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This is the second of a two-part case report. The first installment is in The American Journal of Psychoanalysis 52(1).
Shirley was in analysis with me for 750 sessions during 6 years. The history of her vomiting has been discussed in connection with the initial interview. As treatment progressed, there were several more instances of night terror with sudden retchings upon awakening. Over the years, these crises diminished. What remained were a few attacks of diarrhea with nausea, but no vomiting, some periods of poor appetite, and eventually, anxiety attacks with hardly any gastrointestinal components. Insight into the meaning of her vomiting as a symbol of self-loathing developed much later than the improvement in the symptom itself.
Some brief diagnostic considerations may be in order at this point. Nowhere in Horney's writings is there any description of the hysterical personality. DSM-III-R lists criteria for histrionic personality disorder. Shirley's symptomatology meets the criteria listed under this heading. It is worth remembering that DSM-III-R, as well as its precursors, is based on descriptive models, not psychodynamic ones.
Paul Chodoff (1974) published an excellent overview on hysteria that helped to clarify earlier confusing and contradictory concepts. A later contribution in 1978 by Hyler and Spitzer led directly to the current definition in DSM-III-R.
The following is from the 70th session, which took place after 6 months of analysis.
I had a very bad weekend … fighting nausea … I thought of what my brother and I had been talking about, and for the first time I did not feel