An Analysis of a Case of Functional Vomiting and Bulimia*

For a number of years it has been known that psychological factors play an important role in certain types of gastro-intestinal disturbances. In the past few years considerable work has been done by several investigators along the line of peptic ulcers, anorexia nervosa, functional vomiting, etc., but to date there has been little written of vomiting associated with bulimia.

Alexander mentioned that the emotional factor in appetite formation is exaggerated in bulimia and is due to an increased craving for love. George Wilson reported that in one of his cases with gastric symptoms there were intense incorporating tendencies which were repressed and lead to over-compensation through increased activity and ambitious effort in life associated with retaliation fears because of the castration wish. Walter Kaufman and Felix Deutsch point out that in their cases of anorexia nervosa, they always found an open conflict between the family and patient and that often there was a preceding history of obesity and overeating which was usually associated with neurotic behavior of parents who placed emphasis on the question of eating. In an early paper Freud states that “chronic vomiting is of psychic origin and that a painful affect which was originally exhibited while eating, but was suppressed produces nausea and vomiting.” With regard to neurotic vomiting Jones postulated that the patient was rejecting an incorporated penis conceived as an incestuous pregnancy.

In the non-analytic literature John M. Berkman reported that in 117 cases of functional vomiting all seemed to have an emotional background.