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Alexander describes the four-year psychoanalysis of a patient who had suffered from pruritus ani for seven years. The patient came into analysis because of anxieties and chronic social and marital difficulties. She had anal and genital
itching, vaginal discharge, nausea, bloating and fullness of the abdomen, constipation, and diarrhea. She also showed aggressive defiance, a stubborn and retentive personality, hostility, and periods of depression. Defensive struggles against conscious recognition of passive, oral-receptive wishes and destructive, rivalrous impulses underlay the symptoms. The author believes that the patient's unconscious desires to receive all the nourishment of the mother's breast, all the love and warmth from the mother's body, were denied and rejected by the use of anal mechanisms which permitted both retention of desired bodily content and a degree of control of the frustrating, disappointing mother. The itching and scratching thus represented aggressive grabbing of desired objects according to the equation feces = penis = baby = breast. Simultaneously, the scratching provided guilt-relieving punishment for the hostile, incorporative nature of these impulses. The author thinks that the anal sensations were necessary to bind primary separation anxiety; that is, to prevent symbolic loss of the internalized objects.