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Kiely L, Conti J, Hay P. Anorexia nervosa through the lens of a severe and enduring experience: 'lost in a big world'. J Eat Disord 2024; 12:12. [PMID: 38254163 PMCID: PMC10804804 DOI: 10.1186/s40337-023-00953-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Severe and enduring anorexia nervosa (SE-AN), is a serious and persistent illness, despite 'state of the art' treatment. Criteria have been theoretically proposed, but not tested, and may not adequately capture illness complexity, which potentially inhibits treatment refinements. The clinical reality of death as an outcome for some people who experience SE-AN (1 in 20) and broadening access to voluntary assisted dying, further complicates the field, which is undeveloped regarding more fundamental concepts such as nosology, treatment, recovery definitions and alternative conceptualisations of SE-AN. The present paper is in response to this and aims to build upon qualitative literature to enhance phenomenological understandings of fatal SE-AN. METHOD A published book, being the legacy of a 32-year-old professional artist offers a rich account of a life lived with AN, for 18 years with continuous treatment. A polysemous narrative via the interrelationship between the languages of the artist's words and visual art is translated via interpretative phenomenological analysis (IPA), offering rich insight into the SE-AN experience. FINDINGS The process of analysis induced three superordinate themes (1) Disappearing Self (2) Dialectical Dilemma (3) Death and Dying: Finding Meaning. Two cross cutting themes traversed these themes: (a) Colour and (b) Shifting Hope, where the former produced a visual representation via the 'SE-AN Kaleidoscope'. Collectively the themes produce a concept of SE-AN, grounded in the data and depicted visually through the artist's paintings. CONCLUSIONS The picture of SE-AN revealed in the analysis extends upon conceptualisations of SE-AN, highlighting key processes which are thus far under explored. These factors are implicated in illness persistence eliciting opportunities for further research testing including diagnostic considerations and treatment directions. In SE-AN, distorted body image extends to a global distortion in the perception of self. Additional criteria for the severe and enduring stages of illness related to (1) self and identity processes (2) measures of 'global impoverishment' across life domains are proposed for consideration in the future testing of putative defining features of SE-AN.
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Affiliation(s)
- Laura Kiely
- School of Medicine, Translational Health Research Institute, Western Sydney University, Sydney, Australia.
| | - Janet Conti
- School of Psychology, Translational Health Research Institute, Western Sydney University, Sydney, Australia
| | - Phillipa Hay
- School of Medicine, Translational Health Research Institute, Western Sydney University, Sydney, Australia
- Mental Health Services, Camden and Campbelltown Hospitals, SWSLHD, Campbeltown, NSW, 2560, Australia
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2
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Abdoli M, Scotto Rosato M, Cipriano A, Napolano R, Cotrufo P, Barberis N, Cella S. Affect, Body, and Eating Habits in Children: A Systematic Review. Nutrients 2023; 15:3343. [PMID: 37571280 PMCID: PMC10420931 DOI: 10.3390/nu15153343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 07/22/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
The present review investigates the complex associations between children's affective states, body perceptions, and eating habits, thus providing crucial insights for potential health interventions. Following PRISMA guidelines, three databases were searched for peer-reviewed studies exploring the relationship between eating habits, emotional states, and body image perceptions in a population of children (5 to 11 years old). A total of seven articles were included. Our findings revealed a pattern of associations between negative emotional states, like anxiety and depressive feelings, and maladaptive eating behaviors. Additionally, explicit influences from parental feeding practices, peer pressure, socioeconomic factors, and children's body perceptions were observed to shape eating habits, with a pronounced tendency among older girls towards dieting and food preoccupation. Our results underline the intertwining nature of age, gender, and emotional states. Furthermore, our findings accentuate the urgency for comprehensive interventions that acknowledge and address the complex interplay of emotional, familial, and socioeconomic factors alongside children's body image perceptions. The criticality of continued research, particularly ones employing longitudinal designs and diverse demographic samples, is highlighted as we strive to understand and navigate such multifaceted relationships to enhance children's health and well-being.
