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Psychoanalytic Treatment of Eating Disorders

Book by Tom Wooldridge · 12 quotes · Bulimia, Psychopathology, Eating Disorder

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Psychoanalytic Treatment of Eating Disorders Quotes

“While many anorexic and bulimic patients describe themselves as feeling disconnected from their bodies, or even like heads without bodies, they are also trapped in an inability to differentiate affect from bodily state, as evidenced through difficulty articulating feelings verbally, and the use of food and the body as the primary or only means of self-expression.”

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“If the eating disorder is concretized by the "not-me" ED, the patient is allowed the safety to look around comers, to follow this "other self' into the kitchen; the bathroom; yes, even the bedroom; to observe. Shame and blame are reduced; curiosity is enhanced. Conceptually this is interesting. Many patients are able to observe once allowed to look. They know well who they are at these moments. Relationally, however, they have never been entitled to look, and, as a result, self-observation and understanding have been thwarted by relational constraints and consequent immediate behavioral enactments. Ongoing, the patient is asked to consider what alternative behaviors can replace eating, purging or restricting. If the patient weren't thinking about food or weight, what else would she be thinking about? What else is needed? As the patient begins to consider concrete alternatives to symptomatic behavior, "contracts" are developed between patient and therapists.”

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“If mental health has been associated with the ongoing development of resilient and adaptive coping through early positive attachment experiences, psychopathology later in life has been associated with disturbances in attachment, characterized by deficits in coping with novelty and stress (Schore, 2001). For those who go on to develop eating disorders, there have often been pathological failures in early maternal responsivity, as well as maternal impingements. Bruch (1973), one of the first psychoanalysts to theorize about and treat eating disorders, noted that often. these patients have what she calls an interoceptive problem - difficulty distinguishing between inside and outside and between self and other - as the result of having their mothers' needs imposed upon them throughout development. As a result, the potential, or transitional space, never achieved as a space between two people, becomes an embodied, or "in-myself' space (Boris, 1984).”

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“Moreover, the body is the projection screen for deadly objects stemming from primary, traumatic links with caretakers, compulsory binges and food rejection may amount to an angry response aimed at denying and attacking the body. Additionally. dysfunctional eating behaviors are often attempts to regulate extremely painful emotions, especially those that may influence an individual's narcissistic balance. This condition is shared with different forms of psychic distress, whereby an object or a behavior plays the role of regulating the "'outer" emotions in response to a lack of adequate internal resources to contend with traumatic stressors. From this perspective, EDs can be conceptualized as dysfunctional strategies of affect regulation that are connected to an impaired capability to recognize, metabolize, and mentalize affects (Lunn & Poulsen, 2012).”

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“Eating disorders are a silent form of destruction: a destruction of vitality and the hope for a meaningful existence. They create the illusion of time stopping. Past, present, and future collapse: the insidious negative self-talk is too loud, and/ or the aftermath of trauma too pervasive and/or the affects too overwhelming. The body itself becomes the theater of war (McDougall, 1989) wherein the feelings, memories, longings, and stories that have led to the symptoms feel so dangerous that they are dissociated from the behaviors themselves.”

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“A person struggling with an eating disorder keeps their rituals and disordered behaviors secret - it is a double life of sorts - and the behaviors themselves could be thought of as a maladaptive attempt at a solution. The symptoms are used to maintain a state of mind, full of fantasies of the possibilities of a 'moment' or a 'life', without what 'feels' unbearable. The person, in the eating disorder (ED) 'body-state,' truly believes that there is no other way.”

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“Goodsit (1997), for example argued that patients with anorexia nervosa manifest a facade of pseudo- self-sufficiency when confronted with parents who are themselves self-absorbed, anxious, or otherwise unavailable. In this process, the maturation of the anorexic's self-object and self-regulatory capacities are unable to fully develop, leaving them painfully dependent upon others for their well-being. Bulimic patients, in contrast, are seen as more tension-ridden impulsive, and conflicted about whether to pursue their own lives or to remain available to a parent who utilizes them to maintain his or her own psychic equilibrium. In this context, symptoms - whether self-starvation, bingeing, and/or purging - emerge as last-ditch efforts at self-soothing and tension regulation. Over time, eating disorders become chronic conditions that provide patients with a compensatory identity and sense of self.”

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“With an eye toward the striking difference in prevalence of anorexia nervosa and bulimia nervosa between males and females, Sands (1989) suggested that young girls are presented with culturally shaped barriers to obtaining developmentally necessary mirroring and idealization. Whereas boys' needs for mirroring may be gratified through "showing off, being cocky, acting smart or aggressive”, girls are expected to be "lady-like." It is only in the realm of physical appearance that girls are encouraged to seek mirroring and, thus, in later life women are more predisposed than men to manifest psychopathology through bodily symptoms such as eating disorders.”

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