Enema abuse is a pernicious disorder, not extensively reported in the psychiatric literature. It may occur as an isolated paraphilia, klismaphilia (Denko, 1973, 1976), or as a symptom reflecting more pervasive illness or abnormality of attitude (Engel, 1975; Greenberg-Englander and Levine, 1981). Our patient had been using enemata excessively for sixteen years and presented in a state of cachexia; she had both obsessive-compulsive and affective symptoms, both frequently found in association with anorexia nervosa (Snaith, 1981).