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Five cases are described in which the symptom complex occurred, four women and one man, differing clinically in other respects and including hysterias, obsessional neurosis, paranoid character, impotence with stuttering. All manifested periodic 'eating and sleeping mania' (Essucht u. Schlafsucht), in which enormous quantities of sweet things, cakes, unappetising remnants, scraps of paper, etc., were devoured, while persistent, unrefreshing sleep, disturbed by erotic dreams or onanism, accompanied the process of digestion. There were alternating periods of abstemiousness with diminished sleep. The eating and sleeping bouts were accompanied by erotic excitement, and by a state of profound depression, inactivity and neglect of the person, feelings of guilt and disgust at the subjects' own body, fattened by eating. Fasting removed the guilt and led to elation, well-being, energy and self-satisfaction, but without erotic excitement. Guilt and disgust followed the yielding to the cravings of hunger, and the cycle recommenced. Familial and external factors reinforced both oral fixation and its relation to erotic stimulation at the genital level. The onset was usually at puberty with profound reaction to the physical changes.
The exciting cause, as in melancholia, was loss of a loved object or a narcissistic wound, but the author distinguishes the cases from melancholia clinically and psychogenetically. The melancholic's symbolic incorporation of the object is largely sadistic, whereas these cases in which ingestion is actual, manifest a regression from the genital to the oral level in an attempt to retain the object, but the love cathexis in phantasy is largely undisturbed. Eating represented a perverted sexual act. In addition, the cases manifested marked castration complex, and the ingested substances were