Conscious and unconscious identification of female anorectic patients in in-patient psychotherapy

Abstract

Women are up to ten times more likely to develop anorexia nervosa (AN) than men. Psychoanalytic explanations of this disparity generally emphasize female identification problems due to unresolved conflicts with maternal representations. Based on clinical observation, we identify a subtype of AN patients characterized, first, by consistent idealization of the father who needs the patient for the fulfilment of his own narcissistic needs and, second, by the patient's need to be idealized by the father due to suffering in connection with early emotional malnutrition on the part of the mother. To illustrate this hypothesis, we present the case of a well-educated young woman displaying unconscious attachment to patriarchial family patterns and conflicting conscious ‘emancipated’ beliefs regarding sexual equality in terms of competence and rights. In concluding, we discuss our hypothesis and consider consequences for the psychodynamic treatment of such patients.