Anorexia Nervosa

What Is Anorexia Nervosa?

Anorexia nervosa is an eating disorder. Eating disorders are conditions in which there is a serious disturbance in the way a person deals with food, weight, and body image.

The main feature of anorexia nervosa is excess weight loss or maintaining an abnormally low weight for one’s age and height. It is accompanied by a variety of changes in behavior, emotions, thinking, perceptions, and social interactions.

Food and eating dominate the life of a person with anorexia nervosa. Weight loss is achieved by excessive dieting and other extreme ways of controlling weight. These behaviors are fueled by an intense desire to be thinner and a fear of becoming fat. Body weight and shape become the main or even sole measures of self-worth. Maintaining an extremely low weight becomes equated with beauty, success, self-esteem, and self-control and is not seen as a problem.

People with an eating disorder think about food, weight, and body image constantly. They usually have chronic medical and psychological problems related to these issues and how they eat.

Eating disorders can require long-term medical care and disrupt functioning in school, work, and relationships. While severe cases can lead to permanent disability and even death, recent advances in the understanding of anorexia nervosa provide hope for more success in treatment. Currently, about 75% of people with anorexia nervosa experience improvement with treatment.

Although often thought of as a disorder of recent times, anorexia nervosa was well described in medical literature over 100 years ago. The name, however, is misleading. Anorexia nervosa literally means “nervous loss of appetite.” But people with this disorder lose weight and then maintain an abnormally low weight despite intense hunger.

Anorexia Nervosa: What Are The Warning Signs And Symptoms?

The main criteria necessary for the diagnosis of anorexia nervosa are:

• Excessive weight loss or lack of normal weight gain, often to the point of starvation
• Intense fear of gaining weight or becoming fat
• Distorted image of body weight or shape
• Absence of at least three menstrual periods in a row in females

The following are common behaviors that occur in anorexia nervosa:

• Significant reduction of the amount of food eaten
• Avoiding eating; skipping meals
• Intense focusing on food, eating, and body weight and shape
• Repeatedly weighing oneself
• Denial of hunger
• Rigid eating patterns, such as extreme controlling of calories and fat even when underweight
• Unusual rituals at mealtimes, such as cutting food into tiny pieces, moving food around the plate, and throwing out food so it does not have to be eaten
• Storing or hoarding food
• Collecting recipes and cooking for others while finding excuses to avoid eating
• Wearing baggy clothes to hide the amount of weight lost
• Obvious fear or anxiety before eating and guilt after eating
• Complaining of bloating and unusual fullness after eating only small amounts of food
• Excessive or compulsive exercising

In addition to extreme dieting, many people with anorexia nervosa use excessive exercising to burn off calories and keep their weight very low. If unable to exercise for some reason, they may experience extreme guilt or even panic. Thus, they may continue to exercise despite injury and exhaustion.

Binge Eating And Purging

About half of the people with anorexia nervosa also regularly engage in binge eating and then purging to keep their weight low.

Binge eating means eating an abnormally large amount of food within a certain amount of time, usually accompanied by a feeling of lack of control over eating.

• Binge eating means eating an abnormally large amount of food within a certain amount of time, usually accompanied by a feeling of lack of control over eating.
• Purging means ridding the body of food by self-induced vomiting or misuse of laxatives, diuretics, or enemas.

Binge eating is usually very distressing to people with anorexia nervosa because of their fear of weight gain. It often causes greater obstacles to recovery.

Purging usually begins because it appears to be a solution to cravings for food on the one hand and terror about gaining weight on the other. Purging can actually lead to episodes of overeating since it allows the person to give in to food cravings and then feel that s/he can “get rid of the food” without gaining weight. Although purging usually starts gradually, it typically escalates over time, and the person eventually feels completely out of control.

Changes In Emotions And Relationships

Anorexia nervosa is associated with significant emotional changes and often with marked changes in relationships with family members and friends. In the early stages of weight loss the person may feel better about herself or himself, seem excessively cheerful, show a burst of self-confidence, and be more outgoing.

