Anorexia nervosa. Staff subversion of therapy

The treatment of anorexia nervosa (AN) is often complicated by the subversion of therapy by the patient. We describe the undermining of treatment by ward personnel as a result of their lack of understanding of the psychodynamics of AN and their perception of these patients as not being "sick" in the traditional sense and therefore not entitled to the "sick role." The incidents which occurred in our center are discussed as to their possible origins, the patient's response, and the remediation employed. The remedial approaches which may have the most promise are presented.