Analysis of Psychogenic Anorexia and Vomiting in a Four-Year Old-Child1

Recapitulation of the patient's emotional development shows severe traumatization during the course of her primitive dependence. The first trauma arose from the sudden weaning at the age of four

months when her mother became pregnant. This resulted in simple physiological tension. The low degree of differentiation in the psychic apparatus of a four-month-old child still allowed solution by a short cut, as it were. Thus a substitute gratification, namely, thumb-sucking, was sufficient to achieve release of tension and mastery of the trauma. Though not yet representing a neurotic symptom this solution already may account for a certain amount of oral fixation and may have its bearing on the future choice of symptom. The next trauma occurred at the age of thirteen months when the next sibling was born. Again it took the form of a frustration of her anaclitic needs. A solution as simple as the former resort to thumb-sucking was no longer sufficient. Functions had already been acquired which could be lost. She gave up walking, habit-control, and whatever independence she already had achieved. She also may have prolonged her convalescence from measles in a tendentious way to procure the satisfaction she was deprived of. However, her regression failed to achieve its purpose and the precocious maturation she subsequently showed may be regarded as an attempt to master the environment actively where she had failed to do so passively.