BECOMING ANOREXIC: ON LOSS, DEATH AND IDENTIFICATION AND THE EMERGENCE OF ANOREXIA NERVOSA

Abstract

This paper investigates the connections between death, pathological identifications and anorexia nervosa. Literature is reviewed concerning various psychodynamic models of causation of anorexia, and in particular transgenerational patterns in the evolution of this eating disorder, with reference to problems in the development of autonomy of the emerging self. The role of loss in the family is examined, and the development of pathological identifications is described. A case of an adolescent girl initially presenting with an unexplained seizure is described in which multiple identifications seem to be occurring while the patient develops anorexia, perhaps reflecting previous losses in the family and also in a kind of strange identification with, and mimesis of, the parents' unmourned dead. It is suggested that the development of these multiple identifications gives some aetiological clues to this puzzling illness and also indicates a therapeutic focus. It is argued that a psychodynamically‐informed child psychiatrist can bring an enriching approach to working with patients with this disorder.

ACKNOWLEDGEMENTS

I should like to thank Maria Rhode for her helpful contribution to thinking about the clinical material in this paper, and Michael Carter who helps me to make sense of everything.