ABSTRACT
Since 1980 there has been a virtual epidemic of bulimia and other eating disorders among teenage females. Psychoanalysts have focused on the individual intrapsychic aspects of anorexia and bulimia, with emphasis on the dyadic transference. At the same time, object-relations theory offers a lens for examining the contribution of the marital-parental couple and the family to anorexia and bulimia. Using a combined individual, couples, and family object-relations approach, this chapter discusses the developmental background and onset of bulimia in a teenage girl and illustrates a typical interplay of intrapsychic and interpersonal forces operating in eating disorders. It is important to differentiate epidemic peer-group fad bingeing-purging on the one hand, and post-anorectic bingeing-purging on the other, from the syndrome of true normal-weight bulimia. Because of difficulties around boundary regulation on all levels within the family, the pre-bulimic child comes to share the familial difficulty around self-holding and self-regulation.
