[Psychogenic determinants of bulimia nervosa].
Eating disorders, especially bulimia, are considered to be the most sensitive barometer of the process of Westernisation and (partly for this reason) cultural, family and psychological factors seem to play a key role in their aetiology. The increase in their frequency can be linked with the significance that is ascribed to the body and eating in Western culture. Viewed from the psychodynamic perspective, eating disorders are treated as a formed by a culture symptomatic manifestation of dysfunction of very varied personality, neurotic and prepsychotic mechanisms. They are expressed through a person's attitude to their own body and eating. The relation between the body and food may be treated as a metaphor of the relation of the female patient with various aspects of herself and significant persons in her life. The mechanisms of arising of psychological bulimia and anorexia are convergent in this model. Differences in the clinical picture are linked with the strength of mechanisms of control. In the case of anorexia nervosa restrictive type, we are dealing with complete control over the body and eating as an expression of denial of various desires and impulses. In the case of bulimia nervosa and bulimic symptoms in anorexia nervosa, we observe the occurrence of alternate yielding to desires and impulses in the act of eating and a denial of yielding to them in vomiting and other compensatory behaviours. An attempt to understand the links between the individual bulimic psychopathology of the patient and functioning of the family system constitutes an important supplement to the above theories. Many authors draw attention to the similarity of functioning of families with anorexia and bulimia. Open and stormy expression of tension is typical for bulimic families, as are various traumas concerning children. The conceptions presented above should be considered to have practical significance in the course of therapy rather than as exhaustive descriptions of all determinants of eating disorders.
Pilecki
Maciej Wojciech
MW
Klinika Psychiatrii Dzieci i Młodziezy, Uniwersytet Jagielloński Collegium Medicum, Kraków. mzpileck@cyf-kr.edu.pl
D000856:Anorexia Nervosa / Q000523:psychology; D001294:Attitude to Health; D052018:Bulimia Nervosa / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D005260:Female; D006801:Humans; D015994:Incidence; D012649:Self Concept