Abstract
Eating disorders (EDs) can be viewed as “embodied acts” that help to cope with internal and external demands that are perceived as overwhelming. The maintenance of EDs affects the entire identity of the person; the lack of a defined; or valid sense of self is expressed in terms of both physical body and personal identity. According to attachment theory, primary relationships characterized by insecurity, traumatic experiences, poor mirroring, and emotional attunement lead to the development of dysfunctional regulatory strategies. Although the literature shows an association between attachment style or states of mind, trauma, behavioral strategies, and various EDs, the debate is still ongoing and the results are still conflicting. Therefore, we believe it is important to examine and treat EDs by understanding which narrative trajectory intercepts distress in relation to narrative and embodied self-concept. Drawing on clinical observation and a narrative review of the literature, we focus on the construction and organization of bodily and narrative identity. Because bodily representations are the primary tools for generating meaning, organizing experience, and shaping social identity from the earliest stages of life, we focus on the role that bodily interactions and sensorimotor and proprioceptive patterns have played in the development of EDs. We consider the role that lack of attunement, insecure attachment, and relational trauma play in mentalizing, affecting self-representation and emotion regulation strategies. The paper also considers a semantic mode of trauma in EDs that involves a top-down pathway through beliefs and narratives about oneself based on lack of amiability, on devaluation, and on humiliation memories. Finally, we would like to highlight the proposal of an integrated model with multiple access model to psychotherapy that takes into account the complexity of ED patients in whom aspects related to dysregulation, body image disintegration, and post-traumatic symptoms are associated with a suffering sense of self and a retraumatizing narrative.
Highlights
Anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other eating disorders (EDs) are characterized by poor awareness and emotional regulation in the form of “embodied acts” used to cope with internal and external demands that are perceived as overwhelming and stressful (Cook-Cottone, 2006; Verschueren et al, 2021)
Greater attachment anxiety is associated with greater symptom severity and poorer therapeutic outcomes (Illing et al, 2010), and it appears that it is emotional dysregulation that mediates the impact on Eating disorders (EDs) symptoms
Combining clinical observations with recent findings from the literature, this article proposes a reflection on the functioning of EDs that includes the impact of early relational trauma on emotion regulation strategies, the role of attachment relationships in the development and maintenance of these disorders, the narrative construction of the self and the symptom, and connections with somatic memories
Summary
Anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other eating disorders (EDs) are characterized by poor awareness and emotional regulation in the form of “embodied acts” used to cope with internal and external demands that are perceived as overwhelming and stressful (Cook-Cottone, 2006; Verschueren et al, 2021). Greater attachment anxiety is associated with greater symptom severity and poorer therapeutic outcomes (Illing et al, 2010), and it appears that it is emotional dysregulation that mediates the impact on ED symptoms These studies support the perspective that attachment insecurity, along with a lack of emotional regulation skills, plays a role in the development of and resistance to change in EDs. When the experiences of emotional neglect occur in the relationship with the caregiver, mental closeness becomes painful and the natural need for closeness tends to be expressed at the physical level, for example, through excessive attention to body-oriented material care and feeding. If the patient is able to tell his or her own story in different ways (somatically, interactively, or linguistically), this can lead to a deep integration between his or her brain, body, and connection to others
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