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Affiliation(s)
- Marzieh Abdoli
- Observatory on Eating Disorders, Department of Psychology, University of Campania “Luigi Vanvitelli”, Viale Ellittico, 31, 81100 Caserta, Italy; (M.A.); (M.S.R.); (A.C.); (R.N.); (P.C.)
| | - Marco Scotto Rosato
- Observatory on Eating Disorders, Department of Psychology, University of Campania “Luigi Vanvitelli”, Viale Ellittico, 31, 81100 Caserta, Italy; (M.A.); (M.S.R.); (A.C.); (R.N.); (P.C.)
| | - Annarosa Cipriano
- Observatory on Eating Disorders, Department of Psychology, University of Campania “Luigi Vanvitelli”, Viale Ellittico, 31, 81100 Caserta, Italy; (M.A.); (M.S.R.); (A.C.); (R.N.); (P.C.)
| | - Rosanna Napolano
- Observatory on Eating Disorders, Department of Psychology, University of Campania “Luigi Vanvitelli”, Viale Ellittico, 31, 81100 Caserta, Italy; (M.A.); (M.S.R.); (A.C.); (R.N.); (P.C.)
| | - Paolo Cotrufo
- Observatory on Eating Disorders, Department of Psychology, University of Campania “Luigi Vanvitelli”, Viale Ellittico, 31, 81100 Caserta, Italy; (M.A.); (M.S.R.); (A.C.); (R.N.); (P.C.)
| | - Nadia Barberis
- Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy;
| | - Stefania Cella
- Observatory on Eating Disorders, Department of Psychology, University of Campania “Luigi Vanvitelli”, Viale Ellittico, 31, 81100 Caserta, Italy; (M.A.); (M.S.R.); (A.C.); (R.N.); (P.C.)
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3
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Mirabella M, Muzi L, Franco A, Urgese A, Rugo MA, Mazzeschi C, Speranza AM, McWilliams N, Lingiardi V. From symptoms to subjective and bodily experiences: the contribution of the Psychodynamic Diagnostic Manual (PDM-2) to diagnosis and treatment monitoring in eating disorders. Eat Weight Disord 2023; 28:35. [PMID: 36997702 PMCID: PMC10063489 DOI: 10.1007/s40519-023-01562-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 03/17/2023] [Indexed: 04/01/2023] Open
Abstract
PURPOSE Atheoretical and descriptive conceptualizations of eating disorders (EDs) have faced substantial criticism due to their limited ability to assess patients' subjective characteristics and experiences, as needed to determine the most appropriate treatment options. The present article provides an overview of the clinical and empirical literature supporting the potential contribution of the Psychodynamic Diagnostic Manual (PDM-2) to both diagnostic assessment and treatment monitoring. METHODS Following a discussion of the most relevant shortcomings of current diagnostic models of EDs and a description of the rationale and structure of the PDM-2, evidence supporting the core PDM-2 dimensions of ED patients' subjective experiences (i.e., affective states, cognitive processes, relational patterns, somatic/bodily experiences and states) are examined, alongside their relevance to ED diagnosis and treatment. RESULTS Overall, the reviewed studies support the diagnostic importance of these patterns of subjective experiences in EDs, highlighting their potential role as either predisposing or maintaining factors to target in psychotherapy. A growing body of multidisciplinary evidence also shows that bodily and somatic experiences are central to the diagnosis and clinical management of ED patients. Moreover, there is evidence that a PDM-based assessment may enable closer monitoring of patient progress during treatment, with regard to both subjective experiences and symptom patterns. CONCLUSIONS The study suggests that current diagnostic frameworks for EDs would benefit from the addition of a person-centered perspective that considers not only symptoms, but also patients' full range of functioning-including their deep and surface-level emotional, cognitive, interpersonal, and social patterns-to improve patient-tailored interventions. LEVEL OF EVIDENCE Level V, narrative review.
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Affiliation(s)
- Marta Mirabella
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Laura Muzi
- Department of Philosophy, Social Sciences, Humanities and Education, University of Perugia, Perugia, Italy.
