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 psychodynamically‐informed 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.

ACKNOWLEDGEMENTS

The authors wish to thank Drs Paul Robinson and Sheilagh Davies for their helpful suggestions in an earlier draft and Professor Phil Richardson for comments on the final draft.

Notes

1. For the purpose of this paper the term anorexia is synonymous with anorexia nervosa unless it is specifically stated otherwise.

2. Inhibition of will, inability to act.

3. Freud's italics.

4. Boris (1984) conceptualized anorexia as lack of capacity to accept ‘good things’ due to a desire to possess. As envy and greed are unconsciously linked, any act of acceptance of desired ‘things’ that mother possesses increases their sense of envy. The anorexic solution is not to accept anything. Boris also discusses the issue of boundaries and fusion with the maternal object.