DEATH AND ANNIHILATION ANXIETIES IN ANOREXIA NERVOSA, BULIMIA, AND SELF-MUTILATION Sharon K. Farber, PhD Cape Cod Institute Craig C. Jackson, PhD Special Education Services Johanna K. Tabin, PhD Chicago Center for Psychoanalysis Eytan Bachar, PhD Hebrew University of Jerusalem Self-starvation, bulimic behavior, and self-mutilation comprise a triad of asso- ciated self-harm syndromes that are potentially life threatening, with anorexia nervosa having the highest mortality rate of any psychiatric disorder. They are associated with trauma and are extremely resistant to treatment. These patients present a disturbing lack of anxiety about their own life-threatening behavior, yet are preoccupied with death and anxiety about annihilation. Because disso- ciation compartmentalizes and separates psychological and somatic aspects of traumatic experience (psychological and somatoform dissociation), it enables these patients to disavow the life-threatening nature of their behavior, which makes the dissociative processes the most destructive factor in this psychopa- thology. The self-harm symptoms are a presymbolic form of communication that must be decoded and confronted in treatment to make recovery possible. For many patients who starve, purge, or mutilate themselves, the body is speaking of death. They require a treatment that protects their safety, determines their personal construct of death, treats the dissociative pathology and sadomas- ochism, and builds signal anxiety and other ego functions, especially affect regulation. Keywords: annihilation, anxiety, anorexia, bulimia, self–mutilation Self-starvation, bingeing and purging, and self-mutilation comprise a triad of associated perverse self-harm syndromes that are also associated with trauma and, like other perversions, are resistant to treatment. Each syndrome alone is potentially life threatening Sharon K. Farber, PhD, Cape Cod Institute, Eastham, Massachusetts; Craig C. Jackson, PhD, Special Education Services, Wellington, New Zealand; Johanna K. Tabin, PhD, Chicago Center for Psychoanalysis, Chicago; Eytan Bachar, PhD, Department of Psychiatry and Department of Psy- chology, Hebrew University of Jerusalem, Jerusalem, Israel. Correspondence concerning this article should be addressed to Sharon K. Farber, PhD, 142 Edgars Lane, Hastings-on-Hudson, NY 10706. E-mail: Sharon_Farber@psychoanalysis.net Psychoanalytic Psychology Copyright 2007 by the American Psychological Association 2007, Vol. 24, No. 2, 289 –305 0736-9735/07/$12.00 DOI: 10.1037/0736-9735.24.2.289 289 This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.