Obesity: Psychoanalytic Challenge

The purpose of this paper is to examine obesity from a psychoanalytic perspective in the context of current theoretical, clinical, and biological knowledge. Obesity is usually defined in terms of body weight and includes those individuals who are 20% or more above their optimal weight, or who have 20% or more of their body weight composed of adipose tissue. Categories of obesity are based on the age of onset, types of abnormal eating patterns, and the degree of body-image disturbance. From a psychiatric standpoint, obesity is neither psychopathologically nor developmentally a uniform syndrome. Yet, the literature seems to suggest a common psychodynamic thread, especially in connection with “developmental” or “childhood onset” obesity. Those psychoanalysts who initially explored the psychogenesis of obesity linked it to disturbances in the oral phase of development (Alexander, 1934; Bychowski, 1950; Hamburger, 1951; Rascovsky et al., 1950). Freud's (1905) concept of an oral erotogenic zone promoting sexual pleasure independent of nutritional requirements was the foundation of this hypothesis. The latter held that excesses or deficiencies of oral stimulation during infancy led to partial or total “fixations” at the oral stage of development. These “fixations” were the result of either too much or too little pleasurable gratification during the oral phase. Therefore, the infant who failed to obtain an appropriate amount of oral gratification might regress to an oral level of behavior under future stressful circumstances. Examples of oral behavior include overeating, thumbsucking, smoking, drinking, and other types of orally devouring activities. Over time, the concept of oral gratification was broadened to include the infant's total kinesthetic, visual, auditory, and affective experience with the mother during the earliest stage of development. Since feeding is so central an activity during infancy, every component of the mother–child relationship can become associated