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 exem-plifed in the paradox of persecution by refeeding and the curious double game that evolves.