Pearls and Pitfalls of Treatment for Anorexia Nervosa

Abstract

I recall my pearls and pitfalls of anorexia nervosa (AN) treatment. Illness education for the patients and their families begins with an interview. The most important purpose of clinical laboratory tests is to exclude other diseases that cause emaciation. Primary care requires urgent medical hospitalization and exercise restrictions depending on body weight to prevent aggravation of illness and death. Because ordinary clinical laboratory tests do not show abnormalities until patients become seriously ill, inspection items that can frequently provide abnormalities, including hormone values or bone mineral density, should be considered and used for psychoeducation. The prevention of hypoglycemic coma as a fatal complication involves supplementary food intake after self-measurement of blood sugar. The primary treatment for hypokalemia accompanied by vomiting or laxative abuse is rehydration by consuming water and salt. The prevention of short stature involves shortening the low-weight period to less than a body mass index (BMI) of 16 kg/m² when the secretion of insulin-like growth factor-I (IGF-1) decreases. Decreased bone mineral density is the primary complication of AN. The recovery of body weight and menstruation are the most effective treatments for osteoporosis. Medical therapies to normalize bone mineral density (BMD) in severely emaciated patients have not yet been established. Patients with AN tolerate body weight gain when they recognize that the advantage of body weight gain is superior to the psychological merits of emaciation and avoidance as stress coping, and through psychoeducation based on impactful medical information. The period of gluttony during the recovery process is the most difficult for patients. Family is a resource for recovery, and interventions to promote adaptive coping styles reduce the caregiving burden and improve mental health. We emphasize the need to increase patient resilience for recovery. The cooperation of medical experts, family members, and school officials supports patients on the difficult treatment path of AN.