Hypochondrie

Abstract

After a short description of the features of severe monosymptomatic hypochondria and of several psychogenetic characteristics the four structural entities will be presented: an encapsulation in which psychotic and/ or traumatic states will be held together by a second skin in an autistoid way; a weakened ego, which could not transform toxic elements, having no mental quality, into thinkable ones, and thus, the mental system is threatened; an introject, that is a fusion of an archaic super ego with distorted part-objects, which then acts pseudo-caring or persecuting; a cathected organ, which becomes an autistic object and functions as a substituted encapsulation. The hypochondriac dynamics occur between these entities, often preceded by processes of projections and reintrojections. In the hypochondriac dynamics the ego is threatened by annihilation, is not able to think a containing object because projective identifications fail to function. The toxic elements are displaced to the organ and the ego submits itself to the introject. The self depends on the autistic object, the organ, and on the introject for survival. What emerges between these entities can be understood as self-referential dynamics, characterized by an autistoid retreat. As a treatment goal the necessity of the transformation of toxic elements into mental ones will be shown. That is the only way patients could get back sovereignty over the autistoid and hypochondriac processes.