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PIETRO CASTELNUOVO-TEDESCO INTRODUCED THE panel by pointing out the relation of obesity to anorexia, bulimia, and compulsive eating. He stressed that all these conditions may be seen as facets of a broad category of eating disorders characterized by disturbance of the body image, concern over being fat, and the perception of being too fat. These entities also are related to other forms of psychopathology, such as depression, addictions, and gambling. He noted that it is one of the contributions of psychoanalysis that all these conditions can be seen as related to one another clinically, developmentally, and dynamically.
Castelnuovo-Tedesco reviewed the early psychoanalytic contributions to the understanding of obesity, which emphasized the vicissitudes of the oral drive and its impact on character formation. From a more current perspective, eating disorders are noteworthy not only because of the frequency with which they occur, but also because of the close relation between drive discharge and the problem of maintaining adequate controls. Although the principal symptom expresses a disturbance in drive discharge, incapacity of the ego to perform its necessary functions and significant pathology in self-representation are also impressive features.
Personality characteristics frequently found in obese people are, first, that they often use food for self-soothing, substitutive gratification and as a replacement for disappointing objects; in this way they achieve a kind of independence and autonomy (not consistent with the stereotype of the orally dependent personality) ordinarily derived from the contribution of the later developmental stages (primarily, anal and phallic-oedipal). A second important characteristic, shared with those who have other impulse disorders, is that they do not readily seek treatment, and when they do, it is often one that promises