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Part of the book series: Nutrition ◊ and ◊ Health ((NH))

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Abstract

People with anorexia nervosa have abnormal eating behaviors with associated cognitive misconceptions concerning body image and disturbances of mood, as well as alterations of a wide variety of hormonal and metabolic systems (see Chapter 5 for a further description of anorexia nervosa). Currently, many investigators conceptualize these disorders as being due to a combination of cultural-social, psychological, and biological factors (1,2). In general, the response of patients with anorexia nervosa to psychotherapeutic or pharmacological treatments has been limited. The purpose of this chapter is to review the evidence for the efficacy of available drug treatments for anorexia nervosa and guidelines for pharmacological therapy (Table 1).

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Kaye, W.H. (1999). Pharmacologic Therapy for Anorexia Nervosa. In: Goldstein, D.J. (eds) The Management of Eating Disorders and Obesity. Nutrition ◊ and ◊ Health. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-694-2_7

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  • DOI: https://doi.org/10.1007/978-1-59259-694-2_7

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-4757-6761-2

  • Online ISBN: 978-1-59259-694-2

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