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Chessick reviews literature on the genesis and treatment of eating disorders—from anorexia to obesity. Eating and obesity can be means of dealing with and expressing affects stemming from conflicts within the system of selfobjects. Binge eating can be self-soothing and can provide orgiastic-like pleasures. It can also
evolve into drug use. Eating and starvation are used to redirect primitive aggression and to ward off self-fragmentation. The bodily changes of the anorectic can represent affects such as depression. The acts and fantasies that the anorectic is obsessed with have specific unconscious meanings, oral through oedipal, although earlier conflicts and pregenital selfobject problems are stressed in this paper. Effective treatment requires the judicious use of such resources as internists, self-help groups, and medication. Initially a "structure building" (Bruch), supportive, and reality-testing approach is used. This may be followed by work with projections and splitting (Kernberg), especially if strong negative transferences appear. The last phase stresses the more classical unconscious meanings of the disturbed eating behavior (Fenichel). These are long, difficult, although not impossible cases with much likelihood of countertransference problems.