We are delighted to publish this second edition of Anorexia Nervosa: Guidelines for Assessment and Treatment in Primary and Secondary Care, based on the first author's long-standing "St George's" Approach, which has been so well received since it was first published in 1994. The book aims to outline in a clear, practical way, the minimal intervention necessary within primary and secondary care settings if the psychopathology of this serious and life-threatening illness is first to be identified and then treated with some hope of success. This first attempt at a time-limited and basic meaningful intervention involves concurrent use by both patient and therapist (and also, to some extent, the family) of the 'self-help' book Anorexia Nervosa: The Wish to Change and the Patient's Log Book, and all three books can be purchased as a package.

Arthur Crisp, MD, DSc, FRCP, FRCP(E), FRCPsych, is emeritus professor of psychological medicine in the University of London at St George's Hospital Medical School. He has treated patients suffering from anorexia nervosa for over 35 years and has researched the condition extensively. Lisa McClelland, BSc, MB, BS, MRCPsych, was lecturer in psychiatry at St George's Hospital Medical School and worked with Professor Crisp in the Anorectic Unit. She is now a consultant psychiatrist in Devon.

We are delighted to publish this second edition of Anorexia Nervosa: Guidelines for Assessment and Treatment in Primary and Secondary Care, based on the first author's long-standing "St George's" Approach, which has been so well received since it was first published in 1994. The book aims to outline in a clear, practical way, the minimal intervention necessary within primary and secondary care settings if the psychopathology of this serious and life-threatening illness is first to be identified and then treated with some hope of success. This first attempt at a time-limited and basic meaningful intervention involves concurrent use by both patient and therapist (and also, to some extent, the family) of the 'self-help' book Anorexia Nervosa: The Wish to Change and the Patient's Log Book, and all three books can be purchased as a package.

INTRODUCTION 1 THE NATURE OF THE PSYCHOPATHOLOGY 3 Differential diagnosis 6 II APPROACH TO THE ASSESSMENT 9 PSYCHOPATHOLOGY 9 Level 1 Behavioural 9 Level 2 The phobic avoidance mechanism 12 Level 3 The avoided phobic 'object' - the maturational conflict 12 PHYSICAL FINDINGS 17 General appearance 17 Gastrointestinal system 19 Cardiovascular system 19 Renal system 19 Musculo-skeletal system 20 Endocrine system 20 Central nervous system 21 Anorexia nervosa with comorbidity 21 Additional complications resulting from vomiting/laxative abuse 22 INVESTIGATIONS 24 Blood tests 24 ECG rhythm strip 25 Chest X-ray 25 Urine analysis 25 PREGNANCY AND MOTHERHOOD IN ANOREXIA NERVOSA III TREATMENT 27 Assessment 31 What are the aims of the intervention? 31 Identification of target weight 33 INTERVENTION 1 Assessment interview 36 INTERVENTIONS 2-13 The initial intensive psychotherapy 37 Interventions 2-5 Engagement of the patient and family Intervention 2 - Patient 38 Intervention 3 - Patient 41 Intervention 4 - Patient 42 Intervention 5 - First family meeting 45 Interventions 6-9 Every two or three weeks Intervention 6 - Patient 46 Intervention 7 - Patient 47 Intervention 8 - Patient 48 Intervention 9 - Second family meeting 50 Interventions 10-13 Every 3-4 weeks Intervention 10 - Patient 51 Intervention 11 - Patient 52 Intervention 12 - Third family meeting 53 Intervention 13 - Patient - ending acute phase of intervention 53 Planning follow-up 55 When to admit to hospital 56 Use of the Mental Health Act 57 Physical treatments 58 IV TERTIARY REFERRAL 60 Relationship to specialist centres 60 Indications for referral