«In solitude is safeness»: a patient perspective on eating disorders in the context of multiple childhood trauma

Abstract

To capture the core pathology of eating disorders (EDs) in the context of multiple childhood trauma, the aim of this study was to describe variation and common features in the lived experiences of ED patients with childhood physical, emotional, and/or sexual abuse and neglect. Semi-structured interviews were conducted post-treatment with nine participants aged 25-59; data was analyzed with Interpretative Phenomenological Analysis. Four master themes emerged across EDs and trauma categories: 1) Shape and weight as regulators of closeness and distance, 2) ED as a sanctuary for counteracting feelings of helplessness and incompetence, 3) ED as a designated caregiver, and 4) ED filling an existential emptiness while emptying unwanted emotions. Informants emphasized interpersonal aspects through the overarching core theme of the ED as protective, self-preservative strategies in relationships with others. ED onset was described as related to the failure of parental figures and their functions, whereas ED maintenance related to the highly isolative and self-perpetuating nature of the disorder. The hypothesized model may have important clinical implications, especially in terms of the therapeutic working alliance, and we suggest that developmental issues are considered when developing future treatments for this ED subgroup.