Psychoanalytic Approach to Eating Disorders

NHS states that the average GP will have one to two anorexic patients in their practice. However, this is probably more, as eating disorders are such a secret, and many people do not come forth to be treated. Anorexia is a mental eating disorder, characterised by; refusal to maintain normal weight for ones age and height, (more than 15 percent below predicted weight. intense fear of becoming obese, which doesn’t diminish even with weight loss, body image distortion and absence of at least three consecutive menstrual cycles expected to occur (in women sufferes) For many years psychoanalytic theorists have been interested in the distal influences on anorexia nervosa an extremely common eating disorder. It has been argued that the psychoanalytic approach has made great contribution to understanding mental disorders such as the later, not just through theories, but also through therapies and case studies.

This essay will touch upon the aforementioned topics. It became clear that although the psychoanalytic theory has, and forever will make massive contribution in our understanding of mental disorder, there are many fundamental flaws of the theory. There are many theories under the broad umbrella of psychoanalysis, this essay will begin discussing the personality theories such as the ‘object relations theory’; this psychoanalytic theory describes the process of developing the mind as one grows in relation to others in the environment, primarily the family and especially between mother and child.

Palazzoli proposed an object relations theory of the mental disorder anorexia nervosa. Palazzoli formulated that the anorexic patient identifies her body with her ‘bad’ internalized mother, who has not been integrated with her psyche. The body is internalised as a maternal object, therefore when changes begin at puberty, the child sees this as a direct attack from the internalised mother. The patient’s response is to fight back against the internalised mother by controlling her body through controlling food intake and exercising.

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Therefore the psychoanalytic approach proves to have contributed to our understanding mental disorder greatly. However, one weakness of this theory would be that the theory is highly theoretical, therefore all data is based on a concept that cannot be verified objectively. On the other hand, Art therapy has qualities which are integrated with the object relations theory allowing the patient to express unconscious internal material without activating defence mechanisms, proving the psychoanalytic theory to be key in our understanding of mental disorder.

Another personality theory that comes under psychoanalysis would be Freud’s theory of psychosexual development. Freud expressed that if there was any problem at any of the stages of development, stressful experiences would arise in adult life through regression. The link from this theory to anorexia nervosa or bulimia nervosa would be fixation in the phallic stage of development (3-6), Males have the capacity to develop the Oedipus complex, while females, the Electra complex. At this stage children begin to differentiate between male and females through genital awareness.

Males are intrigued by their mothers and are jealous of their father’s intrusion, resulting in castration anxiety. In the case of the female, she is attracted to her father, and realises that she doesn’t have a penis, this leads to penis envy and the wish to be a boy, she too internalises these feelings. However Freud argued that fixation for both male and female children can occur at this point through displacement of their ‘feelings’ onto their bodies thus resulting in vanity, preoccupation with body shape, and anorexia.

Freud (1889/ 1954) likened eating disorders to " a melancholia occurring when sexuality has been underdeveloped…Loss of appetite is in sexual terms loss of libido". Ironically Freud’s daughter suffered from anorexia. While this psychoanalytical explanation is effective in helping to understand mental disorder such as anorexia there are weaknesses; perhaps one of the biggest weaknesses is that Freud doesn’t place enough emphasis on culture or society and how both factors play a massive role in a child’s behaviours.

Erickson argues that too much emphasis is placed on sexual urges and not enough on later factors, and many argue that much of freuds work is highly reductionistic. However it could be urged that Freud provided a valuable insight into how early experiences affect adult personality and how these fixations can lead to psychological problems and mental disorder in later life. Another weakness put forth was one by neo Freudian Karen Horney; she argued against penis envy and claimed that this was merely a woman’s envy of men’s power in the world, which was justified.

She also claimed that womb envy occurs just as much in men, and that men were envious of a woman’s ability to bear children. This therefore faults Freuds psychosexual theory, indicating that the psychoanalytic approach does not necessarily contribute to the understanding of mental disorders. The anal stage of the psychosexual model is also thought to be able to give a plausible explanation as to why mental disorders occur, i. e. anorexia nervosa.

It is thought that the anal stage is when a child learns to control excretion and that fixation occurring at this stage could lead to power struggle, between the child and parent. Thus the child may feel the need to gain autonomy over themselves and their bodies, therefore creating an illusion of control and this could lead to mental disorders such as anorexia nervosa or bulimia nervosa. It is also thought that children experiencing conflicts at the anal stage can develop anal personality traits, namely those associated with orderliness, cleanliness or compulsion.

