Is Anorexia Nervosa a Disorder of the Self? A Psychological Approach

Abstract

The debate concerning the pathogenesis and the maintaining factors of eating disorders, anorexia nervosa in particular, is ongoing especially since therapeutic interventions do not result in satisfactory and enduring rates of remission. This paper presents a model for the pathogenesis of eating disorders, based on the hypothesis of a deficiency in the development of the self. We present the theory in light of new evidence concerning the role of attachment insecurity in the development and maintenance of eating disorders. In particular, we define the self in eating disorders in a comprehensive way by taking into account recent evidence from experimental psychology and neurobiology. The paper considers the development of the self in terms of its synchronic (i.e., experienced in the moment) and diachronic (i.e., experienced as continuous over time) aspects. Both synchronic and diachronic aspects of the self are relevant to the expression of eating disorder symptoms. Further, the maturation of the self is interwoven with the development of attachment functioning from infancy to adolescence. This interplay between these developmental processes of the self and of attachment could be crucial in understanding the pathogenesis of eating disorders. The final part of the paper suggests a neurobiological link between the theory of the self in the eating disorders and the spatiotemporal functioning of the brain. Disturbances in spatiotemporal functioning may represent the neurobiological pathway by which deficiencies in the self is related to attachment functions in individuals with eating disorders.

Neurobiology of Anorexia Nervosa: Serotonin Dysfunctions Link Self-Starvation with Body Image Disturbances through an Impaired Body Memory

“…This view is in agreement with a recent hypothesis that describe anorexia as a disturbance of the self (Amianto et al, 2016) specifically associated “with spatial functioning possibly related to experiencing one's own body as an integrated aspect of the self, and temporal functioning possibly related to integrating the self in a coherent narrative over time.” (p. 7). More, it is also in agreement with the free energy framework suggesting that pre-existing mental models shape current perception (Friston and Kiebel, 2009).…”

Embodiment Mediates the Relationship between Avoidant Attachment and Eating Disorder Psychopathology

“…According to literature studies, attachment styles might lay the groundwork for identity development and might represent an important psychopathological factor of resilience (Amianto, Northoff, Abbate Daga, Fassino, & Tasca, ; Mikulincer & Shaver, ). The prevalence of insecure attachment is high in adults with EDs, and several studies demonstrated connections between insecure attachment and ED psychopathology (Abbate‐Daga, Gramaglia, Amianto, Marzola, & Fassino, ; Tasca & Balfour, ).…”

Parental and Adult Attachment and Eating Symptomology in Eating Disorder Patients and Sine Morbo Individuals

“…On the basis of these assessments, a combination of a categorical diagnosis and a dimensional description of the patient's personality and attachment functioning can be suggested in order to build a better understanding of the personal ED symptomology, appropriate treatments, and to promote good therapeutic alliance (Illing et al, 2010;Tasca et al, 2009b;. Since the degree of attachment security is associated with ED symptomology, an attachment-sensitive can be beneficial for certain ED patients (Amianto et al, 2016;.…”

“…Attachment interventions in ED treatment should support four key areas (Amianto et al, 2016;Faber & Dubé , 2015;Keating et al, 2013;Kuipers et al, 2016;Maxwell et al, 2014;Tasca et al, 2009aTasca et al, , b, 2011Tasca et al, , 2013…”