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Eating Disorders: A Contemporary Introduction

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Tom Wooldridge

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“One of our central tasks with patients with eating disorders is facilitating the capacity to postpone action in favor of reflection. We inevitably find especially early on, that this is challenging: the pull to binge, or purge, or restrict is difficult, often impossible, to resist. To understand this fact, in this chapter we begin with a discussion of Freud’s (1914) notion of the compulsion to repeat and then formulate the eating disordered patient's symptoms as repetitions against traumatic themes from childhood, never-ending (because never fully successful) attempts to magically undo the pain of the past.”

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Book:Eating Disorders: A Contemporary Introduction
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“Patients with eating disorders typically report little power to stop their eating disordered behaviors (i.e., reversibility), are often unaware of the thoughts and feelings they have when engaging in them (i.e., self-observation), and, by definition, their behaviors are self-defeating and fail to forward their development in constructive ways (i.e., appropriateness).”

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Book:Eating Disorders: A Contemporary Introduction
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“We all need to feel safe, that the world is predicable, that obstacles can be overcome, and conflicts resolved -in short, to maintain narcissistic equilibrium. When such conditions are met, infants can pleasurably engage with their environments. When faced with overwhelming experience, internal or external, they must find a way to restore their fragile self-esteem. Some infants, especially when faced with overwhelm that cannot be overcome, turn away from reality and toward omnipotent solution. This learned response feels dependable and, over time, takes on an addictive quality, restricting her access to other solutions and pathways to further growth.”

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Book:Eating Disorders: A Contemporary Introduction
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“Mourning is the vehicle of transformation through which traumatic themes can be acknowledged, disillusioned wishes for an ideal object relinquished and painful early relationships transformed into aspects of the subject’s character that are carried forward in constructive ways.”

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Book:Eating Disorders: A Contemporary Introduction
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“In her article, Williams (1997) describes a class of "psychically porous” patients who suffer from eating disorders, most frequently bulimia nervosa, and suggests that they had parents who themselves suffered extensive traumas and as a result were either frightening or frightened or both in relation to the child.”

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“Desire cannot be understood apart from the contexts, relational and cultural, that shape it. A patient with bulimia, for example, may not desire food as a substitute for mother but, rather, because that is the only available "vocabulary" through which her desire can be expressed. The analyst's task becomes not only to uncover desires that have been defended against but also to help the patient begin to want freely so that, over time, new containers of desire can emerge, both inside and outside the analytic relationship.”

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Book:Eating Disorders: A Contemporary Introduction
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“Patients with eating disorders contend with an emotional landscape marked by isolation and loneliness as well as shame, guilt, and embarrassment, not to mention a profound hopelessness about the possibilities of emotional connection. Help with these struggles will never be found in a pill or a set of therapeutic exercises, in spite of the potential usefulness of both. It is only through a meaningful emotional connection that we can help patients begin to "bear the unbearable and to say the unsayable".”

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“Modern obstetrics still preaches that birth is a battle between mother and child and worries that babies grow too large to safely exit the bodies that built them. However, obstetricians cannot accurately discern a baby's size in utero toward the end of a pregnancy, according to recent studies. When ultrasounds predict big babies, they are wrong about half the time, far too frequently to be relied upon. This fact has not stopped doctors from inducing or scheduling surgery for pregnant people, essentially claiming they cannot birth their own babies, that their babies won't fit through the birth canal before they have even tried. Despite obstetric alarm sounding, what we know hardly suggests that women routinely build babies too large to birth.”

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