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There has been a surprising dearth of discussion in psychoanalytic literature about the meaning and treatment of bulimic behavior. A number of books and articles have emerged in recent years that have attempted to shed light on this baffling symptom (e.g., Schwartz, 1988; Emmett, 1985; Garner and Garfinkel, 1985; Swift and Letven, 1984). These authors have posited differing theoretical formulations primarily based on drive, ego, object-relations or self-psychology models. Schwartz (1988) edited the first comprehensive volume to address bulimia from a specifically psychoanalytic perspective. The authors included in this text tend to work predominantly within a structural/drive model or an object-relations model.
Classical drive theory generally focuses on the centrality of the wish for incestuous impregnation and a resulting defensive regression from genitality. An object-relational perspective mainly stresses the importance of a core failure during the separation/individuation phase of development (Schwartz, 1988; Sours, 1980; Sugerman and Kurash, 1982). Casper (1983) has addressed ego psychological issues with regard to the regulation of intolerable inner states. Swift and Letven (1984) have presented a framework for understanding bulimic phenomena by extrapolating from Michael Balint's notion of the “basic fault.” Their contention (which will be explored further later on) is that bulimics manifest a basic fault in their ego, particularly in their capacity to regulate tension states. Johnson (1985) and Chessick (1985) explore some of the self-psychological ways of understanding bulimic behavior. These will also be discussed further.
Though this list of authors is not exhaustive, it does adequately represent the limited psychoanalytic writings on this topic and the various emphases presented. The intention of the present article is to weave together a more integrative approach to understanding bulimia, specifically with regard to chronic bulimic behavior. Women' suffe