The nature of the relationship between accidental trauma and psychopathology may not always be clear. Cases of post-traumatic anorexia nervosa have been described but without detailed attention to pre-existing psychopathological processes. This may give rise to spurious conclusions about direction of casualty. We describe a male patient who developed anorexia nervosa on two occasions, both episodes occurring during the convalescent period following traumatic accidents several years apart. The intervening period was characterized by strict self-regulation and conflict avoidance, typical of anorexia nervosa but with the body maintained at only a moderately low weight. We suggest that accidents can arise at times of crisis in such ongoing attempts at intense self-regulation. They may then reflect the escape from control of impulsivity and also provide an ultimate means of avoidance of further guilt-laden behaviour. They can be understood in the light of pre-existing psychopathology. The difficulties in early recognition and diagnosis of anorexia nervosa, especially in the male and in the absence of extreme weight loss are also discussed.