Anorexia can be due to several causes, and the background of the symptom can differ widely.
This paper deals mainly with psychogenic anorexia in (pre)adolescent girls. It is based on psychoanalytically-oriented literature and on seven cases of the author.
Psychogenic anorexia is seen as a single, but important symptom within the defense-organisation of an oral impulse-control conflict. It is a preverbal defensemechanism with a definite function of alarm. It is, speaking with Frazier: a bodylanguage form of acting out.
The author makes a distinction between two forms of psychogenic anorexia in (pre)adolescence, the 'anorexia nervosa' and the 'anorexia mentalis'.
In contrast to the first form, the Jatter is rather difficult to cure, the more so if the goal is not only the treatment of the anorexia, but of the patient. In anorexia mentalis a depression is found with guiltfeelings of extreme severity, centered around phantasies of oral conception. (Pre)adolescent increase of impulses is the starting point of the symptoms, but the disease itself must be seen as based on a disturbed development of Ego-functions during a very early oral stage, caused by (or resulting in) a profound disturbance of the mother-child relationship. The fear of losing control of oral intake results in a nearly complete anorexia.
Underneath, the symbiotic-dependant relationship with the snother inhibits any further emotional development.
Finally some problems of treatment are discuseed. The author especially mentions the danger of neglecting the disturbed development of character in anorexia 'mentalis'.