Alexithymic Addiction in a Bariatric Patient with Bipolar Disorder: A Case Report and Psychodynamic/Psychopathological Discussion

This case report presents a complex clinical picture involving a bariatric patient with bipolar disorder and pronounced alexithymic traits, who developed a pattern of compulsive food intake followed by substance use. The case explores how alexithymia—defined as a deficit in the ability to identify and verbalize emotional states—can obscure the psychodynamic basis of addictive behaviors. The patient oscillated between mood instability and emotional emptiness, using food and drugs as failed substitutes for symbolic representation. The discussion integrates concepts from neurobiology, affect regulation, and psychodynamic theory, showing how deficits in early mother-infant symbolic interaction may underlie both alexithymia and addictive disorders. The patient lacked access to internalized symbolic tools, relying instead on immediate gratification and impulsivity. Pharmacological treatment alone proved insufficient; therapeutic progress occurred only when symbolic mediation was restored through psychodynamic engagement. The case highlights the diagnostic overlap between affective disorders, eating disorders, and addiction within a broader symbolic framework. It underscores the limitations of categorical approaches and advocates for a structural reading of mental suffering that emphasizes language, representation, and subjectivity. This report contributes to the growing body of literature on transdiagnostic models and demonstrates the clinical relevance of linking alexithymia to symbolic failure and affective dysregulation in modern psychiatric practice.