According to psychodynamics, the development of a healthy body image is, initially, based on a healthy parent-child relationship and, later, on a healthy relationship with the outside world.
A new-born baby does not yet have a fully integrated sense of self; rather, she experiences herself as a mass of separate experiences. It takes the loving care of an emotionally attuned parent to help the newborn child develop a sense of self and, with it, a confident sense of her own body.
Initially, the child must learn to differentiate between pleasure and pain, and she does this with the help of a parent’s sensitive touch and loving gaze. Once this stage is complete, she begins to differentiate herself from others, and here still, she needs parents who are helping her through this process with mirroring behaviour and reciprocal interaction. When, at around 15-18 months of age, she begins to use that dreaded word- “no!”- and can finally recognise herself in the mirror, she is beginning to recognise herself as being separate from her parents and her own, unique person. She begins to experience herself as one whole being, rather than a separate mind and a separate body. Finally, by the age of 6-8, she should be able to understand in an abstract manner the difference between her subjective self with her own mind and the objective other. From here on in, the parents have done all they can and, provided nothing goes wrong later (which it can) to once more upset the balance between her mind and her body, this little girl should go on to become a healthy young adult.
That’s what’s supposed to happen. However, when a teenager or young adult develops an eating disorder, psychodynamic theory says that this is because something went wrong somewhere in that process. For example, if the child was never allowed the space and freedom to explore her own independence, she might never have developed a healthy sense of being her own separate person different from the rest of her family; and, while this might work out alright during childhood, once adolescence hits and she is expected to suddenly become independent, she lacks the tools to cope and develops anorexia nervosa as an exaggerated search for self-control, or as a guilt-free rebellion against the parents who wouldn’t give her freedom. Or, perhaps, something went wrong earlier, and she was never given the empathic touch of a parent that was necessary for her to learn the limits of her body; in this case, she might grow up into a young adult unsure of her true size, and consequently develop bulimia nervosa.
In psychodynamic therapy, the analyst would try to correct what went wrong in the developmental process and help the anorexic or bulimic to develop a stronger internal sense of self-control and to bridge the gap between mind and body.