| | - Anna Franco
- Eating Disorder Clinic "Residenza Gruber", Bologna, Italy
| | - Alessia Urgese
- Eating Disorder Clinic "Residenza Gruber", Bologna, Italy
| | - Michele A Rugo
- Eating Disorder Clinic "Residenza Gruber", Bologna, Italy
| | - Claudia Mazzeschi
- Department of Philosophy, Social Sciences, Humanities and Education, University of Perugia, Perugia, Italy
| | - Anna Maria Speranza
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Nancy McWilliams
- Graduate School of Applied and Professional Psychology, Rutgers University, Lambertville, NJ, USA
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
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4
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Castellini G, Cassioli E, Rossi E, Mancini M, Ricca V, Stanghellini G. Bridging cognitive, phenomenological and psychodynamic approaches to eating disorders. Eat Weight Disord 2022; 27:2273-2289. [PMID: 35179727 PMCID: PMC9556383 DOI: 10.1007/s40519-022-01379-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/17/2021] [Indexed: 10/29/2022] Open
Abstract
Cognitive, psychodynamic, and phenomenological scholars converged their attention on abnormal bodily phenomena as the core psychopathological feature of eating disorders (EDs). While cognitive approaches focus their attention on a need for "objective" (i.e., observable, measurable) variables (including behaviours and distorted cognitions), the phenomenological exploration typically targets descriptions of persons' lived experience. According to a new emerging phenomenological perspective, the classic behavioural and cognitive symptoms of EDs should be considered as epiphenomena of a deeper core represented by a disorder of the embodiment. The cognitive-behavioural model is the most studied and, up till now, clinically efficacious treatment for EDs. However, as any coherent and scientifically grounded model, it presents some limitations in its application. Numerous patients report a chronic course, do not respond to treatment and develop a personality structure based on pathological eating behaviours, since "being anorexic" becomes a new identity for the person. Furthermore, the etiopathogenetic trajectory of EDs influences the treatment response: for example, patients reporting childhood abuse or maltreatment respond differently to cognitive-behavioural therapy. To obtain a deeper comprehension of these disorders, it seems important to shift attention from abnormal eating behaviours to more complex and subtle psycho(patho)logical features, especially experiential ones. This characterisation represents the unavoidable premise for the identification of new therapeutic targets and consequently for an improvement of the outcome of these severe disorders. Thus, the present review aims to provide an integrated view of cognitive, psychodynamic, and phenomenological perspectives on EDs, suggesting new therapeutic targets and intervention strategies based on this integrated model. Level of Evidence: Level V.Level of evidence Level V: Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.
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Affiliation(s)
- Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| | - Emanuele Cassioli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Eleonora Rossi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Milena Mancini
- Department of Psychological Sciences, Health, Territory, G. d'Annunzio University of Chieti and Pescara, Chieti, Italy
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Giovanni Stanghellini
- Department of Psychological Sciences, Health, Territory, G. d'Annunzio University of Chieti and Pescara, Chieti, Italy.,Centro de Estudios de Fenomenología y Psiquiatría, Diego Portales' University, Santiago, Chile
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Biberdzic M, Tang J, Tan J. Beyond difficulties in self-regulation: the role of identity integration and personality functioning in young women with disordered eating behaviours. J Eat Disord 2021; 9:93. [PMID: 34332636 PMCID: PMC8325868 DOI: 10.1186/s40337-021-00398-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Past research has established individual relationships between disordered eating behaviours (DEB) and both self-regulation difficulties and identity disturbance. However, no research has looked at the shared influence of these constructs on DEB nor at personality functioning in individuals with DEB. METHODS In the present study, self-regulation was explored in terms of effortful control, impulsivity and emotion regulation while identity integration was measured in terms of impairments in self-functioning using a sample of 247 undergraduate students. RESULTS Significant associations were found between all components of self-regulation and DEB, with the exception of impulsivity. Identity instability was also associated with self-regulation difficulties and DEB. Structural Equation Modelling analyses indicated that identity instability partially mediated the relationship between self-regulation and DEB. Lastly, disordered eating was associated with difficulties in personality functioning, with young women presenting with DEB reporting significantly greater difficulties in both self and interpersonal personality functioning. CONCLUSION Behavioural eating anomalies should be considered as epiphenomena secondary to a possible deeper issue that reflects difficulties related to identity integration and potential personality functioning. The clinical implications of these findings are discussed.
