Handbook of Eating Disorders: Physiology, Psychology, and Treatment of Obesity, Anorexia, and Bulimia

By Kelly D. Brownell; John P. Foreyt | Go to book overview

18
Inpatient and Outpatient
Treatment of
Anorexia Nervosa

Arnold E. Andersen


Introduction

This chapter describes a comprehensive treatment program for inpatients and outpatients with anorexia nervosa. The treatment is based on my and my associates' experience with several hundred patients on the Phipps Psychiatric Service of The Johns Hopkins Hospital and a review of historical principles. It is intended to be a pragmatic guide to treatment.

We believe that anorexia nervosa is a psychological illness with profound biological and social consequences. It occurs only in societies that value thinness despite abundant food. Anorexia nervosa is a temporarily effective pseudosolution to a profound internal or external crisis that may occur during development, as noted by Bruch5 and Crisp,6 or in adult life.2

In order to deal with the psychological aspects of anorexia nervosa, much work must first be done for the nutritional rehabilitation and medical care of the patient. Only after the anorexic illness is resolved can the patient continue progress through the developmental stages described by Erikson.7 The end products of these stages are separation, individuation, the capacity for intimacy, and the fulfillment of meaningful contributions to family and society.

Inpatient and outpatient treatment deal with similar problems that vary in severity and chronicity. Outpatient treatment can be successful

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