Anatomy of Anorexia

According to the author, a psychotherapist who has treated close to 300 anorexics and written widely in the field (Treating and Overcoming Anorexia Nervosa, etc.), this very serious mental illness, which chiefly afflicts teenage girls, has a recovery rate of only 25%-35%. Because current health care policies severely limit hospitalization for anorexia, Levenkron concentrates on the importance of detecting early symptoms. Drawing on case studies from his practice, he outlines the progressive physical and psychological stages that, if unchecked, lead inexorably to life-threatening weight loss. Reacting to a societal obsession with thinness, adolescent girls at first delight in the sense of achievement they feel after successfully dieting away a few pounds. For some, it can lead to a compulsion to lose even more weight by engaging in rigorous exercise programs and severely restricting calories. When those close to a girl express concern about her thinness, the anorexic typically responds by aggressively defending her behavior, often frightening her parents--who usually wish to avoid exacerbating the situation--into leaving her alone. The anorexic now considers her thin body a special accomplishment and resists all efforts to make her gain weight. In this clearly written and informative study, Levenkron reviews several treatment options, including individual, group and family psychotherapy, self-help groups and behavior modification, as well as medication and hospitalization when necessary, and emphasizes the importance of tailoring treatment to the complex and highly individualized needs of each anorexic. He recommends combining professional treatment with altering negative family dynamics when possible--even between divorced parents--and fostering an atmosphere of communication and trust. Agent, Olga Wieser. (Feb.)