The developmental issues associated with the female bulimic involve issues of autonomy and the urge for developing an identity different from the mother is responsible for the anorexia nervosa and bulimia. The girl places a distance between herself and the mother to secure this autonomy and individuality. The girl believes that she can develop an identity and survive on her own when she is physically separated from her mother. The same gender provides the impression that she and her mother are one, even if physically separated. A blurring of boundaries causes the girl to look for external objects to comfort herself. Bulimic females eat to make sense of relatedness. Then they purge to create an illusion of control over the mother: to reject or as a defense or to incorporate the mother first and then expel her. Disruptions in the primary feeding stage or the oral stage must have instilled a sense of not having had her own way then, and she may have had a loss of confidence about her needs being met. The issue is, therefore, that of autonomy and authenticity.
Refusal to eat may be to reach a goal or purpose, or it may be that this refusal is an expression of some other unresolved idea, as if the illness is a metaphorical expression of another problem. The self-starvation will be solved if we find the purpose behind the action. Hyperactive behavior is seen in patients with bulimia nervosa. Excessive exercising is one symptom. The preoccupation with food is another. Theorists have interpreted the anorexic behavior as a fixation at an earlier stage of development known as the oral stage. Food and hunger are the main preoccupations. Reasons have to be found as to why young girls especially regress to that earlier oral stage.
Susan, a young girl of eighteen years of age, was diagnosed with bulimia nervosa after her parents found that she was not eating at meals. She had lost a great amount of weight and looked emaciated. Results at school showed a decline. They contacted a doctor’s friend and asked for help. The parents were worried that she might be sickening for something. The doctor referred her to a psychiatrist who made the diagnosis of bulimia nervosa. She was using laxatives to purge herself of the food partaken. Her parents were taken aback by this revelation.
The therapist started working on her.
One reason that psychologists indicate is that strong positive or strong negative feelings were produced during the experience of the mother’s influence. This expresses itself as the struggle for autonomy during adolescence. The strong feelings return, and the girl behaves as she used to when much younger. Basically, a psychological process is involved as much as a physiological one. Anyone who has not been fed adequately will always be thinking about food. The reasons for the disorder are perfectionism, anxiety, obsession, low self-esteem, and poor self-confidence.
The central issue is that of control in all the four themes of bulimia nervosa: behavioral, interpersonal, developmental, and socio-cultural.
Individuals sometimes develop a lack of control in different contexts in their lives. In order to handle these crises, they exacted control over their body in different manners, one of which is bulimia. They could also unknowingly exert control over their family and acquaintances. The attempt to make amends for the lack of control was to use the power of control in another activity. This aspect of control is discarded in the therapy. The therapist or the family should make no attempts to control the situation. The goal of therapy should be to influence and not to control. The patient should find a way out. She needs to exert sovereignty over her life. Therapy is not a match of wills. Power is the capacity to bring about tangible outcomes or effect changes in the world. Control is the perception of that ability.
The patient’s power is actually only illusory in nature. She believes that she has to attain power over others so that she is able to take risks in her behavior or thoughts or ideals, or beliefs. The risk-taking behavior allows her to feel that she is in command. This is where the clash of ideas occurs, and she may react with the bulimia.
Bateson, who was a great researcher and contributor to psychology, had different ideas on power. He indicated that power could not be accepted as central to systemic therapy. However, many other researchers believed strongly in the incorporation of power in family therapy. Victim feminism and power feminism have been identified by them. Victim feminism has two components: personal power, which exerts power over one’s body and personal life. Public power is the “use of money and influence to make changes for other women.” Victim feminism is accepted, but power feminism is not as it involves the taking of power from others. Some therapists have deconstructed the power concept. They follow Foucalt, who believed that power exists in interpersonal relationships. Another researcher White sees power as positive and creative. So, the theme of present-day therapy actively avoids control games in treatment for bulimia nervosa. The therapist and client work together to find common ground for creating a collaboration. Self-awareness and goal setting is accomplished. The client is allowed to feel that she is controlling the progression of therapy. The relationship between the therapist and client would be one of complementarity or symmetrically.