Depression, anxiety, irritability, anger, and rapid mood shifts usually follow and may become severe as starvation progresses. Sometimes mood seems dull or flat, and the person may appear extremely withdrawn and aloof. Binge eating, dieting, exercising, and purging may become ways to escape from unpleasant feelings.

Deterioration in relationships may occur, especially as others express concern about the person’s condition. However, sometimes a person with anorexia nervosa becomes more dependent on certain family members as the disorder progresses and may even express fears that parents will stop taking care of her or him if recovery occurs.

What Causes Anorexia Nervosa?

There is no single cause of anorexia nervosa. Several different factors are usually involved in producing this disorder.

• Cultural pressures
• Psychological issues
• Family enviroment
• Genetic factors
• Life transitions
• Perpetuating factors

Cultural Pressures

In many societies, being extremely thin is the standard of beauty for women and represents success, happiness, and self-control. Women are bombarded with messages from the media that they must diet to meet this standard. However, this idealized ultra-thin body shape is almost impossible for most women to achieve since it does not fit with the biological and inherited factors that determine natural body weight. This conflict leaves most women very dissatisfied with their body weight and shape.

More recently, pressure has also increased on men to be lean and muscular. In addition, in certain occupations (such as dancing, modeling, and sports like gymnastics, figure skating, running, and wrestling), the pressure to maintain a specific weight and appearance is especially strong.

Psychological Issues

Psychological characteristics that can make a person more likely to develop anorexia nervosa include:

• Low self-esteem
• Feelings of ineffectiveness
• Poor body image
• Depression
• Difficulty expressing feelings
• Rigid thinking patterns
• Need for control
• Perfectionism
• Physical or sexual abuse
• Avoidance of conflict with others
• Need to feel special or unique

People with anorexia nervosa often appear emotionally driven not only toward weight loss, but also in other areas of their life, such as schoolwork, physical fitness, or career. It has also been suggested that in some cases of anorexia nervosa, self-starvation may be a way to avoid the sexual and social demands associated with adolescence.

One of the problems in determining which traits may cause anorexia nervosa is that the weight loss itself causes certain psychological disturbances to develop. These may include depression, anxiety, irritability, mood swings, obsessive thinking, feelings of inadequacy, social withdrawal, and personality changes. Thus, some of the traits that occur in anorexia nervosa may be a result, rather than a cause, of the disorder.

Family Environment

Some family styles may contribute to the development of anorexia nervosa. Families of people with the disorder are more likely to be:

• Overprotective
• Rigid
• Suffocating in their closeness

In these cases, anorexia nervosa develops as a struggle for independence and individuality. It is likely to surface in adolescence when new demands for independence occur.

Other characteristics of families that may increase the chance of developing anorexia nervosa are:

• Overvaluing appearance and thinness
• Criticizing a child’s weight or shape
• Being physically or sexually abusive

Genetic Factors

Anorexia nervosa occurs eight times more often in people who have relatives with the disorder. However, experts do not know exactly what the inherited factor may be. In addition, anorexia nervosa occurs more often in families with a history of depression or alcohol abuse.

Life Transitions

Life transitions can often trigger anorexia nervosa in someone who is already vulnerable because of the factors described above. Examples include:

• Beginning of adolescence
• Beginning or failing in school or at work
• Breakup of a relationship
• Death of a loved one

Dieting and losing weight can also set off anorexia nervosa.

Perpetuating Factors

Once anorexia nervosa has developed, several factors can perpetuate the disorder. These factors include:

• Symptoms of starvation
• Other people’s reactions to the weight loss
• Emotional needs filled by feelings of self-control, virtue, and power from controlling one’s weight

The resulting cycle makes it more difficult to stop the disorder and become healthy again.

What Medical Problems Can Anorexia Nervosa Cause?

Many physical changes can occur with anorexia nervosa. A large number of these may be attributed to weight loss. Others are complications related to purging.

