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Chronic acting out which is always considered as posing a formidable analytic problem becomes even more difficult to understand and interpret when it is intertwined with a life-threatening psychosomatic illness.
Regression to pregenital fixations and ego disturbances involving the capacity to neutralize instinctual energies, particularly aggression, have been described as factors common to acting out, psychosomatic illnesses, as well as many other conditions.
Rosenfeld (1964) has written that with excessive acting out one may anticipate varying degrees of ego disturbance and ego weakness, interference in the capacity for verbal thought, and inhibition in sublimation. Kanzer (1957) has reiterated the point of view that in acting out there is a fixation on early motor and preverbal patterns of discharge and that there is a disposition to regress from thought to fantasy and from fantasy to action. Schur (1955) links resomatization to the prevalence of primary process and the failure of neutralization.
Is acting out a frequent or usual accompaniment of psychosomatic illness? Is this tendency correlated with the severity of the overt somatic symptomatology or with the underlying ego and instinctual problems? As an initial attempt to answer these questions it is necessary to attempt to identify and understand the acting out aspects of the symptomatology of a patient with a psychosomatic illness. What hinders a clarification of these questions is the relative difficulty in identifying and interpreting the acting out as it occurs accompanying a psychosomatic illness. Acting out in the transference, neurotic acting out, and the chronic acting out of certain character neuroses are familiar to us. But in psychosomatic disorders, behaviour that under other circumstances would be clearly understood as acting out may be thought to be a rational response to the pain and disruption of the physical illness. This is especially true in those patients whose psychosomatic disorder