Anorexia and Bulimia

  • Peter HartwichEmail author
  • Georg Northoff


The movement of the psychiatric history back and forth between somatic and psychiatric etiopathogenesis has been for anorexia nervosa for more than 300 years. Today we see the causes of the different disease types: early anorexia nervosa, anorexia nervosa in puberty, chronic, and late anorexia nervosa, as well as bulimia as somatic and psychodynamic. A neuropsychodynamic approach combines psychodynamic models and experiences with somatic aspects. In particular the neuronal imbalance between self-referential processing and sensory processing of one’s own body experience leads to a paraconstruction of the self-mentalization and de-physicalization of the body. For the therapy of the various forms of disease, future-oriented approaches result.

Our neuropsychodynamic concept consists of the following aspects: mostly there is to be found a disposition in the family with psychiatric illnesses. In puberty the patients have autonomy conflicts; the result is a self-alteration which is followed by a disbalance between self-referential and sensorimotor processing, then the imbalance crosses the threshold, and the paraconstruction of self-mentalization of one’s own body follows with the typical overly controlling behavior and severe eating problems.

We describe examples of a typical case in puberty and also a case of late anorexia.

In some rare cases, there is even a transition to schizophrenia regarding to the concept of the danger of losing the spatiotemporal structure of the self depending on the level of the personality structure.

All this shows that neuropsychodynamic psychotherapy focuses on strengthening the self.


Different types of anorexia nervosa Neuronal imbalance between self-referential processing and sensory processing of one’s own body Paraconstruction of the self-mentalization and de-physicalization of the body Danger of losing the spatiotemporal structure of the self Neuropsychodynamic psychotherapy focuses on strengthening the self 


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Authors and Affiliations

  1. 1.Department of Psychiatry, Psychotherapy, PsychosomaticsGeneral Hospital of Frankfurt am Main, Teaching Hospital University FrankfurtFrankfurtGermany
  2. 2.Mind, Brain Imaging, and Neuroethics, Institute of Mental Health ResearchUniversity of OttawaOttawaCanada

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