Psychodynamic Treatment of Anorexia Nervosa and Bulimia

Early treatment literature on anorexia nervosa and bulimia reported almost exclusively on brief treatment approaches that entailed either psychopharmacological or cognitive-behavioral interventions. While this literature demonstrated that one-third of these patients were treatable with brief therapy and another one third showed improvement, the final one-third of these patients did not respond to brief interventions. Recent research indicates that this last group of patients may also suffer from significant personality disorders or Axis II co-morbidity. Considered difficult to treat, these patients require longer term, informed individual psychotherapy. Designed specifically to address the challenges of this difficult-to-treat population, this volume is the first to focus exclusively on exploring eating disorders from a psychodynamic perspective.
Chapters are written by foremost clinicians in field who examine their current views regarding the etiology and treatment of this client population from a psychodynamic perspective. Part I, focusing on aspects of the self and questions of technique, covers such topics as the role of interpretation of transference and resistance; the relationship of bulimia, dissociation, and empathy; eating disorders as displacement from psychological self to body self; boundaries in the psychotherapeutic relationship; and an interpersonal psychoanalytic technique for treatment. Part II, addressing special subpopulations, discusses the implications of treating eating disorders with patients who also exhibit masochism, borderline personality disorder, and false-self/narcissistic disorders. This section also includes a unique chapter that delves into gender identity issues in male bulimia nervosa. Part III, reflecting feminist psychodynamic perspectives, offers new ways of thinking about development, countertransference, and the role of therapist in the treatment of women with eating disorders. Part IV examines the integration of such approaches as object relations and family systems, psychodynamic and behavior therapy, and offers discussion on disorders of the self in anorexia nervosa.
Written primarily for the advanced clinician who treats clients with eating disorders, PSYCHODYNAMIC TREATMENT OF ANOREXIA NERVOSA AND BULIMIA is a valuable resource for psychiatrists, psychologists, social workers, and other mental health practitioners who work with this difficult-to-treat population. It also serves as supplementary reading for advanced graduate courses that feature a component on eating disorders.

Craig L. Johnson, Laureate Psych. Clinic, Tulsa, Oklahoma.