‘Personality’ and Anorexia Nervosa – the Phobic Avoidance Stance

Experience and behaviour in anorexia nervosa is subordinate to the need to achieve and maintain a low body weight in the presence of the impulse, generated by starvation, to forage and ingest, and moreover in the presence of abundant food supplies. The stance is a phobic avoidance one. Normal adult body weight and attendant post-pubertal 'fatness' is feared and avoided through the process of pubertal regression, facilitated primarily by dietary carbohydrate (and fat) avoidance, but otherwise and less effectively by the vomiting/purging syndrome. The maintenance of this stance requires a total commitment of self-control and control of the environment - which are experienced by others as a primary narcissism within the 'patient' and as a tyrannical manipulative attitude to those others.