Towards a more specific model of anorectic pathogenesis: Parental selfobject use of the pre-anorectic child.
Decades of research on the anorectic's family relationships have contributed a certain measure of depth and precision to our current understanding of this syndrome's pathogenesis. Yet none of the existing etiological formulations is specific as regards the predisposition to anorexia nervosa in that they also apply to other psychopathological conditions. Furthermore, many of these models do not address the precipitation and maintenance phases of the disorder, preferring to remain narrowly focused on premorbid personality factors. As well, existing etiological conjectures do not adequately explain several phenomena regularly encountered among anorectics, such as their relentless quest for perfection and their unusually intense autonomy strivings. In line with this problematic, the current work outlines a modal etiological pattern that is specific to core-group restrictive anorectics and that addresses the precipitation and maintenance phases of the disorder as well as predisposition. It also offers an explanation for their assiduous quest for perfection and their inordinately strong autonomy strivings. It does so by focusing on a hitherto largely overlooked aspect of relationships in the anorectic family, namely the particular ways in which the pre-anorectic child is called upon to compensate for parental emotional deficits. It is conjectured that the predisposition to anorexia nervosa arises in the context of her simultaneous function as a self-denying, merged selfobject to her mother and as an omnipotent, idealized selfobject to either or both parents. Such selfobject use of the pre-anorectic child is argued to leave her with a heightened sensitivity to environmental rejection experiences because of her inordinate dependence on external validation combined with the habit and expectation of being seen as "special". In addition, she finds herself with a uniquely polarized false-self system, particularly strong autonomy strivings, and a highly restricted repertoire of behaviours deemed acceptable, all of which eventuate in a particular proneness to shame and self-rejection. Moreover, this particular conjunction of family relationships and resulting cognitive and emotional distortions is seen to readily distinguish the anorectic from other psychodiagnostic groups with whom she shares certain clinical characteristics. It is the above combination of premorbid personality characteristics that is conjectured to place her at special risk for anorexia in the face of the normal developmental and environmental stresses of adolescence. More precisely, these personality factors place her at such risk, firstly, by compromising her ongoing self-esteem regulation either by sharply restricting the conditions under which she is able to maintain a relative sense of emotional well-being or by introducing an inherent tension or instability into her false-self system. Secondly, the adaptive mechanisms learned within the postulated selfobject relationships help to determine the coping strategies that she chooses in adolescence. That is, the anorectic's self-perfecting in the form of slimming is seen to exemplify an "adult" version of an earlier strategy for the avoidance of shame and self-rejection. As this strategy, however, essentially represents the misapplication of a local solution to a global problem, in contradistinction to the situation of the non-anorectic dieter, it ultimately fails. This, together with the family systemic factors so often cited in the literature and the strongly polarized, countervailing tendencies within her false-self system, are argued to eventuate in a series of intrapersonal and interpersonal vicious escalations that conspire to entrench her ever further in her symptoms.
Source: Dissertation Abstracts International, Volume: 57-04, Section: B, page: 2864.
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