Psychopathology of anorexia nervosa: a defence from depression. An interpretation according to Massimo Fagioli’s Human Birth Theory – two case reports

Abstract

This paper focuses on anorexia nervosa with an emphasis on its onset and treatment, and it particularly addresses two aspects of the disease, which seem completely in contrast with one another – prolonged fasting and recurrent episodes of binge eating/purging behaviour. From a psychopathological viewpoint, these can be considered two symptoms of the same disease, whose psychopathological core is often depression. The anorexic phase is characterised by control of food intake and interpersonal relationships due to a paralysis of affections and mental rigidity, which often provide a schizoid defence against depression and sometimes against fragmentation. In the bulimic phase, a break in this defence reveals violent and uncontrollable affects beneath depression. One possible hypothesis to evaluate would be whether these alternating phases can be overcome if they are interpreted as a false resolution of an intrapsychic conflict as defined by Fagioli’s Human Birth Theory, based on a psychic defence reaction that may arise in newborns, and which he termed annulment pulsion. If pathogenic factors are present in the first year of life, the annulment pulsion may become pathological and can explain the psychosis in anorexia nervosa patients. This paper presents two clinical cases involving two young women, one suffering from anorexia nervosa purging type with self-induced vomiting complicated by comorbid drug abuse and the other suffering from anorexia nervosa binge eating/purging type and comorbid drug and alcohol abuse. Both were successfully treated with psychodynamic psychotherapy (individual and in groups) based on the interpretation of dreams according to Human Birth Theory, which posits that a dream is a thought expressing itself through images. The patients were treated for 4 and 5 years, respectively. The scores on three standardised tools, Eating Disorder Inventory-3, Symptom Checklist-90-Revised and Toronto Alexithymia Scale, administered before and at the end of treatment, accurately reflected their baseline condition and their clinical improvement. The treatment induced a reduction or resolution of symptoms and a qualitative improvement in the patients’ oneiric activity. The encouraging outcomes for these patients support the interpretative hypothesis proposed in this article and the value of the approach based on Human Birth Theory in treating anorexia nervosa. Further work on the subject is clearly warranted.