Researchers from the UK, Denmark and Australia have published a series of seven new papers in the journal European Eating Disorders Review, following patients with anorexia nervosa and other eating disorders. The large data group, which is based upon data culled by Professor Arthur Crisp over a period of 35 years at the Middlesex Hospital Medical School, and later St George's Hospital Medical School, both in London, has given insights into the female and less common male variants of the disease. Professor Crisp concludes that his theory of anorexia, developed in the 1960s holds true, and that the disease is a 'phobically driven avoidance stance, 'a biological solution to an existential problem'.' The findings reveal peaks for anorexia in children born in March/April and October, and a trough for the disease for February births. This had been previously observed, although was not found to be statistically significant. However, the behaviour of the mother was found to be an important factor: 'Because of this modest replication we went on to explore the possible relationship of any such peak in births to background parental variables that we thought could provide some explanations. Of the 16 that we examined only one was statistically significant, but quite highly so, namely the presence of undue maternal preoccupation with personal body weight and shape and with maintaining it at normal levels,' reads the report. The report speculates that some women may suffer seasonal bouts of anorexia, related to seasonally affected disorder (SAD), and causing a corresponding fluctuation in fertility, which in turn causes the peaks and troughs in the data. In 'Enduring Nature of Anorexia Nervosa', Professor Crisp outlines how the disease persists, despite fluctuations in how the disease is reported. In 'Death, Survival and Recovery in Anorexia Nervosa', he outlines says: 'If untreated or ineffectively treated, early death, often in the third or fourth decades of life, ensures a high mortality rate-three or fourfold that of the general population of comparable age. Such early deaths are most often due to suicide or the variety of idiosyncratic complications of the accompanying malnutrition.' People suffering from anorexia can, however, go on to lead almost normal lives if treated successfully, although mortality rates for suicide and malnutrition will remain constant. The disease appears to protect against certain genetic diseases, perhaps through avoiding certain triggers that would begin in puberty. 'These include cystic fibrosis, hypertrophic cardiomyopathy, Huntington's chorea, ulcerative colitis. The condition might indeed abort, mute or delay the onset of such potentially fatal developments.' The disease is also not incompatible with a long life, and the author treated women of 78 and 82 years. Development of anorexia is strongly correlated with puberty, with onset occurring later in males, and earlier in non-white females. Females were more likely to abuse laxatives, and to hoard food, while males were more likely to be vegetarian. Males were also more likely to be vegan or abuse alcohol. The extremely rare male version of the disease generated 72 patients over 35 years, producing much new information. 'Family over-protectiveness towards and enmeshment with the patient as a child are judged to have been more common features in the male, as is paternal obesity,' reads the report 'Anorexia Nervosa in Males'. Professor Crisp identified a pattern for anorexia. He found that by age 16, the majority of females want to weigh less than they do, and two-thirds will have tried to diet. This could lead to fluctuating calorie intake; an extreme example is the bingeing and vomiting of bulimia nervosa. However, in anorexia, the pattern is to maintain restrictions on calorie intake. Professor Crisp believes that this determination to deny normal food brings about a relief from panic. In defence of his Concept of Phobically Driven Avoidance of Adult Body Weight/Shape/Function, Professor Crisp says, 'It is suggested the anorexia nervosa is rooted in a biologically based avoidance behaviour driven by a phobia of normal (usually female) adult bodyweight [...]. These had been resolved by the consequent avoidance behaviour, at the cost of psychological, social and physical crippling amounting to partial suicide. The phobia, and its intensity, may be denied but will be revealed if normal adult body weight is fully restored, even though, with psychological help, more effective strategies may become available to tackle its maturational consequences. Without help the avoidance behaviour, with its attendant 'compromise with suicide', may remain the only alternative to actual suicide, at least in the first instance.'