Kadish Yael Adira
Department of Psychology, School of Human and Community Development, University of the Witwatersrand, South Africa.
Psychoanal Rev. 2012 Apr;99(2):227-52. doi: 10.1521/prev.2012.99.2.227.
A set of characteristic symptoms allow for the relatively straightforward diagnosis of eating disorders. Simultaneously and paradoxically, underlying the eating disorders are a wide variety of personality organizations/disorders, stretching from the neurotic to the borderline and narcissistic, and even to conditions approaching psychosis. This paper will argue that the inherent commonalities can be ascribed to pathological organizations of a similar nature and quality, operational across the spectrum of eating disorders and functioning in a particular, sadomasochistic way. The typical forms that eating disorders take are based on the specific ways that food and the body are used, that is, symptom manifestation. These distinctive symptom manifestations appear to be related to Steiner's (1982, 1993) notion of a psychic retreat. Pathological organizations and psychic retreats are latent until called upon either sporadically or continuously. When activated, these defensive structures operate like a complex psychic skeleton around which the unique psychodynamics of each patient become rearranged and thereby transformed.
一组特征性症状使得饮食失调的诊断相对直接。与此同时且自相矛盾的是，饮食失调的背后存在着各种各样的人格结构/障碍，范围从神经症性到边缘性和自恋性，甚至到接近精神病的状态。本文将论证，内在的共性可归因于具有相似性质和特质的病理性结构，它们在各种饮食失调中起作用，并以一种特定的施虐受虐方式运作。饮食失调所呈现的典型形式基于食物和身体被利用的特定方式，即症状表现。这些独特的症状表现似乎与斯坦纳（1982年、1993年）提出的心理退缩概念有关。病理性结构和心理退缩在被偶尔或持续唤起之前都是潜在的。当被激活时，这些防御结构就像一个复杂的心理框架，围绕着它，每个患者独特的心理动力学就会重新排列并因此发生转变。
