Body image, sexuality and the psychotic core

The mental representation of the body--that is, the body image--is a basic element of the person's relationship to himself as well as to reality. From a developmental point of view the body image only becomes finally integrated to form the basis of the person's sexual and gender identity at the end of adolescence. This final body image can contain distortions compared to the person's real body (as viewed by others) and thus can represent a break with some aspects of external reality. In this paper I use material from the analyses of two patients, one adult and one adolescent, to show the compelling quality of the need to maintain a specific body image, and how it becomes related to their sexuality. I also discuss how, when the body image is one that is distorted, it forms a psychotic core to the personality in that it must affect the person's relationship to external reality.