This psychoanalytically informed research project combines three theoretical trajectories together with illustrative clinical material to present an exploration of anorexia through a particular conceptual lens. The three theoretical areas are synthesised in an original way through the ideas and arguments presented in the thesis. The theory included: contemporary understandings of eating disorders; contemporary Kleinian literature on pathological organisations and psychic retreats (Steiner, 1982; 1987; 1992; 1993; 2011); and literature on autistic-like (autistoid) defences in non-autistic adults (S. Klein, 1980; Tustin, 1972; 1973; 1978; 1981; 1986; 1991). The research aimed to interrogate and explicate the relationship between pathological organisations of personality structure in anorexia, using case studies and vignettes to illustrate and elaborate the arguments. There was also some consideration of other types of eating disorder, similarly conceptualised. Case material from clinical work as a psychoanalytically informed psychotherapist was used as data in all but one case, in the latter instance interview material being used. The body of the thesis was structured in the form of four journal articles.

This study explored three areas believed to play a central role in the pathogenesis and presenting clinical picture of the eating disorders, anorexia nervosa and bulimia. Measures of personal effectiveness, family dynamics, and traditional sex-role beliefs were assessed in groups of restricted anorexics, bulimic anorexics, normal weight bulimics and controls. Control subjects manifested the highest degree of psychological adjustment, resourcefulness, and self-direction, while restricting anorexics obtained the lowest score on this measure. Bulimics experienced the highest degree of personal effectiveness of the patient groups, with bulimic anorexics falling in-between restricting anorexics and bulimics. Control subjects also reported that they felt more independent, accepted and tolerated in their family than any of the eating disorder groups. Bulimic subjects scored closest to controls on this measure, with bulimic anorexics experiencing the least degree of acceptance, tolerance and independence of all groups. Finally, control subjects defined themselves in a more traditionally masculine role than did any of the eating disorder groups. Restricting anorexics were most likely to describe themselves as passive, submissive, constricted and sensitive; bulimic subjects were more likely to endorse such self-descriptive adjectives as assertive, uninhibited, self-confident and competitive. Bulimic anorexics perceived themselves to be less traditionally feminine than did restricting anorexics, but more than bulimics or controls. The results of this study support the theory that ego deficits contribute to the development of eating disorders.