Suggested community psychiatric nursing interventions with clients suffering from anorexia nervosa and bulimia nervosa.

Clients suffering from the fasting and gorging syndromes of anorexia and bulimia nervosa are at significant risk of self-harm even if treated with apparent success in hospital. Two major issues (not inevitably co-existing) appear to be at work in these illnesses; distorted perception by the sufferer of his or her own body appearance and stressful interpersonal relationships originating in one of a variety of groups of which the sufferer is a member. (Fear of psychosexual maturity, that is, the clients' inability to develop an age-appropriate sexual identity, is treated in this paper as being the product of faulty interactional patterns; it is also a less clear-cut issue in bulimia nervosa than in anorexia.) A supervised hospital in-patient treatment regime concentrating upon weight gain, effective discouragement of purgation and vomiting, possible drug treatment and perhaps dual or independent usage of individual or group psychotherapy with focused cognitive-behavioural task-oriented approaches, will not realize effective change unless these issues are resolved. Community psychiatric nurses (CPNs) are well-placed to observe and supervise people with eating disorders who are potentially vulnerable to relapse following discharge from hospital. Strategies for effective CPN interventions in the community care of anorectic and bulimic clients are suggested in the paper.