ABSTRACT
Research in a large children’s hospital confirmed that in over 25% of anorexic adolescents seeking help for their anorexia the actual reality of sexual abuse was firmly established. The concepts of unconscious phantasy and part-object relations provide conceptual keys to the understanding of the meaning, origins and significance of these disorders. They can help explain the psychotic potential of some patients with severe anorexia nervosa and the transition to a state of overt psychosis in others. The art work took the form of regular sessions of free painting and drawing, sometimes in the presence of the occupational therapist, and it was clearly important to Dorothy. After two years of this supportive and rehabilitative regime, Dorothy was deemed sufficiently stable to be discharged to continue treatment as an outpatient. The view that Dorothy has needed to control the anxiety mobilized by unconscious destructive wishes towards the displacing rival baby can shed light on the meaning of her obsessional rituals.