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Affiliation(s)
- Marko Biberdzic
- School of Psychology, University of Wollongong, Wollongong, NSW, 2522, Australia.
| | - Josephine Tang
- School of Psychology, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Junhao Tan
- School of Psychology, University of Wollongong, Wollongong, NSW, 2522, Australia
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6
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The association between separation individuation process and binge eating disorder in adolescents aged 12-18. Eat Weight Disord 2021; 26:1089-1096. [PMID: 32926344 DOI: 10.1007/s40519-020-01004-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To evaluate the associations between separation individuation (SI) process and binge eating disorder (BED) in adolescence aged 12-18 years old, as most challenges related to SI process and eating disorders (EDs) tend to arise in this age group. METHODS This is a cross-sectional study of 30 adolescents diagnosed with BED and 332 healthy adolescents as a control group. All adolescents diagnosed with BED underwent clinical interviews and all adolescents in the study filled in self-reported questionnaires. RESULTS Our results highlighted higher levels of need denial (p = 0.014) and rejection expectancy (p = 0.008) of SI difficulties in adolescents with BED as compared to the ones without BED. CONCLUSION This is the first study of its nature providing good evidence for the association between SI process and BED in adolescents. Although these difficulties in SI process by themselves are not evidence of causative link, these results can contribute to the understanding of the causative factors in BED and underpin further research. The correlation can be used as a consideration in the prevention and treatment of BED. LEVEL OF EVIDENCE Level III, case-control analytic study.
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7
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Granieri A, Guglielmucci F, Costanzo A, Caretti V, Schimmenti A. Trauma-Related Dissociation Is Linked With Maladaptive Personality Functioning. Front Psychiatry 2018; 9:206. [PMID: 29887807 PMCID: PMC5980986 DOI: 10.3389/fpsyt.2018.00206] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 05/03/2018] [Indexed: 12/05/2022] Open
Abstract
Background: Extensive research has demonstrated the positive associations among the exposure to traumatic experiences, the levels of dissociation, and the severity of psychiatric symptoms in adults. However, it has been hypothesized in clinical literature that an excessive activation of the dissociative processes following multiple traumatic experiences may jeopardize the psychological and behavioral functioning of the individuals, fostering higher levels of maladaptive personality functioning. Methods: The study involved 322 adult volunteers from Italy. Participants completed measures on traumatic experiences, dissociation, and maladaptive personality traits. Results: The number of traumatic experiences reported by participants were positively associated with dissociation scores and maladaptive personality scores. Mediation analyses showed that dissociation acted as a partial mediator in the relationship between traumatic experiences and overall maladaptive personality functioning. Regression curve analyses showed that the positive association between maladaptive personality functioning and dissociation was stronger among participants with higher exposure to traumatic experiences. Conclusion: Exposure to multiple traumatic experiences may increase the risk for an excessive activation of the dissociative processes, which in turn may generate severe impairments in multiple domains of personality functioning.
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Affiliation(s)
| | | | - Antonino Costanzo
- Faculty of Human and Social Sciences, Kore University of Enna, Enna, Italy
| | - Vincenzo Caretti
- Department of Human Sciences, LUMSA University of Rome, Rome, Italy
| | - Adriano Schimmenti
- Faculty of Human and Social Sciences, Kore University of Enna, Enna, Italy
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8
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Granieri A, La Marca L, Mannino G, Giunta S, Guglielmucci F, Schimmenti A. The Relationship between Defense Patterns and DSM-5 Maladaptive Personality Domains. Front Psychol 2017; 8:1926. [PMID: 29163301 PMCID: PMC5673655 DOI: 10.3389/fpsyg.2017.01926] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 10/18/2017] [Indexed: 11/25/2022] Open
Abstract
Aim: Research has extensively examined the relationship between defense mechanisms (DM) and personality traits. However, no study to date has explored if specific defenses (alone or in combination) are able to predict dysfunctional variants of personality domains, as conceived in the alternative DSM-5 model for personality disorders. This study aimed to investigate the relationship between DMs and DSM-5 maladaptive personality domains among adults. Materials and Methods: Three hundred and twenty-eight adults aged between 18 and 64 years old completed measures on DMs and maladapive personality domains. Regression analyses were performed to determine which DMs predicted the maladaptive personality domains of negative affectivity, detachment, antagonism, disinhibition, and psychoticism. Results: According to psychoanalytic literature, results showed that immature defenses positively predicted maladaptive personality domain scores, whereas mature defenses were generally related with better personality functioning. Moreover, different defense patterns emerged as significant predictors of the maladaptive personality domains comprised in the alternative DSM-5 model for personality disorder. Discussion: Our findings support the view that defense patterns represent core components of personality and its disorders, and suggest that an increased use of immature defenses and a reduced use of mature defenses have a negative impact on the development of personality.
