Adolescent alternation of anorexia and obesity: Workshop, 1950.

Abstract

N THIS paper we shall present a report of our experiences in working I with a 13;-year-old girl who alternated between overweight and cachexia.We hope that, by reviewing the first twenty months of therapy with this adolescent girl and both her parents, we may contribute in some way to a further understanding of the intrafamilial nature of conflicts which may be expressed in the symptoms of a child, and of the meaning of starvation and overeating. This review will perhaps also serve to illustrate both the possibilities and the difficulties inherent in collaborative psychotherapy.Since we are concerned here with aspects of anorexia nervosa and obesity, we have surveyed the literature on both subjects. One is at once struck by the ways in which, as reported, the two are alike. The family milieu and the character of the parents, as well as the developmental and past histories of the patients whose cases have been recorded, are strikingly similar. T h e psychopathology, as enunciated by some authors, is also almost identical in both conditions. We shall present a brief summary of the findings in the literature.Rynearson and Gastineau (l), in their recent book on obesity, surveyed the literature comprehensively and concluded that there was no evidence for endocrine, metabolic, constitutional or hereditary factors of prime importance in obesity. Dr. Rynearson has been heard to say, "The only glands involved in obesity are the salivary glands." They point out that their experience agrees with that of most internists and students of obesity that excess food intake and lack of exercise are the important factors in producing obese individuals (2).Shick ( 3 ) believes that there is evidence for constitutional factors in obesity. H e quotes Freud's statement that psychologic experiences of the child are registered on an organism with a certain constitutional endowment, and believes that individuals have tendencies toward obesity.Bruch (4), in her extensive work with obese children, has found little evidence for disturbed physiology as a cause of obesity. Most authors agree that the most important single cause for overweight is excessive eating.The pathological physiology of anorexia nervosa has only recently been proved to be the effect and not the cause of the disorder. The clinical pictures of anorexia nervosa and Simmonds' disease (pituitary cachexia) ap-387 This document is copyrighted by the American Psychological Association or one of its allied publishers.This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Anorexia nervosa as a defense against anaclitic depression

“…domineering and controlling (Ber1in et al, 1951;Sours,1974), and overprotective (Selvini-Palazzoli), 1974). These mothers are often over-concerned with eating or other gastrointestinal functions (Berlin et al, 1951;Rampling, 1978). Some mothers view food solely in terms of its nutritional value rather than as a means of appetite satisfaction.…”

“…Such maternal austerity fails to convery the attitude of confidence in the child necessary to take the risks attendant with separation. Other mothers of anonectics overemphasize the need to eat and overvalue theimportance of being full (Berlin et al, 1951;Bruch, 1973). Consequently, eating becomes unrelated to hunger or appetite.…”

“…Benedek), 1936;Waller et al, 1940;Masserman. 1941;Moulton, 1942;Lorand, 1943;Berlin et al ,1951;Thoma, 1967Thoma, , 1977. Rejection of the wish to be orally impregnated (Lorand, 1943); Waller et al, 1940;Moulton 1942;Sylvester, 1945), oral sadism (Benedek, 1936), reaction formation against oral incorporative wishes (Masserman, 1941), and regression from the adolescent maturational demands of sexuality (Rampling, 1978) were some of the major psychological sexual explanations offered for the disorder.…”

‘No entry’, an invitation to intrude, or both? Reflections on a group of anorexic patients

“…A rich psychoanalytic and psychiatric literature on anorexia describes a multitude of psychic processes, defences and states of mind. Anxieties about sexuality (Breuer and Freud, ; Freud, ), greed, orality, genitality and oral impregnation (Abraham, ; Berlin et al ., ; Lehman, ; Waller et al ., ), the role of the mother, the father and the couple (Birksted‐Breen, , ; Bruch, , ; Boris, ; Jessner and Abse, ) are all hypothesized to be implicated in the development and maintenance of anorexia. External events – in particular, actual or phantasied sexual intrusion – have also been invoked as important causal factors (Majid and Treasure, ; Mullen et al ., ; Oppenheimer et al, ; Stuart‐Smith, ); and family therapists have described a transgenerational conflict of loyalties and the families’ need to have a perfect child (Selvini‐Palazzoli, ) or family characteristics of enmeshment, overprotectiveness, rigidity and lack of conflict resolution with a psychologically vulnerable child in a ‘psychosomatic family’ (Minuchin et al ., ).…”

Anorexia nervosa

“…Most authors explain the illness as being secondary to ambivalent oral sadistic, cannibalistic, and oral impregnation fantasies which are denied by refusal of food and by defeminization of the body through weight loss (Berlin et al, 1951;Blitzer et al, 1961;Falstein et al, 1956;Grimshaw, 1959;Lorand, 1943;Margolis & Jernberg, 1960;Masserman, 1941 ;Tustin, 1958;Waller et al, 1940). Crisp (1967) understands the syndrome as representing a weight phobia in which normal weight is equated with growth and loss of physiologic and psychologic childhood for which the child feels unprepared.…”