[Reciprocity of intrapsychic and interpersonal processes in anorexia nervosa: observations and interpretations from the therapy of the family].

This article uses sections of transcribed tape-recordings of family interviews to elucidate the pubescent anorexia nervosa of a 14 year-old girl within the context of her family interactions. The reciprocal action of intrapsychic disturbance and interpersonal processes within the family, as well as the feedback machanisms involved in both systems are discussed. Analogous to the neurotic aspect of the anorexia itself, the neurotic family dealings with the puberty crisis are shown, which are dedicated to the repression of drive-desires, turn against, a restructuring of family equilibrium necessitated by the life cycles of various family members, resulting in a power struggle for symmetrical positions within the family. Analogous to the internal ego disorder found in anorexia, the permanent struggle to differentiate ego functions and integrate bodily experience and thereby achieve indentity as a separate, autonomous subject is described. The struggle for autonomy is made more difficult by family norms which do not allow for the expression of personal desires, needs and interests. Thoughts on the development of anorexia nervosa relevant to the family situation described in our example follow the phenomenological presentation. The disturbance in self-object differentiation arises from the early mother-child relationship, and is viewed as the result of the mother's disturbed relationship to primary maternal preoccupation. A symbiotic-antagonistic relationship between mother and child is perpetuated by means of mystifying, binding strategies. The family keeps the traditional roles of victim an savior ready to overcome psychosocial crises. Finally, the casuitry explains anorexia as a form of confrontation within a family context, which is moulded by the norms of village social structure.