Narrative and Bodily Identity in Eating Disorders: Toward an Integrated Theoretical-Clinical Approach

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.

State of Mind Assessment in Relation to Adult Attachment and Text Analysis of Adult Attachment Interviews in a Sample of Patients with Anorexia Nervosa

“…Specifically, attachment insecurity has a prevalence ranging from 70% in eating disorder patients [ 45 , 46 ] to 95% [ 47 ] and 100% [ 48 ]; it has also been considered an important risk factor for the occurrence of dysfunctional eating behaviors in the nonclinical population [ 19 , 49 ]. Traumatic life experiences, especially when experienced early and repeatedly over time, considerably increase this risk and play a major role in both the development and maintenance of dysfunctional circuits [ 50 ]. These experiences are rooted in the childhood strategies of insecure attachment (avoidant pattern (A), ambivalent pattern (C), and disorganized pattern (D)) and then in adult SoM (dismissing (DS), entangled (E), unresolved (U), or cannot classify (CC)) [ 51 , 52 ].…”

“…In summary, examining the attachment dynamics in the life histories of ED patients and understanding the quality of their SoM are essential activities in the clinical setting, not only for the formulation of a diagnostic hypothesis but also to elucidate useful information with respect to what these aspects of the individual’s functioning suggest about the therapeutic relationship, the outcome of treatment, the possible responses to separations during the therapeutic process, and the risk of dropping out [ 50 , 83 , 84 ]. Knowledge of the regulatory systems for coping with vulnerability learned in childhood, in interaction with attachment figures, makes it possible to maintain an attitude of emotional closeness appropriate to the patient, in addition to aiding in development of the therapeutic relationship and helping the patient develop new strategies to cope with stressful situations.…”

Are you how you eat? Aspects of self-awareness in eating disorders

“…Based on clinical reports and a narrative review of the literature, it has been observed that patients with ED experience a distortion between their perceived body image and schema and their actual reality (Thurm, 2012; Miller, 1991; Longo & Haggard, 2012; Pellegrini et al, 2021; Riva, 2014). Consequently, individuals with ED exhibit a significantly stronger response to the rubber hand illusion, both in terms of perceptual (proprioceptive bias) and subjective (self-report) measures, compared to healthy controls (Eshkevari et al, 2014).…”

“…Consequently, the formation and organization of our body image are integral aspects of our overall identity. From this perspective, the maintenance of an ED directly affects the subject’s identity (Pellegrini et al, 2021; Longo & Haggard, 2012). In line with self-objectification theory, which posits that individuals come to view themselves as objects to be evaluated based on appearance, the maintenance of an ED can exacerbate this tendency (Fredrickson & Roberts, 1997).…”

“…In line with self-objectification theory, which posits that individuals come to view themselves as objects to be evaluated based on appearance, the maintenance of an ED can exacerbate this tendency (Fredrickson & Roberts, 1997). Given that our understanding of our bodies plays a central role in assigning meaning to our experiences, addressing factors such as body interactions, sensorimotor patterns, and proprioceptive patterns is crucial in ED treatment (Pellegrini et al, 2021; Longo & Haggard, 2012).…”