Meaning, metaphor, and metabolization: the case of eating disorders.

Eating disorders mark deficits in the ability to be nourished and to symbolize embodied experience. Such deficits can be traced to difficulties in early relationships that inhibit the development of self-regulatory functions and the progressive differentiation of self from other. Often, we find mothers who are insufficiently developed, leaving the child either austerely avoiding intrusion or struggling to digest maternal provisions without becoming lost in them. Explorations that link anorexia to deficits in symbolization are in line with psychoanalytic theorizing that marks the concretization of meanings in anorexia. Bulimia, in contrast, has been linked to deficits in self-regulatory capacities that are not necessarily tied to deficits in mentalization. Clinical experience suggests that people with bulimia are often "failed anorexics" who have achieved higher levels of self-development. Case examples explore some of the dynamics underlying such difficulties and how metaphors aid the work with those for whom embodied experience remains largely unsymbolized.