The anorexic mask : a case study of a patient with co-morbid nervosa and factitious disorder?

Abstract

This study is a case-study of a patient who was diagnosed as having co-morbid Anorexia Nervosa and Factitious Disorder. It would appear that central to an understanding of both of these disorders is the patient's disturbed relationship to her own body. The existing literature on co-morbid Factitious Disorder and Anorexia Nervosa is rare, with only three cases published. A careful reading of these cases suggests that in all of these cases, Factitious Disorder may have been the primary diagnosis. In this case there was as overidentification with the patient role, and the patient's anorexic symptoms appeared to serve the function of meeting the patient's acute dependency needs. Thus, the patient's Anorexia Nervosa masked the Factitious Disorder and appeared to be secondary to the Factitious Disorder. It is argued that these disorders share several common dynamics, namely the inability to separate from the mother, high parental expectations as well as the use of the body as a transitional or pre-cursor object. In addition there are some common dynamics in the psychotherapy of these patients. All of these factors suggest that in both these disorders the developmental arrest may be located at a pre-verbal level.