Julia Hollmann – Eating Disorders

Eating Disorders as a Boundary Experience - A Qualitative Analysis of Normative Concepts of Bodyrealities


Over 80 % of women over 18 are unhappy with their body and show dissatisfaction with their appearance. Anorexia Nervosa is a frequent disease, especially of young women, but the number of males being affected is increasing steadily as well. ICD-10 defines guidelines to confirm the diagnosis of Anorexia Nervosa. These are for example, being underweight (15% lower than expected for that specific age), loss of weight also as a body image disturbance with a disordered relation to the own body and its perception. As a result, symptoms are striving for thinness and fear of becoming larger though underweight. My project focuses on three main topics concerning Anorexia Nervosa:

1) Body image perception disturbance in patients with Anorexia Nervosa
One of the major symptoms of Anorexia Nervosa is the body image disturbance, conditioning an „overestimation of their body weight“. As a result, there are different aspects we should wonder about concerning the body image of an anorectic person: Does an anorectic patient consider her body as part of herself? Or is there a differentiation between her body and herself, between physicalness and her mind? In accordance with Foucault, we cannot separate from our body; our body and ourselves are always combined. There is no way to separate. But nevertheless, we can dissociate ourselves from our body, as Foucault names the body „a cage“ or „a peel“ of ourselves. Our body cannot be seen in a strictly anatomical and rational way. Philipa Rothfield terms this actuality „corporeal constructs and material interface to indicate that there is a materiality of the body which participates in the inscription process“, which means that the body is not „an objective given, whose nature is independent of the sorts of discourses through which it is understood“. There is always the background, environment and the experiences that have to be considered when we are talking about the human body. There is a development of the human body caused by this influence. Referred to an anorectic patient, we should wonder what purpose is behind starvation and cachexia. Is changing the body image an aim? Or is the disturbed body image the reason for starvation? Does she perhaps pursue a bodyless body? A body without traces of damage and harm, that looks nice, pretty and pure an utopian body? Or is this disease the quest of perfection that never ends?

2) Normality and Pathology
„It is such a terrible disease because you watch your child deliberately hurting herself, and obviously suffering, and yet you are unable to help her“ (Bruch H. The golden cage. The enigma of Anorexia nervosa. First Harvard University Press; 2001) This sentence shows the problem with terminology of normality and pathology. In this phrase we can see two points of view. On the one hand there is a despairing mother, considering the status of her daughter as pathologic. On the other hand, there is a diseased child with little insight into and understanding of her disease. Considering the different body images and also considering that there are different rules and norms in each society and culture, it is obvious that there can be a problem to define what we call normality and pathology. The average of a value is one of the definitions or equivalent of what we experience as normality. Everything that deviates from the average is noticed as pathology. But there are other opinions defining normality and pathology; for example not as two different, opposed terms and definitions but defining pathology as a quantitative deviation of normality. A pathologic status consequently shows too much or less of what we call normality. Disease is the result of an overabundance or deficit of stimulation of the concerned tissue. Especially in psychiatric disorders, the borderline between normality and pathology is hard to define- is a patient that shows symptoms of anorexia, with no loss of weight yet, already seen as affected by the disease or should this patient still be considered as „normal“? How can we say that a young anorecitc patient is not normal? Only because her body doesn`t correlate with the average of bodies at that age?

3) Society and Anorexia Nervosa
Anorexia nervosa is a common disease of young adolescents. Especially at that age, young people underlie a huge influence of their peer group. Society consequently could play an important role when we are talking about a disease like Anorexia Nervosa. There are two main topics I am working on, concerning the influence of our society: What influence does the the image of the perfect female body have on an anorectic patient? Does our society favour a disease as Anorexia Nervosa?

In my project, I want to answer these questions by analyzing narratives of anorectic patients, physicians treating them and parents living with them. Eventually, there will be an intercultural German-French comparison.

Author: Julia E. Hollmann (geb. Weiss)


Supervisor: Univ.-Prof. Dr. Norbert W. Paul

1. http://www.sirc.org/publik/mirror.html
2. Paulson-Karlsson G, Nevonen L. Anorexia nervosa: treatment expectations a qualitative study. Journal of Multidisciplinary Healthcare 2012:5.
3. Horn K, Scholz M. Eine neue Methode zur Erfassung der Korperwahrnehmung bei Patienten mit Anorexie Nervosa. In: Joraschky P et al. Korpererleben und Korperbild. Stuttgart: Schattauer Verlag; 2009.
4. Reich G, Cierpka M. Essstorung und Adipositas: Epidemiologie- Diagnostik- Verlaufe- Grundzuge der Therapie. In: Reich G, Cierpka M. Psychotherapie der Essstorungen: Krankheitsmodelle und Therapiepraxis- storungsspezifisch und schulenubergreifend. Stuttgart: Thieme Verlag; 2010.
5. Kummel F: Die anthropologische Struktur der Zeit. Elftes Kapitel: die Erscheinungen der psychopathischen Zeitlichkeit. ff. http://www.friedrich-kuemmel.de/schriften.html
6. Armstrong D. The temporal body. In: Cooter R, Pickstone J. Companion to medicine in the twentieth century. New York: Routledge; 2003.
7. Urgesi C et al. Visual body perception in Anorexia Nervosa. International Journal of Eating disorders 2012.45:4.
8. Foucault M. Die Heterotopien. Der utopische Korper. Zwei Radiovortrage. Berlin: Suhrkamp Verlag; 2013. 9. Rothfield P. Bodies and subjects: medical ethics and feminism. In: Komesaroff P. Troubled bodies: critical perspectives on postmodernism, medical ethics, and the body. Duke University Press; 1995: 189
10. Bruch H. The golden cage. The enigma of Anorexia nervosa. First Harvard University Press; 2001
11. Canguilhem G. Das Normale und das Pathologische. Berlin: August Verlag; 2013.

Conferences and talks: 2013: October, 5th: International conference in shifting temporality, Roscoff, France. Title of speech: Shifting temporalities in psychiatric disorders.


Author: Julia Hollmann