Meetings of the New York Psychoanalytic Society

September 28, 1948. ON NEUROTIC OBESITY. Gustav Bychowski, M.D.

Bychowski finds obesity, chiefly among women, to be an expression … of autoplastic processes dominated … by unconscious mechanisms'. These patients eat compulsively; when unable to eat, they become anxious; they behave towards food as an addict to his drug, lapsing into compulsive eating whenever they are frustrated; they are emotionally unstable, and tend to develop reactive depressions. Food for them has special unconscious meanings—strength, security, maternal love. Compulsive overeating implies introjection (cannibalistic incorporation) of the mother. Guilt and depression therefore follow bouts of overeating. The development of fat expresses an identification with the mother including fantasies of pregnancy. Denial of femininity is prominent, with attitudes typical of the female castration complex. The cushion of fat protects the patient against both the aggression of the male and her own exhibitionism. Bychowski postulates that the ego accomplishes the autoplastic expression of the conflict by making use of complex metabolic processes, such as water retention and changes in lipid and carbohydrate metabolism. Basically, these individuals are engaged in a fruitless, lifelong struggle for permanent retention of the infantile love object by means of its partial incorporation.

Dr. Hilde Bruch commented that observers starting from widely divergent positions reach similar conclusions about obesity. Her own studies confirm Dr. Bychowski's conclusions. In childhood, obesity occurs in males as often as in females; both show confusion about their sexual rôles. Organic etiology is rare in obesity. In her experience obese patients are very difficult to analyze. Dr. Bela Mittelmann finds that obese patients are so difficult to manage that sometimes intramural therapy is necessary. Dr. C. P. Oberndorf observed that similar neurotic mechanisms may be found in both obese and nonobese patients and as