A comparative exploration of the internal object relations world of anorexic and bulimic patients

Abstract

This explorative qualitative research investigates whether there is a difference in the symbolic meanings between the bulimic’s behaviour of purposefully expelling food versus the anorexic’s deprivation of food by administering the Thematic Apperceptive Test, as well as, conducting in-depth, semi-structured individual interviews with two bulimic women, two anorexic women of the restrictive sub-type and one anorexic woman of the binge-eating/ purging sub-type, whose ages ranged from twenty-one to thirty-five years of age. Both the conscious and unconscious themes that emerge from their stated relationship with food and their TAT responses are explored, with particular interest being focused on whether the symbolic meaning of food is in essence a “symbolic equation” for an object, specifically the mother and parental couple. The concept of “symbolic equation” is explored analytically from a Kleinian perspective to ascertain whether it is not food, per se that the anorexic is depriving herself of or that the bulimic suddenly and uncontrollably ingests, but then rapidly and violently expels. On the contrary, it appears that the refusal to introject or the ambivalent battle between introjection and expulsion of food is used as a disguise for the underlying conflictual object relation/s. The modified version of the Bellak Scoring System (1986) was used to analyse their TAT responses in order to elicit the themes that represent their internal worlds and object relations. Individual thematic content analysis was conducted on each interview transcript separately, and then a comparative analysis performed to explore commonalities and differences across the transcripts and TAT responses amongst the three anorexic women as a group and the bulimic women as a separate group. After which, the two different eating disorder groups were compared to explore both their differences and similarities. The findings suggest that a variety of conscious and unconscious motives might best be understood within the historical context of each participant’s early development and family dynamics. It appears that the anorexic is unconsciously motivated, at least partly, by her desire to repudiate any experience of dependency, separateness, loss, frustration, envy, fear, guilt and helplessness. Conversely, the bulimic appears to be motivated, at least partly, by the repetitive magical quest to restore a ‘good’ self-object bond and to stifle her destructiveness. Nonetheless, underlying both the anorexic’s and the bulimic’s illness is an ambivalent struggle with internalising a gainful and durable link to an object, which can in some way be permitted to be ‘good’. This appears to have its origin in the mother-daughter relationship, father-daughter relationship, parental couple, as well as, the triangular space between the mother-daughter-father link.