Changes in body metabolism associated with weight loss leads to a lowering of:

• Heart rate
• Blood pressure
• Breathing rate
• Body temperature (which may result in feeling cold)

Other physical symptoms include:

• Thinning or drying of the hair
• “Lanugo” hair (a fine hair that develops on the face, back, or arms and legs)
• Dry skin
• Restlessness and reduced sleep
• Yellowish color on the palms of the hands and soles of the feet
• Lack of or infrequent menstrual periods

Self-induced vomiting and laxative abuse are associated with physical complications such as:

• Swollen salivary glands (evident by swelling on the sides of the face)
• Erosion of tooth enamel, increase in dental cavities
• Fatigue
• Body fluid loss
• Bloating, swelling of the feet and ankles
• Soreness or tears in the lining of the mouth or throat
• Constipation, stomach cramps
• Numbness and tingling in the limbs
• Dizziness, weakness, fainting

Anorexia nervosa can lead to serious symptoms, such as heart problems, seizures, and kidney damage. Death may even occur as a result.

Osteoporosis (the loss of bone mass) is common in anorexia nervosa. It can lead to a variety of problems, including a tendency toward stress fractures and other bone abnormalities.

What Is An Appropriate Body Weight?

There is no agreed-upon simple answer to this question. There are a number of “standards” used, such as weight charts that provide an “expected weight” depending on height, age, and gender. However, these are of limited value because they do not take into account the large differences between people in terms of genetic and related factors that determine where body weight settles comfortably.

Weight, just like most other physical features, varies naturally among people. You can make small changes in your body weight, but when pushed too far, the body tries to make biological adjustments to get back to its more natural weight.

• People with anorexia nervosa usually weigh less than 85% of their body’s normal weight.
• In anorexia nervosa, regaining weight should be slow but steady. Most experts recommend a rate of weight gain between two to four pounds a week on average.
• The goal should be a weight that is above the weight where normal menstruation occurs. This is almost always above 90% of average weight as reported on weight charts (taking age and height into consideration).
• However, rather than establishing an exact weight expectation, it is preferable to try to normalize eating and let weight settle at its natural level.

What Is “Normal” Eating?

“Normal” eating for an adolescent or young adult woman is around 2000 calories a day spread over three meals and snacks. During recovery from anorexia nervosa, many more calories may need to be consumed in order to get back to a normal weight. The number of calories varies depending on the person’s weight, metabolism, current eating patterns, and tolerance for change.

The amount eaten should be enough to ultimately reduce hunger. Increasing the amount eaten causes an increase in metabolic rate, so more calories are required just to maintain a stable weight.

Another aspect of normalizing eating involves learning to feel more relaxed eating a wide range of foods. Weekly and even daily meal planning should gradually but explicitly incorporate foods previously avoided. Normalizing eating also involves spacing meals properly throughout the day.

How Is Anorexia Nervosa Diagnosed?

The diagnosis and evaluation process usually begins with a detailed interview with the person with anorexia nervosa and family members. Questions are usually asked about:

• Weight history
• Eating patterns
• Concerns about weight and shape
• Dieting and weight-losing behaviors
• Whether or not binge eating has been a problem
• Problems in the family or other relationships
• Physical and psychological symptoms that occurred before the disorder started
• Physical and psychological symptoms that have occurred since it started

A thorough medical evaluation is also performed in order to assess the physical problems that may have resulted from weight loss, vomiting, and laxative abuse. This involves a complete physical examination and may require blood tests and/or an electrocardiogram.

It is important to rule out other possible physical explanations for the weight loss and become aware of other physical problems that may affect the treatment planning.

What Are The Treatments For Anorexia Nervosa?

There are a number of treatments used for anorexia nervosa. A treatment plan is developed to address the specific needs of the individual. It usually includes treating any serious medical problems first and then focusing on weight gain and addressing the psychological issues that have led to the development and maintenance of the anorexia nervosa.

Regaining weight is a key part of any treatment plan since improvements in mood, personality, and interpersonal relationships cannot be sustained without it.

