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Considering that most analysts are inexperienced with anorexia nervosa, a new book on this disorder is to be welcomed. That anorexia nervosa is primarily an affliction of adolescent girls belies its significance to analytic clinicians and theorists. Dr Sours reminds us that it has long fascinated psychiatrists, particularly in relation to psychosomatics. He broadens our perspective by exploring it in connexion with our increasing understanding of development, narcissistic, and borderline pathology, and the interplay of cultural change and psychopathology.
According to Dr Sours there is an absolute increase in anorexia nervosa in the United States, Great Britain, Japan, and the countries of continental Europe, particularly among the upper classes. The reasons are uncertain. Sours sets before us as possibilities the progressively earlier onset of menses ('the age of menarche in white girls in Western cultures has decreased from 16.5 years to 12.5 years in the last 125 years', p. 281) and changes in child rearing practices which produce premature pressure on adolescents for independence and responsibilty. The implication is that physiological and cultural changes cause a developmental imbalance between intensified drives, fragile ego structures, and diminished support from family and social institutions. In this soil, anorexia nervosa is more likely to develop.
Dr Sours writes informatively about adolescent development and the current psychosocial field in the more well-to-do social classes. He gives us a lively picture of the self-absorption prominent in certain segments of Western society, in particular the seeking and regulation of pleasure, the pride in self control, which are manifest in the extremes of excessive dieting and compulsive running, and in a general preoccupation with unrealistic ideas of fitness. And he sees the anorectic's striving for thinness as part of the current pursuit of perfection, of control and mastery over body and mind, and of the