Status Dynamic Treatment of a Case of Bulimia

Abstract

According to Marshall (1993), bulimic individuals often emerge from families where the methods of parental governance are characterized by excessive coerciveness, disregard for who the child actually is, and insistence on conformity to an a priori template of how the child should be. Later, these methods are adopted by the child in her attempts to control her own behavior. Bulimic binge eating represents a rebellious reaction against these coercive and self-disregarding methods of familial and self governance. Bulimic purging represents a reinstatement of the coercive regime and sets the stage for further rebellion in the future. A critical practical implication of this formulation is that therapeutic emphasis should be placed on changing the self-governance strategies of bulimic individuals. A clinical case is presented in which such a focus resulted in a highly favorable outcome.