The ‘anal retentive’ personality is thought to be compulsive, and a perfectionist. This easily links with mental disorders such as anorexia nervosa. This proves the psychoanalytic approach to be key in our understanding of mental disorders. One criticism however is that most of Freud’s work is based on findings of case studies, single individual cases are often unique and there are problems with generalization, as individual differences occurs every day in amongst people, therefore results for one individual may be different for another.

Although it has been argued that the order of behaviour and age ranges of the psychosexual stages are correct, thus giving us a deeper insight and better understanding of the contributions made from psycho analytics to childhood and mental disorder later on in life. Perhaps the most obvious link between Freud’s sexual stages and mental disorder such as anorexia nervosa is the ‘oral stage’ this stage is from around 0 to 18 months and is the first stage in the psychosexual model.

It could be formulated that a child fixated at the oral stage could be preoccupied later on in life with food, thus, leading to anorexia nervosa. Supporting evidence for this was carried out by Jacobs at al (1966) using Rorschach inkblots to compare the orality of smokers and non-smokers. It was found that smokers emerged as possessing oral personality types, as this personality type is preoccupied with anything to do with the mouth, i. e. Thumb sucking, smoking, masticating and most obvious: eating, therefore mental disorders such as anorexia may be more likely to occur in these types of individuals.

Thus the psychoanalytic contributes greatly to our understanding of mental disorder as the theory provides us with studies. On the other hand a weakness would be that the psychosexual stages model is simplistic and naive, as the assumption that only childhood experiences cause harm to the personality and that later experience are not harmful is simplistic. It could also be labelled deterministic, as the model implies that all children who are fixated at particular points in the stages will develop some sort of mental disorder which is untrue.

Mental defence mechanisms also play an important part in the psychoanalytic theory of mental disorder. Freud theorised that a defence mechanism is a tactic developed by the ego to protect against anxiety and to safe guard the mind against feelings that society may look down upon or that are too difficult for the conscious mind to cope with. One important defence mechanism would be ‘displacement’ it is believed that the affect of painful memories that the mind can’t cope with can be displaced and then attached to another memory. This could be the case with many patients suffering from an eating disorder. i. e. Mary was sexually abused as a child. She doesn’t know how to cope with this, people at school then begin to bully her and call her fat. therefore her ego uses the defence mechanism of displacement, and displaces the bad memories of sexual abuse onto food, and refuses to eat and then develops anorexia.

This shows how greatly the psychoanalytic theory contributes to our understanding of mental disorder. The case of the wolf man supports the theory of displacement. The wolf man first came to see Freud in 1910 with body dysmorphic disorder; The essential feature of this disorder is a preoccupation with an imagined defect in appearance or disproportionate concern with a slight physical anomaly. Wolf man suffered from anxiety and depression and approached Freud for treatment, explaining that he would have a recurrent dream that would wake him up on most nights.

He would dream that he could see six white wolves sitting on a walnut tree staring at him outside of his window – the sight terrified him. Freud traced all his problems back to childhood neurosis. It turned out that when wolf man was around two years old that he had woken up and had seen his parents having sexual intercourse. The violence of this act had terrified him and since then he had been dreaming about and had developed a fear of wolves.

It was argued that wolf man could then have seen copulation between animals in the papers and then have displaced this onto his parents. This is because the memory of seeing his parents having sexual intercourse had frightened him so much that the defence mechanism ‘displacement’ arose. In order to safe guard his conscious mind. This case study is proof that the psychoanalytic approach deeply aids us in understanding of mental disorders. However, it has been argued that there was no ‘unconscious’ and that all mental activity was conscious. The unconcious is also unfalsifiable and lacks explanatory or predictive value.

Throughout this essay it may seem that the psychoanalytic approach contributes to our understanding of the mental disorder, which is supported by case studies and theories however there seem to be many weaknesses of the theory suggesting that theories may need to be revised and tweaked in order to provide us with substantial theories to explain mental disorders such as anorexia nervosa. In conclusion it seems that although the psychoanalytic approach has been influential and has many strong points, overall the theory is slightly discredited and doesn’t contribute to our understanding of mental disorder in the case of anorexia nervosa as much as it should for a theory that has been standing for so many years.

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