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A rather typical case of anorexia nervosa is described in some detail, with brief observations on several others. The authors have restated the basically preoedipal genesis of this condition pointing out that, although the dramatic symptom of anorexia appears at puberty or in adolescence, the ominous diagnosis of anorexia nervosa is not warranted without an infantile history replete with such gastrointestinal difficulties as very early feeding and bowel disturbances. They mention the more common hysterical anorexia developing as a response to dawning sexuality. This must not be confused with the graver disease. The underlying process in anorexia nervosa, despite the obsessional façade, is believed to be a psychotic process.
Although sudden and dramatic changes in the clinical picture take place during a specific regimen of 'insight' psychotherapy or drugs, moving the patient from the home to the hospital is the crucial factor in stemming the downhill course of the disease. It not only removes the patient from the tension-ridden environment peopled by those individuals playing a major role in the genesis of the disease, but also introduces him to a regressive environment where the personnel supply some measure of an 'anaclitic' milieu.
The weight of the demands made on the therapist by the patient and relatives may be of sufficient magnitude to mobilize unconscious or conscious hostile reactions in him. An adequate psychotherapeutic approach requires a physician who is prepared to dedicate large quantities of time and effort and who can accept frustration and failure. The most effective means of therapy is the attainment of some gratification, through a human relationship, of the vast anaclitic needs of these patients.