Treatment of Anorexia Nervosa: What Can Be the Role of Psychopharmacological Agents?

Abstract

In approaching this problem, can we learn anything from a knowledge of the drugs and similar substances which people with anorexia nervosa sometimes consume in attempts to sustain their adjustments? It must be a moot point as to whether purgatives and diuretics can be psychopharmacological agents! However, anorectics certainly consume them because of the desirable psychological consequences associated with their dehydrating effects — the experiences and self-perceptions of reduced weight, sunken facies, flattened abdomen, etc. In the past a few anorectics have taken to consuming large amounts of amphetamine compounds and/or thyroid medication but, as well as being hard to come by, these drugs have never been popular with the majority of anorectics for reasons that I will touch on later. Some anorectics become dependent on hypnotics, including alcohol, and minor tranquilizers; others insist on taking the contraceptive pill. I believe that an inspection of this range of drugs tells us that the anorectic’s task in life is to maintain her low body weight so that she feels reasonably secure. However, her panic at the prospect of losing control over her weight and her aroused and exhausted state mean that she is still generally anxious, tense, and weary. At the same time she wishes to be seen as normal and not in need of treatment. Against this background it is well to remember that suicide is the commonest cause of death in anorexia nervosa and that psychotropic drug overdose is the commonest form of suicidal act in this population.