Eating disorders such as anorexia nervosa have generally been associated with the adolescent years of growth, although they may occur in the early to mid-adult years as well. An eating disorder is defined as a disturbance in eating behavior that jeopardizes a person's physical or psychological health. Anorexia nervosa is examined in the literature in terms of its nature and characteristics, diagnostic issues, psychodynamic aspects of the physical disorder in terms of etiology, psychological consequences of the disorder, and treatment modalities. For some the disorder is chronic, and for others it is merely episodic. Individual anorectics, in the course of the disorder, experience marked psychological changes in relation to the state of starvation itself and to the patterns of interaction within the family. This has consequences for treatment. Much of the current psychotherapeutic thinking about the disorder derives from Sigmund Freud and Hilde Bruch. Bruch sees the contemporary anorectic as unprepared to cope with the psychological and social consequences of adulthood as well as with sexuality. The anorectic experiences a paralyzing sense of ineffectiveness and anxiety about her identity, and she therefore chooses for control of her body (Bruch, 1973, 155).
The onset and course of anorexia nervosa are remarkably predictable. Sometimes the onset follows an upset, such as a failed romance, and sometimes it occurs without a clear precipitant. The patient begins to diet, and after a time the dieting becomes driven by a fear of losing control of the appetite. Many sufferers go no further than this and hover for years on the brink of a more serious disorder. In some young women, severe dieting changes into an implacable pursuit of thinness, an obsession with food and calories, and a sheer abhorrence of body fat. The anorectic typically denies her illness and does not perceive herself as emaciated. She will usually exaggerat...