Paradox, persecution and the double game: psychotherapy in anorexia nervosa.

OBJECTIVE

In anorexia nervosa, the interface between psychotherapy and effective physical management continues to arouse dissent. For this reason, theoretical underpinnings and their practical applications were explored.

METHOD

A selective review of the literature was based on the authors' clinical experience in hospital treatment settings.

RESULTS

The psychosomatic paradigm, the threat to life, the reward characteristics and the developmental trajectory of anorexia nervosa necessitate a particular form of integrated psychotherapy.

CONCLUSIONS

The approach is essentially that of self psychology but with an important departure which must be addressed in the therapeutic process. This is exemplifed in the paradox of persecution by refeeding and the curious double game that evolves.