Listed below are articles written by Doctors, Therapists, Nutritionists, and others who have worked in the field related to Eating Disorders Awareness and Treatment. If you have an article you'd like to submit, please e-mail it to: [email protected] (include the article, the proper credits and any links you'd like to appear).

SELF-MEDICATION, TRAUMATIC REENACTMENT, AND SOMATIC EXPRESSION IN BULIMIC AND SELF-MUTILATING BEHAVIOR

by: Sharon Klayman Farber, Ph.D., B.C.D.

ABSTRACT: A psychoanalytic framework provided direction for research on the association between binge-purging (bulimic) and self-mutilating behaviors, comparing them for similarities and differences. The similarities in the multiple functions and psychosomatic processes served by these behaviors are presented, as well as the phenomenon of symptom substitution. Both behaviors tend to be practiced by those with severe personality and dissociative disorders and posttraumatic stress disorder. Both serve ego-compensatory needs in the absence of the adequate ability to regulate and modulate emotions, moods, and tensions. They may serve as compensatory attempts to differentiate self and object, define and differentiate body boundaries, master severe childhood trauma by means of psychophysiological addictive reenactments, and to express emotion.

KEY WORDS: bulimia; self-mutilation; addiction; trauma; symptom substitution.

People who binge and purge and those who self-mutilate embody the theme of the 1995 conference, Mind, Memories, and Metaphors. Paradoxically, these apparently self-destructive behaviors have the capacity to alleviate psychic pain in some individuals, and serve other restorative, redemptive, cleansing and healing functions (Farber, 1995a). Lacking the ability to use metaphor or symbol to express emotion or unspeakable pain, their acts of self-harm may serve to narrate that which their minds cannot remember and their words cannot say. The author has come to know this from her years of clinical practice and from her research on the association between binge-purge behavior and self-mutilating behavior, a study which compares binge-purging behavior and self-mutilating behavior for similarities and differences (Farber, 1995a). The similarities in the multiple psychic functions and psychosomatic processes served by these behaviors will be presented, along with their implications for assessment, engagement, and countertransference.

DEFINITIONS

Binging is the consumption of large amounts of food, usually in a concentrated period of time. Purging is the deliberate concrete attempt to undo the binge, usually by self-induced vomiting and/or laxative abuse, enemas, or diuretic abuse. Excessive exercise and long stays in a sauna may function as variants. Self-mutilation is the infliction of injury to ones body resulting in tissue damage or alteration. It occurs primarily among the mentally retarded, psychotic patients, prisoners, and in personality disordered patients (Favazza, 1987; Simeon, Stanley, Frances, Mann, Winchel, and Stanley, 1992; Walsh and Rosen, 1988; Winchel and Stanley, 1991). A variant of self-mutilation is body modification, a passive form in which an individual engages another to mutilate his body, as in the increasingly popular practices of tattooing, body piercing, decorative scarification, and branding (Juno and Vale, 1989).

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©1997 Sharon Klayman Farber, Ph.D., B.C.D. Reprinted with Permission.

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