Introduction

Once considered quite rare, eating disorders are now encountered with increasing frequency by most clinicians. These forms of psychopathology have become so commonplace as to merit extensive coverage in the lay press. Equal attention has come from professional groups so that, in addition to a wealth of articles and books, there is even a separate journal dedicated to the investigation of eating disorders. Yet, in spite of being widely studied, eating disorders remain poorly understood, with disputes revolving around their diagnosis, etiology, and appropriate treatment.

Psychoanalysis had been aware of anorexia nervosa well before this disorder became fashionable. As early as 1889, Freud wrote to Fliess that “the well known anorexia nervosa of girls seems to be … to be a melancholia occurring where sexuality is undeveloped. Loss of appetite—in sexual terms, loss of libido (Freud, 1889/). In the ensuing years, this disorder has been reinterpreted along the lines of each new development in psychoanalytic thought, so that to trace the history of its explanatory literature is almost to follow the historical course of psychoanalysis itself. Early traditional theories stressed that anorexia was a defense against wishes or fears of oral impregnation. Ego psychology focused on the weakness and ineffectiveness of the anorexic's ability to achieve individuation or self-reliance in adolescence, possibly as a result of disturbed early mother—child interactions. Adherents of an object-relations approach conceived of the disorder as the weakened psychological self's paranoid reaction against a powerful bad object which had become equated with the corporeal self. Family and interactional theorists commented on the family's exploitation of the anorexic child in order to maintain a pathological equilibrium within the home. Most recently, anorexia has been studied from the framework of self psychology, identifying failures in empathic mirroring and idealization during childhood.

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