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Chapter 12 - Eating Disorders

from Part III - Application and Adaptations for Mental Health Presentations

Published online by Cambridge University Press:  18 May 2023

Anthony Bateman ,
Peter Fonagy ,
Chloe Campbell ,
Patrick Luyten  and
Martin Debbané
Anthony Bateman
Affiliation:
Anna Freud National Centre for Children and Families, London
Peter Fonagy
Affiliation:
University College London
Chloe Campbell
Affiliation:
University College London
Patrick Luyten
Affiliation:
University College London
Martin Debbané
Affiliation:
University College London
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Summary

There is considerable evidence of mentalizing problems in patients with eating disorders, with non-mentalizing modes, especially in relation to body weight and shape, being dominant. The mentalizing model assumes the existence of developmental vulnerabilities, especially during adolescence, and that the range of different symptoms associated with eating disorders may have the common function of being attempts at social self-regulation. Controlling eating is a way of managing social and emotional developmental milestones that the person perceives as insuperable. Patients with eating disorders become stuck in a low mentalizing experience of themselves and their bodies. Clinical treatment based on this formulation is discussed as it is applied in a combined program of individual and group psychotherapy, together with psychoeducation.

Keywords

anorexiabinge eating disorderbulimiaembodied mentalizingepistemic mistrustMANTRApretend modepsychic equivalencesocial cognitionteleological mode
Type
Chapter
Information
Cambridge Guide to Mentalization-Based Treatment (MBT) , pp. 298 - 318
Publisher: Cambridge University Press
Print publication year: 2023

