It is known that forming a therapeutic relationship with eating disorder patients is a difficult task and that the rate of treatment dropout is quite high. In particular, anorexic patients tend to deny the seriousness of the illness as the malnutrition progresses. Inevitably, this leads to forced feeding. Also, the family of a patient daily alternates between the two extremes of forcing the patient to eat and, failing to do so, adopting an entirely laissez-faire attitude. A more productive approach is possible, however, by incorporating the patient's own ideas and wishes if the treatment is started early. Treatment skills such as cognitive behavioral therapy which employs self-help element have developed over the years because of the need for self-control in the treatment of bulimia nervosa. This new therapeutic idea has influenced the treatment of anorexia nervosa. Guided self-help is now regarded as a possible element in the treatment of anorexia nervosa if the patients are not severely malnourished.
 For bulimia nervosa, the treatment with highest evidence of treatment effect is cognitive behavioral therapy (CBT) and guided self-help before the full introduction of CBT. In Japan, the treatment is often limited to pharmacotherapy by antidepressants but treatment guidelines overseas do not recommend the employment of pharmacotherapy only. The introduction of regular meal plans and symptom monitoring by patients themselves is expected to improve the treatment outcome in Japan.
 Continuity of care is extremely important in the case of eating disorders. The number of patients who drop out of treatment after inpatient treatment continues to be high. The treatment plan after discharge, including such topics as monitoring the signs of relapse and how to deal with them, should be discussed carefully with the patient and family and be conveyed to the doctor in charge of outpatient treatment.
 As with other psychiatric illnesses, early detection and the early start of treatment is very important with eating disorders. School nurses have the relevant information to detect eating disorders, at an early stage, through the annual physical check-up. With the publication of guidelines for school nurses, there will be more referrals of early cases to primary care psychiatrists. The appropriate treatment of these early cases is necessary.
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