Many cases seem to follow some sexual difficulty. This may only be the development of sexuality which comes with puberty or it may follow episodes of petting or intercourse which the girl cannot handle psychologically.
When the family is examined it is often found that there is a disturbance in family relationships. The outward appearance may be one of family harmony but beneath this calm lies well controlled hostility.
The mothers are usually domineering and rigid in outlook; both parents are intense and seek affection and approval from the girl to compensate for their hostility to each other.
Many theories have been advanced for the cause of this disorder, but at the moment there is no proof which is convincing. Freudian theory sees this as a rejection of sexuality or of pregnancy. Other psychiatrists see it as part of the obsessive-compulsive personality disorder or of depression. Whatever the cause, the treatment is difficult.
There does appear to be a disturbance in the body image the girl has of herself. A few start off being overweight, many are of normal weight, a few are underweight.
Despite the fact that the girl is obviously underweight to all other observers, she may insist that she is “just right” or “not too thin.”