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Anorexia Nervosa: A Somatic Disorder

1958; BMJ; Volume: 2; Issue: 5090 Linguagem: Inglês

10.1136/bmj.2.5090.190

0959-8138

E. Williams,

Genetic Neurodegenerative Diseases

The results of treatment in anorexia nervosa are poor and have not benefited from its inclusion with the psychosomatic disorders (Cobb, 1950).Indeed, the approach to treatment has recently become confused owing to the mystery which now surrounds its aetiology, at one time explained in terms which, if superficial, at least were easily understood.In his original description of the disease Sir William Gull (1874) attributed the want of appetite to a " morbid mental state," claiming that its origin is " central and not peripheral," and that the state might be called " hysterical without committing ourselves to the etymo- logical value of the word, or maintaining that the subjects of it have the common symptom"s of hysteria."He described his patients as " wilful, often allowed to drift their own way into a state of extreme exhaustion," in this way clearly implying that the illness is largely self- induced.Samuel Gee (1907) described it as a melan- choly-" no more than a high degree of the melancholy which affects so many girls about the age of puberty and for somie years afterwards," arising, he said, "from a morbid excess of that craving for sympathy which is so common to all mankind, as is especially strong in the female sex."Ryle (1936), in his Schorstein Memorial Lecture, summarized the sequence of events in this way: "A psychic trauma or a foolish habit or some combination of the two results in a loss of appetite and a suppression of the menses.Starvation follows and with starvation an aggravation of the anorexia."Ryle (1936) protested that " physicians subject to the lures of endocrinology have been tempted sometimes to find a basis for the symptoms of the disease in a primary deficiency or disharmony of the internal secretions."Psychiatrists, on the other hand, have claimed the illness in all its aspects as their own.History-taking has given way to psycho-analysis; physical findings are now ignored; and treatment has been ousted by therapy, either psychotherapy or electric convulsion, or both.