Contemporary psychoanalytic perspectives on gorge-vomiting. A case illustration

The purpose of this paper is to bring recent formulations derived from different lines of conceptual development within psychoanalytic theory to bear on the anorectic and bulimic/gorge-vomiting syndromes. A brief review of major trends and conceptual advances in psychoanalytic theory is followed by a clinical case presentation of a hospitalized anorectic and gorge-vomiting adolescent girl. Her chaotic history, vexing clinical picture, and turbulent course of treatment are reviewed. Finally, a comprehensive formulation derived from self-psychology, psychodynamic developmental theory, and object relations theory is advanced with a view toward titrating clinical manifestations to their developmental origin, providing a more comprehensive understanding of symptomatology, and securing the formation of a more accurate treatment program.