TREATING AND OVERCOMING ANOREXIA NERVOSA

Principally this is a guide for therapists that puts forth an unusual model for the treatment of anorexia nervosa; but because it has a remarkably jargon-free discussion of the disorder's causes, and six illustrative case stories, it should be of interest to affected families as well. Levenkron, the psychotherapist--author of The Best Little Girl in the World (1978), a novel about anorexia that became a TV special, finds that the incidence of the disease is expanding: he now sees patients from all socioeconomic levels, from teenage to late middle age, and of both sexes--though most common, still, are women who first become ill between 13 and 22 years of age. Behind anorexia and associated eating disorders, he believes, is ""a pathological exaggeration of society's message to women,"" afflicting a generation of young girls and women ""indoctrinated by the thin ethic."" Their disordered eating behavior takes three forms: limiting intake, alternating bouts of starvation and overeating, and vomiting after eating. Levenkron describes the evolution of each form, and proposes his treatment model: Nurturant Authoritative Psychotherapy. Traditional psychotherapy, which calls for a neutral attitude on the part of the therapist, is unsuitable for anorectics, Levenkron argues. Because there seems to be, in parents of anorectics, a pattern of passive-dependency that leads the patient to think she is altogether on her own, the therapist needs to be an authority figure who can ""help the patient become younger and less mature within the therapeutic relationship""--and thus learn to accept emotional support. He has considerably more to say--in particular, about the family, hospitalization, and the training of therapists. Integral to the discussion are the six diverse cases; five, involving women ranging in age from 16 to 46; one, a 15-year-old boy. Levenkron would have ""the afflicted"" be aware, finally, that ""you are a victim of a disease, and not the designer of a creative way of being special."" Important for professionals, informative for those with a personal stake.