Anorexia Nervosa in the Male

As in females, there is need to differentiate between an atypical and a genuine or primary form of anorexia nervosa in males. Reevaluation of 9 male patients, observed over a period of 25 years, revealed 4 as being atypical, with refusal to eat being incidental to various unspecific psychiatric conditions, and 5 as belonging to the primary group, with food refusal being a late symptom that stood in the service of a relentless pursuit of thinness, and was associated with hyperactivity, inaccuracy in the perception of bodily states and an all pervasive sense of ineffectiveness. The families in the atypical group appeared more overtly disturbed, whereas in the primary group they gave the impression of adequate functioning. The underlying disturbance, a deficit in confirmation of child initiated behavior, was recognized only during intensive psychotherapy. Understanding of this pattern resulted in the development of a more effective therapeutic approach. Diagnostic classification, usually psychoneurosis early in the picture and schizophrenia later on, showed little relationship to the final outcome.