The aim of this paper is to consider the needs of carers of people with adult anorexia nervosa both from a theoretical and practical basis. Families have been successfully involved in the management of adolescent anorexia nervosa but it is uncertain how best to work with the families of people who have a more chronic course of illness. The management of severe, persistent, eating disorders has benefited from the application of theory derived from models of health behaviour. These theory-driven approaches can also be applied to work with carers. We argue that illness perception theory can also have potential utility in understanding the needs and difficulties faced by carers. In this paper we briefly review these theoretical models and consider how they can be applied to carers of people with chronic anorexia nervosa. Finally we discuss how these theory driven approaches can guide the development of interventions for use with carers. Copyright © 2002 John Wiley & Sons, Ltd and Eating Disorders Association.