[Anorexia nervosa - thoughts on psychogenesis and psychotherapy]

In this work I tried to classify Anorexia nervosa into two groups, the central group and the reactive group. The central group contains four different subgroups, the immature, the schizoid, the hysterical and the compulsive type. In the first two subgroups the lack of appetite appears primarily at the onset of the disease, and the fear of growing up plays an important role. In the latter two subgroups the lack of appetite comes later on the basis of a conscious or subconscious suppression of the appetite; here prevails a wish to be slender and the disturbance of the aesthetic value orientation. The basis of this syndrome lies in the interpersonal constellation in the family during the childhood. In tests and interviews of the parents of 20 patients was proved, that the fathers have weak and immature character structures, show little interest in the family, they are hypochondriacl, undecisive and not self-confident. On the contrary the mothers are more normative and they endeavour to accept or compensate some parts of the father-role. In the course of these excessive efforts they lose their motherhood and become secondarily dominating grumbling persons. By the lack of the normal father-daugher-relationship, the maturation of sexuality and feminity is disturbed. The method of psychotherapy of those ambivalent, unmotivated patients with ego-splitting is different from that of other neuroses in many points, such as activity, flexibility and educational control on the part of the therapist instead of the psychoanalytic neutrality. In such cases therapists should not be reluctant to act as an object of identification for these patients.