the cost-effectiveness of the various treatments. treatment can be expensive; due to limitations in health care coverage, people hospitalized with anorexia nervosa may be discharged while still underweight, resulting in relapse and rehospitalization. research has found comorbidity between an eating disorder (e.g., anorexia nervosa, bulimia nervosa, and binge eating) and ocd does not impact the length of the time patients spend in treatment, but can negatively impact treatment outcomes. for children with anorexia, the only well-established treatment is the family treatment-behavior. for other eating disorders in children, however, there is no well-established treatments, though family treatment-behavior has been used in treating bulimia. a 2019 cochrane review examined studies comparing the effectiveness of inpatient versus outpatient models of care for eating disorders. four trials including 511 participants were studied but the review was unable to draw any definitive conclusions as to the superiority of one model over another. barriers to treatment a variety of barriers to eating disorder treatment have been identified, typically grouped into individual and systemic barriers. individual barriers include shame, fear of stigma, cultural perceptions, minimizing the seriousness of the problem, unfamiliarity with mental health services, and a lack of trust in mental health professionals. systemic barriers include language differences, financial limitations, lack of insurance coverage, inaccessible health care facilities, time conflicts, long waits, lack of transportation, and lack of child care. these barriers may be particularly exacerbated for those who identify outside of the skinny, white, affluent girl stereotype that dominates in the field of eating disorders, such that those who do not identify with this stereotype are much less likely to seek treatment. conditions during the covid-19 pandemic may increase the difficulties experienced by those with eating disorders, and the risk that otherwise healthy individuals may develop eating disorders. the pandemic has been a stressful life event for everyone, increasing anxiety and isolation, disrupting normal routines, creating economic strain and food insecurity, and making it more difficult and stressful to obtain needed resources including food and medical treatment. the covid-19 pandemic in england exposed a dramatic rise in demand for eating disorder services which the english nhs struggled to meet. the national institute for health and care excellence and nhs england both advised that services should not impose thresholds using body mass index or duration of illness to determine whether treatment for eating disorders should be offered, but there were continuing reports that these recommendations were not followed. in terms of access to treatment, therapy sessions have generally switched from in-person to video calls. this may actually help people who previously had difficulty finding a therapist with experience in treating eating disorders, for example, those who live in rural areas. studies suggest that virtual (telehealth) cbt can be as effective as face-to-face cbt for bulimia and other mental illnesses. to help patients cope with conditions during the pandemic, therapists may have to particularly emphasize strategies to create structure where little is present, build interpersonal connections, and identify and avoid triggers. medication orlistat is used in obesity treatment. olanzapine seems to promote weight gain as well as the ability to ameliorate obsessional behaviors concerning weight gain. zinc supplements have been shown to be helpful, and cortisol is also being investigated. two pharmaceuticals, prozac and vyvanse, have been approved by the fda to treat bulimia nervosa and binge-eating disorder, respectively. olanzapine has also been used off-label to treat anorexia nervosa. studies are also underway to explore psychedelic and psychedelic-adjacent medicines such as mdma, psilocybin and ketamine for anorexia nervosa and binge-eating disorder. outcomes for anorexia nervosa, bulimia nervosa, and binge eating disorder, there is a general agreement that full recovery rates range between 50% to 85%, with larger proportions of people experiencing at least partial remission. it can be a lifelong struggle or it can be overcome within months. miscarriages: pregnant women with a binge eating disorder have shown to have a greater chance of having a miscarriage compared to pregnant women with any other eating disorders. according to a study done, out of a group of pregnant women being evaluated, 46.7% of the pregnancies ended with a miscarriage in women that were diagnosed with bed, with 23.0% in the control. in the same study, 21.4% of women diagnosed with bulimia nervosa had their pregnancies end with miscarriages and only 17.7% of the controls. relapse: an individual who is in remission from bn and ednos (eating disorder not otherwise specified) is at a high risk of falling back into the habit of self-harm. factors such as high stress regarding their job, pressures from society, as well as other occurrences that inflict stress on a person, can push a person back to what they feel will ease the pain. a study tracked a group of selected people that were either diagnosed with bn or ednos for 60 months. after the 60 months were complete, the researchers recorded whether or not the person was having a relapse. the