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Eating disorders as a specific method of solving the sexual identity crisis
Abstract
This article is dedicated to the subject of eating disorders in the context of sexual development of women in adolescence and early adulthood. Epidemiological and symptomatological data on eating disorders have been reviewed and results of empirical studies on sexuality of females with eating disorders as well as several theoretical concepts dedicated to these disorders have been analysed. The results of our own study including 73 females with eating disorders have also been presented. Methods used in the study: Life Check List, and Sentence Completion Test (SCT), a Self-rating Scale on Eating Disorders (FSE). The results suggest comorbidity of eating disorders and negative attitude towards both sexuality and males neglecting sexual behaviour.
The sexual concerns of eating-disordered patients have received scant attention in the professional literature. Drawing upon patient examples, the author reviews the range of sexual dysfunctions and relationship difficulties that beset patients with anorexia nervosa and bulimia nervosa. She describes those factors that restrict full sexual expression, including shame, difficulties experiencing joy and liveliness, spiritual malaise, and the role of trauma. Special issues related to pregnancy, homosexuality, the effects of psychotropic medication on sexual response, and concerns of the older patient with an eating disorder are also reviewed. Countertransference struggles of the therapist that evolve as the patient experiences conflict in and enhancement of her sexual life are also reviewed. Finally, treatment implications are outlined. In order for eating-disordered patients to recover, they must find meaning in their lives outside of the eating disorder alone. This necessitates developing and maintaining human bonds, including sexual ones. This permits the patient new, mature modes of relating with others and experiencing a vital, lively sense of oneself.
Objective
This study examined pretreatment variables to predict outcome in two treatments for bulimia nervosa. Method: Patients were offered either 16 weeks of cognitive-behavioral therapy (CBT) or a self-treatment manual followed by up to 8 weeks of CBT (sequential group). Using complete data, stepwise regression analyses were performed. Results: It was found the a longer duration of illness and lower binge frequency predicted a better outcome both at the end of treatment (p < .001) and at 18 months of follow-up (p < .005). In the sequential group, lower pretreatment binge frequency predicted better outcome at the end of treatment (p < .05) and at 18 months of follow-up (p < .05). In the CBT group, longer duration of illness predicted better outcome at the end of treatment (p < .02). Discussion: It is concluded that (1) those with more frequent binging may require a more intense intervention and (2) those who have been ill longer may be more motivated to respond to treatment. © 1997 by John Wiley & Sons, Inc.
Anorexia nervosa, as a clinical condition of differing severity, is presented with particular emphasis on the importance of dynamic psychotherapy, which in some cases may be the life saving treatment of choice. Beginning with the historical perspectives, the clinical picture of anorexia nervosa is presented, with its incidence, psychologic, organic, and laboratory findings, family background, course, and outcome. Psychodynamic understanding of its nature is discussed with its significance for planning and conducting of psychotherapy. Its prevalence among adolescent girls, but also occational occurrence occasional boys is analyzed. How to diagnose anorexia differentially from other medical and psychiatric conditions like hypopituitarism, neoplastic disease, tuberculosis, vitamin deficiency, schizophrenia, obsessive compulsive neurosis, hysteria, and depression is outlined. Dynamic psychotherapy is presented in considerable detail with emphasis on ventilation and gradual uncovering of the guilt produced experiences from the areas of sex and hostility, ego support through introjection of the therapist's attitude, desensitization during such contact, and adjustment of the stress generating environment through management of the family atmosphere or change of the patient's surroundings. In spite of recent research into some new therapeutic approaches properly used dynamic psychotherapy remains the important stand by in treatment of anorexia nervosa, with occasional life saving quality in some particularly severe cases.
1. The family histories, childhood environment, and previous mental health of 38 patients with the syndrome known as “anorexia nervosa” have been examined. They show that parental neurosis, disturbed parent-child relationships, childhood neurotic traits, and previous neurotic illness, are common. These are all features of the “neurotic constitution”.
2. More specific findings are: parental invalidism, hypochondriasis and dietary preoccupations; and, among the patients, earlier feeding difficulties.
3. The personalities of the group are poorly-integrated and show a variety of neurotic traits. Obsessional traits occur in half, but their exact significance for anorexia nervosa is uncertain.
4. Intelligence is nearly always at least average.
5. There is no evidence for constitutional or acquired endocrine disorder in the premorbid clinical picture. The illness itself is explicable without assuming endocrine changes, except for ( i ) compensatory adjustment to undernutrition, ( ii ) a specific mechanism causing the amenorrhoea, when this occurs early. This mechanism probably also causes the amenorrhoea which may accompany other psychic disturbances not specially associated with anorexia or loss of weight. Endocrine therapy seldom, if ever, materially affects the course of illness.
6. The psychiatric symptomatology is diverse. There is no neurosis specific to anorexia nervosa, and no specific anorexia nervosa. We are not convinced that we have been dealing with a psychiatric entity.
7. The prognostic survey shows that the definitive symptoms persist in about half the cases, and that residual neurotic symptoms are the rule. Fifteen per cent. die from the illness or its complications.
8. Treatment is unsatisfactory. A plea is made for a broader and more flexible approach to this problem.