Psychosomatic Medicine 4:62-73 (1942)
© 1942 American Psychosomatic Society

A Psychosomatic Study of Anorexia Nervosa Including the Use of Vaginal Smears

¹ Department of Psychiatry, Psychiatric Institute and Hospital, 722 West 168 Street, New York City

Anorexia nervosa is discussed as a psychosomatic entity in which fantasies of oral impregnation are dramatized through starvation, vomiting, and amenorrhea. Four cases are presented, two with premenstrual cyclic vomiting of hysterical conversion nature, and two with complete amenorrhea and a persistent phobia for food.

The vaginal smear technic of Papanicolaou and Shorr is used to investigate the endocrine ovarian status, and the percentage cornification in the smear is used as an estimate of estrogen activity. Smears done for a year on a case of cyclic vomiting showed that hysterical vomiting was associated with increased cornification; the pattern was interrupted by testosterone and precipitated by estrogen. Menstruation occurred for the first time in two years following suggestion through control injections of sesame oil. A case of persistent anorexia without vomiting showed atrophic smears, which improved with weight gain; estrogen induced menstruation, but may have increased conflict.

There is no evidence that physical therapy does more good than harm, and prolonged psychotherapy is favored in cases with good intelligence and cooperation. Long hospitalization in adolescents is recommended because of extreme resistance and neurotic parental attitudes.