Body self. Development, psychopathologies, and psychoanalytic significance

Ego development or, more broadly, the sense of self has at its core a cohesive, distinct, and accurate body self. Compromise of body self development as a result of early overstimulation, empathic unavailability or nonresponse of the caretaker, and inconsistency or selectivity of response can lead to specific developmental arrests, including body-image distortions, nonintegration of body self and psychological self, and difficulties in the regulation of tension states and affect. The individual may then attempt to repair those disrupted developmental needs by such symptomatic expressions as eating disorders, compulsive exercise, substance abuse, and the creation of physical danger, as a step toward integration of mind and body as well as a defensive antidote to painful affect. In the psychoanalytic treatment of these patients, the need for the analyst's attunement to the patient's development of body self as well as psychological self development is illustrated by clinical vignettes of the enactments and attempted restitution of specific developmental trauma.