Insidious: The relationship patients have with their eating disorders and its impact on symptoms, duration of illness, and self‐image

Abstract

ObjectivesIn published clinical and autobiographical accounts of eating disorders, patients often describe their disorder in personified ways, that is, relating to the disorder as if it were an entity, and treatment often involves techniques of externalization. By encouraging patients to think about their eating disorder as a relationship, this study aimed to examine how young female patients experience their eating disorder as acting towards them, how they react in response, and whether these interactions are associated with symptoms, illness duration, and self‐image.DesignStructural Analysis of Social Behavior (SASB) was used to operationalize how patients experience the actions of their eating disorder and their own reactions to the disorder.MethodThe relationship between patients (N = 150) and their eating disorders was examined with respect to symptoms, duration of illness, and self‐image. Patients were also compared on their tendency to react with affiliation in relation to their disorder.ResultsPatients’ responses on the SASB indicated that they tended to conceptualize their eating disorders as blaming and controlling, and they themselves as sulking and submitting in response. Greater experience of the eating disorder as being controlling was associated with higher levels of symptomatology. Patients reacting with more negative affiliation towards their disorder were less symptomatic.ConclusionsWhen encouraging patients to think about their eating disorder as a relationship, comprehensible relationship patterns between patients and their eating disorders emerged. The idea that this alleged relationship may resemble a real‐life relationship could have theoretical implications, and its exploration may be of interest in treatment.Practitioner points Patients were able to conceptualize their eating disorder as a significant other to whom they relate when encouraged to do so.Patients tended to experience their disorder as controlling and domineering.Exploring the hypothetical patient–eating disorder relationship may prove helpful in understanding dysfunctional relational patterns.Helping patients to rebel against their eating disorder could potentially aid in symptom reduction.

Take charge: Personality as predictor of recovery from eating disorder

“…There is ample evidence that most patients with eating disorder have insecure attachment and the associated features of deficits in mentalizing, in regulating emotions, in self-compassion, and of negative self-evaluation (Clinton, 2006;Dakanalis et al, 2016;Forsen Mantilla et al, 2017;Goss & Allan, 2014;Nazzaro et al, 2017;O'Shaughnessy & Dallos, 2009). Attachment patterns, i.e.…”

“…Regardless of psychotherapeutic perspective, most therapies include keeping a food journal and working to understand internal and external factor that contribute to the disorder. Examples of internal factors are body dissatisfaction, emotions regulation difficulties, low self-esteem, insecure attachment, poor mentalizing, loneliness and personality vulnerabilities (Clinton, 2006;Culbert et al, 2015;Dakanalis, Clerici, & Carra, 2016;Forsen Mantilla, Clinton, & Birgegård, 2017;Goss & Allan, 2014;Kelly & Tasca, 2016;Nazzaro et al, 2017;O'Shaughnessy & Dallos, 2009). External factors can be traumatic experiences, bullying, interpersonal difficulties, rejection, criticism, failure, stress and loss, that can trigger and/or maintain eating disorder thoughts and symptoms.…”

The unsafe haven: Eating disorders as attachment relationships

“…Finally, we tested a double mediation model where attachment security on the ASQ (i.e., Confidence subscale) was hypothesized to predict ED symptoms (EDEQ Global Score), mediated by perceived actions of the ED (SASB Surface 1) and self‐image (SASB Surface 3). We chose the most salient aspects of the ED actions and self‐image in relation to symptoms (i.e., the Autonomy vector of Surface 1, most strongly associated with ED symptoms in Forsén Mantilla et al ., ; and Cluster 6 measuring Self‐blame on Surface 3, most strongly associated with ED symptoms in Forsén Mantilla & Birgegård, ). Thus, Secure Attachment (variable X ) was modelled as affecting EDEQ directly, indirectly via ED autonomy, indirectly via self‐criticism, and indirectly through both of these.…”

“…In treatment, patients are often encouraged to externalize their illness, that is to regard it as a separate entity, as a means of encouraging objectivity and preventing over‐identification with the disorder (Scott, Hanstock, & Patterson‐Kane, ; White & Epston, ). A recent study (Forsén Mantilla, Clinton, & Birgegård, ) investigated how patients with different ED diagnoses related to their EDs when encouraged to conceptualize this as a dyadic intrapersonal relationship. Patients of all diagnostic groups described relationship patterns that resembled highly negative and enmeshed real‐life relationships with implications for symptom levels and self‐image.…”

Perceptions of the “anorexic voice”: A qualitative study of health care professionals

“…HCPs presented the AV as a means of helping clients to gain some distance from anorexic behaviours and connect with other interests and qualities, in line with previous research (Scott, Hanstock, & Patterson‐Kane, ). They also suggested that acknowledging the voice in treatment could assist service users to become critical of this element of AN; hence, the AV could be used to “[mobilise] anger towards the illness” (Forsén Mantilla, Clinton, & Birgegård, , p. 12) and help service users to mount a “resistance” to it (Maisel, Epston, & Borden, , p. 12). In this way, empathy for the client's experience can be used to facilitate behavioural change in AN.…”