Am J Psychiatry 1977; 134:974-978
Copyright © 1977 by American Psychiatric Association
On the course of anorexia nervosa
RC Casper and JM Davis
The authors trace three phases in the course of anorexia nervosa and
compare its physical and psychological symptoms with those of starvation.
Phase I, which may occur months or years before the illness, usually
includes precipitating events that result in loss of self-esteem and
increased self-consciousness about physical appearance. During phase II
patients develop the "anorectic attitude," an unreasonable fear of eating,
and show pride in their ability to lose weight. By phase III patients are
forced by the severity of starvation symptoms to admit that they are ill.
Although many of the physical symptoms of starvation and anorexia nervosa
are similar, anorectic patients, in contrast to victims of starvation, show
high initiative, the ability to suppress hunger, restless hyperactivity,
and body image distortion.
