[Making real].

Abstract

OBJECT: This paper has the aim to explore psychopathological traits of anorexia nervosa leading to somatization, in critical periods of this disorder, in the clinical framework of analytically oriented psychotherapy performed in hospital setting. DESIGN: Psychodynamic observations in high risk cases, with at least three years of follow-up, are compared with different crisis situations, of psychosomatic or psychic nature. Common and specific psychopathologic features are outlined. BACKGROUND: General Hospital background, liaison problems, and integrative needs between medical and psychotherapeutic caregivers are not only aspects of real situation, but also a group matrix of change for anorexic patients. PATIENTS: Twelve high risk subjects with restricting anorexia were studied, out of a sample of 36 women with eating disorders, admitted to hospital between 1989 and 1991. They were treated by integrated psychotherapeutic and medical methods, in a supportive, unprescriptive therapy plan. RESULTS: Psychosomatic crisis points out that the process that makes real death risks and fantasies is both intrapsychic and interpersonal one. Absence of a cohesive inner organization leads patients to try to establish fusion with other and to search for cohesion in hospital field turning away from adaptive integration in real life. Psychotherapy, in this setting, is a first movement of integrating identity as separate from family and field. From doctor's point of view, to be only concretely oriented involves the risk of losing patient's thought dimension, and, from psychotherapist's point of view, to pay attention only to mind or interactions involves the risk of losing real subject's and field's coordinates. Converging attention and investment by both caregivers seem to rapidly reverse somatization process and to help a first step of integration by the anorexic patients.