The possible significance of some behavioural correlates of weight and carbohydrate intake.

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of 82 patients with primary anorexia nervosa and a pilot study of 16 patients with massive obesity. The anorexia nervosa patients-G male and 76 female-have all been seen at length by myself, and the majority have been treated as in-patients. Many of them have been referred to in previous reports [l-5]. In particular the view has been expressed that many patients with anorexia nervosa come from an obese or otherwise nutritionally disordered population so far as family and personal constitutional factors are concerned. Not all patients with anorexia nervosa develop this illness in their teens. The majority of the remainder in the present series have been women who developed the illness in their twenties, often having first become more obese during their teens. The majority of the massively obese patients, one male and 15 female, were admitted routinely and successively under a general physician and later seen by me, initially as a collaborative exercise. Only two of these patients were referred directly to me by their general practitioners, one patient because of her high amphetamine intake, the other because his general practitioner wanted psychiatric treatment for the patient’s complaint of being overweight. Five of these patients have subsequently been treated as in-patients in a psychiatric unit, each for about 6-8 consecutive months during which time they have all lost between 8-10 st. in weight. Another two of these patients provided a history of anorexia nervosa during their teens. The discovery of such relationships, between marked underweight and gross overweight, has led to the present study: in particular, to the examination of such psychosomatic factors as sexual behaviour and level of activity in the two groups, also to the consideration of such concepts and descriptive features as ‘denial’, ‘compulsion’ and ‘addiction’, seemingly applicable to and shared by both groups. Firstly I want to restate my view [2, 61 that primary anorexia nervosa is almost invariably a state of weight phobia, hingeing on and pivoting round puberty. This central phobia, no longer only of excess weight as part of a feeding disorder, but of normal (functioning) adolescent weight, is usually evident and fearfully admitted to by the patient. There are some few patients who vigorously deny such a fear. They only come to reveal it in a treatment situation in which they are being pressed to gain weight up to a ‘normal’ amount. I do not therefore take the view that the psychopathological disorder in anorexia nervosa is any longer primarily a feeding disorder akin [7] to the feeding disorders of childhood in which food more often seems to represent and stand for the (absent) mother and for her (absent) love. The intervening factor separating off these feeding disorders and anorexia nervosa, and giving a