Directives in anorexia nervosa: use of the "Ulysses Agreement".

The course of anorexia nervosa frequently has episodes of exacerbation during which motivation and insight are reduced, cognition is impaired and treatment resistance is increased. Formalizing a directive to be used during these episodes when the patient has greater motivation and insight is one way of reducing treatment resistance. We describe a form of directive, called the "Ulysses Agreement".