There is little research currently available on the general health of RMWs and future research should examine this further and focus on general health and access to support services.

Self-starvation, bulimic behavior, and self-mutilation comprise a triad of associated self-harm syndromes that are potentially life threatening, with anorexia nervosa having the highest mortality rate of any psychiatric disorder. They are associated with trauma and are extremely resistant to treatment. These patients present a disturbing lack of anxiety about their own life-threatening behavior, yet are preoccupied with death and anxiety about annihilation. Because dissociation compartmentalizes and separates psychological and somatic aspects of traumatic experience (psychological and somatoform dissociation), it enables these patients to disavow the life-threatening nature of their behavior, which makes the dissociative processes the most destructive factor in this psychopathology. The self-harm symptoms are a presymbolic form of communication that must be decoded and confronted in treatment to make recovery possible. For many patients who starve, purge, or mutilate themselves, the body is speaking of death. They require a treatment that protects their safety, determines their personal construct of death, treats the dissociative pathology and sadomasochism, and builds signal anxiety and other ego functions, especially affect regulation.

No abstract

This paper examines by a selective review of the literature on secondary anorexia nervosa the under‐recognized role of death fears and anxieties in the etiology of this paradoxical condition. By drawing on the psychology of the survivor, the anorexic patient is conceptualised as a “survivor by proxy” of the parent. In developing and confronting these themes, areas of knowledge otherwise thought unrelated to anorexia are discussed. Of particular importance are the Rheingold theories on maternal destructiveness, the catastrophic death complex in women, Lifton's psychology of the survivor (particularly the survivor child), research on maternal depression, morbid obsessions, necrophilia, and murderous obsessions in mothers towards their children. The main thrust of this reconceptualization is that death fears and anxieties, and a close associative linking between eating, death, and other basic life functions, plays a central and not peripheral role in the dynamic etiology of secondary anorexia nervosa.

Measures of dissociation and depression were obtained from 26 women with anorexia nervosa, 18 with bulimia nervosa, and 31 non eating disordered controls using the Questionnaire of Experiences of Dissociation (Riley, 1988) and the Beck Depression Inventory (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961). Eating disordered subjects scored significantly higher on both dissociation and depression than non eating disordered subjects. A moderate positive correlation was found between dissociation and depression in both the anorexia nervosa and bulimia nervosa groups. The data are discussed in terms of previous research and possible future studies. The necessity for further enquiry of the role of dissociation in the etiology of eating disorders is underscored.