This paper examines by a selective review of the literature on secondary anorexia nervosa the under‐recognized role of death fears and anxieties in the etiology of this paradoxical condition. By drawing on the psychology of the survivor, the anorexic patient is conceptualised as a “survivor by proxy” of the parent. In developing and confronting these themes, areas of knowledge otherwise thought unrelated to anorexia are discussed. Of particular importance are the Rheingold theories on maternal destructiveness, the catastrophic death complex in women, Lifton's psychology of the survivor (particularly the survivor child), research on maternal depression, morbid obsessions, necrophilia, and murderous obsessions in mothers towards their children. The main thrust of this reconceptualization is that death fears and anxieties, and a close associative linking between eating, death, and other basic life functions, plays a central and not peripheral role in the dynamic etiology of secondary anorexia nervosa.

Binswanger's “The Case of Ellen West” is an often quoted case history in the literature on eating disorders and, therefore, is both a well‐known and historically important contribution to the field. While most authors emphasize in their own interpretations, her preoccupation with food and her fear of being fat, a careful study of Ellen West indicates that the dominant focus of discussion in this case history as revealed by a descriptor frequency count, is her existential struggles with death symbolism and death anxiety. These themes do not usually emerge from contemporary accounts of her life. Objectively interpreted and properly understood, it is our opinion that Ellen West provides an early and potent example of an exploration of the theme of death in the literature on eating disorders.

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