Cognitive and emotional conflict in anorexia: reanalysis of a classic case

This paper outlines a theory of the causation of anorexia. Extending Lewis's work on shame, I propose that anorexia involves an interminable quarrel between patient and family. This quarrel is caused by unacknowledged shame, leading to chain reactions of emotion, sequences of shame and rage. To illustrate, I use an earlier case study, a microanalysis of dialogue in a psychotherapy session. This study provided an analysis of the cognitive structure of the quarrel but not of the emotional structure. The proposed theory complements and extends the earlier study, and suggests a treatment rationale and method.