Autistic mechanisms in a case of pornography addiction

Based on the description of the treatment of a patient with pronounced self-esteem problems, severe relationship disorders and pornography addiction, the author illustrates the extent to which autistic phenomena and autistic defence formations play an important role in the treatment of patients who could also be described as narcissistic or neurotic from a different perspective. After an introduction to the theoretical considerations of Bick, Tustin, Meltzer, S. Klein and Ogden on this topic, the case of a young man with a migration background and early trauma due to separation is described, in which the autistic phenomena and the autistic defence only became apparent during the course of treatment. In particular, this concerns the patient's initial inability to perceive the analyst as a receiving and containing three-dimensional object and to enter into an emotional exchange with him. Instead, the patient clung concretely to the analyst in the sense of an adhesive identification according to Meltzer. In his pornography addiction, he used sexual arousal in conjunction with the image of the "ideal female body" as autistic form according to Tustin to ward off fears of falling apart. The author describes how he had to struggle for a long time to be recognized by the patient as a three-dimensional object.