The Psychoanalytic Approach to Bulimia

Abstract

B ulim ia: Psychoanalytic Treatment and Theory is good reading for any resident who wish es for a more com ple te underst anding of th e cond it ion. Ha rveyJ . Schwartz, IVLD. edi te d a nd con t r ibuted to this com pre he ns ive six teen cha pter boo k cove ring a wide ra nge of topics regarding bu limia. The book evolves fr om a n overvi ew of an alyti c conce pts a nd ge ne ral th eories to specific conditions such as pr egn an cy, wor k inhibition a nd add ict ive beh avior. In quick sum mary, th e a na lytic th eory is th a t th e buli mic's development results from a mother's sym bo lic un availability during th e patien t 's development. There is mat ernal a mbivalence towards th e child a nd her use of th e child for he r own narciss istic need s. The father is found to be ove rst im ula t ing a nd sed uc t ive, a nd th e patient has ea rly a nd frequent expos ure to primal scen es . An analogy is drawn between t he devouring of food by th e patient a nd forcing the finger int o her throat with resulting regurgit ation as representing a sim ultaneous iden ti ficat ion with both parents. The secre t ivene ss tha t is inh erent to bu limia belies it s hea vy pr esen ce in high fun ctioning adult s. The cond ition is ce r tainly not incon gruou s with ac hieveme nt a nd profession al success. It is a co mmo n disorder a mo ng female doct or s and nurses as well as a mong other profess iona ls. Peopl e with bulimia a re oft en married a nd a re frequently more sexually ac t ive th an a no re xics. Depression is mo re com mo nly rep ort ed in bulimia but su icide a nd death from com plica t ions are not cha rac te rist ic. For a high fun cti oning professional it is su rprising ly easy to em pa thize with th e pat ien ts described in thi s text; thus one finds while reading it an incr easin g desire to und erst and bulimia beyond th e DSM-III-R. Dan iel G escnsway, M.D. em phasizes in his cha pter " Bulimia a nd Pr egna ncy" th at th e syndrome is not on e of a n ea t ing di sorder but reflect s underl yin g persona lity disturban ces. This cha p te r was clear a nd, a long with addressing pr egnancy, es ta blish ed a strong foundation for a n a na lyt ic und erstanding of bu limia. In a n ea rl ie r chap ter C J . T abin an d J.K. T abi n wr ite that " wha t d ist ingu ished th e bulimic or