Pragmatic information on the eating disorders.

Anorexia nervosa and bulimia are the prevalent eating disorders in adolescence and can well be regarded as a public health problem. Information on weight history, menstrual history, eating behavior, purging behavior, preoccupation with and fear of weight gain, activity level, depressive symptomatology, and impulsive behaviors is necessary in order to make the diagnosis of anorexia nervosa or bulimia. It is important to remember that bulimia patients have a fluctuation of weight within a normal weight range and usually do not have amenorrhea. The treatment of anorexia nervosa must include medical management, psychotherapy, behavioral therapy, and family therapy. Beginning treatment with outpatient therapy may be successful in adolescents who have a good prognosis and whose parents are willing to cooperate in family therapy. If a patient remains underweight, then she is not being effectively treated for the anorexia nervosa. Most patients will need an initial hospitalization for nutritional rehabilitation and continued outpatient therapy. Recently, bulimia has been recognized as a discrete disorder. Treatment approaches are currently being developed for this disorder and include behavioral techniques, group therapy, antidepressant and anticonvulsant medication, and psychotherapy.