Anorexia nervosa: a psychoanalytic commentary

A discussion of "The Fear of Being Fat," by C. Philip Wilson, M.D. The view is presented that primary emphasis on sexual conflicts, especially Oedipal, as causative psychological factors in anorexia nervosa is a limiting and narrow view of the problem. The symptomatology and sexual and aggressive conflicts and fantasies, with the accompanying defenses, can best be understood within the framework of the process of separation of self from object and the seemingly insoluble dilemma in regard to the struggle to achieve a sense of separateness and individuality. This has its effects on the development of the body image, with its internalized symbolic representations of the environment, and through the body image on the ego, superego, and instinctual life. Anorexia nervosa is an expression of ego-defective development arising from varying degrees of failure to resolve the process of developing a sense of individuality. There result primitive aggression, archaic guilt, and great difficulties in establishing an integrated sense of sexual identity. Sexualization of all aspects of interpersonal relationships is fostered by intensification of the need for sensory stimulation, e.g., by touch, the fantasy of touch, by vision, and by oral fantasies and activities. This leads to intensification of defenses against overt sexual expression on all levels, as well as against primitive aggressive fantasies and guilt. The symbolic significance of various symptoms in anorexia nervosa is discussed.