Binge eating disorder: The subjugation of the “hungry self”.

Abstract

The “hungry self” is a self- and body-state (Petrucelli, 2015) characterized by profound need and accompanying frustrated rage that develops because of childhood maltreatment, which is prominent in patients with binge eating disorder (BED). In these patients, this part of the self is sadistically subjugated to a greater or lesser extent by another part of the self, developed through a powerful identification with an abusive parental figure. Binge eating episodes are a channel through which to express these otherwise subjugated affects which remain more-or-less dissociated from the patient’s conscious mind in her day-to-day life. Central to the treatment of BED is the facilitation of the outward expression, in the transference, of aggression, as this supports the patient’s efforts to break free of the experience of emotional subjugation and can, over time, facilitate her capacity to express these important affects in new relational contexts.

From symptoms to subjective and bodily experiences: the contribution of the Psychodynamic Diagnostic Manual (PDM-2) to diagnosis and treatment monitoring in eating disorders

“…Additionally, ED patients may report feeling that their body changes continuously and unpredictably [99,100]. ED symptoms such as starvation, thinness, and binge eating may be underpinned by an underlying set of values triggered by a disturbed body experience [101]. This may relate to experiences of pathological failure in early maternal responsivity and maternal impingement, resulting in a mind-body split and what has been defined by Bach [102] as a "disembodied self."…”

“…Consistent with Bruch's [74] hypothesis that ED patients demonstrate an "interoceptive problem"-that is, difficulty distinguishing between inside and outside and between self and other-the S Axis suggests that, for many ED patients, food and the body become the primary targets of selfexpression. Specifically, in the face of unprocessed trauma and emotions, the body may become the tool with which individuals with EDs desperately attempt to gain mastery and control over their feelings [101]. For instance, they may misread the somatic sensation of hunger as a subjective feeling of emptiness or a desire for emotional bonding; alternatively, binge eating or elimination behaviors might be psychopathological correlates of underlying identity diffusion or dissociation.…”

“…This implies the need for an in-depth evaluation of ED patients' experiences and perceptions of their body and bodily symptoms to inform patient-tailored interventions. As eating pathologies may be viewed as disorders of self-regulation that center on the body [101], ED patients' somatic experiences might be particularly relevant to their treatment. Accordingly, the body must be considered a psychotherapeutic tool that can help therapists connect with and respond to patients' "unformulated experiences," through the identification and containment of bodily sensations and affects, and their articulation in words.…”

“…Moreover, therapists must use their own bodies as a medium for picking up non-verbal information from ED patients. In this way, they may better understand patients' bodily experiences [101], which may contribute to strengthening the patient-therapist relationship-one of the most robust predictors of therapy outcome [112].…”

Typological features of eating disorder patients: A review of publications

“…The central focus in the treatment of eating disorders involves facilitating the external expression of aggression through transference, as this supports the patient's efforts to free themselves from the experience of emotional subordination. Subsequently, it may enhance the patient's ability to express these emotions in new relational contexts (Wooldridge, 2022).…”