Self Psychological Reflections on the Origins of Eating Disorders

It is the intent of this paper to understand eating disorders as one major form of self pathology in which there has been both “traumatic” and chronic disturbance in the empathic connectedness between parents and child. I will offer the hypothesis that what we see clinically as anorexia and bulimia represent two variations of a defensive structure mobilized to cope with a specific, sudden, and prolonged disruption in the early parent–child relationship (or more accurately, the archaic self–selfobject dimension of the parent–child relationship). Such a massive failure, through its particular disruption of the empathic milieu that maintains the integrity of the child's self, prevents the internalization of certain soothing and tension-regulating structures. It promotes dissociative defenses that become congruent with the more chronic empathic failures that exist (Geist, 1984), although in disparate form, in the families of both anorectic and bulimic women. The interweaving of these acute and cumulative developmental empathic failures (and the resulting structural deficits) becomes the childhood anlage of eating disorders; the primordial foundation for the adolescent's later attempt to fill in the structural deficit (to substitute for the frustrated selfobject needs) by symbolically recreating within the symptoms of anorexia and bulimia both the danger to the self and the efforts at self restoration.

Such a hypotheses, derived from the author's individual long-term psychotherapy with 20 eating-disorder patients,* represents an attempt to begin to determine the relationship between the general features of self pathology and the specific characteristics of a given clinical symptom. For it is only as the specific deficits that exist in the psyche of eating-disorder patients are mapped out as a clinical entity that it will be possible to determine and “spell