A psychodynamic view of psychosis within the context of anorexia nervosa.
Item
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Title
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A psychodynamic view of psychosis within the context of anorexia nervosa.
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Identifier
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AAI9207122
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identifier
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9207122
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Creator
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Schulwolf, Marthe.
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Contributor
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Adviser: Vera Paster
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Date
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1991
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Language
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English
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Publisher
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City University of New York.
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Subject
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Psychology, Clinical | Women's Studies
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Abstract
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This study addresses the intersection between anorexia nervosa and psychosis, i.e., the circumstances, nature, and content of psychotic phenomena in individuals with anorexia nervosa, in order to illuminate the underlying dynamics of anorexia nervosa. Based on the theoretical literature on anorexia nervosa and on the anaclitic/introjective model of personality and psychopathology developed by Blatt and Shichman (1983), it is proposed that anorexia functions as an exaggerated introjective defense structure against anaclitic needs. It is often precipitated by an intensification of anaclitic needs or by the demand for separation at adolescence, a demand which individuals with a personality strongly skewed towards the anaclitic line can only meet via exaggerated introjective mechanisms. Based on a review of the clinical literature on psychotic phenomena among anorexics, four variables are proposed which can be classified as either anaclitic or introjective: (a) precipitant of psychosis, (b) quality of psychosis, (c) content of psychosis, (d) process of recompensation. It is hypothesized that variables (b) and (c) show a high tendency toward congruence, allowing for an easy differentiation between two types of psychosis--an introjective psychosis, which represents an exacerbation of the introjective defense of anorexia nervosa at a more primitive level, and an anaclitic psychosis, resulting from a disintegration of the defense with the ego becoming flooded by anaclitic needs. The case of "Sylvia" is presented. Sylvia manifested a lengthy depressive psychosis centered on the belief that "God wanted her to fast," in conjunction with a unique "atypical eating disorder" consisting of continuous self-feeding via naso-gastric tube, resulting in a 9-year hospitalization. Sylvia's illness is conceptualized as an introjective "psychotization" of anorexia nervosa. Sylvia's case supports the views of Palazzoli (1978) on anorexia nervosa, of Winnicott (1960/1965a) on the False Self defense, and of Rizzuto (1979) and Jones (1991) on the role of the God representation as a transitional object. It illustrates the progressive function that regression can serve, the importance of the patient remaining in control, the role of processes of internalization, and the necessity for a rebalancing and reintegration of the two developmental lines in order for a true recovery to occur.
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Type
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dissertation
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Source
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PQT Legacy CUNY.xlsx
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degree
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Ph.D.
