Hostile interaction in a general hospital ward leading to disturbed behaviour and bulimia in anorexia nervosa: its successful management.

A girl of 17 years with severe anorexia nervosa, treated on a medical ward in a teaching hospital, developed bulimia, stole food, was sometimes doubly incontinent, behaved angrily, and aroused the hostility of patients and staff. The growth of a vicious circle of hostility is described and it was hypothesized that the hostility had aggravated the bulimia. On the basis of this hypothesis the situation was clarified with the patient and staff, attitudes changed, the patient's appetite dropped within a day from about six times to one-and-a-half times the normal and her behaviour became normal. The significance of these events is briefly discussed.