The sense of self in anorexia-nervosa patients: a psychoanalytically informed method for studying self-representation

This paper has two purposes: to study a central psychological feature of anorexia nervosa, the disturbed sense of self, and to demonstrate the utility of an empirical research method to explore a psychoanalytic concept such as self-representation. The aim of the study was to distinguish the sense of self of anorexia-nervosa patients from that of other psychiatric patients, as well as from non-patients. We obtained open-ended self-descriptions, which provide access to self-representations, from 77 young women between the ages of 14 and 24 who made up three groups-anorexia-nervosa patients (n = 15), control psychiatric patients (n = 15), and control non-patients (n = 48). The self-descriptions, when rated on 18 scales that fell into four factors (Agency, Reflectivity, Differentiation, and Relatedness) and two affective scales (Anxiety and Depression), showed that the two patient groups shared characteristics that significantly differentiated them from women who were not patients-a lower sense of agency and relatedness. What significantly differentiated the anorexia-nervosa patients from the other psychiatric patients, as well as from the nonpatients, were a heightened and harsh self-reflectivity and more openly expressed depressive and anxious affect in the self-descriptions. The implications for treatment and for understanding eating disorders are discussed.