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First of, this isn't my area of specialty...there are some great RD's out there who do this for a full time living and I admire them. I've dealt with it over the years, and even now, a few pass through my life, but these have some type of psychosis--- so it gets strange.

I've been quoted mortality rates as high as 20%....but because there are so many different degrees and a few types, it's hard to tell. Like I said, I know some that are over 50. I had one that was in her late 70's when she developed it, and that the more weight she lost, the happier she got. So we quit telling her what she weighed. She died weighing 67 pounds.

There are meds given, sometimes appetite stimulants along with antidepressant that have hx of causing weight gain.

Like all things, they have to want to get better. A lot of it has to do with a distortion in body image. Seeing themselves as fat when they aren't etc. Finding the roots of the whole disorder is the beginning.

And personally, making rounder female bodies in the real world less an object of contempt. But it's a bugger to try to get a girl to gain weight when some guy is ragging on a normal size girl on TV and calling her a cow. The message is clear....the smaller the better and body fat is an unforgivable sin.

Secondly, they all have foods or groups (fats, meats, stuff with any starch etc) they are terrified of, so helping them overcome the fear and incorporate them into their lives is another behavior change. One facility has them sit down with a calendar and actually plan that on "Tuesday, I will eat ice cream" etc. They're encouraged to actually enjoy the food, right down to the texture, temperature etc.

The downside is in treatment, they can be the most self-absorbed, manipulative patient you will ever deal with. You have to be an Army Drill Sargent in nature to work with them (and that ain't me fer sure). Which makes empathy sometimes hard to come by.

Especially if they are in treatment against their will. You have to weigh them turned around where they can't see the scales. Not let them have access to water prior to weighing (they'll gorge on it so they'll weigh more). Weigh them in their underwear (they've been known to put weights in their clothes).

Eating....well, the rules are you eat your meal OR drink a can of supplement-- period. And then you can't go to the bathroom for a period of time after-wards. Some girls have been vomiting for so long that helping them keep down food is the first step. Like I said, I admire anyone who can help these girls overcome it...on my end, I'm just ragging on the cow-callers ;)