Analysis of psychogenic anorexia and vomiting in a 4-year-old child.
Analysis of psychogenic anorexia and vomiting in a 4-year-old child.
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4岁儿童心因性厌食呕吐原因分析.
DOI：
10.1080/00797308.1945.11823131
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发表时间：
1945
期刊：
影响因子：
--
通讯作者：
E. Sylvester
中科院分区：
文献类型：
--
作者：
E. Sylvester
亚伯拉罕认为，抑郁症的心理成因的决定性因素如下：体质构成、以兄弟姐妹竞争为重要因素的口头层面的力比多固定，以及在俄狄浦斯情结解体之前发生的对母亲的失望。力比多客体关系中的一种基本紊乱是一种诱发因素。对母亲的敌意仍然是主要的冲突，因为母亲作为一个客体的丧失加速了疾病的发生。食粪的冲动代表自我惩罚，也代表吞食被摧毁的物体的食人冲动。它们产生于对口腔虐待水平的固定，这种固定需要对吮吸、咬和咀嚼等过度强烈的冲动进行强大的防御，这个病例提供的观察结果，虽然显示出与神经性厌食症的心身实体惊人的相似之处，但揭示了亚伯拉罕在状态nascendi中假设的精神抑郁症的结构。在一个4岁儿童的神经症的发病、病程和治愈过程中，我们发现了进食障碍的躯体表现和受威胁的客体丧失的中枢心理问题之间的因果关系。在这个病人的疾病的一个阶段的生理功能的干扰承担如此戏剧性的比例，导致长期和密集的专门的医疗。然而，躯体表现将被看作是一种综合性情绪障碍的一个方面，它与对成年抑郁症的分析所提出的童年经历的重建密切相关。
According to Abraham the decisive factors in the psychogenesis of melancholic depression are the following: The constitutional makeup, libido fixation on the oral level with sibling rivalry as an im-portant factor, and disappointment in the mother which takes place before the dissolution of the oedipus complex. A basic disturbance in the libidinal object relation is a predisposing factor. Hostility against the mother whose loss as an object precipitates the illness remains the central conflict. The coprophagic impulses represent selfpunishment and also the cannibalistic impulse to devour the destroyed object. They arise from the fixation on the oral sadistic level which necessitates strong defenses against the excessively strong impulses of sucking, biting, and chewing.This case presents observations which, while showing striking resemblances to the psycho-somatic entity of anorexia nervosa reveals the structure of the melancholic depression as postulated by Abraham, in statu nascendi. The causal connection between the somatic manifestation of disturbed intake and the central psychological problem of threatened object loss is demonstrated in the onset, course, and cure of the neurosis of a four-year-old child. The disturbance of physiological function in one phase of this patient's illness assumed such dramatic proportions as to lead to prolonged and intensive exclusively medical treatment. The somatic manifestation, however, will be seen to be only a single aspect of a comprehensive emotional disturbance that closely corresponds to the reconstruction of childhood experiences as suggested by the analysis of depression in the adult.