Eating Disorder Pathologies
Professor Arthur H. Crisp
The term 'eating disorder' reflects the trivialisation of these profoundly damaging illnesses which are rooted in dyslipophobia (distressing fear, common in the adolsescent female, of normal body 'fatness'). It is widespread in teenage female populations. It is less dictated by fashion and a more enduring property than is often recognised.
Anorexia nervosa, the most severe of the eating disorders, reflects an avoidance of this phobic object enabled by the selective reversal of the underlying pubertal process through the mechanism of severe dietary calorie restriction. The disorder, which is egosyntonic, thereby aborts/holds at bay the underlying and otherwise overwhelming adolescent developmental conflict that puberty, sooner or later, has precipitated.
The state is biologically unstable and requires the afflicted person's constant vigilance if it is to be sustained, and the impulse to ingest and gain weight resisted in the presence of plentiful supplies of food. Its egosyntonicity and associated denial and concealment of the core psychopathology often renders any symptomatology difficult to identify and attribute to the disorder. Such symptomatology is either a product of the disorderd metabolism or else rooted in the repertoire of behaviourally expressed defences necessary for maintenance of the state.
Disordered metabolism can express itself within any of the bodily system. Vomiting and diarrhoea are two common expressions of desperate strategies designed to protect against weight gain after having surrendered to the impulse to ingest. Hyperactivity in work/lesuire can be another feature. Control of the environment is paramount and can express itself in terms of deceit, ritual, social phobias, tantrums and other manipulations. Cigarette smoking, as a defence against ingestion, in teenage females is importantly driven by dyslipophobia and can also operate powerfully within anorexia nervosa. Alcohol and other drug uses fulfil a variety of defensive purposes.
Although the disorder to some extent serves as a defence against depression, it can also ultimately lead to exhaustion and terminal depression as others give up and isolation becomes complete. Untreated anorexia nervosa carries a high mortality with approximately half of this occurring as suicide. With certain treatments this can be reduced significantly and recovery and normal fecundity become more common.
Crisp, A.H., Joughin, N., Halek, C. and Bowyer, C. (1989) Anorexia nervosa and the Wish to Change: Selfhelp and Discovery, the Thirty Steps. 2nd Edition. Hove: Psychology Press.