Chiceta, IffinoisNOREXIA NERVOSA has presented a frequent topic for discussion A in the medical and psychiatric literature of many nations. I t is the intent of this paper: 1) to review this general literature with emphasis on clarification of some of the conflicting statements that have been made; 2) to study in some detail the dynamics of starvation; 3) to review more specifically the literature that concerns the anorectic male; 4) to present in detail the case histories and treatment of two prepubescent boys with this symptom complex, and to refer briefly to two others; and 5) to formulate in the discussion that concludes the paper the psychodynamic aspects of the subject. A comparison between our male and female cases, an explanation for this symptom choice, apparent reasons for the less frequent occurrence of this symptom complex in boys, and finally, practical suggestions for treatment will also be offered.REVIEW OF THE GENERAL LITERATURE OF ANOREXIA NERVOSA Although Morton (25), in a book published in 1694, was probably the first writer to refer to this symptom complex, as he does in the chapter entitled "Of a Nervous Consumption," Sir William Gull (10, 11), in 1874, described and named anorexia nervosa. While he had observed the condition in males, he described it as occurring typically in girls between the ages of 16 and 25 who showed extreme loss of weight with no demonstrable organic disease, slow starvation pulse, amenorrhea, and low respiration rate. A tendency to irritability, remarkable energy and ceaseless activity in these patients despite poor nutritive functions were also pointed out by him. He regarded the cause as a "perversion of the ego" and said the want of appetite was due to a morbid mental state. Although he had seen one fatal case, he regarded the prognosis for the most part as favorable. He advised feeding a t regular intervals and surrounding the patients with persons who had the greatest control over them. H e added significantly that the inclination of the patient should in no way be consulted.Since this early description of anorexia nervosa, many articles have appeared in the literature as adequately reviewed by Rahman and others (23)

A developmental scheme has been proposed which recognizes clusters of variables of adolescent behavior in the area of heterosexual object relationship development. These periods-(I) stage of sexual awakening (13-15), (II) stage of practicing (14-17), (III) stage of acceptance (16-19), (IV) stage of permanent object choice (18-25)-reflect the developing capacity of object relationship and are a a recapitulation on a higher level of functioning of the separation-individuation operations of the infant. The dating patterns at these levels of development provide a sensitive indication of growth, and unworked-through development is reflected in immature patterns. The current trends in dating described are considered to be a function of the prolongation of adolescence and not pathological.

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One cohort of low birth weight, preterm quintuplets and one cohort of low birth weight, preterm quadruplets were regularly tested during the first two years of life to determine if these infants lag behind in development as is reported for low birth weight, preterm singletons. Bayley mental and motor scales of development were administered at three month intervals through 18 months and again at 24 months of age; scores were adjusted for gestation. Decarie measures of Object Constancy and Objectal Relations were obtained at the same ages to study attachment to mother in a multiple caretaking situation. Both adjusted and unadjusted Mental Development and Motor Development Indices were significantly correlated with birth weight. Low birth weight preterm multiple birth infants do lag behind initially in development but they "catch" up by 2 years. Objectal scores developed earlier than object constancy scores on the Decarie, and this difference persisted longer for low birth weight infants. It was inferred that the multiple caretaking situation did not interfere with the specific attachment to the mother.