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Affiliation(s)
| | - Luana La Marca
- Faculty of Human and Social Sciences, Kore University of Enna, Enna, Italy
| | - Giuseppe Mannino
- Department of Law, Libera Università Maria Santissima Assunta (LUMSA), Palermo, Italy
| | - Serena Giunta
- Department of Law, Libera Università Maria Santissima Assunta (LUMSA), Palermo, Italy
| | | | - Adriano Schimmenti
- Faculty of Human and Social Sciences, Kore University of Enna, Enna, Italy
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9
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Monteleone AM, Castellini G, Ricca V, Volpe U, De Riso F, Nigro M, Zamponi F, Mancini M, Stanghellini G, Monteleone P, Treasure J, Maj M. Embodiment Mediates the Relationship between Avoidant Attachment and Eating Disorder Psychopathology. EUROPEAN EATING DISORDERS REVIEW 2017; 25:461-468. [PMID: 28762262 DOI: 10.1002/erv.2536] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 06/01/2017] [Accepted: 06/27/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The overvaluation of body shape and weight of persons with eating disorders (EDs) is putatively explained by a disturbance in the way they experience their own body (embodiment). Moreover, attachment disorders seem to promote the use of body as source for self-definition. Therefore, we assessed the role of embodiment in the connection between attachment styles and ED psychopathology. METHOD One-hundred and thirteen ED patients and 117 healthy subjects completed the Identity and Eating Disorders (IDEA) Questionnaire, the Eating Disorder Inventory-2 (EDI-2) and the Experiences in Close Relationships Scale. RESULTS Eating disorder patients displayed IDEA, EDI-2 and Experiences in Close Relationships scores significantly higher than controls. IDEA total and subtotal scores mediated entirely the influence of avoidant attachment on EDI-2 interoceptive awareness and impulsivity. DISCUSSION These findings demonstrate a relationship between insecure attachment and disorders of identity and embodiment and point to embodiment as a possible mediator between avoidant attachment and specific ED psychopathological traits. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Alessio Maria Monteleone
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy.,Department of Psychological Medicine, King's College London (KCL), Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Giovanni Castellini
- Psychiatric Unit, Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Valdo Ricca
- Psychiatric Unit, Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Umberto Volpe
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco De Riso
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Massimiliano Nigro
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Zamponi
- Psychiatric Unit, Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Milena Mancini
- DiSPUTer, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Giovanni Stanghellini
- DiSPUTer, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Department of Cognitive Science and Language, Diego Portales University of Santiago, Chile, Italy
| | - Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Janet Treasure
- Department of Psychological Medicine, King's College London (KCL), Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Mario Maj
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
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Amianto F, Northoff G, Abbate Daga G, Fassino S, Tasca GA. Is Anorexia Nervosa a Disorder of the Self? A Psychological Approach. Front Psychol 2016; 7:849. [PMID: 27378967 PMCID: PMC4906654 DOI: 10.3389/fpsyg.2016.00849] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 05/20/2016] [Indexed: 01/26/2023] Open
Abstract
The debate concerning the pathogenesis and the maintaining factors of eating disorders, anorexia nervosa in particular, is ongoing especially since therapeutic interventions do not result in satisfactory and enduring rates of remission. This paper presents a model for the pathogenesis of eating disorders, based on the hypothesis of a deficiency in the development of the self. We present the theory in light of new evidence concerning the role of attachment insecurity in the development and maintenance of eating disorders. In particular, we define the self in eating disorders in a comprehensive way by taking into account recent evidence from experimental psychology and neurobiology. The paper considers the development of the self in terms of its synchronic (i.e., experienced in the moment) and diachronic (i.e., experienced as continuous over time) aspects. Both synchronic and diachronic aspects of the self are relevant to the expression of eating disorder symptoms. Further, the maturation of the self is interwoven with the development of attachment functioning from infancy to adolescence. This interplay between these developmental processes of the self and of attachment could be crucial in understanding the pathogenesis of eating disorders. The final part of the paper suggests a neurobiological link between the theory of the self in the eating disorders and the spatiotemporal functioning of the brain. Disturbances in spatiotemporal functioning may represent the neurobiological pathway by which deficiencies in the self is related to attachment functions in individuals with eating disorders.
