Bulimia: a historical outline.

The frequent occurrence of the eating disorder bulimia and major scientific contributions raise the question as to its origins, history, and course. Considerable information exists on bulimia. This paper reviews the historical references to the disorder from the first recorded report to the present (2,500 years ago to ca. 1970). The concept of bulimia has undergone various changes, beginning with a monosymptomatic, and leading to a polymorphous clinical picture. In addition, after being fused with the concept of kynorexia (incessant voracious eating followed by vomiting), the concept of bulimia has again attained a unified manifestation. Some symptoms appear to have taken on a different evaluation in time. All this must be seen in the context of the multiple changes which the concept of bulimia has undergone. Its characteristics justify neither a "new" disorder nor, as a consequence, an additional name.

[Bulimia]. / Bulimie.

In a literary synopsis we inform about eating addiction or binges already known in antiquity and differentiated as bulimos (fames bovina) respectively as kynorexia (fames canina), partially in a still true description. The syndrome, occurring increasingly since one decade, consists of periodically pathological and excessive devouring of food, mostly consecutive restrictive diet and/or vomiting, use of laxatives, depressivity, experience of shame and guilt s.o. At a prevalency of 5% of the (psychiatric) patients mainly women (95%) are concerned, showing a postpubertary begin of disease. In spite of certain connexions to the anorexia nervosa we have to define the bulimia as its counterpart. The different etiological conceptions suppose an epilepsy-like disorder, an attachment to the (endogenic) depression or the presumption of neuro-endocrine events. Largely it is applied to intra- and interpsychical neurotic conflictuality, though actually behavioristical aspects seem to be preferred. The therapeutic intentions comprise anticonvulsives and antidepressives in view of medicamentous treatment; the psychical treatment comprises psychoanalysis, outpatient and inpatient clinical psychotherapy and all actually usual methods up to self-help groups.

[Bulimia]. / Bulimie.

For the last decade the bulimia syndrome, known since Antiquity, has been observed to be on the increase, predominantly among females, the onset of the disease occurring after puberty. Symptoms, connections with anorexia nervosa, aetiologic and pathogenetic aspects, and therapeutic approaches are being discussed.

[An undisguised case history in an example of contemporary literature. Psychoanalytic reflections on K. Struck's "The Mother"]. / Die unverstellte Krankengeschichte in einem Beispiel zeitgen5AOSSISCHER Literatur. Psychoanalytische Betrachtungen zu K. Struck: Die Mutter.

The novel "The Mother" by K. Struck describes the protagonist's intensive experiences between her great desires, disappointment and hatred. In this connection her own disturbed child-mother relation and its negative effects on her relation towards other persons and her mother role is revealed. Thy are explained by psychoanalytic principles.

[Prognosis of anorexia nervosa in adolescence]. / Zur Katamnese der Pubertätsmagersucht.

A group of 28 patients with anorexia nervosa, who had fallen ill at the age of 15 (14 to 18) and were examined for the first time at the age of 17 (14 to 23), were all examined again 10 (5 to 20) years later. In the vast majority (25 cases), the anorexia syndrome sensu stricto had completely, or very nearly, disappeared. While weight and menstruation had returned to normal, nutrition behavior was sometimes still disturbed, although to a lesser extent than before. The course of the disease in the long term generally leads to disappearance of the symptoms; fatal issues and psychotic manifestations are extremely rare. In half of these 28 cases, however, there are other neurotic symptoms (depression, anxiety, obsession), indicating the underlying neurotic disturbance. In the matter of social integration (separation from original family, successful education, professional activity), positive developments predominate. More than one-third of the patients have married. The results are compared with those of some other investigations in this field.

[Genital self-mutilation in women]. / Genitale Selbstbeschädigung bei Frauen.

Concerning the very rare phenomenon of female self-mutilation, some long-term observations of 2 young women are reported. In consequence of their frequent self-mutilation an exstirpation of their uterus had become necessary. Their pathodynamics under reference to the few analogic cases in the literature are outlined.

[The differential diagnosis of anorexia nervosa. Coincidence of somatic disease and psychogenic emaciation (author's transl)]. / Zur Differentialdiagnose der Anorexia nervosa. Koinzidenz von somatischer Erkrankung und psychogener Magersucht

Three female patients with cachexia are reported in whom a psychogenic emaciation (anorexia nervosa) had been assumed. The postpubertal onset of the disease, deliberate limitation of diet, vomiting and subsequent emaciation and--in 2 patients--amenorrhea, as well as demonstrable experience of conflict supported this. The disease ran a lethal course. Autopsy revealed serious somatic diseases (stenosis of the ileum in two cases and brain tumor in one); their symptoms had been largely overlapped by those of anorexia nervosa.

[Hallucinations and experience of fear]. / Halluzinationen und angsterleben

Hallucinations, which are experienced in fear-evoking situations of helplessness and (external) danger, are attempts of defence and the realisation of elementary needs of self-preservation and security. The reality-denying self-deception is accompanied by the mobilisation of own protective potencies. Hallucinations are experienced fearfully, so that there is a situation of helplessness and danger. They are--as neurotic symptoms--an attempt to realise libidinous and/or aggressive desires with the manifestation of (condemning and punishing) defence in the projective perception. The self-deception here concerns the denial of own internal conflicts.