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The Natural History, Treatment and Prognosis of Anorexia Nervosa, Based on a Study of 38 Patients

From the Bethlem Royal and Maudsley Hospitals

ABSTRACT

Summary and Conclusions:

1. The family histories, childhood environment, and previous mental health of 38 patients with the syndrome known as "anorexia nervosa" have been examined. They show that parental neurosis, disturbed parent-child relationships, childhood neurotic traits, and previous neurotic illness, are common. These are all features of the "neurotic constitution".
   
2. More specific findings are: parental invalidism, hypochondriasis and dietary preoccupations; and, among the patients, earlier feeding difficulties.
   
3. The personalities of the group are poorly-integrated and show a variety of neurotic traits. Obsessional traits occur in half, but their exact significance for anorexia nervosa is uncertain.
   
4. Intelligence is nearly always at least average.
   
5. There is no evidence for constitutional or acquired endocrine disorder in the premorbid clinical picture. The illness itself is explicable without assuming endocrine changes, except for (i) compensatory adjustment to undernutrition, (ii) a specific mechanism causing the amenorrhoea, when this occurs early. This mechanism probably also causes the amenorrhoea which may accompany other psychic disturbances not specially associated with anorexia or loss of weight. Endocrine therapy seldom, if ever, materially affects the course of illness.
   
6. The psychiatric symptomatology is diverse. There is no neurosis specific to anorexia nervosa, and no specific anorexia nervosa. We are not convinced that we have been dealing with a psychiatric entity.
   
7. The prognostic survey shows that the definitive symptoms persist in about half the cases, and that residual neurotic symptoms are the rule. Fifteen per cent. die from the illness or its complications.
   
8. Treatment is unsatisfactory. A plea is made for a broader and more flexible approach to this problem.