Anorexia nervosa and bulimia: Diagnosis and comprehensive treatment

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