ABSTRACT
This chapter presents the history of diagnosing and treating anorexia nervosa (AN) and bulimia nervosa (BN). It describes the evolution of understanding anorexia within psychoanalysis, from the initial understanding of Freud and Drive-Defense model, through Object-Relations model, to self psychology. Describing the key concept of selfobject, the chapter suggests that eating disorders reflect a deficit of the sense of self. Such conceptualization offers explanation to central characteristics of eating disordered patients, such as self guilt and self deprecation, as well as to the therapeutic negative response often found in the treatment of those patients. Lastly, self psychology advocates a special therapeutic stance that emphasizes attunement to the needs of the self from an experience-near position. By comparing self psychology to other contemporary approaches, mainly the Kleinian approach and relational psychoanalysis as well as CBT and family therapy, the chapter highlights the similarities across such approaches in the understanding of eating disorders. Finally, the chapter describes issues of epidemiology, gender distribution, and prevention.
