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The psychoanalytic treatment of young adults is an important part of a current research programme at the Anna Freud Centre. Some of the patients under study have presented with eating disorders. Although the young woman whose case is described in this paper does not form part of present investigations, her analysis has, I believe, important theoretical and clinical implications, and seems worth recording on that account. I have called her Millicent which is, of course, a pseudonym.
She came into analysis when she was 23. At that time, I was already interested in the psychoanalytic scrutiny of certain patients in whom so-called addictive overeating formed both a major symptom and a leading preoccupation. Their eating excesses did not, however, simply conform to this rather loose description. There were other important characteristics. I had in mind patients whose eating was wholly unrelated to hunger and took the form of a need to cram every available space; who hated the effect this excessive cramming had on the appearance of their bodies; and who felt powerless to stop the process except, perhaps, through prolonged exercise, vomiting or purgation, or - as in this case - for short periods of starvation. And although they often shared with the anorexic the belief that fatness was to be despised, their compulsive eating precluded any possibility of achieving this idealized state.
If this sounds rather like the delineation of an increasingly familiar clinical syndrome, nowadays often referred to as bulimia