Post-traumatic anorexia nervosa--a case study.
The nature of the relationship between accidental trauma and psychopathology may not always be clear. Cases of post-traumatic anorexia nervosa have been described but without detailed attention to pre-existing psychopathological processes. This may give rise to spurious conclusions about direction of casualty. We describe a male patient who developed anorexia nervosa on two occasions, both episodes occurring during the convalescent period following traumatic accidents several years apart. The intervening period was characterized by strict self-regulation and conflict avoidance, typical of anorexia nervosa but with the body maintained at only a moderately low weight. We suggest that accidents can arise at times of crisis in such ongoing attempts at intense self-regulation. They may then reflect the escape from control of impulsivity and also provide an ultimate means of avoidance of further guilt-laden behaviour. They can be understood in the light of pre-existing psychopathology. The difficulties in early recognition and diagnosis of anorexia nervosa, especially in the male and in the absence of extreme weight loss are also discussed.
Davis
J da R
Jda R
Department of Mental Health Sciences, St George's Hospital Medical School, London, UK.
Crisp
A H
AH
D000328:Adult; D000856:Anorexia Nervosa / Q000523:psychology* / Q000628:therapy; D016241:Child of Impaired Parents / Q000523:psychology; D003674:Defense Mechanisms; D006801:Humans; D007207:Individuation; D008297:Male; D009104:Multiple Trauma / Q000523:psychology; D012803:Sick Role; D012931:Social Environment; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology* / Q000628:therapy; D015431:Weight Loss