Negative Delusions and the Symbolic Body: A Hypothesis on the Co-Occurrence of Psychosis and Anorexia in Adolescence.

Summary

Anorexia nervosa in adolescents with early-onset psychosis may function as a 'negative delusion' that erases the symbolic body rather than distorting it, according to a hypothesis grounded in Lacanian psychoanalytic theory. This framework suggests that self-starvation serves as a defense against psychotic threats by negating the body's role in social and intersubjective meaning, stemming from a shared failure in symbolic integration. The proposal reframes the clinical overlap between the two conditions, offering implications for early diagnosis and intervention without creating a new diagnostic subtype.

Study at a glance

Abstract

Early-onset psychosis and anorexia nervosa, while traditionally conceptualised as distinct disorders, demonstrate significant clinical overlap, particularly during adolescence. This period of profound bodily and identity transformation is a critical window where both conditions can emerge, sometimes with complex, overlapping symptoms. However, existing explanatory frameworks often fail to account for this comorbidity, leaving a conceptual gap. This hypothesis paper proposes that anorexia nervosa, when emerging in the context of adolescent psychosis, functions as a 'negative delusion'. This is not a pathological belief involving the distortion of the symbolic body, but rather its erasure. Drawing on Lacanian psychoanalytic theory, we argue that this erasure stems from a shared structural failure in symbolic integration common to both psychosis and this form of anorexia. The hypothesis is built upon a Lacanian theoretical framework, utilising concepts such as the mirror stage, the paternal function (Name-of-the-Father), the symbolic body and jouissance. The argument is further elucidated through clinical vignettes that illustrate how self-starvation can serve as a defence against psychotic threats by negating the body's symbolic dimension within social and intersubjective meaning. This framework has significant implications for early diagnosis and intervention. Rather than proposing a new diagnostic subtype, it identifies a structural configuration-anorexia functioning as a 'negative delusion'-that may be operative in a subset of presentations at the intersection of psychosis and eating restriction. By reframing the comorbidity, this paper provides an original perspective on the intertwined failure of symbolic embodiment and its clinical consequences, outlining future research directions in phenomenology and neurobiology.

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