Sadomasochistic Relations Between Ego and Superego in Anorexic Patients

Rita K. Teusch, PhD



In this article, the false or deficient self of the anorexic (Geist, 1989; Goodsitt, 1985; Johnson, 1991; Lerner, 1993; Rizzuto, 1988) is elucidated from the perspective of Freud’s tripartite model. Although self-psychology has highlighted the importance of guilt and shame in pathological narcissism (Kohut, 1971, 1977; Morrison, 1994), the concept of the superego rarely appears in recent self-psychological discussions. For Freud (1914/1957a, 1915/1957b, 1915/1957c, 1919/1955, 1923/1961a, 1924/1961b), an early sadistic superego–ego ideal was instrumental in bringing about pathological changes in the ego when it suffered disturbances in normal narcissistic development. This author investigates the premature, pathology-inducing ego split that Freud repeatedly described, involving a sadistic archaic superego dominating a weak ego. It is suggested that the analyst’s awareness of this sadomasochistic relationship between ego and superego is crucial to an understanding of the anorexic’s perfectionism, self-punishment, feelings of ineffectiveness, and omnipotence. In severe anorexia, the archaic superego has taken hold of the whole of the patient’s ego, but is frequently not recognized as such. Several of Freud’s papers addressing pathological disruptions during the normal narcissistic stage of development are discussed (Freud, 1914/1957a, 1915/1957b, 1923/1961a, 1924/1961b). The effects of the sadomasochistic superego-ego relationship will be illustrated in a case presentation. Implications for treatment and management of countertransference are outlined.

Psychoanalytic Psychology, 32/1: 191-212, October 2015.

Link to Online Publication [available in the library]

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