The multifaceted pathogenesis of anorexia nervosa requires an experienced team of psychiatrists, nutritionists, endocrinologists, internists or pediatricians, and nurses. Each patient should be considered individually since there are as many variations as there are patients. It is important to maintain communication between the different members of the team in order to present a unified front to the patient. Invariably, the patient will try to find and exploit the most minimal differences of opinion between the members of the team. Ideally, all important decisions should be made by one central team leader. Nurses, aides, and other paramedical personnel should be instructed about how to deal with the patient's behavior and charming search for allies.

There is no specific treatment and the methods reported are, at best, controversial. The etiology of this disorder is unknown, and etiological factors are probably different in each patient. It is therefore important to tailor the therapeutic approach to each patient.

Many cases of established and severe anorexia nervosa require prolonged hospitalization for psychological and nutritional rescue. Separation from parents and home environment is only part of what is to be gained from hospitalization. Administrators and health insurance companies must understand this need.

Hospitalization is indicated for the following: Severe and rapid weight loss

Serious metabolic or cardiovascular problems (hypokalemia less than 2.5mmoll~1) despite oral replacement, blood urea nitrogen more than 10.6mmoll^1 of urea (30mgdl ) in the presence of normal renal function, pulse less than 45min~1, systolic blood pressure less than 70mmHg, or a body temperature less than 36 °C Severe depression and suicide risk Psychosis Family crisis

Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

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