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“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.”

MindBodySufferingEmotionAnorexiaEating DisorderBulimiaPsychopathology
Book:Psychoanalytic Treatment of Eating Disorders
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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.”

MindSufferingEmotionAnorexiaEating DisorderBulimiaPsychopathology
Book:Psychoanalytic Treatment of Eating Disorders
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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).”

MindBodySufferingEmotionAnorexiaEating DisorderBulimiaPsychopathology
Book:Psychoanalytic Treatment of Eating Disorders
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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).”

MindBodySufferingEmotionAnorexiaEating DisorderBulimiaPsychopathology
Book:Psychoanalytic Treatment of Eating Disorders
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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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Book:Psychoanalytic Treatment of Eating Disorders
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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.”

WomenAnorexiaEating DisorderBulimiaBingePsychopathologyPurgeBodyweight
Book:Psychoanalytic Treatment of Eating Disorders
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“Sadly, fierce in-group/out-group biases live within the eating disorder complex, generating and sustaining an ethical code of the culture as girls and women project their shadow upon one another. Individuals with anorexia secretly scorn those who struggle with bulimia or binge eating, those with bulimia and binge eating feel gross, often “wishing to be anorexic,” yet detesting their slim sisters with vicious jealousy. A callous hierarchy is formed, with anorexia as the ideal; bulimia, as a very distant underworld second; and binge eating, clearly at the bottom of acceptability.”

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Book:Psychoanalytic Treatment of Eating Disorders: When Words Fail and Bodies Speak
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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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Book:Psychoanalytic Treatment of Eating Disorders
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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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Book:Psychoanalytic Treatment of Eating Disorders
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“Numerous patients with eating disorders refuse to eat with their families and friends, even insisting on eating only in private. Many of the practices that are seen as essential for creating and sustaining relatedness - the sharing of food, living together, sexual relationships, and even reproduction - are consistently negated by anorexic and other eating disordered practices.”

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Book:Eating Disorders: A Contemporary Introduction
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“Each internal representation of the mother has its corresponding self-representation - the first as bad, empty, and guilty and the second as passive, compliant, and good. Working together, these internal objects undermine patient’s journeys toward adulthood, which is compatible with the symptoms and behaviors of the disorder.”

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Book:Eating Disorders: A Contemporary Introduction
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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).”

WomenMental HealthBody ImageAnorexiaEating DisorderBulimiaPsychopathologyBody Dysmorphia
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.”

WomenMental HealthBody ImageAnorexiaEating DisorderBulimiaPsychopathologyBody Dysmorphia
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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Book:Eating Disorders: A Contemporary Introduction
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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.”

WomenMental HealthBody ImageAnorexiaEating DisorderBulimiaPsychopathologyBody Dysmorphia
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".”

WomenMental HealthBody ImageAnorexiaEating DisorderBulimiaPsychopathologyBody Dysmorphia
Book:Eating Disorders: A Contemporary Introduction
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“In families of eating-disordered patients, the narcissistic use of the daughter by the mother is often immediately striking. Throughout the literature the degree of enmeshment or symbiosis between mother and daughter is remarked upon. Daughters are torn between the urgings of their own developmental strivings and their need to meet their mothers' narcissistic needs.”

WomenMental HealthBody ImageAnorexiaEating DisorderBulimiaPsychopathologyBody Dysmorphia
Book:Eating Disorders: A Contemporary Introduction
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“Eating disordered patients often grow up in families that place an inordinate amount of importance upon bodily appearance, including weight, and focus upon particular parts of the body: protruding tummies, thunder thighs, and tree-trunk legs. We see these same pathogenic qualities in much of the advertising that is directed toward women and girls.”

WomenMental HealthBody ImageAnorexiaEating DisorderBulimiaPsychopathologyBody Dysmorphia
Book:Eating Disorders: A Contemporary Introduction
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“When eating disordered symptoms arise in men, Schoen (ibid.) writes, they may signal difficulty integrating dependency needs into a masculine identification. Sands (2003) notes that men are more likely to express disavowed needs and wants through projections onto others - witness the preponderance of compulsive sexual behaviors in men - whereas women are more likely to use their own bodies to contain disavowed desires.”

