Becoming needless: A psychoanalytically informed qualitative study exploring the interpersonal and intrapsychic experiences of longstanding anorexia nervosa

This study explored the interpersonal and intrapsychic experiences of individuals living with longstanding anorexia and considered how such experiences might influence barriers to recovery. Six women, aged between 22 and 44, were interviewed on three occasions using a psychoanalytically informed qualitative research design. Three interrelated themes emerged: "all on our own," becoming needless and "nobody speaks your language." Interpersonal experiences were characterized by abusive mistreatment, abandonment, and rejection, which, at times, seemed to be re-enacted with acute health care staff, mental health professionals, and mental health services. Participants developed a conviction of being undeserving and fundamentally flawed, perhaps in a defensive attempt to establish a sense of control and survive these overwhelming experiences potentially operating as a self-protective enclave. Ultimately, participants seemed to be describing, defending against the pain of relatedness by striving to have no needs. Participants seemed stuck in this state of self-protection, hampering their ability to develop trust in the therapeutic relationship. Directions for future research and implications for psychotherapeutic work are also discussed.