Restoring connection in the face of disconnection: an integrative approach to understanding and treating anorexia nervosa

Abstract

This article explores the role of disconnection as a mediating process that creates the conditions for the development of anorexia nervosa (AN) and its intractability with regard to treatment. Intrapersonal (e.g. biological and psychological) and interpersonal (e.g. behavioral and affective) processes that contribute to the disconnections characterizing AN are described and an integrative model of disconnection is presented. Discussion of this model is followed by a description of a Relational/Motivational Multifamily Therapy Group that involves patients and family of origin as well as extra-familial members who have an emotional investment in the patient. This group, informed by Relational-Cultural Theory, Stages of Change Theory, Motivational Interviewing, and preliminary research findings and developed in partnership with patients and families, specifically identifies and repairs disconnections associated with AN. A clinical vignette from this group shows how a RelationalMotivational Multifamily Therapy Group facilitates the restoration or development of connections on individual, dyadic, and 'group-as-a-whole' levels. The article ends with implications for research related to viewing AN as a disease of disconnection.

Two models of multiple family therapy in the treatment of adolescent anorexia nervosa: a systematic review

“…They include psychoeducational multifamily groups for families of adolescent and adult sufferers [31][32][33][34] partially inspired by McFarlane's psychoeducational model [35]. These usually take the form of time-limited outpatient workshops (6-8 sessions) involving educational/cognitivebehavioral, motivational, and problem-solving components, along with relational elements.…”

Ketamine as a Treatment for Anorexia Nervosa: A Narrative Review

“…Patients also report that their eating disorders often feel intertwined with their identities [165] and report anguish at physically "taking up space" [166,167]. Additionally, disconnection from the self, others and the world is core to AN [168][169][170]. It is possible that ketamine may have an additional therapeutic impact for patients with AN by promoting flexibility, ego dissolution, detachment from one's internal dialogue and openness to experiences [162].…”

A pilot study of multifamily therapy group for young adults with anorexia nervosa: Reconnecting for recovery

“…This challenge may relate to the interplay of intrapersonal (e.g., poor emotion regulation [Lavender et al, 2015]) and interpersonal (e.g., avoidance of intense emotion [Schmidt & Treasure, 2006]) processes of disconnection characterizing AN (Tantillo, Sanftner, & Hauenstein, 2013). This challenge may relate to the interplay of intrapersonal (e.g., poor emotion regulation [Lavender et al, 2015]) and interpersonal (e.g., avoidance of intense emotion [Schmidt & Treasure, 2006]) processes of disconnection characterizing AN (Tantillo, Sanftner, & Hauenstein, 2013).…”

“…Although individual therapy approaches and FBT for young adults with AN have shown promise, the illness remains difficult to treat. This challenge may relate to the interplay of intrapersonal (e.g., poor emotion regulation [Lavender et al, 2015]) and interpersonal (e.g., avoidance of intense emotion [Schmidt & Treasure, 2006]) processes of disconnection characterizing AN (Tantillo, Sanftner, & Hauenstein, 2013). The interplay of disconnections from self, one's body, and others can amplify interpersonal disconnections with family members who experience distress and high caregiving burden (Zabala, Macdonald, & Treasure, 2009.)…”