Bridging cognitive, phenomenological and psychodynamic approaches to eating disorders

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.

Untitled

“…It is worth agreeing with G. Castellini et al, (2022), who noted that an integrated psychotherapeutic approach focused on typological features may make it possible to overcome the limitations of existing treatments, improve the prognosis of patients with eating disorders by taking into account the dimensions of the psychopathology of food addiction, as well as emotional, perceptual, experiential, relational and identity-related problems that together form the basis of these severe disorders in a single multidimensional psychopathological and treatment model.…”

Anorexia nervosa as a disorder of the subcortical–cortical interoceptive-self

“…The main symptoms of AN revolve around the body: a strong fear of gaining weight, excessive worries about body shape and weight, and a distorted view of one’s body [ 1 ]. In addition, these patients report an altered emotional experience, characterized by a difficulty in recognizing and expressing emotions, namely alexithymia or unstable emotions [ 6 , 95 , 96 ]. Given the interdependent nature of physiological and subjective emotional states, the extent to which an individual can detect and interpret bodily signals has been considered influential in shaping emotional experiences [ 97 – 99 ].…”

“…It is characterized by low body weight, fear of weight gain and distorted perception of own body or persistent lack of recognition of the seriousness of the current low body weight [ 2 ], resulting in the highest mortality rate of any psychiatric illness [ 3 ]. Patients with AN also report profound disconnection from their own body sensations and emotions [ 4 – 6 ], with consequent difficulty in understanding their own and others’ internal experiences [ 7 , 8 ].…”

“You’re Just Looking at One Piece of the Puzzle… My Weight”: A Phenomenological Examination of Diagnostic Crossover in Eating Disorders

“…AN and BN are often described via binary oppositions -success and failure, control and out-of-control, strength and weakness -despite sharing many of the same diagnostic features and having relative high rates of diagnostic crossover (Castellini et al, 2022;Eli, 2018;Kearns, 2020). Previous research point to the moral associations of certain ED behavioral symptomology and cultural attitudes towards different body sizes (e.g., anti-fat bias), as part of the underpinning for why certain EDs are understood as 'better' or 'worse' (Burns, 2004;Counihan, 1992).…”