The use of transitional objects in self-directed aggression by patients with borderline personality disorder, anorexia nervosa, or bulimia nervosa

Pathological organizations and psychic retreats in eating disorders

A set of characteristic symptoms allow for the relatively straightforward diagnosis of eating disorders. Simultaneously and paradoxically, underlying the eating disorders are a wide variety of personality organizations/disorders, stretching from the neurotic to the borderline and narcissistic, and even to conditions approaching psychosis. This paper will argue that the inherent commonalities can be ascribed to pathological organizations of a similar nature and quality, operational across the spectrum of eating disorders and functioning in a particular, sadomasochistic way. The typical forms that eating disorders take are based on the specific ways that food and the body are used, that is, symptom manifestation. These distinctive symptom manifestations appear to be related to Steiner's (1982, 1993) notion of a psychic retreat. Pathological organizations and psychic retreats are latent until called upon either sporadically or continuously. When activated, these defensive structures operate like a complex psychic skeleton around which the unique psychodynamics of each patient become rearranged and thereby transformed.