Anorexia nervosa and bulimia: diagnosis and comprehensive treatment

The following principles are associated with successful treatment of anorexia nervosa and bulimia: (1) correct identification of these syndromes by history and mental examination, rather than by the elimination of all possible medical explanations; (2) a balanced approach between changing the abnormal weight or eating pattern and understanding and correcting the predisposing and underlying psychodynamics; (3) an empirical practical approach to treatment that avoids speculative concepts of origin; (4) an understanding of the natural history and underlying psychopathology of these disorders; (5) a non-blaming supportive approach, with variation in the specific kind of psychotherapy chosen according to the needs and abilities of the patient; (6) global treatment goals including psychologic, biologic, and social improvement; (7) avoidance of procedures with high morbidity such as tube feeding, hyperalimentation, and high-dose medication; and (8) an attitude of realistic optimism. Virtually all aspects of these disorders have the potential for complete improvement.