You ask some very good questions about complex problems. Obviously it would take someone who knows you very well to give you a meaningful answer. I will say that frequently patients with long term problems often have very sudden changes in moods, and are sometimes quick to attribute it to the medication not working. For me the most useful strategy is not too look at symptoms on a day to day level but rather month to month. Anorexics do indeed have a 'bad reputation' with psychiatrists. Usually it is because these patients seem much more ambivalent about accepting help. People who are ambivalent often aren't reliable about keeping appointments, compliance with recommended treatment, etc. I don't know if this is your case, because I don't know you. Probably if you are involved with regular psychotherapy, and perhaps had regular primary care doctor appointments to monitor your health, a psychiatrist might feel more comfortable treating you (I don't know if you have these things or not). Unfortunately there are no quick fixes to anorexia, and whatever treatment you get will likely take a long time to pay off.