Inaccessibility in eating disorders

Abstract

This paper details some different manifestations of inaccessibility encountered in working with eating disorders. Using clinical material relating to anorexia and bulimia, the destructive and defensive measures that make it so difficult to reach, understand and change such pathologies are explored. The main hypothesis is that the degree of inaccessibility is a salient prognostic indicator and marker of the severity of the eating disorder. The role and meaning of extreme, pervasive and rigid inaccessibility is considered along with psychic positions of greater porosity that offer more hope, optimism and ‘movement towards life’. Finally, the therapeutic implications are examined in attempts to work with these difficult to engage and often refractory conditions, both at the individual and institutional level.

Keywords:

• inaccessibility
• eating disorders
• anorexia
• bulimia

Acknowledgements

Special thanks to Marilyn Lawrence and Gianna Williams for sharing their insights. I am also grateful to colleagues for helpful discussions and I appreciate the willingness of my patients to permit publication of material from our sessions.

Notes

1. Anorexics created their own website, giving each other advice on how to keep their addiction going, cultivate and enhance it. They are not seeking to get rid of their habit, but to maintain and further entrench it.