Anorexia e bulimia nervosa: um estudo de casos graves à luz da Psiquiatria e da Psicanálise

Abstract

This study aims at analyzing critical cases of Anorexia and Bulimia, based on psychiatric and psychoanalytic approaches. The issues that motivated this study were essentially clinical: difficulties in the approach and in the clinic conduction. It is characterized as a clinic-qualitative study with a theoretical reference in the current psychiatric classifications, in the classical psychiatry, in the Freudian and Lacanian psychoanalytic theory and in the theoretical contributions of authors with experience in Anorexia and Bulimia clinic. NIAB – Nucleus of Anorexia and Bulimia Investigation of Federal University of Minas Gerais (Núcleo de Investigação de Anorexia e Bulimia da Universidade Federal de Minas Gerais – located in Belo Horizonte, MG), was the scenary of this study. The interdisciplinary service focused on Lacanian psychoanalytic orientation is a characteristic of this service. The study was developed between 2005 and 2007 and the source of data was built by me and some other professional of NIAB team, through psychiatric treatment, to 8 patients with critical Anorexia and Bulimia phases. The ‘critical cases’ were the ones that put the treatment in jeopardy, in other words, the cases that almost jeopardized the treatment leading to life risk, challenging the work team and demanding therapeutic efforts and innovations. The observation of psychopathological and clinical phenomena linked to psychoanalytic listening was the method of data collection and the treatment and data analysis were done in the clinic case building, through discussions and supervisions of cases in the clinical sessions with NIAB team. The outcome of the study, through observation and the construction of very critical clinical cases, points that the gravity of the case does not rely only on the psychic structure of a person (neurosis, psychosis or perversion), but also on the impasses during treatment. The impasses revealed by the study were defined as a trigger to death, the rejection of the Other, the pulse drift, deadly symbiosis resulting in a difficult transference relationship and the residual case. The study allows, in one hand, identify the role of the anorexic symptom and/or bulimic in each case, that could be of expression of a conflict or psychic suffering, of a structural characteristic (melancholy) or of a way of settling down in non-triggered psychosis (imaginary compensation or suppliance), and on the other hand, warn that each case should be considered unique in its conduction.