2005 Volume 45 Issue 5 Pages 333-340
In the study and treatment of eating disorders, a wide variety of mechanisms, psychological bases, and treatment methods have been advocated and practiced. Other diseases for which therapists have such widely differing perspectives are unusual. The reasons for this are 1) the various kinds and degrees of psychological/physical pathology of eating disordered patients, 2) the considerable differences in the general characteristics of patients visiting various facilities, for instance primary care vs. specialized care facilities and psychiatry vs. psychosomatic medicine, and 3) differences between therapists in fundamental ways of thinking about eating disorders. Medical facilities should cooperate with each other in the treatment of eating disordered patients based on an objective evaluation of each patient and an appropriate choice of treatment. The Department of Psychosomatic Medicine, Kyushu University mainly treats severe anorexia nervosa (AN) patients who have a severe desire for thinness and severe body weight loss. Inpatient therapy has been done by "Cognitive behavioral therapy with behavioral restriction". The average duration of inpatient therapy from 1990 to 2002 was 153 days, and the average increase of BMI was 3.1 (7.7 kg) . Factors independently affecting BMI gain in inpatient therapy were the duration of inpatient therapy and BMI at admission. The longer the duration of inpatient therapy and the lower the BMI at admission, the more BMI gain. Moreover, the prognosis 3.5 years after discharge was excellent or good for 70% of our AN patients who underwent inpatient therapy from 1996 to 2000. Although our inpatient treatment has led to a good prognosis for these severe AN patients, the current economic situation has pressured us to shorten the duration of inpatient therapy making it impossible for the patients to have the time necessary for successful recovery. It would be desirable to coordinate the ideas of the various elements of the medical system dealing with AN patients so that we can develop a more unified system of treatment, a treatment system that meets the great variety of needs of our patients, and to make greater efforts to promote our needs to public officials overseeing medical issues to insure that our proposed programs are accepted.
