Elsevier

Comprehensive Psychiatry

Volume 47, Issue 3, May–June 2006, Pages 189-193
Comprehensive Psychiatry

Treatment of eating disorders improves eating symptoms but not alexithymia and dissociation proneness

https://doi.org/10.1016/j.comppsych.2006.01.001Get rights and content

Abstract

Background

Eating disorders have been reported to increase in frequency, but it is yet unclear what psychological characteristics increase the proneness toward the development of eating disorders. Alexithymia (AL; a difficulty in awareness to one's emotions) and dissociation proneness are 2 such plausible features.

Method

In this study, we evaluated the efficacy of a combined intervention (group therapy, individual therapy, and pharmacologic therapy) in a group of soldiers with eating disorders (n = 30) in the Israel Defense Forces. Moreover, we examined whether AL and dissociation proneness were frequent in this group and whether clinical improvement was associated with an improvement in these factors as well.

Results

High scores on the AL and dissociation measures were noted. The intervention was associated with a 50% decrease in the Eating Attitudes Test and Eating Disorders Inventory scores, consistent with our clinical impression of improvement in the eating symptoms. However, the decrease observed on the Dissociative Experiences Scale and Toronto Alexithymia Scale scores was minimal.

Conclusions

The combined intervention was efficient in our sample of patients with eating disorder despite the small sample size. The aforementioned specific psychometric change may be indicative of the lack of importance of changes in AL or dissociation proneness in the short-term improvement in patients with eating disorder.

Introduction

The prevalence of eating disorders has been reported to increase in recent decades, especially among young girls [1]. Anorexia nervosa reaches a prevalence of 1%, whereas bulimia nervosa is estimated to affect 5% of the population. Strong cultural influences are possibly behind this epidemic, but although the cultural pressure among Western girls is ubiquitous, it is not clear why only certain individuals will develop an eating disorder [2]. Therefore, the search for specific psychological variables that may contribute to the pathophysiology of these disorders is of great importance. Two such relevant factors are alexithymia (AL) and dissociation proneness, both considered as strategies of dealing with negative emotions.

Alexithymia was originally characterized as an inability to find words to describe one's feelings but is also conceptualized as a dysfunction in identifying (or awareness to) one's feelings [3], [4], [5]. Alexithymia has been studied in psychosomatic diseases, functional somatic symptoms, and depressive and anxiety disorders [6], [7], [8], [9], and has also been associated with suicidality [7]. Patients with eating disorders have a significant difficulty at identifying their feelings and expressing them verbally (especially negative affects and anger) [10], [11], [12], [13], [14], [15], [16]. They may attempt to avoid feared sensations by attempting to constrict emotional experiences in general. Moreover, bulimic patients might deal with negative feelings by excluding the bad object or feelings through the vomiting symptom. Alexithymia may result in patients with eating disorders also from frequent traumatic experiences during childhood such as sexual abuse (secondary AL), and the symptom may be one way to regain control. If one function of AL is the avoidance of affect [8], then patients with eating disorders should be more alexithymic. Indeed, an association was reported between anorexia nervosa and AL [6], [9], [10], [11], [12], [13] and between bulimia and AL [14], [15], [16].

Dissociation results from a disintegration of consciousness, memory, identity, and perception and is considered a defense mechanism against intolerable trauma and/or memories [17], [18]. Dissociative disorders and experiences are related to childhood neglect and abuse history [19], [20], [21]. These features (abuse and neglect) are quite frequent among patients with eating disorders, particularly those involving bulimic features, and may therefore explain the high dissociation tendency in patients with eating disorders [22], [23], [24]. These patients are also characterized by emotional disavowal, a retreat to eating and fasting experiences, disturbed body image, and bodily sensations (such as increased pain tolerance) and identity problems. These features may link eating disorders with the process of dissociation [25], [26]. Dissociation could also be related to self-injurious behavior in patients with eating disorder [27], [28].

In this study, we examined the efficacy of our treatment program for eating disorders in a sample of young soldiers at a military clinic and to evaluate the rate of AL and dissociation proneness in the sample, both before and after treatment. This study reports on the results of 2 consecutive groups of patients with eating disorders treated in 2002 and 2003.

Section snippets

Sample

The sample included soldiers referred to the Eating Disorder Clinic at the Zeriffin Mental Health Clinic, Israel Defense Forces during the years 2001 to 2003. This military clinic is the only eating disorders clinic in the army, supplying tertiary services to soldiers from the whole army. Yearly, the clinic examines 200 soldiers, and only up to 5 of these are discharged from military service because of severe symptoms and significant decrease in functioning (Hartuv, personal communication). The

Results

Twenty-four subjects completed the treatment period, and 6 patients (all women) dropped out because of noncompliance and lack of motivation. The dropouts' diagnoses were anorexia nervosa [2], bulimia nervosa [3], and eating disorder NOS. [1]. Their initial scores on the various scales were similar to those of the completers. For the completers, the scores on the EDI-2, EAT-26, DES, and TAS-26 scales before and after treatment are displayed in Table 1.

Discussion

The main findings of this study are as follows: the intervention was associated with a significant improvement in eating symptoms (50% decrease in the EAT-26 and EDI-2 scores), but there was no significant decrease on the DES and TAS-26 scores. The decrease on the EDI-2 and EAT-26 was similar to the clinical impression of significant improvement. This specific psychometric change may be indicative of the lack of importance of changes in AL or dissociation proneness in the short-term improvement

References (47)

  • T.N. Wise et al.

    Secondary alexithymia: an empirical validation

    Compr Psychiatry

    (1990)
  • M. Bach et al.

    Alexithymia and somatization: relationship to DSM-III-R diagnosis

    J Psychosom Res

    (1994)
  • G. Akyuz et al.

    Frequency of dissociative identity disorder in the general population in Turkey

    Compr Psychiatry

    (1999)
  • C.A. Ross et al.

    Dissociative experiences among psychiatric inpatients

    Gen Hosp Psychiatry

    (1992)
  • J. Modestin et al.

    Dissociative experiences and dissociative disorders in acute psychiatric inpatients

    Compr Psychiatry

    (1996)
  • A.E. Becker et al.

    Eating disorders

    N Engl J Med

    (1999)
  • J. Polivy et al.

    Causes of eating disorders

    Annu Rev Psychol

    (2002)
  • J.C. Nemiah et al.

    Affect and fantasy in patients with psychosomatic disorders

  • J.C. Nemiah et al.

    Psychosomatic illness: a problem in communication

    Psychother Psychosom

    (1970)
  • P.E. Sifneos

    The prevalence of alexithymic characteristics in psychosomatic patients

    Psychother Psychosom

    (1973)
  • S.B. Zeitlin et al.

    Alexithymia and anxiety sensitivity in panic disorder and obsessive compulsive disorder

    Am J Psychiatry

    (1993)
  • M.J. Zonnevijlle-Bender et al.

    Do adolescent anorexia nervosa patients have deficits in emotional functioning?

    Eur Child Adolesc Psychiatry

    (2002)
  • O. Guilbaud et al.

    Alexithymia and depression in eating disorders

    Encephale

    (2000)
  • Cited by (0)

    View full text