I think that to answer that question, the best reference I could give is called the Handbook of Treatment for Eating Disorders. Chapter one is Historical Perspective on Treatment. One of the big differences that I have noticed even as early as the early 1980s is when an adolescent had an eating disorder they would usually just put her on a psychiatric unit or put her in a psychiatric hospital. Treating eating disorders is so specialized that the type of treatment, the generic type of treatment in psychiatric hospitals wouldn't do a thing. Any type of punitive approach was not helpful, but to have been sitting with other people who don't have trouble eating is not going to help because women with anorexia are so skilled. They are playing food games and hiding food and making it look like they are eating when they are really not. The biggest change I have seen is that people's awareness has increased so they know that anorexia needs a specialty type of treatment. These women need to be in residential treatment centers that specialize in eating disorders. So instead of just throwing them in with everybody else, they are being sent to more and more places that are just treat eating disorders and that's where they are sending these kids, too. Cognitive behavioral therapy works really well. In the residential treatment centers, when they go to meals they are with staff who are helping them to learn how to eat and not play food games. In the regular population this is a problem; it just brings out shame and guilt for the women with an eating disorder. In a controlled environment, they can teach her how to eat, so I would say that's a biggie. The newest research out there is that they are finding that older women have eating disorders whereas it used to be thought of as an adolescent disorder. If you didn't have an eating disorder by the age of 25, it was rare that you were going to develop one. And now even here in our center we have seen more and more women in their 40s that developed an eating disorder in their 40s and now they are 43 and trying to figure out what's going on. So we are seeing more and more older women developing eating disorders. Some other research that's going on is "genetic versus learned behavior." Years ago they didn't even think there was anything genetic about an eating disorder but it was a learned behavior and a type of addiction women show to deal with the pain but now they are looking at the genetics and what's going on there.
