The Anorexia Nervosa Syndrome

From a close scrutiny of the literature on anorexia nervosa and from working with anorexia nervosa patients in psychoanalytic therapy, it is apparent that the disorder causes among analysts differences of opinion regarding diagnosis, psychopathogenesis and treatment.

Analysts are often reluctant to treat anorexia nervosa patients. It is one of the few psychosomatic disorders which are life-threatening, for it is associated with an overall mortality rate varying from 7–15 per cent (Sours, 1969). When an anorexia nervosa patient embarks on her relentless pursuit of thinness and absolute control over her body, the emaciation can proceed to cachexia and inanition, sometimes ending in circulatory collapse or cardiac arrest (Ziegler & Sours, 1968). Uncertainties about diagnosis, therapy and the patient's physical health often arise, and the analyst is confronted with the question of whether hospitalization for refeeding and restoration of nutrition and health is necessary (Bruch, 1966); (Crisp, 1968); (Falstein et al., 1956); (Sours, 1973).

I intend first to summarize the literature on anorexia nervosa with emphasis on some issues of diagnosis, treatment and medical management. Then I will draw on my own experience with anorexia nervosa patients whom I have treated either in a university hospital or in private practice.

Central to the discussion is the point that anorexia nervosa is not a specific nosological entity with predictable findings and a predictably grave outcome.

I want to emphasize that there is a group of adolescent girls with anorexia nervosa who can be treated with traditional analytic techniques. The other two groups of anorexia nervosa patients, who display regressive dedifferentiation, possible loss of self–object separation and mental self–body–self differentiation and reactivation of archaic ego states, frequently first require auxiliary medical management. Nevertheless, once their relentless starvation stops and life is no longer endangered, analyti