02/23/2019, 16:29, Vienna  DEUTSCH / ENGLISH

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If one wants to psychodynamic interpret the sequential process of a bulimia attack, before the actual start the apparent exclusive relationship of the patients with food is already notable and important; here the mental preoccupation with food exceeds every level and becomes the center of their life design. It is almost as if the whole world is actually replaced with food, which is possibly the immense significance that the mother holds in early childhood. It appears to act as a symbiotic relationship between two people, and others are principle excluded from it, which likely indicates a regression in a pre-oedipal phase. This is supported by the growing lack of interest in the social environment, which, according to Fenichel indicates a "depletion of object occupations" [See Fenichel, 1931, 70; zit. n. Ettl, 2001 22] and represents an equivalent to the feelings of emptiness [See. Ettl, 2001 22].

As immediate trigger for binge eating a loss of object can be seen in its broadest sense, "primal scene" and the model of any trigger situations appear to be the "self-separating-mother" or the persistent feeling of the isolated experienced self separated by the maternal object. Consequently, a perceived diffuse separation anxiety is triggered by the affected, which can occasionally extend to outright panic. This anxiety, however, often only perceived as a "bodily discomfort", which often can not be described in detail and remains diffuse. The fact that the trigger situation that caused the separation anxiety is interpreted as a somatic event (hunger), is evidence of the depth of regression, namely in an early, infantile phase in which the distinction between soma and psyche has not yet occurred. Otto Fenichel and Karl Abraham collectively say that the hunger of the bulimic is designate as a mask behind which a "lust for narcissistic [sic] supply" [Ettl, 2001 39] hides which however needs to be hidden from the superego [See. Ettl, 2001 39ff.]....

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