Heathen Talk: Psychoanalytic Considerations of Eating Disorders and the Dissociated Self

ABSTRACT

An intermix of direct behavioral intervention incorporated in a psychoanalytically oriented stance is needed to treat the eating-disordered patient. Symptomatic behaviors too quickly get entrenched and need to be urgently addressed. Particularly with the eating-disordered teen, treatment goals must include immediate intervention with eating behaviors while, at the same time, attempting to reach the disowned part of the patient, often hidden behind bingeing, purging, or other disordered behaviors. This work involves an expansion of the unwitting but often hierarchical structure of contemporary treatment. Understanding dissociation as an interpersonal enactment as opposed to developmental impairment allows patient and therapist to work in tandem to search for the parts of the patient hidden behind food and weight obsessions. The goal is not merely symptom reduction but also to find the part of the patient who is reluctant to enter the room.