The young woman reaches with bony fingers, draws a foreign cigarette from her case, and lights a match. She stretches her long legs across the floor, resting her weight on the tiny pelvis outlined by her jeans. The smoke dances slowly around her soft, beautiful face as she begins to talk about why she is so thin, about her anorexia nervosa.

"The egotism and vanity involved with anorexia is unbelievable," she says. "You spend hours a day examining yourself, looking at your body. Gaining one pound is a big thing." Unlike most anorexics, who deny there is anything wrong with them, she wants to talk about the strange disease she has for five years. But she doesn't want people to know who she is.

She is extremely skinny--not svelte, but unnaturally thin. She starved herself torturously to achieve and maintain her underweight state. She ignored the hunger pangs in her stomach and she denied to her family and friends that she was hungry, because she felt fat and wanted to be thin. When she got horribly skinny people got very worried but she thought she still needed to lose weight, and still she would not--or could not--eat. "It's this big secret," she says of the first stages of anorexia. "You're so guilty about it, but it's obvious that everybody knows about it. And you still think there's nothing wrong with you."

The textbook definition of anorexia nervosa is "a chronic illness principally affecting young girls after puberty. It is characterized by severe weight loss which is self-induced, amennorhea [loss of period], and a specific psychopathology." However, after a century of research on anorexia nervosa, this definition does not hold up well. The psychopathological basis for the disease is still not defined specifically enough to bring doctors who treat anorexia to a consenus on its cause. Furthermore, one in ten diagnosed anorexics is male.

A widely accepted definition of anorexia is not likely to emerge soon. Anorexic patients are perhaps too rare and too scattered to support large conclusive research studies; large hospitals admit only ten to twelve anorexic patients a year, people whose self-starvation has put their lives in danger, who have lost more than 20 per cent of their normal body weight.

Dr. Warren E.C. Wacker, director of the University Health Services, says UHS treats about eight anorexics a year, two of whom have to be hospitalized in Stillman Infirmary. Since most anorexics deny there is anything wrong with them and are generally brought to the doctor by their parents, Dr. Lauring Conant, an internist at UHS, says, there are probably more anorexic students at Harvard than UHS treats.

The most pervasive aspect of the disease is denial; anorexics' denial of their hunger, to themselves and to others, is extreme. They deny that they have any emotional or physical problems. While on ritualized and limited diets they are apt to suffer from digestive problems, but they deny they are ill and avoid seeing doctors who might force them to confront their self-starvation.

Anorexics have a distorted sense of their own body size, seeing themselves as much fatter than they actually are, and they have extreme goals for the size they consider ideal. They are obsessed with nutrition and food. They love to prepare meals, watch others eat, and work on nutrition projects for school. They go on eating binges occasionally, but will secretly induce vomiting afterwards. "One sub-group," Dr. George Tully, an endocrinologist at Massachusetts General Hospital, says, "will eat next to nothing for a long time, then gorge a jar of mayonnaise or pickle juice--very unappetizing-sounding orgies--and induce vomiting."

Generally anorexics are achievement-oriented, very intelligent, very depressed people. They are hyperactive, spending enormous amounts of time exercising to burn off calories, and they are very nervous. Most anorexics come from upper class or uppermiddle class homes where food is plentiful; few come from lower class homes, and anorexia is rarely reported in developing countries.

Anorexia is a mystery disease; doctors disagree over practically everything about it. The leading expert on it is Dr. Hilde Bruch, who has been observing anorexics for more than 35 years and has written a book on them. Bruch has developed a psychological composite portrait of the typical anorexic victim: they were, she says, model children who behaved with robot-like obedience because they doubted their abilities to stand up for and assert themselves. Their dieting usually began inexplicably, following trivial remarks about their appearance or upon a change of environment, like going to camp or college. In new situations, the anorexic feels embarassed about being chubby or not athletic enough, and begins dieting.

The dieting gets out of control, Bruch believes, because the anorexic expects it to bring about effectiveness and respect. Since no amount of weight loss can achieve these goals, the anorexic becomes frantic and pursues the diet with renewed fervor. The desire for control of one's life is replaced by the desire to control the body.

Family life plays the greatest role in Bruch's theory of who gets anorexia and why. "It is possible," she writes, "that the success, achievement, and appearance orientation of these families is in some way related to the patient's driving search for something that will earn him respect." Despite the apparent stability in the anorexic's home--very few come from broken homes--Bruch finds in the parents a deep disillusionment with each other. They are competing secretly to prove which is the better parent. The mother is likely to be an achievement-oriented woman, frustrated in her aspirations, very conscientious in her conception of motherhood, subservient to her husband without truly respecting him. The father, despite considerable social and financial success, feels second rate and is preoccupied with physical appearances. He admires fitness and beauty, and expects high achievements and good manners from his children.

Though the children have had a great deal of exposure to education, athletics and the arts, they were not enouraged to think independently or to express their own feelings. Instead of relying on their own inner resources or autonomous decisions, they behaved with complete compliance to authority. When puberty demanded independence of the obedient anorexic child, he turned, Bruch writes, "to indiscriminate negativism."

The male anorexia that Bruch observed was all prepubescent. She found the same desire for autonomy motivating these boys, and leading them to develop overambitious, hyperactive and perfectionist attitudes. Male anorexia, however, is overcome by the flood of hormones at puberty, which leads to new aggression and makes self-assertion possible.

Bruch sees the task of a therapist as being the rewarding of self-initiated efforts to eat by anorexics, and helping them to think for themselves and grow into individuals.