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This paper brings together disparate ideas that have interested me in trying to understand the complicated illness that is anorexia nervosa. It presents questions, contradictions, and paradoxes. Even its general clinical usefulness is questionable, though the major part is a presentation of details of an interesting psychoanalysis of a woman whose first, aborted, pregnancy marked the start of anorexia nervosa and whose second, desired, pregnancy marked the recovery from anorexia and the beginning of a happy family.
Anorexia nervosa is a disease that turns its victims against nature and, even, against life itself. Along with the repudiation of nutritional needs, which poses a threat to individual survival, goes a repudiation of sexuality in terms of psychological interest and physiological functioning, resulting in major interference with reproduction. For females, who make up 90-95% of anorectics, there is regression to prepubertal or pubertal levels of hormones (Katz et al., 1978), manifested in amenorrhea. Studies of male anorectics show a similar loss of sexual interest and potency (Crisp and Burns, 1983) and regression also to prepubertal or pubertal hormonal levels (Crisp et al., 1982; Beumont et al., 1972).
There have recently been some papers taking issue with the claim that anorexia nervosa interferes with normal sexual attitudes, summarized in the polemical review of Scott (1987) who concludes, “there is little evidence for many widely held beliefs concerning psychosexual factors within eating-disordered patients” (p. 199). He cites, in particular, studies of Buvat-Herbaut et al. (1983) and Beumont et al. (1981) and states, “In sum, there appears to be nothing to particularly substantiate a suggestion of oddities within the sexual outlook or behavior among anorectics” (p. 204). Scott dismisses as “anecdotal” the wide clinical experience (Bruch, 1973; Crisp, 1980; Dally and Sargent, 1966; Sours, 1980; Thoma, 1967; among many others) that is inconsistent with h