Objective: In anorexia nervosa, the interface between psychotherapy and effective physical management continues to arouse dissent. For this reason, theoretical underpinnings and their practical applications were explored.
Method: A selective review of the literature was based on the authors' clinical experience in hospital treatment settings.
Results: The psychosomatic paradigm, the threat to life, the reward characteristics and the developmental trajectory of anorexia nervosa necessitate a particular form of integrated psychotherapy.
Conclusions: The approach is essentially that of self psychology but with an important departure which must be addressed in the therapeutic process. This is exem-plifed in the paradox of persecution by refeeding and the curious double game that evolves.
BruchH.Anorexia nervosa: therapy and theory. American Journal of Psychiatry1982; 139:1531–1538.
7.
GabbardGOSubstance related and eating disorders. In: Psychodynamic psychiatry in clinical practice. Washington DC: American Psychiatric Press, 1994.
8.
KohutH.The restoration of the self. New York: International Universities Press, 1977.
9.
BakerHSBakerMNHeinz Kohut's self psychology: an overview. American Journal of Psychiatry1987; 144:1–9.
10.
SternS.The opposing currents technique: for eating disorders and other false self problems. Contemporary Psychoanalysis1992; 28:594–615.
11.
GeistRASelf psychological reflections on the origins of eating disorders. In: BemporadJRHerzogDB, eds. Psychoanalysis and eating disorders. New York: Guilford Press, 1989.
12.
LesterD.Ellen West's suicide as a case of psychic homicide. Psychoanalytic Review1971; 58:251–262.
13.
BorisHNThe problem of anorexia nervosa. International Journal of Psychoanalysis1984; 65:315–322.
14.
RisenSEAnorexia nervosa: theory and therapy—a new look at an old problem. Journal of the American Psychoanalytic Association1988; 36:153–161.
15.
KeysABrozekJMickelsonUTaylorH.The biology of human starvation. Minneapolis: University of Minnesota Press, 1950.
16.
KeeseyR.A set point analysis of the regulation of body weight. In: StunkardAJ, ed. Obesity. Philadelphia: WB Saunders, 1980.
17.
MillerM.Understanding the eating-disordered patient: engaging the concrete. Bulletin of the Menninger Clinic1991; 55:85–95.
18.
RussellJDMiraMAllenBJProtein repletion in anorexia nervosa. American Journal of Clinical Nutrition1994; 59:98–102.
19.
HsuLKGCrispAHHardingB.Outcome of anorexia nervosa. Lancet1979; I:61–65.
20.
RatnasuriyaRHEislerISzmuklerGIRussellGFMAnorexia nervosa: outcome and prognostic factors after 20 years. British Journal of Psychiatry1991; 158:485–502.
21.
TheanderS.Anorexia nervosa. A psychiatric investigation of 94 female patients. Acta Psychiatrica Scandinavica1970; Suppl. 214.
22.
LambD.Psychotherapy with adolescent girls. San Francisco: Jossey-Bass, 1978.
23.
WinnicottDWThe maturational processes and the facilitating environment. New York: International Universities Press, 1965.
24.
MearesR.On ownership of thought: an approach to the origins of separation anxiety. Psychiatry1989; 49:80–91.
25.
MearesR.The secret and the self: on a new direction in psychotherapy. Australian and New Zealand Journal of Psychiatry1987; 21:545–559.
26.
RussellJHuntG.Anorexia nervosa—more than an eating disorder. Nature Medicine1996; 2:366–367.
27.
MastersonJEPsychotherapy of the borderline adult. A developmental approach. New York: Brunner/Mazel, 1976.
28.
FischerN.Anorexia nervosa and unresolved rapprochement conflicts. A case study. International Journal of Psychoanalysis1989; 70:41–54.
29.
KleinM.Envy and gratitude and other works: 1946–1963. London: Hogarth Press, 1975.
30.
ArmstrongJGRothDMAttachment and separation dificulties in eating disorders: a preliminary investigation. International Journal of Eating Disorders1989; 8:141–155.
31.
PiagetJ.The child's conception of the world. Harmondsworth: Penguin, 1973.
32.
RussellJHalaszGBeumontP.Death related themes in anorexia nervosa. Journal of Adolescence1991; 13:311–326.
33.
GaldstonR.Mind over matter—observations on 50 patients with anorexia nervosa. Journal of the American Academy of Child Psychiatry1974; 13:246–263.
34.
WarrenWJacksonCThorntonCRussellJDTouyzSBeumontPJVA study of the relationship between eating disorder and death concern. Australian and New Zealand Journal of Psychiatry1994; 28:463–468.
35.
GoodsittA.Self psychology and the treatment of anorexia nervosa. In: GarnerDGarfinkelP, eds. Handbook of psychotherapy of the eating disorders. New York: Guilford Press, 1985.
36.
MearesRHobsonR.The persecutory therapist. British Journal of Medical Psychology1977; 50:349–359.
37.
BeumontPLargeM.Hypophosphatemia in patients with anorexia nervosa. Medical Journal of Australia1991; 155:519–522.
38.
BruchH.The golden cage: the enigma of anorexia nervosa. Cambridge: Harvard University Press, 1979.
39.
FrankenbergF.Female therapists in the management of anorexia nervosa. International Journal of Eating Disorders1984; 3:25–33.
40.
GutheilTGGabbardGOThe concept of boundaries in clinical practice: theoretical and risk-management dimensions. American Journal of Psychiatry1993; 150:188–196.
41.
EllenbergerHFThe discovery of the unconscious. London: Allen Lane Press, 1970.
42.
EsmanAH‘Sexual abuse', pathogenesis, and enlightened skepticism. American Journal of Psychiatry1994; 151:1101–1103.
43.
RussellJBrownLThorntonC.Disclosure of abusive experiences by patients of an eating disorders unit. Abstract of a paper presented at Eating Disorders ‘95. London, 25–27 April 1995.
44.
GriffithsRGrossGRussellJPatients’ perceptions of bed rest programs. International Journal of Eating Disorders (in press).
45.
PiazzaEPiazzaNRollinsNMAnorexia nervosa: controversial aspects of therapy. Comprehensive Psychiatry1980; 21:177–189.
46.
GordonCBeresinEBHerzogDBThe parents’ relationship and the child's illness in anorexia nervosa. In: BemporadJRHerzogDB, eds. Psychoanalysis and eating disorders. New York: Guilford Press, 1989.
