The Psychology of Eating: From Healthy to Disordered Behavior

238 Eating Disorders

needs may not be able to identify and understand their own internal states.
Other research has argued that the binge–purge cycle shown by bulimics
and some anorexics may represent a conflicting relationship between the
sufferer and her mother, with the binge symbolizing the desire to be close
to the mother and the purge reflecting a desire to reject her (Goodsitt, 1997).
In summary, a psychoanalytic approach emphasizes the function and
symbolism of symptoms and the role of relationships developed in childhood.

Problems with a psychoanalytic model
There are the following problems with a psychoanalytic model of eating
disorders:

• A psychoanalytic model can explain why those with eating disorders
  are predominantly women, and may explain why eating disorders are
  a problem for the West. These factors, however, are not explicitly
  addressed by the model.


• The model does not address what factors have changed over the past
  decade to result in the increased prevalence of eating disorders.


• Some psychoanalytic models describe symbolic meanings of symptoms
  which are considered to apply universally to all sufferers. For example,
  models which take a more Freudian analysis suggest that food means
  oral impregnation and fullness means pregnancy. This analysis does
  not allow for individual differences in the meaning of symptoms. More
  recent analyses, however, do emphasize personal rather than universal
  meanings.


• A psychoanalytic model explains the maintenance of a disorder but does
  not explain why childhood relationships are expressed through food avoid-
  ance. It is a model of perpetuating rather than causal factors.


• A psychoanalytic model is difficult to test and evaluate.


• The focus on the unconscious requires interpretation by the analyst.
  As with all therapies which involve interpretation, it remains unclear
  whether the psychoanalytic formulation is the therapist’s or the patient’s.

A cognitive behavioral model of eating disorders

Cognitive behavioral models of eating disorders draw on the central
components of behaviorism such as classical and operant conditioning, and
focus on concepts such as reinforcement, the stimulus–response process,