Exploring the inner world of severely disturbed bulimic women: Empirical investigations of psychoanalytic theory of female development.

Abstract

ince its inclusion as a distinct psychiatric disorder in the Di-S agnostic and Statistical Manual of Mental Disorders, 3rd ed. (DSM-111; American Psychiatric Association, 1980), bulimia nervosa has been under intense scientific scrutiny to delineate its core behavioral features and to explore its biological, psychological, and social causes. In this chapter we undertake a limited review of theory and empirical research and report on a recent project in which psychoanalytic formulations of bulimia were tested in aWe extend special thanks to Mark A. Blais for statistical consultation. We also thank Gary Harrington for his role in creating the electronic database used in this study and to the Erik H. Erikson Institute at the Austen Riggs Center for financial, technical, and conceptual support in conducting this project.

Dependent and autonomous interpersonal styles and level of differentiation among male patients with eating disorders.

“…A recent meta-analysis found that the MOA Path yielded a high criterion validity effect size (Monroe, Diener, Fowler, Sexton, & Hilsenroth, 2013). Moreover, the MOA path was found to be significantly lower in female patients with EDs compared with non-ED controls (e.g., Fowler et al, 2002).…”

“…Eating disorders reflect the interaction of multiple, complex, interdependent, and multidimensional biopsychosocial determinants. From a psychological, developmental, object-relations perspective, EDs may be conceptualized as entailing a struggle with identity in the context of the dependency-autonomy conflict, transferred to the realms of food and body (Fowler, Brunnschweiler, & Brock, 2002; Sands, 2003). Patients with AN are struggling toward autonomy may deny any need for dependency, either on human objects or on food, and are likely to regard their active refraining from food as serving to organize their sense of self-worth and their identity (Goodsitt, 1997).…”

“…Patients with AN are struggling toward autonomy may deny any need for dependency, either on human objects or on food, and are likely to regard their active refraining from food as serving to organize their sense of self-worth and their identity (Goodsitt, 1997). In contrast, patients with BN are often ambivalent regarding dependency and constantly vacillate between dependence and independence, expressed both in the realm of food and in the context of interpersonal relations (Fowler et al, 2002). Sands (2003) suggests that all ED subtypes are characterized by using and controlling the body to defend against any experience of dependency-related needs.…”

Criterion validity of the Rorschach Mutuality of Autonomy (MOA) scale: A meta-analytic review.

“…The MOA pathological score is particularly successful at discriminating between clinical and nonclinical populations. For example, the MOA pathological score has demonstrated effectiveness in distinguishing bulimic patients (Fowler, Brunnschweiler, & Brock, 2002)-as well as borderline patients with and without self-mutilative behaviors (Baity, Blais, Hilsenroth, Fowler, & Padawer, 2009)-from nonclinical controls. The MOA pathological score has also successfully discriminated between individuals with borderline pathology and those diagnosed exclusively with Axis I conditions (Zodan, Charnas, & Hilsenroth, 2009).…”