results found that the probability of a person previously diagnosed with ednos had a 41% chance of relapsing; a person with bn had a 47% chance. attachment insecurity: people who are showing signs of attachment anxiety will most likely have trouble communicating their emotional status as well as having trouble seeking effective social support. signs that a person has adopted this symptom include not showing recognition to their caregiver or when he/she is feeling pain. in a clinical sample, it is clear that at the pretreatment step of a patient's recovery, more severe eating disorder symptoms directly corresponds to higher attachment anxiety. the more this symptom increases, the more difficult it is to achieve eating disorder reduction prior to treatment. impaired decision making: studies have found mixed results on the relationship between eating disorders and decision making. researchers have continuously found that patients with anorexia were less capable of thinking about long-term consequences of their decisions when completing the iowa gambling task, a test designed to measure a person's decision-making capabilities. consequently, they were at a higher risk of making hastier, harmful choices. anorexia symptoms include the increasing chance of getting osteoporosis. thinning of the hair as well as dry hair and skin are also very common. the muscles of the heart will also start to change if no treatment is inflicted on the patient. this causes the heart to have an abnormally slow heart rate along with low blood pressure. heart failure becomes a major consideration when this begins to occur. muscles throughout the body begin to lose their strength. this will cause the individual to begin feeling faint, drowsy, and weak. along with these symptoms, the body will begin to grow a layer of hair called lanugo. the human body does this in response to the lack of heat and insulation due to the low percentage of body fat. bulimia symptoms include heart problems like an irregular heartbeat that can lead to heart failure and death may occur. this occurs because of the electrolyte imbalance that is a result of the constant binge and purge process. the probability of a gastric rupture increases. a gastric rupture is when there is a sudden rupture of the stomach lining that can be fatal. the acids that are contained in the vomit can cause a rupture in the esophagus as well as tooth decay. as a result, to laxative abuse, irregular bowel movements may occur along with constipation. sores along the lining of the stomach called peptic ulcers begin to appear and the chance of developing pancreatitis increases. binge eating symptoms include high blood pressure, which can cause heart disease if it is not treated. many patients recognize an increase in the levels of cholesterol. the chance of being diagnosed with gallbladder disease increases, which affects an individual's digestive tract. risk of death death rates from eating disorders, owid eating disorders result in about 7,000 deaths a year as of 2010, making them the mental illnesses with the highest mortality rate. anorexia has a risk of death that is increased about 5 fold with 20% of these deaths as a result of suicide. rates of death in bulimia and other disorders are similar at about a 2 fold increase. the mortality rate for those with anorexia is 5.4 per 1000 individuals per year. roughly 1.3 deaths were due to suicide. a person who is or had been in an inpatient setting had a rate of 4.6 deaths per 1000. of individuals with bulimia about 2 persons per 1000 persons die per year and among those with ednos about 3.3 per 1000 people die per year. epidemiology in the developed world, binge eating disorder affects about 1.6% of women and 0.8% of men in a given year. anorexia affects about 0.4% and bulimia affects about 1.3% of young women in a given year. up to 4% of women have anorexia, 2% have bulimia, and 2% have binge eating disorder at some point in time. anorexia and bulimia occur nearly ten times more often in females than males. typically, they begin in late childhood or early adulthood. rates of other eating disorders are not clear. rates of eating disorders appear to be lower in less developed countries. in the united states, twenty million women and ten million men have an eating disorder at least once in their lifetime. anorexia rates of anorexia in the general population among women aged 11 to 65 ranges from 0 to 2.2% and around 0.3% among men. the incidence of female cases is low in general medicine or specialized consultation in town, ranging from 4.2 and 8.3/100,000 individuals per year. the incidence of an ranges from 109 to 270/100,000 individuals per year. mortality varies according to the population considered. an has one of the highest mortality rates among mental illnesses. the rates observed are 6.2 to 10.6 times greater than that observed in the general population for follow-up periods ranging from 13 to 10 years. standardized mortality ratios for anorexia vary from 1.36% to 20%. bulimia bulimia affects females 9 times more often than males. approximately one to three percent women develop bulimia in their lifetime. about 2% to 3% of women are currently affected in the united states. new cases occur in about 12 per 100,000 population per year. the standardized mortality ratios for bulimia is 1% to 3%. binge eating disorder reported rates vary from 1.3 to 30% among subjects seeking weight-loss treatment. based