Risen notes the lack of case material in the analytic literature and presents the case of Susan, a neurotic adolescent with anorexia nervosa. Early concerns with the inhibition of oral aggression included self-imposed giving up of candy at age four and becoming a vegetarian at age nine; she was "disgusted" by food. There were multiple family disharmonies. Her parents were divorced when she was three and a half, remarried soon after, and then both parents divorced a second time. Susan was a compulsive and excellent student, used no drugs, was afraid of sex, did not like her breasts, and felt very guilty about sexual feelings and "losing control." She felt under great pressure from her mother; she needed to be "perfect," "chipper," and "neat." She felt she was not allowed to feel depressed, could not express her anger directly, and had to see her family as perfect as well. She was unable to touch people or be touched by them, was haunted by an "almost" sexual experience, and found her mother's jealousy of her figure intolerable. She was ambivalent about men, having lost two fathers (for which she blamed her mother). As the analysis progressed, she became increasingly aware of herself and of her feelings, especially her anger and fear. The fear of growing up and being sexual was linked to eating, as well as to the pregenital issues of control, sadomasochism, and abandonment. Her mouth was associated to her rage at her father and her death wishes toward him. Most poignantly, she talked about her dependence on her mother and her inability to define herself or her feelings in the context of that relationship. She also became aware of the incestuous triangles she was caught up in with parents and step-parents, her forbidden wish to be pregnant, and finally her rage and death wishes toward her mother. Her guilt and self-punishment, asceticism, and self-demands all were efforts to deal with her rage. Susan also became aware that she was treated as a mother by her mother and as a wife by her step-father, and so became aware of her guilt about leaving her mother. In conclusion, Risen argues for the use of psychoanalysis in neurotic patients with anorexia and regrets the tendency to underuse this effective treatment.
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Meisel, F. (1986). Psychoanalytic Study of the Child. XXXVII, 1982. Psychoanal. Q., 55:371-371