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Abstract
In this paper, we argue that Anorexia Nervosa (AN) can be explained as arising from a ‘lost sense of emotional self.’ We begin by briefly reviewing evidence accumulated to date supporting the consensus that a complex range of genetic, biological, psychological, and socio-environmental risk and maintenance factors contribute to the development and maintenance of AN. We consider how current interventions seek to tackle these factors in psychotherapy and potential limitations. We then propose our theory that many risk and maintenance factors may be unified by an underpinning explanation of emotional processing difficulties leading to a lost sense of ‘emotional self.’ Further, we discuss how, once established, AN becomes ‘self-perpetuating’ and the ‘lost sense of emotional self’ relentlessly deepens. We outline these arguments in detail, drawing on empirical and neuroscientific data, before discussing the implications of this model for understanding AN and informing clinical intervention. We argue that experiential models of therapy (e.g., emotion-focused therapy; schema therapy) be employed to achieve emergence and integration of an ‘emotional self’ which can be flexibly and adaptively used to direct an individual’s needs and relationships. Furthermore, we assert that this should be a primary goal of therapy for adults with established AN.
Highlights
Anorexia Nervosa (AN) is an eating disorder (ED) characterized by self-starvation driven by weight, shape and eating concerns and extreme dread of food, eating and normal body weight (American Psychological Association [APA], 2013; Walsh, 2013; Treasure et al, 2015b)
Our model is not inconsistent with goals of other treatments, such as developing a ‘nonAN’ identity outlined in Maudsley Anorexia Nervosa Treatment for Adults (MANTRA); yet we explicitly argue the meaning of establishing identity as establishing a core emotional sense of self, which can be flexibly and adaptively used to direct an individual’s needs and relationships
We propose AN arises from and perpetuates a lost sense of emotional self; a person without the conductor of the orchestra, persistently reliant upon and sensitive to audience feedback to ascertain if it is performing adequately
Summary
Anorexia Nervosa (AN) is an eating disorder (ED) characterized by self-starvation driven by weight, shape and eating concerns and extreme dread of food, eating and normal body weight (American Psychological Association [APA], 2013; Walsh, 2013; Treasure et al, 2015b). Putative risk factors are depicted and maintenance factors depicted complex, empirically driven models, prompting the inclusion of SSCM in NICE guidelines This falls short of advances made in outcomes from interventions developed for other Axis I disorders, including CBT for depression, generalized anxiety disorder, panic disorder, obsessive compulsive disorder, and Bulimia Nervosa (Butler et al, 2006). Speciality interventions developed to date tend to have complex hypotheses with many diverse target variables This potentially falls into the trap of an unhelpful ‘everything is relevant’ approach common in mental health research and results in the inclusion of many possible risk or maintenance factors into a causal model (Kendler and Campbell, 2009). We propose that an integrative account of the emergence of risk and maintenance factors and their interplay (including how this is potentiated once AN is established) is required to gain the necessary depth of understanding of the development and presentation of AN to develop and inform interventions
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