The Management of Anorexia Nervosa

The severity of anorexia nervosa can vary from mild to life threatening. It is sometimes transient but often chronic. Such variety of disorder requires variety of response. The clinician must choose the right treatment to offer at the right time. The literature contains plenty of advice but most of this is based upon experience and opinion rather than on systematic research and treatment trials. For the most part, this paper will be no exception. Anorexia nervosa is a disorder which is distinct from other psychiatric syndromes but is of uncertain cause. In the face of this uncertainty, treatment tends to be informed by the favoured formulation of the clinician, usually some sort of 'multifactorial theory'. Again this paper is no exception. It will concentrate upon the management of anorexia nervosa in late adolescence and adulthood. The treatment of children requires a different approach (Lask & Bryant-Waugh, 1993). The emphasis of the paper will be upon what can go wrong as well as what may be the best interventions to offer. Often the things that go wrong have more to do with the context of treatment and the way in which it is offered rather than with the treatment intervention itself. ideas concerns weight and eating control. The other concerns wider personal issues such as self-esteem, emotional control and self-image in the broadest sense. These issues are mixed up for many people in our society, especially for young women. The idea that self-worth may be enhanced by slenderness is often, although not always, the initial motivation for the eating restraint which seems to be the necessary way into anorexia nervosa. Most slimmers give up restraint in the face of their bodies' regulatory responses. This is the arguably healthy 'what the hell; it's not worth it' response. For some reason the anorectic-to-be persists and becomes caught up in what seems like a nest of vicious circles. For whatever reason, the more she tries to control her eating and weight, the more potentially out of control these issues feel and the more frightening seems the option of, in any sense, letting go. Her ideas become more extreme. She feels worse about herself. She comes to feel like the driver of a car who is stuck with her foot flat down on both the accelerator and the brake. Too often it feels as though everyone else just wants to give her a push. Of course, she needs to get moving but simply pushing may make matters worse.