«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, selfpreservative 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.

Breaking the cycle: Identifying key symptom pathways of eating disorders and the influence of childhood maltreatment

“…This can also be referred to as embodiment or “the embodied self” (Cassioli et al, 2020; Malecki et al, 2018; Musolino et al, 2020; Young, 1992). ED treatment, especially inpatient treatment, could be an extra trigger for these patients (with a focus on eating, weight normalization, and attachment with the therapist in therapy), which could explain the higher percentage of dropouts (Convertino & Mendoza, 2023; Day et al, 2023; Olofsson et al, 2021). However, there might be aspects central for these patients that are not fully captured by the EDE‐Q questionnaire, like the concept of embodiment after childhood maltreatment.…”