Why food?: an exploration of the psychodynamics of the use of food in eating disordered clients and the implications for treatment

Abstract

This dissertation explores the roles of food in anorexia nervosa and bulimia nervosa. The methodology used is a modified systematic literature review. This study examines how food becomes involved in the development of both anorexia nervosa and bulimia nervosa. Empathic failures in the early care-giving environment result in many developmental arrests, including a lack of self regulatory skills, inability to symbolise, and more importantly deficits in self cohesion. In the absence of symbolisation, the eating disordered patient perceives food, the first bridge between a mother and her child, as a representation of the mother together with her love and care. The relationship between the patient suffering from anorexia nervosa and her mother is usually described as engulfing, leaving no room for the daughter to separate and individuate. The patient’s refusal of food is, in essence, a way of establishing a sense of self, an attempt to separate from the mother in order to survive psychically. For the patient suffering from bulimia nervosa, her mother is often described as passive and rejecting. The mother of the bulimic patient is not necessarily cold, but the care-giving relationship often lacks warmth and nurturing elements. From the self psychology perspective, inadequate self cohesion means the patient constantly relies on food or disordered eating to provide the selfobject functions necessary for the maintenance of self cohesion. The failure to get her selfobject needs met by human beings during the early development also reinforces her dependence on the use of food, a reliable and controllable selfobject. Treatment implications are discussed and recommendations for future research are explained.