ABSTRACT

In previous chapters of this book, I have presented my understanding of how eating disorders develop in adolescents and young adults, and how they may be treated in psychotherapy, a complex but gratifying process. We now must ask how we can prevent such disorders from arising in the ®rst place. Although the answer I give in this ®nal chapter has to be a tentative one because it hasn't been tested systematically, I am convinced that it follows from all that has gone before. I present it in the hope that we can actually learn from clinical experience to forestall the worst psychological handling of the normal Hunger±Satiety drive, which the reader will not be surprised to know I think is a precious asset in our emotional lives, not to be taken for granted. In Chapter 8, we observed that the inadequate care provided Helen by her parents during her infancy and throughout her childhood was followed by the onset of AN in her adolescence. Resolution of this eating disorder seemed to have been brought about by the natural healing forces of the psyche. In Chapter 5, we observed that the inadequate care provided Renee throughout her infancy, childhood, and adolescence was followed by the onset of the BN±AN syndrome when she was a young adult. In Renee's case, cure of her eating disorder occurred during a therapy that supported her healing regression to the ®rst three months of life and new symbolic bondings with her therapist as a new ``mother'' and her Self, which allowed her to redevelop as if she had reborn. I was surprised to ®nd, though perhaps I shouldn't have been, that Renee's renewal occurred in the same sequential steps that I had previously demonstrated to be characteristic of the normal bonding process between parents and infants during the ®rst few months of life (The Symbolic Impetus, 2001), and that gave me a clue as to the way an eating disorder might be forestalled in the ®rst place by healthy handling of the infant's appetitive self. My review of the eating disorder literature, however, failed to turn up case studies with comparable developmental histories against which I could test this hypothesis. I decided, however, to take the hint presented by the cases of Helen and Renee and to explore the premise that primary prevention of eating disorders in adolescents and young adults

required ``good enough'' bonding between parents and their infants during the neonatal period when feeding is such a central part of the adult±child interaction. This made sense to me, because I had already shown in Chapter 2 that faulty parent±infant bonding in earliest infancy was a primary factor in the etiology of infant Trudy's Failure to Thrive.