The symptoms of the illness indicate that the self’s coping abilities have weakened, that internal conflicts have pushed the ego into a state of strain, and that external intervention is required. The symptoms individuals experience vary depending on the nature and intensity of their unmet emotional needs. In many patients with eating disorder symptoms—especially those with bulimia nervosa—parallels can be observed between their eating attitudes, their eating behaviors, and the way they relate to other people. The similarity between bulimic behavior and obsessive behaviors does not mean these patients are obsessive-compulsive. The underlying mechanism in eating disorders is different. Many bulimic individuals display hoarding tendencies. Accumulating friendships or objects can function as psychological “fuel” for them. When examining the relationships of individuals with eating disorders, it becomes clear that they do not internalize their relationships; just as with food, they “take them in” for a period but then expel them without digesting or integrating them.
Internalizing means forming close relationships and establishing authenticity within those relationships. Individuals with eating disorder behaviors experience rapid emotional shifts and dramatic mood changes throughout the day. This indicates difficulties in internalizing experiences and life events. Wanting more in relationships and displaying a kind of “hunger for attention” can hinder relationships from progressing beyond a certain point. This hunger reflects the individual's focus on their own narcissistic needs rather than investing in the relationship. It would not be accurate to simply label this behavior as “egocentric.” The core issue is not an attempt to be egocentric, but rather anxiety related to forming a connection with the other person. Furthermore, unresolved narcissistic needs from earlier developmental periods persist into adulthood, leading the individual to seek fulfillment in their adult relationships. This unfulfilled need interferes with their ability to see the other person, communicate with them, and build a healthy and sustainable relationship. Therefore, individuals with eating disorders frequently seek help due to problems in their relationships.
In reality, forming relationships is something they both desire and avoid. They want it, but they fear it. The relational pattern of “fill and empty,” seen in their interpersonal lives, mirrors the cycle of eating and purging without allowing digestion. In relationships, just as with food, experiences are not digested; instead, they are expelled.
Just as food does not mix with the bloodstream—meaning it cannot become part of the “body”—relationships cannot become part of the “self.” Food is consumed only to survive. In the same way, many relationships are experienced only to the minimal degree necessary. The early maternal relationships of individuals with eating disorders are often marked by unmet needs and disruptions. Their relationships with their mothers tend to be highly conflictual. Mothers of such individuals are often obsessive or depressive in nature.
In eating disorders, internal conflicts find expression through the body. The body becomes the spokesperson for psychological turmoil. The person's internal conflicts manifest as cycles of weight loss and weight gain, eventually becoming a lifestyle. Making the conflict visible and concrete makes it easier to manage—because dealing with what is seen feels more manageable. Many bulimic patients decide to seek help in their late twenties or early thirties when failures in their relationships become more apparent. Superficial relationships may feel safe and harmless, but after a while, they cease to be fulfilling. Thus, seeking help can be understood as a search for fulfillment. Through proper psychological intervention, the source of the unmet need can be identified, and the individual can stop using the body as a spokesperson. When the bulimic mechanism collapses, psychosomatic symptoms may emerge—such as migraine attacks—because the person has learned to somatize and does not know how else to manage internal distress. The language of the body and psychosomatic reactions becomes familiar. As verbal expression and the ability to conceptualize emotions improve, the source of the conflict becomes clearer, reducing both the relational “fill-and-empty” pattern and the cycle of consuming and purging food.
In Bulimic Patients,
- Self-harm toward the body is present. They deprive themselves of food (binge eating is not pleasure-driven but a ritual with unconscious origins).
- There is no internalization in relationships. Their relational style is superficial, and they struggle to form deep, meaningful connections. They experience relationship difficulties—either maintaining long but empty relationships or repeatedly breaking up.
- Conflicts with the mother are highly pronounced, often involving patterns of dependency.
- Mothers of bulimic patients tend to be obsessive or depressive; mothers of anorexic patients tend to be rule-oriented, authoritarian, and rigid.
- They do not typically struggle academically or professionally. Where emotions are absent, problems are minimal.
- Fear of abandonment, difficulty tolerating separation, and intense reactions to relational loss are common.
- Preoccupation with the body is central to their lives.
- Instead of thinking, they act—constant activity provides relief.
- Their hunger for attention in relationships may disrupt relational stability, as they seek emotional “intake” in an excessive, binge-like manner.
