**A Psychological Profile of the Body Self Characteristics in Women Suffering from Bulimia Nervosa**

Bernadetta Izydorczyk

*Department of Clinical and Forensic Psychology, University of Silesia in Katowice, Poland* 

## **1. Introduction**

146 New Insights into the Prevention and Treatment of Bulimia Nervosa

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Bulimia nervosa appears to be a significant medical condition and a serious social problem since it requires long term and multi-dimensional treatment, and its incidence rates among young generation (predominantly women), has incresed significantly in recent years. The results of scientific research described in psychological and psychiatric literature point to a variety of factors that contribute to development of this eating disorder [Fairburn, Harrison, Lacey, Evans, Thompson, Cash, Pruzinsky, Garner, Józefik, Głębocka, Rabe Jabłońska,

Dunajska, Mikołajczyk, Samochowiec, Schier]. The most significant underlying factors include: biological disturbance of hunger and satiety sensing, familial factors (early childhood emotional deficits and traumatic experiences), socio-cultural factors (body image disturbances which develop as a consequence of the "terror" of a slim body, which is being promoted as the only way to success in life), as well as some individual factors such as impulse regulation disturbances, impulsivity, low frustration tolerance, neuroticism, perfectionism, obsessive-compulsive, borderline or histrionic personality disorders [Lacey, Mikołajczyk, Samochowiec]. Lacey and Evan, who defined the concept of Multi Impulsive Personality Disorder, included bulimia nervosa among its major symptoms [Lacey].

In the light of the recent psychological literature, cognitive and emotional body image disturbances are regarded as significant factors behind development of anorexia and bulimia nervosa [Thompson, Cash, Głębocka, Kulbat, Rabe Jabłońska, Schier]. However, far less scientific research is devoted to body image and the body self distortions in individuals suffering from bulimia nervosa [Rabe-Jabłońska, Dunajska]. The recently observed higher incidence of bulimia nervosa (especially among women), compared to anorexia nervosa, seems to point to a multitude of factors that determine development of this disorder. It also indicates the spread of the cultural cult of "ideal and perfect" body image, and the tendency to conform to social norms regarding physical appearance ("what I should look like") and to disapprove of one's current body shape, which is being promoted as a key to success in life. Thus it can be stated that adequate medical care as well as the quality of family, professional and social roles performed in life significantly support a psychological diagnosis of the body self structure, and determine effective therapy for bulimia nervosa.

It is a psychological diagnosis of body experiences and body image in anorexia and bulimia nervosa that I have focused on in my many years of scientific research and therapeutic work with bulimic and anorectic patients [Izydorczyk, Bieńkowska, Klimczyk].

A Psychological Profile of the Body Self Characteristics in Women Suffering from Bulimia Nervosa 149

clinical analysis conducted by Sugarman demonstrates that bulimic females tend to encounter problems in relationships with their mothers. The daughter's ambivalent identification with the mother and her body and femininity, determines the development of pathological behaviours that affect the body such as uncontrolled binge eating and purging. Sands, who represents the object relations perspective on the concept of the self, refers to Kohut's view and argues that bulimia nervosa "compensates" the deficits in the self-object functions that are initially provided by the mother [Sands]. She claims that a bulimic individual identifies him/herself by his or her symptoms with the false, perfectionist self, created under the influence of the person's narcissistic care-givers. Thus food becomes a substitute for the self-object. It is the bridge between the self and the self-object, and the significant transitional object whose role is to regulate the bulimic individual's affective states. The bulimic self (that is the body self) is expressed through body language and represents the primitive need for dependence and separation. Binge eating symbolically compensates for the need for care and dependence, and self-induced vomiting symbolizes

Excessive preoccupation with body appearance, which is a natural consequence of developmental changes that occur during adolescence and emerging adulthood, may lead to body-size dissatisfaction among women with low self-esteem, who have experienced some developmental deficits. This in turn triggers the development of eating disorders such as

According to the psychoanalytic approach, body experiences correlate with the development of an individual's sense of identity. Lowen clings to the opinion that "in fact, a person has a double identity – one of them stems from identification with the ego, the other is related to identification with the body and the feeling regarding it" [Lowen]. Meissner established the basic terminology regarding the body and its image. He defined the body as an actual physical organism. He used the term "the body self' to refer to a psychic structure that forms an integral component of the person's self system. Body image is, according to Meissner's definition, a system of images organized into representations of the body [Krueger]. When dealing with the issue of body experience, Bielefeld distinguished between the body schema and body image [Schier]. The body schema comprises the following components: body orientation which refers to the orientation towards the internal structure of the body as well as its surface; body size estimation (i.e. estimation of the volume, mass, length, and surface area of the *body);* body knowledge (i.e. the knowledge of the body structure and body parts) [Schier]. Body image, as described by Bielefeld, comprises such components as body consciousness which refers to a psychic representation of the body or its specified part perceived at a conscious level; body boundaries (i.e. a sense of separation between the body and the external world); body attitude, that is a person's attitude towards his or her body, measured in terms of positive or negative body perception (body image

Krueger defines the notion of body image, at its early stage of development, as a system of primary bodily sensations. He shares Mahler's view that a sense of touch is the factor behind the emergence of a primitive sense of self. Tactile sensations facilitate the development of the primitive "skin ego" which forms the foundation of a sense of body self [Krueger]. A sense of body boundaries allows to differentiate self from non-self. Empathic resonance between the mother and the child stimulates the process of internalization of reciprocity and affirmation, and consequently determines the development of self-efficacy [Krueger, Schier]. The body boundaries form the foundation for psychological boundaries.

the need for self-identity and for separation from the object [Sands].

bulimia nervosa.

satisfaction and dissatisfaction) [Schier].

In an attempt to provide a psychological profile of the body self characteristics, I have referred to cognitive [Fairburn, Thompson, Cash, Pruzinsky, Głebocka, Kulbat, Rabe-Jabłońska, Dunajska, Izydorczyk] as well as psychoanalytic concepts [Schier, Krueger, Lowen, Pervin, Tyson]. I have operationalized the body self variable and conducted statistical and clinical analysis of the research data using psychometric methods and a projective technique. I adopt terminology which is used in the field of cognitive psychology (e.g. body schema, body image, body self-evaluation, the actual self, the ideal self) and psychoanalysis (e.g. the body self, interoceptive awareness, acceptance of psychosexual development, maturity fear).