WomenMental HealthBody ImageAnorexiaEating DisorderBulimiaPsychopathologyBody Dysmorphia
Book:Eating Disorders: A Contemporary Introduction
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“Object relations theory is concerned with how the patient's early relational experiences have been intemalized as a psychological structure that continues to organize and give meaning to her experiences in the present. Are her objects "whole," reflecting both the good and bad aspects of important early relationships, or are they ''parts," representing of "all good" or "all bad" experiences of intense gratification, longing, or deprivation? The objects that populate her psyche shape the anxieties with which she struggles, the longings she feels, and the defenses she erects to manage the intensities of both. From this point of view, it is the underlying psychological structure -not just the eating disorder symptoms that manifest because of it – that are a focus of treatment. The eating disorder, in other words, is a result of dynamics that are woven through the patient’s personality.”

WomenMental HealthBody ImageAnorexiaEating DisorderBulimiaPsychopathologyBody Dysmorphia
Book:Eating Disorders: A Contemporary Introduction
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“Both childhood digestive problems and pica are associated with later bulimia, and adolescent girls who are high achieving and anxious are at greater risks for disordered eating. Family contention around meals and childhood self-control predict later adolescent consumption (e.g. binging or avoiding foods), with onset of puberty playing an additional role in risks for disordered eating. Physical body changed among girls, marked by spreading hips and adipose deposits, trigger body concerns at the same time that social comparisons heighten to foster unhealthy expectations and more attention to consumption.”

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Book:A Guide to the Psychology of Eating
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“Among all children, popularity and acceptance with peers is a major protective factor against body concerns and disordered eating, whereas body-focused teasing from peers is a risk factor for binge eating and dieting. As a final comment, these relations are most prevalent in societies where media outlets, such as television and social media, are dominant.”

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Book:A Guide to the Psychology of Eating
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“Individuals with Eds evaluate food and body related cues as emotional events and these events trigger dysregulated responses, including deficits in healthy coping strategies and use of maladaptive strategies. Emotional dysregulation and disordered eating worsen in a vicious cycle: engaging in disordered eating, such as restricted food or purging, provides escape from negative emotion particularly when it is stimulated from a food or body related cue, like shopping for a new workout clothing.”

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Book:A Guide to the Psychology of Eating
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“Given that chronic undernutrition can harm cognitive processing, researchers postulate patients with Anorexia Nervosa use a habitual, rule-based tendency to abstain from immediate rewards and select the larger, delayed option. In contrast, patients with Bulimia Nervosa show impulsivity, a deficit in self-regulatory control.”

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Book:A Guide to the Psychology of Eating
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“Individuals who are perfectionists are more likely to comply with norms and to be critical of their own shape, and high trait perfectionism is a documented risk factor for anorexia nervosa and bulimia nervosa as it increases drive for thinness. Drive for thinness is notably predicted by anxiety sensitivity and poor interoceptive awareness, the ability to understand physiological and emotional cues within the body, critical to self-awareness in linking cognitive and emotional processes.”

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Book:A Guide to the Psychology of Eating
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“Treatment of eating disorders is improved by the recognition that strenuous dieting arouses famine protection mechanisms that are prone to initiate a positive feedback spiral.”

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Book:Good Reasons for Bad Feelings: Insights from the Frontier of Evolutionary Psychiatry
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“Eating disorders were not shaped by selection, but mechanisms that regulate eating during famines were. ADHD was not shaped by selection, but mechanisms that regulate attention were. Serious depression was not shaped by natural selection, but capacities for normal low and high mood were.”

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Book:Good Reasons for Bad Feelings: Insights from the Frontier of Evolutionary Psychiatry
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“Patients with anorexia nervosa and bulimia nervosa are surrounded by excess food, but their bodies are aware only of starvation. Their behavior is appropriate for a situation in which getting just a few extra calories might make the difference between life and death.”

WomenEating DisordersAnorexiaBulimiaPsychopathologyEvolutionary PsychiatryMismatchRegulation Mechanisms
Book:Good Reasons for Bad Feelings: Insights from the Frontier of Evolutionary Psychiatry
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