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.

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