Although anorexia nervosa patients are notorious for their 'resistance' to treatment, the phenomenon of drop-out during in-patient treatment of these patients is scarcely described in the literature. In a consecutive series of 133 hospitalized female anorexia nervosa patients the authors found a remarkably high drop-out rate of about 50 per cent, spread over different phases in the therapeutic process. In order to find some 'risk factors' concerning the probability of premature discharge against medical advice, some clinical, demographic and follow-up data were analysed in a retrospective way. Dropping-out appears to be a function of age at admission, duration of illness, educational level, social class and treatment method. These findings are interpreted with respect to different types of resistance to psychotherapeutic treatment both on the part of the patient and her family. In most cases a drop-out has to be considered as a crisis-related event in the treatment process. It does not only require specific attention, but also reconsideration of the whole therapeutic approach to anorexia nervosa patients.

Eighteen female inpatients were included in a double-blind placebo-controlled cross-over study aimed at testing the hypothesis that dopamine blockade may enhance the effectiveness of behavior therapy in the short-term weight restoration of anorexia nervosa patients. The patients were given a uniform contingency management program and, after a baseline period, they alternatingly (3-week periods) received pimozide (4 to 6 mg) or a placebo. During the first two periods pimozide almost significantly enhanced the weight gain induced by the behavior therapy program and beneficially influenced the patients' attitude towards treatment.

SYNOPSISThe estimation of body dimensions in a group of 31 patients with anorexia nervosa and a control group of 20 psychoneurotic females has been studied with different techniques, including a visual size estimation apparatus and the marking of indicated body points on a paper attached to the wall. The results confirm the previously described tendency by patients with anorexia nervosa to overestimate body size in the stage before their treatment in hospital. Various differences between the two groups were found and the anorexic patients were more inconsistent in the estimation of the different body measures. On the basis of correlations with the results of an internal-external control questionnaire, it is suggested that overestimation and variability in visual size estimation could be promoted by an orientation towards external control.

SynopsisWithin a sample of 141 female anorexia nervosa patients comparative investigations were carried out between three subgroups: dieters, binge-eaters, and vomiters/purgers. A number of significant differences were found, especially with respect to age and duration of illness, previous treatment failures, and long-term outcome. The results appear to support the authors' view that the staic idea of anorexia nervosa as a unitary illness should be abandoned and replaced by a dynamic dimensional model according to which, in the course of time, changes may occur in the clinical picture of dysorectic patients.

No abstract

According to several follow-up studies in the literature, anorexia nervosa has to be considered as an affection with a grave prognosis. We have studied the outcome in a group of 32 female patients who could be considered as homogeneous in a number of aspects. The following five criteria, on which the delineation of the syndrome is based, were realized in all the patients: considerable weight loss; limited food intake; amenorrhea; juvenile age of onset; absence of primary organic or specific psychotic disorder. All of them presented a serious symptomatology and had undergone some previous treatment under the form of ambulatory psychotherapy and/or forced feeding. They all received, during their admission in the same hospital, the same form of combined intensive medical and psychotherapeutic treatment. All of them maintained regular psychotherapeutic contacts with the same psychiatrist. According to the outcome, the patients could be categorized into three groups: the cured, the improved, the unimproved. In order to circumscribe some prognostic elements, we have compared a number of clinical, family and personality variables in these groups. As favorable clinical factors can be mentioned: younger age at admission and shorter duration of the illness. Manifestations of impulsive behavior (automutilation, kleptomania, fugues, etc...) and suicide attempts are unfavorable. No definite family factors can be defined, although the absence of psychological interaction with the father seems to be unfavorable. A better prognostic outcome is offered by the following personality characteristics, determined by psychological testing: lower neuroticism and higher self-defensiveness on the ABV; a lower general profile and especially a lower score on the schizophrenia scale of the MMPI; less pronounced tendencies to infantile regression, passivity and sexual repression as these are expressed in the TAT.

Inpatient treatment for anorexia nervosa can be necessary for medical, psychosocial or psychotherapeutic reasons. In general, these patients are characterized by "negative" selection characteristics (illness duration, failures of previous treatments, unfavourable natural milieu, poor motivation, etc). An inpatient treatment program, in which 145 female patients have been admitted, is described. It consists of two phases: a first "symptom directed" phase aiming at weight restoration and normalization of eating, based mostly on behavior therapy principles; in a second "problem oriented" phase, patients are oriented either towards outpatient treatment (family therapy, individual psychotherapy), or, in the majority of the described cases, to an inpatient psychotherapeutic community program. The difficulties of this approach and some outcome results at long-term follow-up are discussed.

In 1979, Askevold and Heiberg made an interesting contribution to the discussion on the hereditability of anorexia nervosa by reviewing a series of case reports concerning monozygotic twins. Their data, however, were not entirely accurate and they also overlooked some important references which are briefly discussed. 3 cases of the authors’ own practice are added. A final examination of the available data with respect to anorexia nervosa in twins does not substantially support the assumption that genetic factors may play a determining role in the etiology of this syndrome.