Anomalous self-experience, body image disturbance, and eating disorder symptomatology in first-onset anorexia nervosa

Lorenzo Moccia,Luigi Janiri,Marianna Ambrosecchia,Lucio Rinaldi,Salvatore Di Pietro,Vittorio Gallese,Delfina Janiri,Valentina De Martin,Gabriele Sani,Marco Di Nicola,Eliana Conte

doi:10.1007/s40519-021-01145-0

Abstract

PurposeAnorexia nervosa-restrictive subtype (AN-R) is a life-threatening disorder relying on behavioural abnormalities, such as excessive food restriction or exercise. Such abnormalities may be secondary to an “objectified” attitude toward body image and self. This is the first study exploring the impact of anomalous self-experience (ASEs) on abnormal body image attitude and eating disorder (ED) symptomatology in individuals with AN-R at onset.MethodsWe recruited Italian female participants, 40 with AN-R (mean age 18.3 ± 2.3) and 45 age and educational level-matched healthy controls (HCs) (mean age 18.2 ± 2.6). ASEs, body image attitude, and ED symptom severity were assessed through the examination of anomalous self-experience (EASE), the body uneasiness test (BUT), and the eating disorder examination questionnaire (EDE-Q), respectively. We conducted multivariate analysis of variance to investigate distribution patterns of variables of interest, and mediation analysis to test the effect of ASEs and body image on ED symptomatology.ResultsIndividuals with AN-R scored higher than HCs on the EASE (p < .0001). A direct effect of ASEs on ED severity (p = 0.009; bootstrapped LLCI = 0.067, ULCI = 0.240) was found in AN-R. After modelling the effect of abnormal body image attitude, the relationship between EASE total score and ED symptomatology was significantly mediated by BUT (p = 0.002; bootstrapped LLCI = 0.001, ULCI = 0.172).ConclusionAlthough the exact pathways linking AN-R to self-disorder remain to be identified, a broader exploration of transdiagnostic features in AN, including explorations of different dimensions of self-experience and intersubjectivity, may shed further light on the clinical phenomenology of the disorder.Level of evidenceLevel III, case–control analytic study.

Highlights

Anorexia nervosa (AN) is a severe and often life-threatening disorder whose onset usually occurs during adolescence and early adulthood
AN may manifest in a restrictive subtype (AN-R) where severe weight loss and starvation may potentially lead to a multitude of adverse medical sequelae, including cardiovascular, metabolic, endocrine, and other disturbances that increase the susceptibility to disease, as well as to increased risk of premature mortality [1]
For the aim of this study, we focused on the distribution patterns of anomalous self-experience (ASE), body uneasiness, and eating disorder (ED) symptoms severity in patients with Anorexia nervosa-restrictive subtype (AN-R) compared to healthy controls (HCs)

Summary

Introduction

Anorexia nervosa (AN) is a severe and often life-threatening disorder whose onset usually occurs during adolescence and early adulthood. Body image disturbances do motivate severe dietary restriction and weight loss behaviours and play a central role in the initiation, persistence, and relapse of AN-R [4]. Whereas disturbances in a broader notion of the concept of the Self have been discussed regarding AN-R [9], the relationship between eating disorders (EDs) and disturbances of the basic self appears to be unaddressed in the literature. This gap prompted our interest to empirically investigate different dimensions of self-experience and subjectivity in the domain of EDs and their relationship with body image, starting from AN-R. The issue is worth pursuing, in the light of both the clinical predictive value of body image distortion in AN-R and the lack of interventions successfully tackling this psychopathological feature [5]

Methods

Results

Conclusion