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This is a monograph of unusual thoroughness, in the best German tradition of a Handbuch. An excellent historical review encompasses both the pathophysiological and the psychological aspects of this syndrome, which has been described under various headings as far back as 1500 A.D. An attempt is made to delineate the syndrome from the 'excessive psychogenic weight loss' (Bliss, 1960) which may occur in childhood, in melancholic depression, in schizophrenia, and in other states. The following factors are diagnostically pathognomonic: 1, the syndrome occurs almost exclusively in the female; 2, it starts at or shortly after puberty; 3, the somatic symptoms—amenorrhea, vomiting, and constipation—nearly always precede the severe anorexia and weight loss; 4, hyperactivity is frequent. The syndrome is 'coherent in the core of its symptoms … and shows variations in its general psychopathology'.
Accordingly, what one might call a 'puberty-crisis' becomes the central theme of the author's psychoanalytic considerations, leaning extensively on Anna Freud's views on adolescents. Unable to cope with the upsurge of instinctual demands, an 'asexual ego ideal—"I am neither boy nor girl"—serves as reaction-formation to assure that sexual wishes shall not reach consciousness'. Food, its intake or refusal, becomes the representation of libidinal and aggressive instinctual