It is indeed rewarding to see that Treasure & Russell, in their editorial on early intervention in anorexia nervosa, ^{Reference Treasure and Russell1} offer much in support of it. Over many years our therapeutic approach in Bristol placed great emphasis on getting patients into treatment as soon as possible after the onset of anorexia. This was supported by evidence from a study which compared outcome in Bristol with two other treatment centres. ^{Reference Morgan, Purgold and Welbourne2} In line with this we emphasised the importance of developing local, easily accessible treatment facilities.

Given their welcome support for close involvement of relatives in the treatment process, Treasure & Russell might well have also included family processes along with the several brain mechanisms that they evaluate as possible reasons why early intervention may be important. If the illness continues for any length of time, such factors as loss of heart by relatives and increased blame for failure to respond to help can lead to the progressive alienation of the relative with anorexia and impairment of the family’s ability to contribute constructively to treatment. Although negative attitudes have long been recognised, they remain a serious obstacle to the development of effective treatments of anorexia nervosa. Surely further research is still required into understanding them more fully as well as into their prevention and management, especially when the illness is at risk of becoming chronic.