The “Perseverant” Personality: A Preattachment Perspective on the Etiology and Evolution of Binge/Purge Eating Disorders

Abstract

The author integrates “psycho-digestive” metaphor with contemporary relational perspectives and developmental research to propose a way of thinking about the etiology and evolution of binge/purge eating disorders—including “purging anorexia,” bulimia, and “yo-yo” binge/dieting—and the personality organization that may underlie them. Focusing on the unifying, cyclical nature of these disorders, the author hypothesizes that an early-developing, fear-based form of somatopsychic perseveration may be set in motion from the beginning of life when a nursing infant is unable to achieve a psychic connection with a physically present and feeding (m)other. Without intervention, such a preattachment failure in (m)other/infant synchrony would inevitably impact all subsequent development. The author proposes that it may also lay the foundation for a uniquely intertwined somatopsychic personality organization—what she calls a “perseverant” personality—that fosters the development of binge/purge eating disorders. A perseverant personality is defined as a solitary and circular mode of being, thinking, and relating that is organized around a sustained physiological and psychological reliance on the feeding as a mode of thought-processing and affect regulation.

Notes

¹To avoid grammatical contortions, from here on I use the feminine gender in this text. However, this in no way is intended to imply that boys are not subject to the developmental course of a perseverant personality. It seems to me that if a boy is unable to shift his identification to his father and remains identified with his unreachable mother, he may become caught in the same “closed-circuit loop” as his perseverant sister. Moreover, the widely held perception that fewer men suffer from eating disorders than women is, in my view, inaccurate. As a society, we allow “wider girth” to men to contain their own toxicity in physical ways. As evidenced by the significant numbers of overweight or obese males, as well as those who binge and purge, yo-yo diet, starve themselves, and/or attempt to regulate the effects of their eating by engaging in “extreme” sports, men use food to help themselves “think” or process their affect as frequently as do women.

²Failures in connection because of severe abuse or neglect in early infancy are known to result in avoidant attachments, failure to thrive and/or, tragically, death. I wish to differentiate between this form of avoidant attachment and the resistance to take in that reflects the later-developing ability to delay gratification in the restrictor anorexic patient.