Outpatient management of anorexia nervosa

The outpatient management of anorexia nervosa is described according to four levels of approach: identification, information, intervention, and intensive treatment. On the first level, emphasis is laid upon early detection and positive diagnosis of anorexia nervosa by focusing on behavioral and attitudinal features of the patient. In mild or benign cases confrontation and information may suffice to induce a rapid reversal of the symptoms. This second level includes (confronting or reassuring) medical clarification and general educational instruction in order to allow the parents to handle the problem themselves. A considerable number of patients, however, require more specific interventions - the third level of problem management. A concrete procedure involving the patient and the family in a directive, problem-specific and contractual approach is presented. Finally, several patients need an intensive and mostly multifaceted treatment program. On this level, the limits of outpatient therapy must be seriously questioned.