Glycaemic dysregulation and relational/affective dysregulation in a patient with diabetes mellitus

Recent psychoanalytically inspired psychosomatics conceptualises somatic di sorders as disorders in the internalised relationship with a regulating obj ect, causing physiological/affective dysregulation. In diabetes mellitus, m easurements of blood glucose allow close monitoring of a form of somatic re gulation. Several authors have reported parallels between glycaemic oscilla tions and relational vicissitudes, in both experimental and clinical settin gs. Mothers of diabetic patients report a history of misattunement in feedi ng patterns, while similar difficulties, on the symbolic level of accepting mutual communication, are found in the analysis of adult patients. More or less conscious opposition to glycaemic regulation appears to be linked wit h problems in distance regulation with the object. The author reports a cli nical case that gives evidence of this parallelism; the patient presents a marked nonintegration and dysregulation of relational and separateness need s, which both emerge, with respect to the analyst and to other objects, in a quickly alternating, violent, juxtaposed fashion reminiscent of descripti ons of disorganised attachment or of borderline patients. These oscillation s are closely paralleled by oscillations in glycaemic control where violent withdrawal from relationships corresponds to physiological and behavioural disruption of glycaemic regulation patterns Improved mentalisation and int egration of the different tendencies in the course of analysis brings to bo th the possibility of stable affective involvement and improvement in diabe tic control.