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Anorexia nervosa is a much more complex disorder than dieting out of hand. Serious developmental defects are at the root of it. It is generally recognized that anorexia nervosa becomes manifest at the time of a developmental crisis, most often when an adolescent girl is confronted with the task of becoming self-reliant and independent, and of growing beyond the immediate family. The severe cachexia and cessation of sexual functioning have been interpreted as expressing fear of adulthood and its responsibilities, specifically fear of sexual involvement. Such fears can indeed be recognized in most, if not all, anorexics, but they are the result of early developmental deficits, not the dynamic explanation of the illness. The question is why are these youngsters unprepared to meet the challenge of adolescence and adulthood? What are the antecedents, the disturbances in their approach to themselves and to life, that make them withdraw to their own bodies and choose the road of self-starvation in their search for selfhood and selfdirected identity.
Evaluation of their developmental history shows that the very features that are glowingly described as evidence of superior behavior are indications of serious maldevelopment. The illness is an effort at declaring independence, a desperate fight against feeling enslaved, not permitted or competent to lead a life of one's own. This effort, instead of solving the underlying problem, only reinforces the difficulties. Changing the body size cannot correct the deficits in overall development or provide the longed-for independence. Hunger itself has a dramatic effect on physiological and psychological functioning. The somatic consequences of starvation are well-known: they represent what are called the classical symptoms of anorexia nervosa. Much of what has been described as “anorectic behavior” closely resembles what goes on in ordinary starving people. Anorexics are reluctant to talk about this and will describe the suffering durin