Alexithymia is characterized by difficulties identifying feelings and differentiating between feelings and bodily sensations, difficulties communicating feelings, and a concrete cognitive style focused on the external environment. Individuals with eating disorders have elevated levels of alexithymia, particularly difficulties identifying and describing their feelings. A number of theoretical models have suggested that individuals with eating disorders may find emotions unacceptable and/or frightening and may use their eating disorder symptoms (i.e., restricting food intake, bingeing, and/or purging) as a way to avoid or cope with their feelings. The current critical review synthesizes the literature on alexithymia and eating disorders and examines alexithymia levels across eating disorders (i.e., anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified), the role of alexithymia in binge eating disorder, and the influence of alexithymia on the development of eating disorders as well as treatment outcome. The clinical implications of the research conducted to date and directions for future research are discussed.

When confronted with an anxiety-producing threat to self-esteem, restrained eaters (dieters) increase their food consumption. The functional explanation suggests that increased eating temporarily counteracts or masks dysphoria for the restrained eater; externality or stimulus sensitivity theories propose that distress shifts the dieter's attention to external stimulus properties (e.g., taste) and to activities stimulated by such external cues. In an attempt to distinguish between these two explanations, anxious and nonanxious restrained and unrestrained eaters were given palatable and unpalatable foods, and consumption was measured. Results support the functional explanations: Distressed dieters increased their intake of food regardless of taste properties. Theoretical and practical implications for both restrained eating and the behavior of eating disorder patients are discussed.

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Clinical recommendations based on these data include encouraging clients to adopt the recommended behavioral changes immediately at the beginning of treatment, and to make complete symptom control a priority. In addition, addressing weight-related self-evaluation and teaching clients to detach from this schema that connects weight/shape with self-esteem may be an effective and feasible step toward relapse prevention.

Anorexia nervosa (AN) is perhaps the most lethal mental disorder, in part due to starvation-related health problems, but especially because of high suicide rates. One potential reason for high suicide rates in AN may be that those affected face pain and provocation on many fronts, which may in turn reduce their fear of pain and thereby increase risk for death by suicide. The purpose of the following studies was to explore whether repetitive exposure to painful and destructive behaviors such as vomiting, laxative use, and non-suicidal self-injury (NSSI) was a mechanism that linked AN-binge-purging (ANBP) subtype, as opposed to AN-restricting subtype (ANR), to extreme suicidal behavior. Study 1 utilized a sample of 787 individuals diagnosed with one or the other subtype of AN, and structural equation modeling results supported provocative behaviors as a mechanism linking ANBP to suicidal behavior. A second, unexpected mechanism emerged linking ANR to suicidal behavior via restricting. Study 2, which used a sample of 249 AN patients, replicated these findings, including the second mechanism linking ANR to suicide attempts. Two potential routes to suicidal behavior in AN appear to have been identified: one route through repetitive experience with provocative behaviors for ANBP, and a second for exposure to pain through the starvation of restricting in ANR.

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Objective: The aim of this study was to compare two maintenance treatment conditions for weight-restored anorexia nervosa (AN): individual cognitive behavior therapy (CBT) and maintenance treatment as usual (MTAU).Method: This study was a nonrandomized clinical trial. The participants were 88 patients with AN who had achieved a minimum body mass index (BMI) of 19.5 and control of binge eating and purging symptoms after completing a specialized hospital-based program. Forty-six patients received 1 year of manualized individual CBT and 42 were in an assessment-only control condition (i.e., MTAU) for 1 year. This condition was intended to mirror follow-up care as usual. Participants in both the conditions were assessed at 3-month intervals during the 1-year study. The main outcome variable was time to relapse.Results: When relapse was defined as a BMI 17.5 for 3 months or the resumption of regular binge eating and/or purging behavior for 3 months, time to relapse was significantly longer in the CBT condition when compared with MTAU. At 1 year, 65% of the CBT group and 34% of the MTAU group had not relapsed. Discussion:The current findings provide preliminary evidence that CBT may be helpful in improving outcome and preventing relapse in weight-restored AN.