The Arts in Psychotherapy 30 (2003) 137–149 Identifying conflicts of anorexia nervosa as manifested in the art therapy process Dafna Rehavia-Hanauer, M.A.C.T. ATR 1 Psychosomatic Department, Sheba Medical Center, Tel-Hashomer, Israel While working as an art therapist treating anorec- tic patients in an in-patient Eating Disorder Depart- ment at a major medical center in Israel, I became aware of a wide range of issues that arose within my art therapy sessions. Although, the eating disorder of anorexia nervosa has been explored extensively and a variety of psychological explanations have been pro- posed, the perspective taken by these theories did not seem to address directly the art therapy process for the patients with whom I was involved. As we know, anorexia nervosa is a multifaceted disorder. Over the years of my work as an art therapist, I realized that there was a need to provide a fuller understanding of the phenomenon of anorexia nervosa and the way it manifests itself through art work and from an art therapy perspective. I wanted to follow the central themes that arose in art and the art therapy process while working with anorectic patients. As proposed by Schaverien (1994), art and art therapy may sym- bolically replace food in the negotiation of the under- lying causes of anorexia nervosa. As I followed the themes that emerged in the art therapy process I was involved with, I found that my patients were trapped in a pattern of conflicting themes. I therefore chose to focus on these conflicts directly. In this paper, I will concentrate on the conflicts that were identified in the artistic process and art products of 10 anorec- tic patients treated over a period of 6 months. The definition of the conflicts and the ways they appear in the art therapy sessions may be a useful tool for assessment and treatment of patients with anorexia nervosa. This study may also provide a more com- E-mail address: dafnarh@excite.com (D. Rehavia-Hanauer). 1 Present address: Pittsburgh, Pennsylvania, USA. prehensive description of the eating disorder anorexia nervosa that is directly tied to the art therapy process and as such may provide a new perspective on this disorder. Literature review In extensive previous research, several different factors have been defined that are important for un- derstanding the eating disorder anorexia nervosa. These factors include socio-cultural, psychological, family, biological, physiological, and developmental factors. Yates (1989) stated that anorexia nervosa would necessarily involve interactions between socio-cultural, psychological, and biological forces and that these forces must then be integrated within a develop- mental framework. On a very basic level, anorexia nervosa can be defined as a psychosomatic illness that combines aspects of the physical body and the mind (Yates, 1989). Research into the biological and physiological factors involved in anorexia has focused on both the outcomes and causes of anorexia. Physical symptoms and signs usually reflect the effect of caloric restriction and subsequent weight loss (Pomeroy, 1997). Menstrual irregularities and decreases in neuro-hormonal discharge are common among anorectic patients (Yates, 1989). Because a majority of patients diagnosed with anorexia are fe- males as were the participants in the present study, this paper will refer specifically to females with anorexia. Cognitive approaches to anorexia nervosa view this illness in relation to a series of cognitive percep- tion distortions about body weight, shape, and eating. The most documented of these distortions relates to concepts of body image. In a significant study, Slade 0197-4556/$ – see front matter © 2003 Elsevier Science Inc. All rights reserved. doi:10.1016/S0197-4556(03)00049-2