Eating disorders in the 1990s: clinical challenges and treatment implications

Eating disorders are, and most likely will continue to be, a ubiquitous clinical and therapeutic challenge. The high morbidity and mortality rate of anorexia nervosa and bulimia nervosa presents a major psychiatric problem in contemporary mental health treatment. The author briefly reviews the importance of comorbidity and sexual abuse in this patient population, the special problems of males with eating disorders, salient countertransference paradigms, the role of masochism, and the impact of projective identification on the treatment process. She describes the major clinical considerations, treatment strategies, and psychodynamic issues, giving particular attention to the role of extended inpatient treatment for the refractory patient. The author urges treaters to be emotionally available to these patients, who struggle with the interpersonal dilemma of maintaining separateness while establishing mature connectedness.