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Eating disorders have been discussed from the point of view of unconscious mechanisms since the first psychoanalytic investigations were made by Freud and Breuer in their work on hysteria. However, since then, the relationship of the symptom to the underlying unconscious dynamic has been investigated only sporadically. What Scott complained of in 1948, referred to in Tustin's paper of 1958, still pertains. That is that “as yet little has been done to trace the specific connections between the symptoms and the instinctive life, the imagination and the interpersonal relations”. Sohn (1973) stressed the envious attacks on the internal breast and the feeding mother. Wilson et al. (1983) reported several psychoanalytic studies which investigated the internal dynamics of anorexics and see the “fear of being fat” and the pathological body image of the anorexic as arising from an identification with a parent who has the same fear to a lesser extent. Thomä describes anorexia nervosa as a neurotic symptom complex; the symptom is an obsession, a “dominant idea” as an addiction that the patient tries to control by the intake or expulsion of food.
The overall impression in reading the literature is that there is no one cause, or determinant, underlying the symptom and that it occurs in a variety of character disorders that range from the borderline to the psychotic. One consistent feature is that it is ten to twenty times more frequent in adolescent females than in males, and that some investigators consider that non-eating in males is of a different order, with a different dynamic, than non-eating in females. Its greater frequency in females has led some investigators (for instance, Palazzol, 1978) to explain it from a family or from a psychosocial point of view. The fact that its incidence is on the increase, not only among middle class females, while it is practically unknown in the third world, indicates social factors at work in the selection of anorexia as a symptom, but th