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In this paper, we argue that Anorexia Nervosa (AN) can be explained as arising from a ‘lost sense of emotional self.’ We begin by briefly reviewing evidence accumulated to date supporting the consensus that a complex range of genetic, biological, psychological, and socio-environmental risk and maintenance factors contribute to the development and maintenance of AN. We consider how current interventions seek to tackle these factors in psychotherapy and potential limitations. We then propose our theory that many risk and maintenance factors may be unified by an underpinning explanation of emotional processing difficulties leading to a lost sense of ‘emotional self.’ Further, we discuss how, once established, AN becomes ‘self-perpetuating’ and the ‘lost sense of emotional self’ relentlessly deepens. We outline these arguments in detail, drawing on empirical and neuroscientific data, before discussing the implications of this model for understanding AN and informing clinical intervention. We argue that experiential models of therapy (e.g., emotion-focused therapy; schema therapy) be employed to achieve emergence and integration of an ‘emotional self’ which can be flexibly and adaptively used to direct an individual’s needs and relationships. Furthermore, we assert that this should be a primary goal of therapy for adults with established AN.

Changes in roles and responsibilities brought about by community care and the reorganization of the UK National Health Service (NHS) have resulted in higher levels of stress and insecurity amongst residential nursing staff working with people with intellectual disability. In the light of these organizational changes, questions have arisen about the relationship between role clarity, perception of the organization and occupational stress. A number of studies have investigated these issues amongst staff working with people with intellectual disability, although there have been few investigations in the UK. The present study examines the relationship between these variables in the context of the differences between the employees of an NHS trust and a charitable organization. The present study involved constructing a measure of role clarity and perception of the organization, and the use of the Maslach Burnout Inventory (MBI). The results indicated that most support workers regarded their role as being clear and their levels of burnout to be comparable with UK nursing norms. Charity staff were more likely to view their organization positively and rated their emotional exhaustion as significantly lower than NHS trust staff. A within-service comparison of homes revealed differences amongst NHS trust and charity homes on sub-scales of the MBI. The results are discussed in the context of previous research and changes in working practices in the field.

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The results were consistent with previous studies suggesting that ability to disengage from distressing beliefs is important in therapeutic progression. Reasons considered for the inability to progress include emotional investment in psychotic beliefs and cognitive processing. Further research is required to clarify the role of logical thought and therapeutic alliance in progress and in predicting outcome.