Factors that determine the types of treatments are:

• The person’s age
• Current living arrangements
• How long the person has had anorexia nervosa
• Overall medical condition, including weight
• Other eating disorder symptoms, such as binge eating, vomiting, or laxative abuse
• Poor results with previous treatments
• Severity of other associated psychological symptoms, such as depression, problems controlling impulses, and personality problems

The overall goals of treatment are to:

• Treat medical complications
• Gradually gain weight to a level that allows normal menstrual periods to begin
• Normalize eating
• Eliminate inappropriate weight control behaviors
• Help the person cope with changes in eating and weight
• Deal with psychological and family problems that have caused the disorder or have led to it being maintained over time

The types of treatments that may be used for anorexia nervosa include:

• Psychotherapy
• Support groups
•  Medication
• Hospitalization

Psychotherapy

• Individual psychotherapy is the cornerstone of treatment for anorexia nervosa, especially for people who are beyond adolescence and who are not living at home. Individual therapy provides a safe place to learn how to identify concerns, solve problems, overcome fears, and test new skills.

  There are many types of individual therapy. Cognitive behavioral approaches can help to develop healthy ways of thinking and patterns of behavior, particularly with food and relationships. Other kinds of therapy emphasize important interpersonal relationships and psychological issues, such as self-esteem.

• Family therapy is almost always used as part of treatment when the person with anorexia nervosa is young or living at home. Family therapy can be useful to provide information about anorexia nervosa, assess the impact of the disorder on the family, help members overcome guilt, improve communication and decision-making skills, develop strategies for coping, and develop practical strategies for overcoming the disorder.

• Marital therapy is almost always valuable when the person with anorexia nervosa is married. The primary goal of marital therapy is to strengthen the relationship. It can provide practical suggestions on how to deal with the disorder. It may also help identify and resolve communication problems.
• Group therapy can play an important role as part of hospital treatment, partial hospitalization or intensive day treatment. There are many different types of groups, each with different goals and orientations. Some groups are “task-oriented” and may focus on food, eating, body image, interpersonal skills, and vocational training. Other groups are aimed at understanding the psychological factors that may have led to the development and maintenance of the disorder.

  Groups can assist in dealing with other associated emotional symptoms, such as anxiety, depression and anger. Sharing experiences with others in a group can be very effective in helping reduce guilt, shame, and isolation, and can lead to important insights regarding strategies for recovery.

Support Groups

Support groups led by non-professionals may be helpful under certain circumstances; however, it is usually best to have groups facilitated by a professional. Support groups can provide people with anorexia nervosa and their families with mutual support and advice about how to cope with the disorder. They can also prepare someone for therapy who is afraid of it. Support groups can be counterproductive if they foster an “anorexic identity” or provide peer-group support for maintaining eating disorder behaviors.

Medication

Many medications have been tried in treating anorexia nervosa. It is generally agreed that medication alone is not effective. Because depression and other emotional problems are often a result of starvation, it is best to focus on weight gain rather than medication. In addition, the effects of starvation decrease the effectiveness of antidepressants and worsen the side effects. However, occasionally, medication may be required to deal with overwhelming anxiety, obsessions, depression, or gastric discomfort following meals.

Hospitalization

Hospitalization is rarely sufficient to cure anorexia nervosa. However, it may be required to:

• Interrupt steady weight loss or promote weight gain if there has been a failure to gain weight in outpatient care
• Interrupt bingeing and vomiting
• Control weight gain that is occurring too rapidly
• Evaluate and treat physical complications
• Address other serious psychological problems reflected by severe depression, suicidal behavior, self-destructive behavior, or substance abuse

One of the advantages of hospital treatment is that it provides a safe environment where food and weight can be carefully monitored while psychological concerns are explored.

There are various settings in which hospitalization can occur, including general hospitals, psychiatric hospitals, and specialized eating disorders programs. Although there are advantages and disadvantages to each of these settings, they can all lead to treatment success. While in the hospital, a variety of types of treatment may be used, such as family meetings, individual therapy, group therapy, occupational therapy, and occasionally medication.

Partial care programs share many features with inpatient programs. Patients receive similar therapeutic services; however, the major difference is that they do not stay overnight. Partial hospitalization has economic and clinical advantages over inpatient treatment.

