Regressive forces in anorexia nervosa

Abstract

In the Studies on Hysteria (Breuer & Freud, 1893), Breuer gave a short description of a young boy and wrote of him as follows :. . .A twelve-year-old boy, who had previously suffered from pavor nocturnus and whose father was highly neurotic, came home from school one day feeling unwell. He complained of difficulty in swallowing and headache. The family doctor assumed that the cause was a sore throat. But the condition did not improve even after several days. The boy refused food and vomited when it was pressed on him. He moved about listlessly, without energy or enjoyment; he wanted to lie in bed all the time and was very much run down physically. When I saw him five weeks later, he gave the impression of being a shy and shut-in child, and I became convinced that his condition had a psychical basis. On being questioned closely, he brought up a trivial explanationa severe reproof given by his father-which had clearly not been the real cause of his illness. Nor could anything be learnt from his school. I promised that I would extract all the information later under hypnosis. This, however, turned out to be unnecessary. In response to strong appeals from his clever and energetic mother, he burst into tears and told the following story. While on his way home from school he had gone into a urinal, and a man had held out his penis to him and asked him to take it into his mouth. He had run away in terror, and nothing else had happened to him. But he was ill from that instant. As soon as he had made his confession he recovered completely. In order to produce the anorexia, the difficulty in swallowing and vomiting, several factors were required: the boy's innate neurotic nature, his severe fright, the irruption of sexuality in its crudest form into his childish temperament and, as the specifically determining factor, the

‘No entry’, an invitation to intrude, or both? Reflections on a group of anorexic patients

“…A rich psychoanalytic and psychiatric literature on anorexia describes a multitude of psychic processes, defences and states of mind. Anxieties about sexuality (Breuer and Freud, ; Freud, ), greed, orality, genitality and oral impregnation (Abraham, ; Berlin et al ., ; Lehman, ; Waller et al ., ), the role of the mother, the father and the couple (Birksted‐Breen, , ; Bruch, , ; Boris, ; Jessner and Abse, ) are all hypothesized to be implicated in the development and maintenance of anorexia. External events – in particular, actual or phantasied sexual intrusion – have also been invoked as important causal factors (Majid and Treasure, ; Mullen et al ., ; Oppenheimer et al, ; Stuart‐Smith, ); and family therapists have described a transgenerational conflict of loyalties and the families’ need to have a perfect child (Selvini‐Palazzoli, ) or family characteristics of enmeshment, overprotectiveness, rigidity and lack of conflict resolution with a psychologically vulnerable child in a ‘psychosomatic family’ (Minuchin et al ., ).…”

Diagnosis and Treatment of Anorexic States

“…Symbolic gratification, coupled with careful medical supervision, may accomplish vital short-term goals. 11 The psychotherapist can continue to work closely with the patient during the hospital stay, and certain insights may become available in the regressed state which can be put to use after the patient recovers. 12 It would be useful, at this point, to describe several different clinical situations that presented as a difficulty in eating and to discuss how they were handled.…”

Female therapists in the management of anorexia nervosa

“…A second difficulty in therapy arises from the relationships often found in the family of the anorexic. Many workers in the field (Meyer & Weinroth, 1957;Tustin, 1959; Wall, 1959;Jessner & Abse, 1960) have noted the sharp rivalry between the sisters or mother and daughter in a family with an anorexic. The anorexic member may have chosen slimness as the one area in which she could be superior or demonstrate her worth within the family.…”