The Anorectic Patient: Her Feelings and Conflicts as an Individual and as a Member of a Family
My report is to highlight a few aspects only of this disease, i.e. the way anorectics (ANs) experience their own body and organize their object relations, and reflects the results and insight of 17 years’ work at the university hospital, at the psychiatric and psychosomatic clinic. I collaborated with endocrinologists, internal specialists, gynecologists, pediatricians and family therapists. The number of patients treated was 70–80, the frequency of weekly sessions being five or less. I particularly want to mention specific traits of ANs and their family members to the treatment to whom I owe some important learning experience. In about half of these cases I arranged for discussions with all or some family members if the AN so desired and agreed to join. The heavy abuse of purgatives, one of the well known aspects of the clinical picture that can reach grotesque proportions, hints at the merciless treatment ANs tend to subject their body to. One of my female ANs used to swallow a whole box of purgatives at once: her bowels ought to function like an ideal flow duct, there should be no exchange (no contact) whatsoever in her body. Even the uterus was experienced as an open bowel by a pregnant AN from which the child was to be prematurely expulsed. Some ANs conspicuously seemed to associate self-induced vomiting with masturbation enabling them to cope with feelings of loneliness and to feel autonomous. One of my ANs could only gradually abandon her long established vomiting ritual after she was able to touch her genitals and ensure discharge of tension, sensation of pleasure and autonomy by masturbation. During long analytic treatment ideas of suicide and aggression will play a major role as well as the fantasy to be immortal, even if the AN’s condition is highly cachectic.