In the DSM-5, Anorexia Nervosa is described as a disorder characterized by preoccupation with body weight and food. Behaviors focus on losing weight, peculiar handling of food, intense fear of gaining weight, obsessive thinking about one's weight, and disturbance of body image in which one feels fat when weight is normal. Denial of symptoms is characteristic of patients with Anorexia Nervosa.

Treatment of Anorexia Nervosa is a multifaceted endeavor. The initial focus of treatment is to restore one's nutritional state to normal. Malnutrition is life threatening and can cause psychological symptoms that make treatment more difficult. If the patient will be treated on an outpatient basis, you should refer to a physician for a comprehensive physical exam and lab work (note that you will need a release to communicate with the physician regarding the client). Hospitalization may be required. Once nutritional status is restored, behavioral, cognitive, and eclectic psychotherapy (including dietary management) may be utilized. Psychodynamic, group, and family therapy have shown to be successful as well.

The first step is to get the individual's cooperation. This is not easy since many patients deny the severity of their symptoms. A weight gain contract may be used so the patient is clear that the bottom line is to normalize eating habits and remain healthy.

Some helpful techniques are challenging distortions in body image, improving self-esteem, general social skills training, assertiveness training, and group treatment.

Conduct an assessment of the patient and address any safety issues. You will also need to establish a therapeutic relationship with the patient so you can motivate him/or her for treatment. A thorough clinical history including an emotional psychosocial will be needed. Make yourself aware of the signs of low self-esteem as well as deficits in self-regulation. Evaluate eating patterns, compensatory behaviors (use of laxatives, obsessive exercise, purging, etc), ritualized behavior around body measurement, and body image. Finally, have the patients self monitor their eating habits as well as their feelings about weight and self-image. Emphasize goal-setting at the very start of treatment. Set specific goals and put them into a few categories so the goals don't seem too overwhelming.

An evaluation with a dietician can be helpful. For a patient with Anorexia Nervosa, an evaluation with a dietician can have a powerful impact by helping the patient to become knowledgeable about nutrition, dieting, and healthy eating.