The more severe cases will require admission to hospital. They are perhaps better in a psychiatric ward or hospital rather than a general hospital. Most will respond to encouragement and supervision of meals rather than to forced feeding. However if the weight loss is extreme and the general physical condition is poor then intravenous feeding may be necessary.

Apart from the attention to the physical state, the emotional side of this disorder needs treatment. The girl herself may need intensive psychotherapy. Often the family, especially the parents, may also need counselling, and it may be better in these cases for parents to have a different therapist to the girl herself.

Anorexia nervosa rarely results in death now unless as a result of suicide, but associated depression is not unusual.

*5/71/1*

Let me give you an example. A doctor recommends a course of chemotherapy to a woman with extensive breast cancer, without offering any alternatives. For her, the alternatives in fact might include: a more or less intensive course of chemotherapy, use of different chemotherapy drugs; use of hormones; radiation treatment to the painful spots; no specific anti-cancer treatment at all; concentrating on controlling her pain with a suitable painkiller; prayer; a grape diet; or taking an overdose of her painkillers. To any one particular person, some of these will be attractive, others will be out of the question. To make the best decision, this woman needs to know the pros and cons of each alternative, and consider them in the light of her own particular life situation and beliefs. The best choice is not the same for everyone.

After getting all the information about these options, one young mother of three might decide to have intensive chemotherapy because she feels convinced that this has the best chance of prolonging her life. Another young mother of three might decide to have no chemotherapy at any stage because she has decided that, for her, the likely side effects are too great compared to the likely benefit. A third might decide to have the radiation treatment at this stage and the chemotherapy later when her symptoms come back. Each of these could be the best and most appropriate decision for each woman at that time.

As time goes by they may revise their decisions according to their own individual experiences. For example, after several months of chemotherapy, the first woman may decide the side effects she has experienced are too great to warrant continuing with it. The second woman might get to know a few other patients who have had successful chemotherapy and decide to try it herself. Again, these could be the best and most appropriate decisions for these women at that time.

*15/40/1*