Report on the Present Medical System for the Treatment of Eating Disorders in Japan and How it can be Improved(Recent Progress in the Treatment of Eating Disorders)

In order to clarify the current medical treatment system for eating disorders in Japan, we collected questionnaires from 444 members of the Japanese General Hospital Psychiatry Association. 95% of the respondents were psychiatrists (N = 420) with a total of 72% of these working at either general or university hospitals. 34% of university hospital -based psychiatrists, 38% of general hospital-based psychiatrists, and 15% of psychiatric hospital-based psychiatrists responded affirmatively to the item : "Treat eating disorders at both inpatient and outpatient settings at your facility". In response to the item : "Provide treatment for eating disorders as much as possible within the capacity of your facility", psychiatrists at the above facilities responded 79%, 62%, and 61% respectively. Looking at the desire to provide care for eating disorder patients for the group as a whole, 21% responded affirmatively to "I participate actively". 65% responded affirmatively to "I participate but not actively" and 14% responded affirmatrvely to "I like to avoid these patients". Age range differences were clearly seen on this item with more than 30% of the age group below 30 responding affirmatively to "I am quite interested in the treatment of eating disorders", and only about 20% for the 40 and older age group. Looking at the responses based on age then, the young physicians had much more interest in the treatment of eating disorders with many having a strong desire to treat this group. Considering that we can expect further increases in the number of eating disorder patients, it is desireable that the number of psychiatrists interested in treating this group also increase. We also looked at psychiatrists attitudes towards for illnesses which are thought to be difficult to treat in psychiatry and found that the responses to : "I participate actively" for these were 25% for "school refusal" followed by 21% for eating disorder 14% for alcoholism and 12% for borderline personality. The difficult treatment areas mentioned included, Iimitations in the staff, difficulties in team-treatment and difficulties in the treatments themselves. Additionally, Iack of time or manpower, unprofitability, inadequate understanding on the part of medical providers, and need to expand treatment facilities were noted. The future needs of the medical system include not only adequate reimbursement, but better administrative management. In addition, expanded treatment facilities along with specialty centers and team- treatment, adequate post-graduate training, and better understanding among general physicians are of great importance. Advancements in family therapy, group therapy, and self-help groups, as well as education of local clinics and schools are needed.