Psychosomatic Medicine 21:182-192 (1959)
© 1959 American Psychosomatic Society

Contribution to the Psychological Understanding of Pruritus Ani

Report of a Case

A case of pruritus ani of 7 years duration is presented. Whereas the patient was in psychoanalysis for over 4 years as the result of a more disturbing character problem, a detailed investigation into the nature of psychodynamic meaning of pruritus ani could be made. The pruritus symptoms themselves are perhaps the most prominent features in a syndrome which includes characteristics of both a physical and psychic nature. Common physical entities include itching and discharge, nausea, bloating and fullness of the abdomen, constipation and diarrhea. Psychological counterparts include, aggressive, defiant, stubborn, and retentive personality traits, hostility, and at times, marked depression.

The syndrome occurs as the result of defensive struggle against the conscious recognition of passive, oral receptive wishes, and destructive rivalrous impulses. The unconscious desires to receive all the nourishment and love from the breast, and warmth from the mother's body, are denied and rejected, resulting in the utilization of the anal mechanism where the desired content can be hostilely retained, and the frustrating, disappointing mother controlled. The itching and scratching of the pruritus thus represents the gratification of aggressively grabbing the desired object in relation to the equation, feces = penis = baby = breast, and, at the same time, represents punishment as the result of the hostile incorporative nature of these impulses. It is also postulated that the anal sensations are necessary to bind primary separation anxiety and thus prevent loss of the internalized object which might result in ego disintegration. The psychodynamic relation of the self-destructive aspect of the scratching and tearing to masochism and its dermatological correlate is described. Also some comments on the technical handling of special problems in such a case are made.