Anguish and despair in adolescents with eating disorders--helping to manage suicidal ideation and impulses.

Adolescents struggling against anorexia nervosa or bulimia nervosa often experience self-punishing thoughts and behaviors, including self-mutilation, and suicidal ideation and attempts. These arise out of the profound anguish and despair frequently experienced by these young people. This paper outlines four particularly salient clinical themes underlying this despair that have significant implications for treatment. A practice perspective is discussed which emphasizes empathic listening and the development of a strong therapeutic alliance with the adolescent. Treatment recommendations draw from narrative theory and practice, and from feminist perspectives. The paper also draws on cognitive therapy and on recent developments in the areas of spirituality and motivational enhancement. Involving the distressed adolescent's family is also addressed.