Partial programs usually provide enough structure around meal times, plus the possibility for intensive therapy, that is sufficient for most patients to make behavioral changes, without requiring them to be totally disengaged from the supports and the therapeutic challenges outside of the hospital.

Inpatient treatment is still the preferred treatment for patients who:

• Are seriously emaciated
• Require close medical monitoring
• Fail to progress in partial care
• Are at serious risk for self-harm

Outcomes of Treatment:

Although weight gain can occur quickly once treatment begins, complete recovery can take a number of years. Many of those who recover in terms of weight remain overly concerned about eating and weight. Relapse can occur during periods of stress.

About 75% of people with anorexia nervosa continue to show improvement after initial treatment.

• About 45% of these people have an excellent outcome
• Another 30% experience considerable improvement
• About 20% of those receiving treatment remain seriously impaired
• Between 2% and 10% die because of the disorder. Deaths are usually related to complications of starvation or suicide. However, death rates appear to be decreasing due to improved treatments.

Factors associated with successful recovery include:

• Motivation to change
• Young age when anorexia nervosa starts
• Short length of illness
• Absence of binge eating or purging

However, recovery is possible in those who have had anorexia nervosa for many years and who have not succeeded with previous treatments. With proper treatment and a strong desire to change, people with anorexia nervosa can go on to live healthy, productive, and satisfying lives.

Early diagnosis and treatment can help prevent serious medical and psychological problems from developing and increase the chance of regaining good health. So, if you think you may have anorexia nervosa, talk with your health care provider or a mental health professional. If you think someone you know may have anorexia nervosa, encourage her or him to get professional help.

How Can I help a Family Member or Friend with Anorexia Nervosa?

Family members and friends of a person with anorexia nervosa can provide important help and support. Here are some suggestions:

• Learn about anorexia nervosa, including treatment options.
• Talk with the person about your concerns, including specific behaviors you have noticed.
• Encourage the person to talk with her or his health care provider or a mental health professional. Offer to go with the person to the appointment.
• If the person denies the problem or refuses to get professional help, suggest that he or she talk with another trusted adult, such as a family member, friend, or teacher.
• Exercise responsibility and authority in getting treatment if the person is a minor.
• Be understanding and patient, but firm. Dealing successfully with anorexia nervosa takes time.
• Do not blame yourself or the person with anorexia nervosa. It is not anyone’s fault.
• Do not focus on or try to control the person’s eating, weight, or appearance.
• Accept the person as he or she is, talk about feelings, and emphasize her or his strengths.
• Take care of your needs too. Consider attending a support group.

Outcomes of Treatments For Anorexia Nervosa

Although weight gain can occur quickly once treatment begins, complete recovery can take a number of years. Many of those who recover in terms of weight remain overly concerned about eating and weight. Relapse can occur during periods of stress.

About 75% of people with anorexia nervosa continue to show improvement after initial treatment.

• About 45% of these people have an excellent outcome
• Another 30% experience considerable improvement
• About 20% of those receiving treatment remain seriously impaired
• Between 2% and 10% die because of the disorder. Deaths are usually related to complications of starvation or suicide. However, death rates appear to be decreasing due to improved treatments.

Factors associated with successful recovery include:

• Motivation to change
• Young age when anorexia nervosa starts
• Short length of illness
• Absence of binge eating or purging

However, recovery is possible in those who have had anorexia nervosa for many years and who have not succeeded with previous treatments. With proper treatment and a strong desire to change, people with anorexia nervosa can go on to live healthy, productive, and satisfying lives.

Early diagnosis and treatment can help prevent serious medical and psychological problems from developing and increase the chance of regaining good health. So, if you think you may have anorexia nervosa, talk with your health care provider or a mental health professional. If you think someone you know may have anorexia nervosa, encourage her or him to get professional help.

How Can I Help A Family Member Or Friend With Anorexia Nervosa?

