Mirror confrontation is a more effective form of exposure because of the strong emotional response it elicits. Patients' pronounced emotional response to this exercise allowed easier identification of the affective and behavioral components of body dissatisfaction and more cogent links into a developmental body image timeline.

There remain problems with satisfaction scales. Qualitative approaches to examine patients' experiences in hospital and the causes of dissatisfaction are recommended.

Previous target weights have been too low to ensure reproductive maturity. The resulting hypoestrogenic state increases the risk of future osteoporosis. Pelvic ultrasound is the safest and most reliable method for determining ovarian and uterine maturity in adolescent girls with anorexia nervosa.

Objective: Neuroimaging and neuropsychology studies in anorexia nervosa have produced conflicting results due to confounding variables of comorbidity, psychotropic medication, age of onset, states of starvation and the absence of homogenous samples and suitable control groups. The aim of this study is to determine if consistent functional abnormalities of the brain exist in a homogeneous sample of women with anorexia nervosa compared to and controls, and to seek any association between such abnormalities and neuropsychological deficits. Methods: Eleven women with anorexia nervosa and no comorbidity underwent regional cerebral blood flow (rCBF) examination using single photon computerised tomography (SPECT) and the Eating Disorder Examination (EDE) Results were compared with those from studies on children and adolescents with AN and 11 control subjects. A battery of neuropsychometric tests (IQ, attention and memory, visuospatial and executive function) was administered to the patient group in order to examine the relationship between rCBF abnormalities and cognitive functioning. Results: Hypoperfusion was demonstrated in the anterior temporal lobe and /or caudate nuclei in 8 of 11 patients. No hypoperfusion was identified in the control group. The patient group demonstrated consistent deficits in memory tasks associated with temporal lobe function. Conclusions: The findings in this adult cohort were very similar to those in studies of children and adolescents with AN (Chowdhury et al., 2003) and significantly different from controls. Cortical involvement in the pathogenesis of anorexia nervosa is postulated and further research requirements are outlined.

Pelvic ultrasonography is generally regarded as the gold standard for determination of pelvic maturity and hence the need for further weight gain in patients with anorexia nervosa. Many clinicians, however, have limited knowledge of this technique. Here, we describe the use of pelvic ultrasonography in anorexia nervosa and present an algorithm to assist the clinician, both with what questions to ask from the radiologist, and how to use the information provided to determine the morphology and hence maturity of the pelvic organs. We then show how this information can be used to assign the level of pelvic maturity a grade from 1 to 5. Finally, we demonstrate use of this system in two patients who progressively gained weight until pelvic maturity was achieved.

Ward based clinical examination revealed a normal tympanic membrane in our very low weight anorexic patients. Our results emphasise the possibility of loss of fatty tissue surrounding the Eustachian tube to be the primary cause for their otolaryngological symptoms. We have attempted to increase awareness among clinicians treating anorexic patients with similar symptoms.

No abstract

Service providers' views were congruent with each other, NICE guidelines and quality standards as proposed by the Royal College. Although clinicians feel that their service fulfils many practice guidelines, there remains areas in which adherence is felt to be lacking.