Barely staying alive : a case study of a male with anorexia nervosa

293 Pages·2017·11.18 MB·English

by  Teri Pomerantz Rumpf

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Doctoral Dissertations 1896 - February 2014
1-1-1984
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Teri Pomerantz Rumpf
University of Massachusetts Amherst
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Rumpf, Teri Pomerantz, "Barely staying alive : a case study of a male with anorexia nervosa and a survey
of therapists working with anorectic patients." (1984). Doctoral Dissertations 1896 - February 2014. 1417.
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BARELY STAYING ALIVE:
A CASE STUDY OF A MALE WITH ANOREXIA NERVOSA AND
A SURVEY OF THERAPISTS WORKING WITH ANORECTIC PATIENTS
A Dissertation Presented
by
TERI POMERANTZ RUMPF
Submitted to the Graduate School of the
University of Massachusetts in partial fulfillment
of the requirements for the degree of
DOCTOR OF PHILOSOPHY
February 1984
Psychology
Teri Pomerantz Ruxnpf
©
All Rights Reserved
BARELY STAYING ALIVE:
A CASE STUDY OF A MALE WITH ANOREXIA NERVOSA AND
A SURVEY OF THERAPISTS WORKING WITH ANORECTIC PATIENTS
A Dissertation Presented
by
TERI POMERANTZ RUMPF
Approved as to style and content by;
Castellano B. Turner, Chairperson of Committee
Dee G. Appley, Member
Daniel Eric Fajardo, Member
Alvin Winder, Member
Seymour M. Berger, Chairper
Department of Psychology
For Noah Clifford Pomerantz Rumpf
iv
ACKNOWLEDGEMENTS
Arriving at the end of my graduate school career marks the end
of a very important period, a time of growth and change. What I have
come to know about psychotherapy and psychology represents the
composite of many moments of learning, both formal and informal. I
wish to acknowledge the friends and fellow students with whom I shared
such moments. I also wish to acknowledge the contributions of Dr.
Harold Jarmon, whose course in object relations helped me formulate
some of the ideas in these pages and Dr. Harold Raush, from whom
I
learned a great deal about psychotherapy. I feel fortunate to have
been his teaching associate. Specifically with regard to this
dissertation, I wish to thank Ms. Melanie Bellenoit, whose assistance
in preparing the manuscript was invaluable. I wish to thank Dr.
Daniel Eric Fajardo and Dr. Alvin Winder for their participation on
my committee. I want to offer special thanks to Dr. Dee G. Appley,
who as a role model, teacher, friend and mentor, has offered support,
encouragement, praise, criticism and affection. I want her to know
that I think I have learned much of what she has tried to teach me.
For Dr. Castellano Turner, special thanks and gratitude, since without
his faith in me, none of this would have been possible. Finally, I
wish to thank my own therapist for her support and for her
contribution to my knowledge of psychotherapy, to thank my father,
who has been patiently waiting for me to finish this degree, and to
thank my son, Noah, for his good humor and tolerance of all the
partially cooked frozen dinners.
:
ABSTRACT
Barely Staying Alive
A Case Study of A Male With Anorexia Nervosa and
a Survey of Therapists Working With Anorectic Patients
Teri Pomerantz Rumpf, B. A., Syracuse University
M.A., Ph.D., University of Massachusetts
Directed by: Professor Castellano B. Turner
The subject of anorexia nervosa has received a great deal of
recent attention in both the popular and scholarly literature.
However, males with anorexia nervosa represent only a small minority
of this population. Experienced clinicians, working with eating
disordered patients over a period of years, may encounter only a few
male patients, or none at all. For this reason, encountering a male
with primary anorexia nervosa was considered a rare event.
This dissertation describes and analyzes the case of a twenty-two
year old male with anorexia nervosa. In addition, the results of an
international survey of clinicians who work with eating disordered
patients are presented. The survey gathered information on males with
eating disorders as well as information concerning the theoretical
orientations and treatment practices of therapists who work with
anorectic and bulimic patients.
Anorexia nervosa is a disorder with a long history. This history
is summarized in the literature review. Also reviewed are issues of
etiology and diagnosis; diverse theoretical perspectives; treatment
approaches; and a summary of the available literature on anorexia
vi
.
nervosa in males. Methodological considerations involved in the
dissertation are presented.
The major part of the dissertation consists of the case history.
Throughout the course of therapy, the primary focus was on the
underlying issues: identity, autonomy and control, rather than on
the pathological eating behavior. However, in any case of severe
anorexia nervosa, consideration must be given to the management of
pathological eating. In this case, weight was not regained until the
underlying issues had been sufficiently worked through.
The data of a survey is presented. While the thirty-five
participating clinicians had had contact with over two thousand
anorectic patients, the number of males treated was less than one
hundred
Finally, anorexia nervosa is discussed from the theoretical
perspectives of pathological narcissism.
vii
TABLE OF CONTENTS
DEDICATION
......
ACKNOWLEDGEMENTS
.... ^
LIST OF TABLES
X
Chapter
I. INTRODUCTION AND BACKGROUND
j
Introduction
^
Historical Perspective • • • . ^
Diagnosis and Subtypes of Anorexia and Bulimia 12
Incidence and Gender Distribution . . . .
22
Mortality Rates
' 25
The Clinical Picture of Anorexia Nervosa 26
The Sense of Self
29
Family Dynamics
^2
Cultural Influences
50
Treatment of Anorexia Nervosa 54
Use of Drug Therapies
54
Outcome Literature
55
Anorexia nervosa in males
73
II. METHOD
83
III. CASE STUDY
92
Introduction
92
Background
96
History
97
Evaluation Phase IO3
The Engagement Phase II5
Psychological Evaluation 117
Therapy Part 1 - February to April, 1981 120
Preface 120
Part I: February to April, 1981 121
Part II: May to June, 1981 143
Termination 167
Countertransference 175
Follow-up 181
IV. SURVEY OF THERAPISTS 185
Introduction 185
Method 186
Procedure 188
viii