DENIAL AND SELF-IMAGE CONFRONTATION IN A CASE OF ANOREXIA NERVOSA

If self-image confrontation is a useful therapeutic tool in combating denial, it should be maximally effective in a condition such as anorexia where, in addition to disturbances in body concept, the visible changes in body structure are so clearly evident. The patient in the case study presented here was followed in psychotherapy by one psychiatrist concurrently with self-image experience (SIE) sessions conducted by a different psychiatrist. During the course of 16 months of hospitalization, 54 SIE sessions were held. During each she was first shown sound motion picture films of herself responding and reacting to a brief, standard interview, and then she was asked a standard set of questions about her feelings in regard to the film sequences. Despite two serious setbacks in the 4th and 7th months of her hospitalization, the patient's weight increased, she recognized some of her problems, and her plans for the future became more realistic. In the SIE sessions changes occurred in her attitudes toward her image on the screen and toward the procedure. Initially she continued to deny the evidence in the films about her condition. Later, however, her satisfaction gave way to disinterest and boredom, and then she became hostile to the procedure and rejecting of her image. Nevertheless she did not discontinue the sessions. Eventually she became able to take a more objective view of herself; to see both positive and negative features in the film; and to respond to aspects of her performance other than her physical appearance alone. Toward the end of her hospitalization, she was doubly shocked to see how terribly thin she had been earlier and how indifferent she had been to her condition. Her body image had changed, so that thinness became ugly rather than comforting to her. The changes in self-image which took place slowly against a great deal of resistance appeared to be associated with the continued and repeated self-image confrontations. These changes are discussed in the paper within the framework of a theory of self-consistency. © Williams & Wilkins 1969. All Rights Reserved.