The aim of any therapy is to help the patient return to a normal life. The anorexic needs to learn there are ways besides starvation to cope with the problems of growing up.

The first step is to return the patient to a healthier physical condition. The patient is not likely to benefit from psychotherapy if her starvation is too severe.

Let’s digress for a minute to look at the difficulties that starvation itself (that is, starvation not necessarily caused by anorexia) can cause. In a famous study by Ancell Keys at the University of Minnesota, thirty-six carefully screened normal males voluntarily decreased their food intake over six months. They each lost an average of 25 percent of their original body weight. The experimenters monitored their progress carefully.

The symptoms produced by starvation were the same we now know as the classic symptoms of anorexia. The men became preoccupied with food-reading cookbooks, collecting recipes, dreaming about food. They reported more depression and noticed that their ability to concentrate was impaired. They developed bizarre eating habits, such as mixing unusual types of foods together, creating superstitions surrounding certain foods, or stretching out their meals for extended periods of time. They noticed increased irritability, difficulty sleeping, a loss of interest in sex, and social withdrawal. After the experiment ended, a few of the men actually went on to become chefs.

The Keys study reveals why restoring weight is such a priority for treatment of anorexia. Extremely low weight, no matter what the cause, results in such severe disturbances in thinking and feeling that any form of therapy is unlikely to be successful until there is some degree of return to a healthier weight. Additionally, in some ways anorexia represents a phobia about mature body weight. As with other phobias, the fear won’t go away until the patient confronts the things she fears most.

Once weight increases to a healthier level, we can start to address other aspects of the illness. We now begin to resolve the underlying psychological issues that contribute to the disorder. The task involves showing the patient how to accept herself and like herself. We help her build a new identity that isn’t based solely on her ability to starve. In so doing, we loosen her grip on childhood and help her make the passage into adolescence and adulthood.

Through family therapy and social-skills training, we work to improve the patient’s relationships. Anorexic girls are so focused on themselves and on their condition that they lose the knack of dealing with other people. They are scared of reaching out for fear they’ll be rejected. As her peers grow and mature, the anorexic is left behind and now has a lot of catching up to do. Treatment focused on social-skills training can help.

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