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This book is a source of nourishment for those seeking an understanding of eating disorders from a psychoanalytic perspective. It is rich in both clinical and theoretical complexity. The position is advanced that the underlying personality disorder must be the primary focus of treatment and that there will be relief from the eating disorder symptom complex as a result of such treatment. The editors point out that retaining this focus in treatment is often contrary to what the patients are ostensibly seeking in the clinical situation. This and other difficulties in conducting treatment are aptly demonstrated in this volume, as is the enormous variability among these patients. The authors do not shy away from describing the regressive symptomatology, the affect explosions, the early forms of object relations, and the intense transference and countertransference reactions that are present in treatment. They also address the circumstances in which medication, hospitalization, or both are necessary adjuncts to treatment.
The volume is divided into six parts: The Fear of Being Fat, Developmental Issues, Restrictor Anorexia Nervosa, Bulimia, Children, and Special Topics. These sections demonstrate a system of classification that the editors have developed in this and other publications. The editors designate fat phobia as underlying many forms of eating disorders.
In Part I (The Fear of Being Fat), the most theoretically dense of the volume, Wilson describes the fear-of-being-fat complex in restrictor and bulimic anorexia nervosa as an orally based set of unconscious conflicts that result in a fixation in the preoedipal phase of development (which influences each subsequent psychosexual phase), fear of object loss (caused by overcontrolling caretakers), a highly distorted body image (as a fat person), and obsessive preoccupations with fears of being fat and desires to be thin. The