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Affiliation(s)
- Federico Amianto
- Regional Expert Centre for Eating Disorders, Neurosciences Department, Psychiatry Section, University of Turin Turin, Italy
| | - Georg Northoff
- Mind, Brain Imaging and Neuroethics Research Unit, The Royal's Institute of Mental Health Research, University of Ottawa, Ottawa ON, Canada
| | - Giovanni Abbate Daga
- Regional Expert Centre for Eating Disorders, Neurosciences Department, Psychiatry Section, University of Turin Turin, Italy
| | - Secondo Fassino
- Regional Expert Centre for Eating Disorders, Neurosciences Department, Psychiatry Section, University of Turin Turin, Italy
| | - Giorgio A Tasca
- Psychology, The Ottawa Hospital, University of Ottawa, Ottawa ON, Canada
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11
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Granieri A. Extreme trauma in a polluted area: Bonds and relational transformations in an Italian community. INTERNATIONAL FORUM OF PSYCHOANALYSIS 2016. [DOI: 10.1080/0803706x.2015.1101488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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12
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Barbasio C, Vagelli R, Marengo D, Querci F, Settanni M, Tani C, Mosca M, Granieri A. Illness perception in systemic lupus erythematosus patients: The roles of alexithymia and depression. Compr Psychiatry 2015; 63:88-95. [PMID: 26555496 DOI: 10.1016/j.comppsych.2015.09.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 09/03/2015] [Accepted: 09/05/2015] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE Alexithymia and depressive mood have been described as important dimensions of several medical diseases. Systemic lupus erythematosus is a chronic condition characterized by unpredictable clinical manifestations. The relationships between alexithymia, depression, and illness perception were examined in systemic lupus erythematosus patients. The interrelationships between psychological factors, such as alexithymia and depressive mood, were explored in systemic lupus erythematosus patients, and associations between these factors and illness perception in SLE were examined. We hypothesized that alexithymia and negative perceptions of illness would be associated in SLE patients, and depression would mediate this relationship. METHODS Subjects were 100 consecutive systemic lupus erythematosus patients attending the outpatient clinic at the University of Pisa rheumatology unit. They completed the Toronto Alexithymia Scale, Beck Depression Inventory, and Revised Illness Perceptions Questionnaire. Clinical variables were measured, disease activity was evaluated using the European Consensus Lupus Activity Measure, and damage was assessed using the Systemic Lupus International Collaborative Clinics/American College of Rheumatology Damage Index. RESULTS There were no associations between clinical variables, alexithymia, and depression. The results highlight the existence of significant links between alexithymia and illness perception for systemic lupus erythematosus patients. Moreover, our data suggest that some of these links are mediated by depression, which is the direct predictor of different aspects of perceived health. CONCLUSION Our findings suggest that studying the role of psychological factors, such as alexithymia and depression, may contribute to a more comprehensive perspective of systemic lupus erythematosus, including their impact on patients' beliefs about treatment effectiveness and emotional adaptation to chronic disease.
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Affiliation(s)
| | - Roberta Vagelli
- Rheumatology Unit, Department of Internal medicine, University of Pisa, Italy
| | - Davide Marengo
- Department of Psychology, University of Turin, Italy; Department of social sciences and humanities, University of Aosta Valley, Italy.
| | - Francesca Querci
- Rheumatology Unit, Department of Internal medicine, University of Pisa, Italy
| | | | - Chiara Tani
- Rheumatology Unit, Department of Internal medicine, University of Pisa, Italy
| | - Marta Mosca
- Rheumatology Unit, Department of Internal medicine, University of Pisa, Italy
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Bifulco A, Schimmenti A, Moran P, Jacobs C, Bunn A, Rusu AC. Problem parental care and teenage deliberate self-harm in young community adults. Bull Menninger Clin 2015; 78:95-114. [PMID: 24870845 DOI: 10.1521/bumc.2014.78.2.95] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Deliberate self-harm (DSH) in young people is a clinical and social problem related to early maltreatment but with little specificity in type of care or abuse determined. A community sample of 160 high-risk young people (aged 16-30) were the offspring of mothers' previously interviewed as vulnerable to major depression. The youth were interviewed to determine DSH (both suicidal and nonsuicidal), childhood maltreatment (using the Childhood Experience of Care and Abuse interview) and major depression (using SCID for DSMIV) before age 17. Around one fifth reported DSH; equal proportions were suicidal and nonsuicidal with a fourth of these with both. DSH was highly related to family context (single mother upbringing and family discord) and poor parental care (including antipathy, neglect, inadequate supervision, and role reversal). Highest odds ratios were for role reversal (OR = 17) and neglect (OR = 11). DSH was unrelated to any type of abuse. Logistic regression showed that role reversal, inadequate supervision, and teenage depression all modeled DSH. There was some specificity, with single mother upbringing, role reversal, and inadequate supervision predicting nonsuicidal DSH, and neglect and role reversal alone predicting suicidal DSH. Role reversal remained a key predictor for both types of DSH when controls were applied. Poor childhood care, which has implications for problematic emotion regulation and empoverished social development, needs to be understood to improve interventions and treatment for DSH in young people.