Family members and friends of a person with anorexia nervosa can provide important help and support. Here are some suggestions:

• Learn about anorexia nervosa, including treatment options.
• Talk with the person about your concerns, including specific behaviors you have noticed.
• Encourage the person to talk with her or his health care provider or a mental health professional. Offer to go with the person to the appointment.
• If the person denies the problem or refuses to get professional help, suggest that he or she talk with another trusted adult, such as a family member, friend, or teacher.
• Exercise responsibility and authority in getting treatment if the person is a minor.
• Be understanding and patient, but firm. Dealing successfully with anorexia nervosa takes time.
• Do not blame yourself or the person with anorexia nervosa. It is not anyone’s fault.
• Do not focus on or try to control the person’s eating, weight, or appearance.
• Accept the person as he or she is, talk about feelings, and emphasize her or his strengths.
• Take care of your needs too. Consider attending a support group.

Frequently Asked Questions: Anorexia Nervosa

Here are some frequently asked questions related to anorexia.

Q: Is anorexia nervosa really more common than it used to be, or is it just being identified more?

A: Both are true. The number of people with anorexia nervosa does appear to be increasing along with society’s increasing obsession with thinness and losing weight. However, anorexia nervosa, along with other eating disorders, is also being recognized more by clinicians. And because the disorder is better known and understood by society and there is more help available, more people with anorexia nervosa are seeking help.

Q: Are depression, obsessive-compulsive disorders, and substance abuse more common in people with anorexia nervosa?

A: Yes. All three of these disorders occur more often in people with anorexia nervosa than in the general population. At this point it is not clear whether the overlap is due to genetic causes.

Q: What is the relationship between sexual abuse and anorexia nervosa?

A: People who have been sexually abused are more vulnerable to developing anorexia nervosa. Preoccupation with food and weight can move the focus away from the abuse and the accompanying painful feelings. Control over eating and weight may replace the lack of control experienced during abuse. Anorexia nervosa may also be a way to make one’s body less attractive to possible abusers.

Q: What is the role of exercise in anorexia nervosa?

A: People with anorexia nervosa use exercise as a key way to keep their weight very low. It also helps decrease guilt that may occur with eating. Like dieting, excessive exercising is used as a means of self-control and avoiding painful emotional issues and may take time away from interacting with other people.For a person who does not eat enough, exercising keeps the body in a state of deprivation. This increases the chance of developing other health problems, including dehydration, fluid imbalances, injuries, and heart problems, and slows the healing process.

Q: What are some issues specific to males with anorexia nervosa?

A: The reasons that males develop anorexia nervosa and the behaviors and feelings they experience are similar to those of females with the disorder. However, because anorexia nervosa is mainly considered a female disorder, males are more likely to be misdiagnosed or undiagnosed. They are also likely to experience more shame and guilt than females about having anorexia nervosa and feel even less well understood than females with the disorder. In addition, most of the available information, treatment programs, and support groups are focused on females.

Q: How can anorexia nervosa affect relationships?

A: Anorexia nervosa can lead to isolation in a number of ways. Because so much attention is focused on issues with eating and weight, the person has much less time for relationships. When interacting with others, discussions tend to focus on eating and weight. In addition, since many social gatherings center on food, people with anorexia nervosa often get caught up in their food issues when with others rather than relating with the people around them.

Putting It All Together: Anorexia Nervosa

Here is a summary of the important facts and information related to anorexia.

• Anorexia nervosa is an eating disorder in which the person has a distorted body image and an intense fear of being fat, diets excessively, and experiences extreme weight loss.
• About 90% to 95% of people with anorexia nervosa are females between the ages of 13 and 30.
• Anorexia nervosa is thought to be caused by a combination of cultural, psychological, family, and genetic factors.
• The weight loss and malnutrition in anorexia nervosa can cause serious medical and psychological problems.
• Treatment usually includes dealing with any serious medical problems first and then focusing on weight gain and addressing the psychological issues that have led to the development and maintenance of the disorder.
• About 75% of people with anorexia nervosa experience improvement with treatment.
• Early diagnosis and treatment can help prevent serious medical and psychological problems from developing.

Glossary: Anorexia Nervosa

Here are definitions of medical terms related to anorexia.

Behavior therapy: A type of psychotherapy that focuses on changing and gaining control over unwanted behaviors.

