The essential features of Anorexia Nervosa and Bulimia Nervosa are that the individual refuses to maintain a normal body weight, is intensely afraid of gaining weight, and exhibits and exhibits a significant distortion in perception of the shape or size of his or her body. Some individuals feel grossly over weight. Others realize that they are thin but are concerned that certain parts of their bodies, particularly the abdomen, buttocks and thighs are too fat. The self esteem of the person is highly dependent on their body shape and weight.
The essential features of bulimia nervosa is binge eating and inappropriate compensatory methods to prevent weight gain (e.g. purging or self induced vomiting). The self esteem of the person is dependent on their weight. The type of food consumed on the binge typically includes high caloric foods such as ice cream or cake. The binge however, is focused on the amount of food consumed than the type and is much greater than normal. Bulimia Nervosa is similar to Anorexia Nervosa except they lack the control that anorectic have.
The cause of both disorders is linked to the persons inability to assert their own separate personality if their withes are different than others. Consequently, they don’t feel in control of their relationships in daily life. This produces anxiety and low self esteem. A focus on losing weight as a source of self esteem avoids facing their problems dealing with issues in daily life. Repair consists of focusing on their difficulty in asserting their separate needs if they believe it to be different from the therapist.
Delusional body image
The patient described there is suffering from Bulimarexia. She also has a delusional body image that is characteristic of anorexia nervosa. She was a size 4 but when she made clothes for herself, she made a size 10. She did not see her body but saw herself as much fatter. How does this happen?
Psychoanalytic theory posits that initially an infant who wants the breast hallucinates it and feels gratified by the experience. Eventually, the infant realizes that simply wishing for the gratifying breast does not make it appear. The ability to test reality helps the person distinguish between wishes and reality. Reality testing fails in wish fulfilling dreams that express both the wish and the fear and in anorexia nervosa where the person’s fear of being fat, results in them seeing themselves as fat.