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In psychoanalysis, body image is the mental representation one has of oneself, which gradually develops in each individual. The body image encompasses fantasies, especially unconscious fantasies, and also involves the environment. The body is one of the subjects Freud dealt with most frequently. In several of his papers, he referred to the constitution and development of the erogenous zones, their representations and importance in the formation of the body image.

The body image is constantly being created and recreated. Caresses and the first affectionate contacts with the people who surround the child during infancy are responsible for molding the body image, and return to the child the image of his own body through containment and eye contact. This is a dialectic process, in which the environment also plays a role. Piera Aulagnier (1991) says that to transform a sensitive region of the body into an erogenous zone, the physiologically sensitive reaction is not enough: time and subjective interrelation are required for the signs of somatic life to become signs of psychic life. In his work on the mirror phase, Jacques Lacan (1949/2004) describes a mechanism of identification that is established through the transformations that occur in infants when presented with a reflection: The mirror offers a tempting image of comprehensive unity, representing what is felt to be a precarious and fragmented self. It was Esther Bick (1968) who, on the basis of clinical material, studied the development of the concept of the skin and its relationship with introjection and projective identification. Didier Anzieu (1985) calls moi-peau (skin-ego) the image of the ego the infant uses in the course of the early phases of his development to represent himself as an ego, on the basis of experiences connected with the body surface.

Various models or clinical hypotheses, such as the neurotic body image, and the primitive-psychotic body image, may be postulated on the basis of clinical psychoanalytical work. The neurotic body image, closer to the notion of normalcy, is the unconscious mental representation of the skin, complete and whole, which envelops and contains warmly. This skin represents the mother's and father's support and warmth, which are in turn the basis for the containment of the self and the limits of the body image. Conversely, in the model of the primitive-psychotic body image, there is no notion of skin, but instead the notion of fluid as the nucleus of the primitive-psychotic body image. Thus, there is only a vague psychological notion of a wall that contains vital fluids, or blood, and fantasies of bleeding, or "emptying out" of those vital fluids. Sometimes this emptying out is linguistically expressed in a fast, uncontrolled speaking style.

This means that the primitive-psychotic concept of the body breaks through and invades what up to then was a different type of mental functioning. These experiences may be expressed through words or through body language, as in psychosomatic disorders. Some patients may have hypochondriac ideas related to the primitive-psychotic body image, such as alleged blood infections, leukemia or hemophilia.

Some concepts related to body image are: hypochondria, body fragmentation, delusions of denial of parts of the body (known as Cottard's delusion), and somatic delusion. Hypochondria based on the psychotic primitive body image may lead to suicidal accidents.

DAVID ROSENFELD

See also: Anorexia nervosa; Bulimia; Demand; Depersonalization; Imaginary identification/symbolic identification; Mirror stage; Object a; Puberty; Schilder, Paul Ferdinand; Self-image; Tube-ego; Want of being/lack of being.