The activity of Operative Unit for the Physiopathology of Adolescence (Pisa, Italy) is based on the interdisciplinary services provided by various experts in adolescent health (physicians, psychologists, psychiatrists, nutritionists), and is performed through a Day Hospital and out-patients' department, rarely by admission.

The adolescents, both males and females, aged 11 - 21 years, attend to the Operative Unit presenting either various pathological symptoms or physiologic variant of normal patterns or bio psychological and existential problems.

Out of the 4.800 adolescents consecutively referred to our Operative Unit, n° 350 female subjects presented Eating Disorders.

All these patients were classified according to DSM III-R categories, n° 86 (aged 12-21 yrs) of them suffered from Anorexia Nervosa (n° 62 anorectic restricting, n° 24 anorectic-bulimic), n° 23 (aged 17-23 yrs) from Bulimia Nervosa, n° 241 (aged 16-22 yrs) from Atypical Eating Disorders.

We present some observations regarding the methodological course during treatment, which lasts from 1 to 5 years, of anorectic patients. The activity functions through a Day Hospital and out-patients' department. Admission is rare; for only 13 anorectic patients out of 86 and for 3 bulimic patients out of 23 the hospitalisation is made necessary, owing to the serious physical conditions. Admission is always referred to an Internal Medicine Department.

Our working program is based on an interdisciplinary approach and management where measures are carried out to integrate both medical and psychological aspects according to the requirements of the various individual cases.

The clinical aspects are carried out through observations, laboratory investigations, instrumental investigations, and the psychological ones through observations, individual and/or family psychotherapy and/or a simplified form of family counselling.

Our aim is to report some considerations concerning the complex psychological and relational net which is created within the operators during the methodological course of treatment for the anorectic patients.

Our considerations regard:

- the role of the physician as caring for the organic parts and as mediator for advice regarding the help of a psychologist and/or psychiatrist. The latter fact is of the outmost importance given that the anorectic patients originally come only for medical advice;

- the elements of complexity and difficulties that can interfere among various operators during treatment are for example: the difficulty experienced by the operators in shaping into a coherent model the surplus of stimuli resulting from peculiar situations; the ambiguity of anorectic pathology, both psychical and organic, confounds the borderline between psychological and medical approach. Hence the need for a container in which multifaced interactions between operators and anorectic patients can be carefully considered as a thing to be done;

- the admission to the department has been seen as being the most crucial point of the entire treatment, because it reveals all the difficulties and contradictions inherent in relations between the anorectics and caring operators.

M. Rolla, A. Andreoni, D. Belliti, M.R. Ceragioli, R. Paolicchi: "Interdisciplinary strategies in anorexia nervosa treatment: observations from an experience". Paper presented at the First International Congress of Adolescentology, Assisi, Italy, October 22-24 1993.

Key Words: Anorexia nervosa, Treatment, Interdisciplinary approach.

Mimma Rolla: Professore associato di Fisiopatologia Endocrina e metabolismo. Unità Operativa di Fisiopatologia dell'Adolescenza, Università di Pisa - Via Roma, 67 - 56100 Pisa.

Alba Andreoni: Endocrinologo, andrologo. Unità Operativa di Fisiopatologia dell'Adolescenza, Università di Pisa.

Deanna Belliti: Endocrinologo, Unità Operativa di Fisiopatologia dell'Adolescenza, Università di Pisa.

Maria Rosa Ceragioli: Psicologo, Unità Operativa di Fisiopatologia dell'Adolescenza, Università di Pisa.

Rossella Paolicchi: Psicologo. Unità Operativa di Fisiopatologia dell'Adolescenza, Università di Pisa