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June 15, 1970. TRAUMA, INCLUDING OVERT SEXUAL TRAUMA IN RELATION TO IDENTITY DISTURBANCE AND NEUROTIC SYMPTOM-FORMATION WITH SPECIAL EMPHASIS ON AGORAPHOBIA. Julian L. Stamm, M.D.
The author presented the case of an agoraphobic patient who had sustained chronic, overt sexual trauma in her childhood. The recurring sexual trauma, as well as the trauma of early maternal and other deprivations, not only led to the usual exhibitionistic, phallic, and Oedipal components of the phobia, but also resulted in a complex of narcissistic vulnerability and identity disturbance that were vital in the formation of the agoraphobia. Her clinical course indicated that whenever she sustained a narcissistic injury, most often resulting from a loss of admiration and exhibitionistic gratification, there was exacerbation of her symptomatology. In analysis, which continued for seven years, her penis envy, orality, and feelings of deprivation were worked through. Conflicting ego and superego identifications, as well as the discrepancy between her narcissistic ego-ideal and her actual perceptions of herself and her parents, led to an unstable sense of identity.