A Historical Overview of the Psychodynamic Contributions to the Understanding of Eating Disorders

Abstract

The objective of this paper is to give an historical overview of the development of psychodynamic theories and to acknowledge their contribution to the understanding of the aetiology of these complex disorders. Relevant psychodynamic and psychoanalytic papers on the historical development of eating disorders were identified through a search of (1) Medline and PsychoInfo, (2) the library of the London Institute of Psychoanalysis, (3) Psychoanalytic Electronic Publishing (PEP), and (4) a number of textbooks on eating disorders.The search revealed a dearth of psychoanalytic historical perspectives about the aetiology of eating disorders in general. Overall most psychoanalytic publications were based on single case studies and concerned primarily with anorexia nervosa. No single model was identified, but a number of psychoanalytic ideas remain consistent throughout. Several psychoanalysts and contemporary psychodynamicallyinformed authors refer to, apply and have further developed a number of these original ideas. This overview highlights the unique contributions of psychodynamic concepts towards a better understanding of the aetiology of eating disorders and how much they have influenced and informed modern thinking on the meaning of these complex conditions. A range of psychodynamic views has emerged and gradually evolved from concentrating solely on intra-psychic factors to a more comprehensive multi-modal model. This tendency has become a fertile ground for cross-fertilization which, along with the bio-social counterparts, remains the fundamental pillars on which modern understanding of eating disorders still rests.Psychoanalytic Psychotherapy ISSN 0266-8734 print/ISSN 1474-9734 online # 2006 The Association for Psychoanalytic Psychotherapy in the NHS

Becoming needless: A psychoanalytically informed qualitative study exploring the interpersonal and intrapsychic experiences of longstanding anorexia nervosa

“…The child, therefore, does not experience being listened to, which in turn generates feelings of ineffectiveness and inadequacy (Bruch, 1978). Consequently, difficulties arise in recognizing their basic needs and relying on internal thoughts, feelings, or bodily sensations to develop their own opinions or self‐concept (Bruch, 1978; Caparrotta & Ghaffari, 2006). These processes are also influenced by overinvolved, intrusive, and controlling family environments with little leeway for self‐expression (O'Shaughnessy & Dallos, 2009).…”

“…Bruch (1978) observed how a compliant false‐self then develops as a way of surviving, avoiding criticism, and defending against parental impingement and intrusion (Kadish, 2013; O'Shaughnessy & Dallos, 2009). Anorexia, therefore, becomes a covert attempt to wrestle back control, autonomy, and compensate for feelings of powerlessness and inadequacy (Bruch, 1978; Caparrotta & Ghaffari, 2006). In the broader literature, interpersonal difficulties are also considered central to the development and maintenance of anorexia and associated with poorer outcome (Arcelus, Haslam, Farrow, & Meyer, 2013; Carter, Kelly, & Norwood, 2012; Jones, Lindekilde, Lübeck, & Clausen, 2015) to the extent that it has been argued that anorexia is inextricably intertwined with interpersonal relationships (McIntosh, Bulik, McKenzie, Luty, & Jordan, 2000).…”

Sense of self and anorexia nervosa: A grounded theory

“…It is argued that the sense of self within mental health problems is complicated, as there is evidence that people do not consider themselves as being ill and the mental health problem, in of itself, is linked to how the self is defined. This is particularly true where mental health problems start within teenage years, as identity is typically formed in adolescence (Caparrotta & Ghaffari, ) and is thus open to significant peer and social influences (as discussed by Charmaz, ). In saying this, it is important to note that identity changes and alters over the lifespan (Mead, ).…”

Behavioral Inhibition System and Behavioral Activation System (BIS/BAS) Motives and Loneliness as Predictors of Eating Disturbances in Female College Students: Interpersonal Context Matters

“…Importantly, there are several reasons to consider loneliness, defined by the phenomenological experience of being isolated and disconnected from others or a feeling of such (Russell, Peplau, & Cutrona, 1980), in studying eating disturbances in young females. First and foremost, eating-related disorders in females have long been considered by clinicians, researchers, and scholars to develop not only from complex intrapersonal processes, but also from dynamic interpersonal experiences (see Caparrotta & Ghaffari, 2006 for a recent review). Indeed, even contemporary psychological theories have underscored the importance of considering an individual's connectedness to their environment in the development and maintenance of eating dysfunctions (Smolak & Murnen, 2001).…”