ABSTRACT
Girls and young women develop anorexia because they are unhappy. The unhappiness that gives rise to anorexia is not so different from the unhappiness that gives rise to bulimia, or depression for that matter. The girl who develops anorexia has extremely negative self-esteem, and high anxiety. Patients with anorexia, whose control over their eating is challenged, for example in an in-patient re-feeding programme, also experience a challenge to their self-esteem. Patients with anorexia reported feelings of ineffectiveness, and low interoceptive awareness. Anorexia appears with increasing frequency from puberty onwards. It is accompanied and usually preceded, by anxiety. Perfectionism is seen as a major risk factor for the development of anorexia, highly characteristic of the disturbance itself, and remains characteristic of those who have recovered. Self-harm is one feature associated with anorexia that is often thought to be associated with the suppression of anger by the patient.
