SYMPTOM FORMATION - AN INTEGRATIVE SELF PSYCHOLOGICAL PERSPECTIVE

The emergence of a relational perspective in psychoanalytic thought su ggests the need for new paradigms of symptom formation. In addition, b iopsychosocial data on the etiology of a number of specific disorders have been accumulating. Self psychology is proposed as a relational mo del of psychopathology that can be incorporated into a biopsychosocial paradigm of symptom formation for Axis I disorders. Four specific pat hways to symptom formation are outlined. The first consists of a self- state of impending fragmentation that is then warded off through invol vement with a substance or activity, as in addictive disorders. The se cond denotes a state of fragmentation without a behavioral means of se lf-restitution other than avoidance, seen in anxiety disorders. The th ird involves the use of a symptom as a compromise formation among conf licting impulses as a result of psychological trauma, as in dissociati ve and somatoform disorders. In the final pathway that I outline, symp toms such as depressive states and work inhibitions result from an int ernalized conflict between maintaining needed relationships and pursui ng self-differentiation. Both internal conflict and developmental defi cit are central in the genesis of symptomatic disorders.