[The dialectic of the obsessionality and the dissociativity: toward a psychopathology of binge-eating].
Binge-eating is one of the most paradoxical phenomena in the symptomatology of anorexia nervosa and bulimia nervosa. The patients seem to be struggling to control their eating behaviors as strictly as possible, and at the same time, they repeat chaotic patterns of binge-eating. The author investigated the descriptive psychopathology of binge-eating in this paper. The author recognized the impulsive nature of binge-eating at first, and compared it with the clinical features of so-called impulse control disorders, such as kleptomania, trichotillomania, and so on. According to the literature review, most impulse control disorders tended to show high coincidence with eating disorders. The mode of the coincidence and the alternation of the symptoms suggested the common psychopathologies between eating disorders and impulse control disorders. The author then inquired into their common psychopathologies, and revealed characteristic features which could be formulated as dissociative. The study of the concept of dissociation proved that this formulation was not only valid, but also useful in understanding eating disorders clinically and theoretically. Binge-eating could be regarded as a manifestation of dissociative pathology. The author inquired further into the psychopathologies of eating disorders and impulse control disorders, and revealed obsessional features in these disorders. Though some investigators regarded the symptoms of eating disorders as compulsive behaviors and considered that eating disorders were variants of obsessive-compulsive disorder, the author pointed out some descriptive differences between them. Nevertheless, the obsessionality formed an important basis of the psychopathology of binge-eating. Finally, the author discussed the relationship between the obsessionality and the dissociativity in eating disorders. These two features were reciprocal factors in mental activity, and were forming dialectical dynamism in general psychological functioning. In anorexia nervosa and bulimia nervosa, the opposition between two factors was morbidly rigid and their sublation could not occur. Though the obsessional and the dissociative features of binge-eating were opposite phenomena, it was important to comprehend them as an incorporated psychopathology. The conceptualization of the dialectic of the obsessionality and the dissociativity could also be useful in understanding other psychopathological phenomena such as addiction and splitting.
Hamagaki
S
S
Department of Psychiatry, School of Medicine, Kyoto University.
D000328:Adult; D007174:Disruptive, Impulse Control, and Conduct Disorders; D004213:Dissociative Disorders; D005260:Female; D006801:Humans; D006963:Hyperphagia / Q000523:psychology*; D007175:Impulsive Behavior; D009770:Obsessive Behavior; D011599:Psychopathology