2 HEARTS BEAT AS ONE - EATING DISORDER IN A TWIN PAIR WITH HYPERTROPHIC CARDIOMYOPATHY

Background: Anorexia nervosa is construed as a phobic avoidance respon se to the existential strains of adolescent growth and maturation. The se strains can take many forms but have the common basis of having bee n prompted, sooner or later, by the impact of puberty. It is the rever sal of this pubertal process, through reduced energy (dietary) intake, that embodies the avoidance mechanism in the disorder. The present re port claims to illustrate an unusual variant of such psychopathology a nd presents supporting evidence in the form of treatment response. Met hod: Concurrent anorexia nervosa and hypertrophic cardiomyopathy in no n-identical twins is described. Literature concerning the problems of identity development in twins is reviewed. One of the twins, our patie nt, is studied in depth. Her changes in weight are related to biograph ical events and to her relationship with her eating-disordered twin si ster. The specific determinants of anorexia nervosa in this case are h ypothesised and discussed. Results: The particular problems of separat ion and identity formation posed by twinship were considered to be sev ere. Development of a potentially fatal and familial illness, hypertro phic cardiomyopathy, prompted by adult growth in the other twin, was e xperienced as catastrophic by our patient; the threat of maturity beca me intolerable and anorexia nervosa was the only solution. Conclusions : A treatment programme that addressed these matters has been successf ul. She now holds a normal body weight and is more able to live with a mbivalent feelings and doubts. She is also more realistic about and ac cepting of her own mild degree of hypertrophic cardiomyopathy.