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  • Print publication year: 2008
  • Online publication date: May 2010

42 - Complex treatments for eating disorders

from Part III - Specific treatments

Summary

Editor's note

The decision of where to treat anorexia and bulimia nervosa, and for how long, is a critical part of management. The agonizing that goes into the decision whether to seek treatment at all has been well illustrated in the popular UK radio series The Archers in which one of the central characters, Helen Archer, developed excessive dieting and marked loss of weight after the suicide of her partner. (For some reason the script writers insisted her condition was not anorexia nervosa, so they might have been thinking of EDNOS – see Chapter 39.) The difficult task her parents had in getting her to seek treatment – ‘there is nothing wrong with me, mum, why do you have to try and control my life?’ – and the subtle and delicate way it was finally achieved, shows the importance of matching the treatment of eating disorders to the right setting. This subject, like most complex interventions, is unfortunately not at the stage of giving evidence-based guidelines but at some point the major differences between the type and duration of treatment in different countries will need to be addressed through some formal comparisons.

Introduction

For the greater part of the twentieth century management of anorexia nervosa (AN) was in the hands of non-psychiatrist physicians, and these patients were usually nursed on general medical wards. With the development of psychological models of anorexia nervosa, management of this condition transferred from general medicine to psychiatry or in some European countries to psychosomatic medicine.

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