Self-destructive illness that doctors find so difficult to treat Tragic illness that drives doctors to desperate measures

DENIAL IS one of the chief characteristics of anorexia - and it is what makes sufferers difficult to treat.

Like alcoholics, people with eating disorders - anorexia and bulimia - typically insist they are in control of the situation and there is no cause for alarm. Their failure to see what is happening makes them resistant to help. Often it is only increasing concern among friends and family that persuades them to seek treatment.

In many cases there is then a second denial stage in which they try to keep the problem secret. Dr Dee Dawson, director of the Rhodes Farm Clinic in north London, which treats children and teenagers, said: "They are the most secretive people in the world. I have known patients who have lived for 10 years vomiting three times a day and their partners never found out. Being secretive is the hallmark of bulimia and anorexia runs it a close second."

There is no single, proven treatment for anorexia, but the most effective approach is cognitive therapy, with the aim of altering the patient's negative thoughts. Anti-depressants are also prescribed but these have the side-effect of suppressing appetite. The chances of successful treatment are greatest when it is started early. Eighty five per cent of anorexia sufferers are young girls, and the peak age for diagnosis is 13. About 100,000 people in Britain suffer from eating disorders of varying severity.

In extreme cases, where a patient's life is threatened, doctors may resort to more radical measures, including electro-convulsive therapy. Brain surgery of the sort that Lena Zavaroni underwent is extremely rare and would only have been undertaken by her doctors in desperation. It is a last-ditch treatment when all other options have been tried. Severe anorexia is extremely difficult to treat and up to one in six sufferers die. Sufferers have a distorted image of their bodies, believing themselves to be fat when they are bone thin.

The helpline number of the Eating Disorders Association is 01603 621414.