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Since the 1870's when Gull and Lasègue described a condition occurring primarily in pubertal girls, there has been little variation in the symptomatology of the condition presented in the literature. The syndrome is characterized by severe emaciation, amenorrhea, constipation, loss of appetite, slowed pulse and respiration, absence of somatic pathology, and strikingly contradictory need for body movement in the face of such severe wasting. Some have found Freud's assumption that impairment in the nutritional instinct was related to the organism's failure to master sexual excitation to be too narrow. Bruch, who deemphasizes intrapsychic conflict, classifies psychological weight loss into 1) psychogenic malnutrition, 2) atypical anorexia nervosa, and 3) primary anorexia nervosa, the last involving disturbances in ego functioning in the areas of body image and perception and a paralyzing sense of ineffectiveness. Psychoanalytic explanations have focused on rejection of pregnancy fantasies with regression to fantasies of oral impregnation. Many therapeutic approaches have been tried, including family therapy, behavior modification, psychotropic drugs, and psychoanalysis. Thomä, a prominent advocate of psychoanalytic psychotherapy for the condition, pointed out that the organic therapies of anorexia have been useful only in the alleviation of the acute symptoms of starvation. He has concluded that those cases receiving psychotherapy had the best prospects for recovery and that success was directly related to the patient's age at the time psychotherapy was instituted. In general, efforts to clarify the mysteries of anorexia nervosa have included biological, sociological, behavioral, and psychoanalytic approaches.