Abstract
Anorexia nervosa is best construed as a phobic avoidance response to the psychosocial maturational implications of adolescent weight. Within this state, surrender to the impulse to eat and consequent weight gain is associated with panic, depression and sometimes specific intense fear of loss of control. So long as the avoidance posture can be maintained the experience of such turmoil is largely avoided.
Complicated ritualistic behaviour may arise to promote and secure the posture. However, its unrewarding and lonely nature still increasingly leaves the individual liable to the experience of depression. Established treatment procedures often assist recovery from the illness but intractable cases arise and it is amongst these that the majority of deaths occur either from inanition or suicide.
The basis for the changes characteristically induced by leucotomy is complex. The procedure often leads to reduced tension and release of appetitive behaviour. This is taken to be due to some direct effect of the cerebral lesion and possibly the intervention may also be construed by some patients as a licence to behave differently. In patients with anorexia nervosa such appetitive release can be expected to promote considerable weight gain. However, the adverse psychological implications of such weight gain for the patient do not appear always to be so immediately or easily relieved.
They may still experience panic, shame or depression and new patterns of social avoidance, or vomiting behaviour may develop. Intensive help of a psychotherapeutic and rehabilitative kind is then still required if the patient is to have the best chance of adjusting healthily to her newly found potential for a more normal nutritional status. Four patients who have undergone such treatment are described in this paper. It is concluded that leucotomy has a small but definite place in the treatment of patients with intractable anorexia nervosa.
Full text
PDF
Images in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- ALTSCHULE M. D. Adrenocortical function in anorexia nervosa before and after lobotomy. N Engl J Med. 1953 May 7;248(19):808–810. doi: 10.1056/NEJM195305072481904. [DOI] [PubMed] [Google Scholar]
- Anorexia nervosa. Br Med J. 1969 Mar 1;1(5643):529–530. [PMC free article] [PubMed] [Google Scholar]
- CARMODY J. T. B., VIBBER F. L. Anorexia nervosa treated by prefrontal lobotomy. Ann Intern Med. 1952 Feb;36(22):647–652. doi: 10.7326/0003-4819-36-2-647. [DOI] [PubMed] [Google Scholar]
- Crisp A. H. Anorexia nervosa 'feeding disorder', 'nervous malnutrition' or 'weight phobia'? World Rev Nutr Diet. 1970;12:452–504. [PubMed] [Google Scholar]
- Crisp A. H., Fransella F. Conceptual changes during recovery from anorexia nervosa. Br J Med Psychol. 1972 Dec;45(4):395–405. doi: 10.1111/j.2044-8341.1972.tb02223.x. [DOI] [PubMed] [Google Scholar]
- Crisp A. H., MacKinnon P. C., Chen C., Corker C. S. Observations of gonadotrophic and ovarian hormone activity during recovery from anorexia nervosa. Postgrad Med J. 1973 Aug;49(574):584–590. doi: 10.1136/pgmj.49.574.584. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Crisp A. H. The possible significance of some behavioural correlates of weight and carbohydrate intake. J Psychosom Res. 1967 Jun;11(1):117–131. doi: 10.1016/0022-3999(67)90064-5. [DOI] [PubMed] [Google Scholar]
- DRURY M. O. An emergency leucotomy. Br Med J. 1950 Sep 9;2(4679):609–609. doi: 10.1136/bmj.2.4679.609. [DOI] [PMC free article] [PubMed] [Google Scholar]
- GLAZEBROOK A. J., PROSEN H. Compulsive neurosis with cachexia. Can Med Assoc J. 1956 Jul 1;75(1):40–42. [PMC free article] [PubMed] [Google Scholar]
- KAY D. W. Anorexia nervosa: a study in prognosis. Proc R Soc Med. 1953 Aug;46(8):669–674. [PMC free article] [PubMed] [Google Scholar]
- Kelly D., Mitchell-Heggs N. Stereotactic limbic leucotomy--a follow-up study of thirty patients. Postgrad Med J. 1973 Dec;49(578):865–882. doi: 10.1136/pgmj.49.578.865. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Richardson A. Stereotactic limbic leucotomy: surgical technique. Postgrad Med J. 1973 Dec;49(578):860–864. doi: 10.1136/pgmj.49.578.860. [DOI] [PMC free article] [PubMed] [Google Scholar]
- SARGANT W. Leucotomy in psychosomatic disorders. Lancet. 1951 Jul 21;2(6673):87–91. doi: 10.1016/s0140-6736(51)91351-7. [DOI] [PubMed] [Google Scholar]
- SIFNEOS P. E. A case of anorexia nervosa treated successfully by leucotomy. Am J Psychiatry. 1952 Nov;109(5):356–360. doi: 10.1176/ajp.109.5.356. [DOI] [PubMed] [Google Scholar]
- Slater P. The use of the repertory grid technique in the individual case. Br J Psychiatry. 1965 Oct;111(479):965–975. doi: 10.1192/bjp.111.479.965. [DOI] [PubMed] [Google Scholar]