[The therapeutic challenge of anorexia nervosa]

Anorexia nervosa represents a typical paradox of adolescence. This paradox drives the adolescent to refuse what he fears he would need too much: this need seems threatening because it would make him dependent on the object of satisfaction which seems alienating to him. Thus, he becomes alienated to his refusal, which worsens the underlying need and increases the refusal. The life of the anorectic is centered on a passion for food and fear of bulimia. In fact, food focuses a greater "appetite" for recognition and to be the centre of attention. Beyond, and with, curing of the symptom, the treatment, by means of the weight contract, tends to resolve this paradox in which the anorectic tries to enclose us. To take up the challenge, the treatment must create the conditions for the emergence of pleasure in desiring what they need, without anxiety about their autonomy.