Autistoid Psychic Retreat in Anorexia

This paper argues that anorexia may be understood to be a particular kind of autistoid psychic retreat: a defensive withdrawal to a primitive enclosed part of the self that has been damaged by early infantile trauma, the result of a disruption to the mother–infant pair. This damage can be envisaged as an enclosed ‘cyst’ or ‘tumour,’ defensively ‘sectioned off’ from the rest of the individual’s psychic life. When a patient takes refuge in an autistoid psychic retreat she is typically experienced as emotionally ‘cut off’ by others, including her psychotherapist, thereby making it difficult to establish and maintain a ‘living’ therapeutic alliance. The resulting countertransference, a crucial diagnostic tool for establishing the existence of an autistoid retreat, simultaneously challenges the therapist with a range of unsettling feelings that require processing in order to access the anorexic’s inner world. The case of a female adolescent anorexic in psychodynamic psychotherapy will be presented. There were two distinct phases in this therapy, the second phase suggesting emergence from the autistoid retreat.This material will be used to illustrate autistoid dynamics and their implications for treating such patients.