Early Psychic Disturbances in Anorexic and Bulimic Patients as Reflected in the Psychoanalytic Process

This presentation aims at demonstrating the emergence of a basic disturbance in the analytic material of anorexic and bulimic patients, namely, the unconscious attempt to restore the lost union with the feeding mother which is both relentlessly sought and equally feared. Food is used unconsciously to represent and control intra-psychically both the object and the affects belonging to that relationship in such a way as to avoid terror of fusion or dissolution of the self.

Introduction

The essential characteristic of anorexia nervosa is a psychically determined rejection of food, usually to counter an impulsion to gorge. It may be partial or absolute, and is invariably associated with a relentless pursuit of thinness. These patients suffer from a disturbance in perception of their body image and can be further distinguished from those suffering from other illnesses accompanied by emaciation and weight loss by a combination of clinical features which have been carefully documented by many authors — perhaps most specifically by Professor Thomä. Bulimia, its obverse, is characterised by addictive over-eating unrelated to hunger. In general, although preoccupation with food and weight dominate the clinical picture of both, the underlying disturbance is a defective self-awareness and disturbed inter-personal experiences.

In a paper on the Early Origin of Eating Disturbances which I read to the British Society in 1978 I illustrated the use of the transference and countertransference to establish a fundamental disturbance at a preverbal level, apparently associated with a failure in nurturing in its widest sense. Adequate nurturing which leads to the delineation of self and non-self is the prerequisite of a successful separation-individuation. It involves the child's capacity to accept and value her own feelings and preferences (Kohut, A. Millar).

A disturbance in this area colours, influences and interacts with each subsequent phase development, culminating in the adoles