Eating Disorders and Personality Disorders

The current view of orthodoxy is that the eating disordered patient is attempting to reassert control over her life by ritually regulating her food intake and her body weight. In this respect, eating disorders resemble obsessive- compulsive disorders. Patients with eating disorders may be in mortal danger. Their behaviour is ruining their bodies relentlessly and inexorably. They might attempt suicide. They might do drugs. It is only a question of time. The therapist’s goal is to buy them that time. The older they get, the more experienced they become, the more their body chemistry changes with age – the better their chances to survive and thrive. Eating disorders - notably Anorexia Nervosa and Bulimia Nervosa - are complex phenomena. The patient with eating disorder maintains a distorted view of her body as too fat or as somehow defective (she may have a body dysmorphic disorder). Many patients with eating disorders are found in professions where body form and image are emphasized (e.g., ballet students, fashion models, actors). The current view of orthodoxy is that the eating disordered patient is attempting to reassert control over her life by ritually regulating her food intake and her body weight. In this respect, eating disorders resemble obsessive-compulsive disorders. One of the first scholars to have studied eating disorders, Bruch, described the patient’s state of mind as “a struggle for control, for a sense of identity and effectiveness.” (1962, 1974). In Bulimia Nervosa, protracted episodes of fasting and purging (induced vomiting and the abuse of laxatives and diuretics) are precipitated by stress (usually fear of social situations akin to Social Phobia) and the breakdown of self-imposed dietary rules. Thus, eating disorders seem to be life-long attempts to relieve anxiety. Ironically, binging and purging render the patient even more anxious and provoke in her overwhelming self-loathing and guilt. Eating disorders involve masochism. The patient tortures herself and inflicts on her body great harm by ascetically abstaining from food or by purging. Many patients cook elaborate meals for others and then refrain from consuming the dishes they had just prepared, perhaps as a sort of “self-punishment” or “spiritual purging.” The Diagnostic and Statistical Manual (DSM) IV-TR (2000) (p. 584) comments on the inner mental landscape of patients with eating disorders But the “eating disorder as an exercise in self-control” hypothesis may be overstated.