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Borgogno FV, Franzoi IG, Barbasio CP, Guglielmucci F, Granieri A. Massive Trauma in A Community Exposed to Asbestos: Thinking and Dissociation among the Inhabitants of Casale Monferrato. BRITISH JOURNAL OF PSYCHOTHERAPY 2015. [DOI: 10.1111/bjp.12170] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pace CS, Cavanna D, Guiducci V, Bizzi F. When parenting fails: alexithymia and attachment states of mind in mothers of female patients with eating disorders. Front Psychol 2015; 6:1145. [PMID: 26321978 PMCID: PMC4532914 DOI: 10.3389/fpsyg.2015.01145] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 07/23/2015] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION In recent years alexithymia and attachment theory have been recognized as two parallel research lines trying to improve the information on the development and maintenance of eating disorders (EDs). However, no research has analyzed these constructs among patients' families. In this study we compared alexithymia and attachment in mothers of patients with EDs and a control group. Further, we hypothesized that mothers of daughters with EDs with insecure and unresolved states of mind will reported high levels of alexithymia. Lastly, we explored the daughters' evaluations of maternal alexithymia. METHODS 45 mothers of ED women and 48 mothers of healthy controls (N = 93) matched for age and socio-demographic variables were administered by the Toronto Alexithymia Scale-20 (TAS-20) (S), while two sub-groups of "ED" mothers (n = 20) and "non-ED" ones (n = 22) were assessed by the Adult Attachment Interview (AAI). Moreover, the Observer Alexithymia Scale (OAS) was administered to the daughters for evaluating maternal alexithymia. RESULTS Regarding alexithymia, no differences were found between ED and non-ED mothers according to the TAS-20, while ED mothers showed more unresolved AAI classifications than non-ED mothers. No correlations were found between the TAS-20 and the AAI. Lastly, ED mothers were evaluated more alexithymic by their daughters with the OAS than those in the control group, and their alexithymic traits were significantly correlated with dismissing states of mind (idealization and lack of memory) in the AAIs. DISCUSSION Our results highlighted an interesting discrepancy among mothers with ED daughters between the low level of alexithymia provided by their self-reports and the high level of alexithymia observed by their daughters, although the OAS showed severe methodological limitations. Maternal attachment states of mind characterized by the lack of resolution of past losses could be connected to a confusing and incoherent quality of parenting.
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Affiliation(s)
| | - Donatella Cavanna
- Department of Educational Science, University of Genoa , Genoa, Italy
| | | | - Fabiola Bizzi
- Department of Educational Science, University of Genoa , Genoa, Italy
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Guglielmucci F, Franzoi IG, Barbasio CP, Borgogno FV, Granieri A. Helping traumatized people survive: a psychoanalytic intervention in a contaminated site. Front Psychol 2014; 5:1419. [PMID: 25538667 PMCID: PMC4258996 DOI: 10.3389/fpsyg.2014.01419] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 11/20/2014] [Indexed: 11/13/2022] Open
Abstract
Psychoanalytic literature on extreme traumatization usually distinguishes between natural catastrophes and man-made catastrophes. While the first ones are usually sensed as nature's ferocity, fate, or God's will, the second ones are experienced as a volountary and violent attack aimed at disrupting other human beings. In this paper we focus on man-made disasters caused by a profit-driven logic. When traumatization is due to irresponsible actions perpetrated by the owners of the major economic resource of a community, it deeply affects the identity of the group, entailing the loss of basic trust and lively parts of the Self. In such a situation, where the whole community is severely traumatized, psychoanalytic group therapy seems to be the most suitable setting: it allows to place the historization of the event and the creation of multiple narratives of somato-psychic suffering. Trust and faith are two crucial factors in the encounter with patients lacking a sense of vitality. The working through of each one through the group field is an essential forerunner to the construction of a recovered sense of faith and reliability that precedes the onset of a true new-beginning.
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