A psychoanalytic framework provided direction for research on the association between binge-purging (bulimic) and self-mutilating behaviors, comparing them for similarities and differences. The similarities in the multiple functions and psychosomatic processes served by these behaviors are presented, as well as the phenomenon of symptom substitution. Both behaviors tend to be practiced by those with severe personality and dissociative disorders and posttraumatic stress disorder. Both serve ego-compensatory needs in the absence of the adequate ability to regulate and modulate emotions, moods, and tensions. They may serve as compensatory attempts to differentiate self and object, define and differentiate body boundaries, master severe childhood trauma by means of psychophysiological addictive reenactments, and to express emotion.
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People who binge and purge and those who self-mutilate embody the theme of the 1995 conference, Mind, Memories, and Metaphors. Paradoxically, these apparently self-destructive behaviors have the capacity to alleviate psychic pain in some individuals, and serve other restorative, redemptive, cleansing and healing functions (Farber, 1995a). Lacking the ability to use metaphor or symbol to express emotion or unspeakable pain, their acts of self-harm may serve to narrate that which their minds cannot remember and their words cannot say. The author has come to know this from her years of clinical practice and from her research on the association between binge-purge behavior and self-mutilating behavior, a study which compares binge-purging behavior and self-mutilating behavior for similarities and differences (Farber, 1995a). The similarities in the multiple psychic functions and psychosomatic processes served by these behaviors will be presented, along with their implications for assessment, engagement, and countertransference.
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