Binge eating: Eating an abnormally large amount of food within a certain amount of time. This is usually accompanied by a feeling of lack of control over eating.

Bulimia nervosa: An eating disorder characterized by repeated episodes of binge eating followed by purging (self-induced vomiting or misuse of laxatives, diuretics, or enemas), using diet pills, excessive exercising, or fasting.

Cognitive behavioral therapy: A type of psychotherapy that combines the techniques of cognitive therapy and behavior therapy.

Cognitive therapy: A type of psychotherapy that focuses on changing unproductive thought patterns. It assumes that by changing your thoughts you can change how you feel.

Purging: Ridding the body of food by self-induced vomiting or misuse of laxatives, diuretics, or enemas.

Additional Sources Of Information: Anorexia Nervosa

Here are some reliable sources that can provide more information on anorexia.

Organizations

National Eating Disorders Association 
Phone: (206) 382-3587 Hotline: 
Phone: 1-800-931-2237

Web site: http://www.nationaleatingdisorders.org/

A non-profit organization that runs a toll-free hotline providing information on eating disorders and referrals to services. Develops educational and prevention materials and programs. Sponsors Eating Disorders Awareness Week in February.

National Association of Anorexia Nervosa and Associated Disorders (ANAD) 
Phone: (847) 831-3438

Web site: http://www.anad.org

Non-profit organization that provides information on eating disorders, referrals to services, local support groups, and educational programs.

Books

Anorexia Nervosa: A Guide to Recovery, by Lindsey Hall and Monika Ostroff. Gurze Books, Carlsbad, CA, 1999.

This is an excellent guide to understanding and overcoming anorexia nervosa. It includes answers to many common questions about the disorder; Monika’s experience with anorexia nervosa and recovery; information on healthy eating and weight; ways to work with yourself on recovery, including getting support, self-exploration techniques, and relaxation exercises; and a section for family and friends.

The Eating Disorder Sourcebook: A Comprehensive Guide to the Causes, Treatments, and Prevention of Eating Disorders, by Carolyn Costin. Lowell House, Los Angeles, 1996.

This is a clearly written guidebook that gives an overview of the symptoms, causes, diagnosis, treatment, and prevention of eating disorders. There are separate chapters on eating disorders in males and guidelines for family members and friends. Much of the book discusses different types of treatment.

Eating Disorders: A Reference Sourcebook, edited by Raymond Lemberg with Leigh Cohn. Oryx Press, Phoenix, AZ, 1999.

This book is a compilation of 40 essays by experts in the field of eating disorders. It covers symptoms, causes, medical complications, and treatment, as well as special sections on males, pregnancy, and childhood abuse and other traumas. It also includes personal stories of people with eating disorders, many resources for further information, and a directory of over 200 eating disorders treatment facilities.

Handbook of Treatment for Eating Disorders, edited by D.M. Garner and P.E. Garfinkel. Guilford Press, New York, 1997.

This 30-chapter volume is comprehensive and scholarly yet practical. Treatments are described in sufficient clinical detail to allow the practitioner to truly understand and model the specific components of the major approaches to treatment. Comprehensive treatment chapters present cognitive-behavioral, psychoeducational, interpersonal, family, feminist, group, and psychodynamic approaches for eating disorders. Additional chapters describe the particulars of inpatient and partial hospitalization as well as pharmacological management of eating disorders. A series of special topics provides the clinician with strategies for adapting treatment to deal with medical complications, sexual abuse, substance abuse, concurrent medical conditions, personality disorders, prepubertal eating disorders, and binge eating disorder as well as how to address patients who refuse to engage in therapy.

Surviving an Eating Disorder: Strategies for Family and Friends, by Michele Siegel, Judith Brisman, and Margot Weinshel. HarperCollins, Scranton, PA, 1997 revised edition.

This book provides valuable insight and practical guidelines for family members and friends of people with eating disorders. It discusses the behavioral and psychological aspects of eating disorders and treatment options. It helps readers deal with their feelings and develop a healthier relationship with the person with the eating disorder.