[Psychopathology in eating disorders: new trends]

Self-starvation as well as binge eating appears to be far more complex than the uniformity of eating disorders clinical features let us predict. One reason is that these "body-centred" behaviours generate severe biological effects, the complications playing a great part in the recovery process. Furthermore, these disorders which origins are likely to be multi-factorial seem to arise from physiological (ephebic modifications, gene pool...), family and sociocultural factors, psychological features predominating in a synergy always leading to a specificity that cannot be ignored. The progression towards mixed forms made the distinction between anorexia and bulimia nervosa, insufficiently accurate, leading to examine the addictive dimension these troubles have in common. Despite different theoretical surroundings, it has been suggested that an insecure style of attachment may be highly implicated in the disorders occurring. Moreover, a great number of surveys insisted on identity disturbance, and predisposition to intemperate dependency, resulting from the poor quality of internalized relationships. From that viewpoint, both fasting and binge eating appear as a form of addiction meant to mitigate the defense mechanisms failure and the flaws of the psychological organization. Impulsivity appears as a way to avoid processing affects, acting-out being here to balance the ego weakness deriving from the lack of inner security. The fluctuations in the sense of self lead them to self-damaging behaviours meant to vent their pervasive, chronic feeling of emptiness. Occurring whereas the subject still depends on his parents, puberty reactivates a vivid anguish of passivity, and generates attempts to take the control back. Therefore, these patients re-enact in their dealings with food and their body dissatisfaction the pattern of unstable relationships established with their kin, characterized by alternating between merging and rejection, engulfment and remoteness.