Recurrent abortions in a bulimic: Implications regarding pathogenesis

Abstract

Despite agreement in psychodynamic formulations that bulimia nervosa results from relatively early developmental difficulties, the role of transitional objects in the syndrome has been debated. We describe the case of a severe bulimic in which repeated pregnancies and abortions fulfilled the same calming function as repeated binging and vomiting. We suggest that the cycle of incorporation and explusion is central to affect regulation and is most compatible with the view that bulimics use their own bodies as transitional objects. We suggest further that such symptoms represent overdetermination, and reflect not only primitive deficits in regulation of internal states but also consequent unresolved conflicts. Thus therapy must be flexible enough to deal with both primary and secondary issues.