may, however, complain about related symptoms such
as fatigue, headaches, dizziness,constipation, or fre-
quent infections.
A physical examination begins with weight and
blood pressure and moves through all the signs listed
above. Based on the physical exam, the physician will
order laboratory tests. In general these tests will
include a complete blood count (CBC), urinalysis,
blood chemistries (to determine electrolyte levels), and
liver function tests. The physician may also order an
electrocardiogram to look for heart abnormalities.
Several different mental status evaluations can be
used. In general, the physician will evaluate things such
as whether the person is oriented in time and space,
appearance, observable state of emotion (affect), atti-
tude toward food and weight, delusional thinking, and
thoughts of self-harm or suicide.TreatmentTreatment choices depend on the degree to which
anorexic behavior has resulted in physical damage and
whether the person is a danger to him or herself.
Medical treatment should be supplemented with psy-
chiatric treatment (see Therapies below). Patients are
frequently uncooperative and resist treatment, deny-
ing that their life may be endangered and insisting that
the doctor only wants to ‘‘make them get fat.’’
Hospital impatient care is first geared toward cor-
recting problems that present as immediate medical
crises, such as severe malnutrition, severe electrolyte
imbalance, irregular heart beat, pulse below 45 beats
per minute, or low body temperature. Patients are
hospitalized if they are a high suicide risk, have severe
clinical depression, or exhibit signs of an altered men-
tal state. They may also need to be hospitalized to
interrupt weight loss, stop the cycle of vomiting, exer-
cising and/or laxative abuse, treat substance disorders,
or for additional medical evaluation.
Day treatment or partial hospitalization where
the patient goes every day to an extensive treatment
program provides structured mealtimes, nutrition
education, intensive therapy, medical monitoring,
and supervision. If day treatment fails, the patient
may need to be hospitalized or enter a full-time resi-
dential treatment facility.
Anorexia nervosa is a chronic disease and relapses
are common and to be expected. Outpatient treatment
provides medical supervision, nutrition counseling,
self-help strategies, and therapy after the patient has
reached some weight goals and shows stability.Nutrition/dietetic concerns
A nutrition consultant or dietitian is an essential
part of the team needed to successfully treat anorexia.
The first treatment concern is to get the individual
medically stable by increasing calorie intake and bal-
ancingelectrolytes. After that, nutritional therapy is
needed support the long process of recovery and stable
weight gain. This is an intensive process involving of
nutrition education, meal planning, nutrition moni-
toring, and helping the anorectic develop a healthy
relationship with food.Therapy
Medical intervention helps alleviate the immedi-
ate physical problems associated with anorexia, but by
itself, it rarely changes behavior. Psychotherapy plays
a major role in the helping the anorectic understand
and recover from anorexia. Several different types of
psychotherapy are used depending on the individual’s
situation. Generally, the goal of psychotherapy is help
the individual develop a healthy attitude toward their
body and food. This may involve addressing at the
root causes of anorexic behavior as well as addressing
the behavior itself.
Some types of psychotherapy that have been suc-
cessful in treating anorectics are listed below.
Cognitive behavior therapy (CBT) is designed to
change the individual’s thoughts and feelings about
his or her body and behaviors toward food, but it
does not address why those thoughts or feelings exist.
This therapy is relatively short-term.
Psychodynamic therapy, also called psychoanalytic
therapy, attempts to help the individual gain insight
into the cause of the emotions that trigger their ano-
rexic behavior. This therapy tends to be longer term
that CBT.
Interpersonal therapy is short-term therapy that
helps the individual identify issues and problems in
relationships. The individual may be asked to look
back at his or her family history to try to recognize
problem areas and work toward resolving them.
Family and couples therapy is helpful in dealing with
conflict or disorder that may be a factor in perpetu-
ating anorexic behavior. Family therapy is especially
useful in helping parents who are anorectics avoid
passing on their attitudes and behaviors on to their
children.Prognosis
Anorexia nervosa is difficult to treat successfully.
Medical stabilization, nutrition therapy, continuedAnorexia nervosa