The theme of death in the French and German literature on eating disorders.

It is not widely appreciated in the English-speaking world that a number of articles written in French and German do address the role played by death preoccupations and concerns in the development and maintenance of eating disorders, particularly anorexia nervosa. In previous published articles these important "hidden" threads have been highlighted in examining in some detail, the writings of the German authors Binswanger, Von Weizsäcker, and Thomä. In this article, the writings of other German authors are also briefly reviewed as well as the French authors Bensoussan, Fouraste, Raimbault, and Thouzery-Loras. Implications and issues are posed for both the researchers and clinicians alike contributing to the literature in English on eating disorders, who do not necessarily embrace these themes in therapy and who may not reflect their significance to theory in the literature itself.

Eating disorder patients at a NSW teaching hospital: a comparison with state-wide data.

The aim of the study was to present data which may be useful in deciding the type of services needed for eating disorder (ED) patients in New South Wales (NSW). The demographic and clinical characteristics of 155 patients consecutively admitted to a special ED unit at a major Sydney teaching hospital during the triennium 1989-1991 were documented and compared with relevant data from the State as a whole (709 admissions for ED to public facilities and 938 admissions for ED to private facilities during the same period). The findings are discussed in the light of information from overseas studies. Although a relatively large number of ED patients are admitted to hospitals in NSW, their short duration of stay suggests that many may receive inadequate treatment. The unit in the Department of Psychiatry at the Royal Prince Alfred Hospital (RPA), the largest public ED service in NSW, provides a special service for these patients. It is effective in bringing about nutritional restoration, with a duration of stay similar to those reported from centres overseas. Most referrals are tertiary, and there is a high prevalence of physical morbidity indicating a need for access to general medical facilities. Most serious physical complications occur in patients who can be identified by their chronicity and by the pattern of their behavioural disturbance. These various factors are considered in the formulation of recommendations for rationalizing the service.

How well are 'cured' anorexia nervosa patients? An investigation of 16 weight-recovered anorexic patients.

Eating behaviour, nutritional intake and psychopathology were examined in 16 weight-recovered anorexia nervosa patients. The Eating Disorders Examination (EDE) and a food diary were the main outcome measures, but body fat content and psychosocial adjustment were also assessed. Although body fat and overall psychosocial adjustment had returned to normal in most patients, 12 still had a restricted eating pattern with nutritional intake below 90% of their energy requirements. These results suggest that weight, menstruation, and psychosocial criteria are not sufficient to determine full recovery from anorexia nervosa, and that attention should be given also to measures of the specific behavioural and attitudinal disturbance.

Dreams of death: Von Weizsäcker's Dreams in so-called endogenic anorexia: a research note.

Viktor Von Weizsäcker's paper "Dreams in so-called endogenic Magersucht (anorexia," first published in the Deutsche Medizinische Wochenschrift in 1937 (translation in M. Kaufman & M. Heiman [1964]. Evolution of psychosomatic concepts: Anorexia nervosa: A paradigm (pp. 181-197), New York: International Universities Press, has been described as a noteworthy and historically important contribution to the recognition of anorexia nervosa as a psychosomatic illness. Von Weizsäcker analyzed the dreams of patients he was treating for "endogenous anorexia" (magersucht). He claimed that in the bulimic phase his patients experienced nightmares dealing with themes of death, but that in the anorectic phases of restricted eating more pleasant dreams dealt with themes of blissful contentment. The authors draw current attention to his work as another early example of the treatment of the theme of death and death symbolism in the literature on eating disorders, and suggest some reappraisal of von Weizsäcker's interpretations of his own material.

A comparison of nutritional management with stress management in the treatment of bulimia nervosa.

In a comparison of nutritional management (NM) and stress management (SM) for treatment of bulimia nervosa, 55 female patients were randomly assigned to either treatment. Therapy consisted of 15 sessions in a group over three months, by the end of which, patients under both treatment conditions showed a significant reduction in the frequency of binge eating and vomiting and a significant improvement in various psychopathological features such as body dissatisfaction and depression. All improvements were maintained over 12-month follow-up NM produced a more rapid improvement in general eating behaviour, a faster reduction in binge frequency and a higher abstinence rate from binge eating. SM led to greater positive changes in certain psychopathological features such as feelings of ineffectiveness, interpersonal distrust and anxiety. NM should be regarded as a necessary first intervention in all bulimic patients. Further psychological therapy, such as SM, is indicated as well for some patients, depending on their specific psychological difficulties.

To weigh or not to weigh? Frequency of weighing and rate of weight gain in patients with anorexia nervosa.

The present study compares the rate of weight gain during refeeding in 15 anorectic patients who were weighed daily with that of 15 who were weighed three times per week. There was no significant difference between the two groups.