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References

Robinson, P, Skårderud, F. Eating disorders. In: Bateman, A, Fonagy, P, eds. Handbook of Mentalizing in Mental Health Practice, 2nd ed. Washington, DC: American Psychiatric Publishing, 2019; 369–86.Google Scholar
Schmidt, U, Wade, TD, Treasure, J. The Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA): development, key features, and preliminary evidence. J Cogn Psychother 2014; 28: 48–71.Google Scholar
National Institute for Health and Care Excellence. Eating Disorders: Recognition and Treatment. London, UK: National Institute for Health and Care Excellence; 2017. www.nice.org.uk/guidance/ng69.Google Scholar
Esterling, BA, L’Abate, L, Murray, EJ, Pennebaker, JW. Empirical foundations for writing in prevention and psychotherapy: mental and physical health outcomes. Clin Psychol Rev 1999; 19: 79–96.Google Scholar
Miller, WR, Rollnick, S. Motivational Interviewing: Helping People Change, 3rd ed. New York, NY: The Guilford Press, 2012.Google Scholar
Robinson, P, Hellier, J, Barrett, B et al. The NOURISHED randomised controlled trial comparing mentalisation-based treatment for eating disorders (MBT-ED) with specialist supportive clinical management (SSCM-ED) for patients with eating disorders and symptoms of borderline personality disorder. Trials 2016; 17: 549.Google Scholar
Bruch, H. Eating Disorders. Obesity, Anorexia Nervosa, and the Person Within. New York, NY: Basic Books, 1973.Google Scholar
Bruch, H. Four decades of eating disorders. In: Garner, DM, Garfinkel, PE, eds. Handbook of Psychotherapy for Anorexia Nervosa and Bulimia. New York, NY: The Guilford Press, 1985; 7–18.Google Scholar
Shai, D, Belsky, J. When words just won’t do: introducing parental embodied mentalizing. Child Dev Perspect 2011; 5: 173–80.CrossRefGoogle Scholar
Shai, D, Fonagy, P. Beyond words: parental embodied mentalizing and the parent-infant dance. In: Mechanisms of Social Connection: From Brain to Group. Washington, DC: American Psychological Association, 2014; 185–203.CrossRefGoogle Scholar
Shai, D, Dollberg, D, Szepsenwol, O. The importance of parental verbal and embodied mentalizing in shaping parental experiences of stress and coparenting. Infant Behav Dev 2017; 49: 87–96.Google Scholar
Afek, E, Lev-Wiesel, R, Federman, D, Shai, D. The mediating role of parental embodied mentalizing in the longitudinal association between prenatal spousal support and toddler emotion recognition. Infancy 2022; 27: 609–29.Google Scholar
Vaever, MS, Cordes, K, Stuart, AC et al. Associations of maternal sensitivity and embodied mentalizing with infant-mother attachment security at one year in depressed and non-depressed dyads. Attach Hum Dev 2022; 24: 115–32.Google Scholar
Shai, D, Belsky, J. Parental embodied mentalizing: how the nonverbal dance between parents and infants predicts children’s socio-emotional functioning. Attach Hum Dev 2017; 19: 191–219.Google Scholar
Garset-Zamani, S, Cordes, K, Shai, D et al. Does postpartum depression affect parental embodied mentalizing in mothers with 4-months old infants? Infant Behav Dev 2020; 61: 101486.Google Scholar
Fonagy, P, Gergely, G, Jurist, E, Target, M. Affect Regulation, Mentalization, and the Development of the Self. New York, NY: Other Press, 2002.Google Scholar
Fonagy, P, Target, M. Attachment and reflective function: their role in self-organization. Dev Psychopathol 1997; 9: 679–700.CrossRefGoogle ScholarPubMed
Fonagy, P, Target, M. Playing with reality: III. The persistence of dual psychic reality in borderline patients. Int J Psychoanal 2000; 81: 853–73.Google Scholar
Arnsten, AF. Stress signalling pathways that impair prefrontal cortex structure and function. Nat Rev Neurosci 2009; 10: 410–22.Google Scholar
Steinhausen, HC. The outcome of anorexia nervosa in the 20th century. Am J Psychiatry 2002; 159: 1284–93.CrossRefGoogle Scholar
Eddy, KT, Tabri, N, Thomas, JJ et al. Recovery from anorexia nervosa and bulimia nervosa at 22-year follow-up. J Clin Psychiatry 2017; 78: 184–9.Google Scholar
Treasure, J, Willmott, D, Ambwani, S et al. Cognitive interpersonal model for anorexia nervosa revisited: the perpetuating factors that contribute to the development of the severe and enduring illness. J Clin Med 2020; 9: 630.CrossRefGoogle Scholar
Luyten, P, Campbell, C, Allison, E, Fonagy, P. The mentalizing approach to psychopathology: state of the art and future directions. Annu Rev Clin Psychol 2020; 16: 297–325.CrossRefGoogle ScholarPubMed
Sekowski, M, Gambin, M, Cudo, A et al. The relations between childhood maltreatment, shame, guilt, depression and suicidal ideation in inpatient adolescents. J Affect Disord 2020; 276: 667–77.CrossRefGoogle ScholarPubMed
Fonagy, P. The feeling that destroys the self: the role of mentalizing in the catastrophic sequelae of shame. In: The Problem of Shame: The 2019 John M. Oldham National Mental Health Symposium. Houston, TX: Menninger, 2019. www.menningerclinic.org/Assets/2019-menninger-symposium-emailwebsite-version.pdf.Google Scholar
Schmidt, U, Treasure, J. Anorexia nervosa: valued and visible. A cognitive-interpersonal maintenance model and its implications for research and practice. Br J Clin Psychol 2006; 45: 343–66.Google Scholar
Treasure, J, Schmidt, U. The cognitive-interpersonal maintenance model of anorexia nervosa revisited: a summary of the evidence for cognitive, socio-emotional and interpersonal predisposing and perpetuating factors. J Eat Disord 2013; 1: 13.CrossRefGoogle ScholarPubMed
Tchanturia, K, Hambrook, D, Curtis, H et al. Work and social adjustment in patients with anorexia nervosa. Compr Psychiatry 2013; 54: 41–5.CrossRefGoogle ScholarPubMed
Castellini, G, Rossi, E, Ricca, V. The relationship between eating disorder psychopathology and sexuality: etiological factors and implications for treatment. Curr Opin Psychiatry 2020; 33: 554–61.Google Scholar
Schulte-Ruther, M, Mainz, V, Fink, GR et al. Theory of mind and the brain in anorexia nervosa: relation to treatment outcome. J Am Acad Child Adolesc Psychiatry 2012; 51: 832–41.e11.CrossRefGoogle ScholarPubMed
Westwood, H, Kerr-Gaffney, J, Stahl, D, Tchanturia, K. Alexithymia in eating disorders: systematic review and meta-analyses of studies using the Toronto Alexithymia Scale. J Psychosom Res 2017; 99: 66–81.Google Scholar
Dolan, SC, Khindri, R, Franko, DL et al. Anhedonia in eating disorders: a meta-analysis and systematic review. Int J Eat Disord 2022; 55: 161–75.Google Scholar
Jewell, T, Collyer, H, Gardner, T et al. Attachment and mentalization and their association with child and adolescent eating pathology: a systematic review. Int J Eat Disord 2016; 49: 354–73.Google Scholar
Caglar-Nazali, HP, Corfield, F, Cardi, V et al. A systematic review and meta-analysis of ‘Systems for Social Processes’ in eating disorders. Neurosci Biobehav Rev 2014; 42: 55–92.Google Scholar
Faber, A, Dube, L, Knauper, B. Attachment and eating: a meta-analytic review of the relevance of attachment for unhealthy and healthy eating behaviors in the general population. Appetite 2018; 123: 410–38.Google Scholar
Cortes-Garcia, L, Takkouche, B, Seoane, G, Senra, C. Mediators linking insecure attachment to eating symptoms: a systematic review and meta-analysis. PLoS ONE 2019; 14: e0213099.Google Scholar
Jewell, T, Apostolidou, E, Sadikovic, K, et al. Attachment in individuals with eating disorders compared to community controls: a systematic review and meta?analysis. Int J Eat Disord 2023. https://doi.org/10.1002/eat.23922Google Scholar
Vartanian, LR, Hayward, LE, Smyth, JM et al. Risk and resiliency factors related to body dissatisfaction and disordered eating: the identity disruption model. Int J Eat Disord 2018; 51: 322–30.CrossRefGoogle ScholarPubMed
Bora, E, Kose, S. Meta-analysis of theory of mind in anorexia nervosa and bulimia nervosa: a specific impairment of cognitive perspective taking in anorexia nervosa? Int J Eat Disord 2016; 49: 739–40.Google Scholar
Leppanen, J, Sedgewick, F, Treasure, J, Tchanturia, K. Differences in the Theory of Mind profiles of patients with anorexia nervosa and individuals on the autism spectrum: a meta-analytic review. Neurosci Biobehav Rev 2018; 90: 146–63.Google Scholar
Cardi, V, Tchanturia, K, Treasure, J. Premorbid and illness-related social difficulties in eating disorders: an overview of the literature and treatment developments. Curr Neuropharmacol 2018; 16: 1122–30.Google Scholar
Troop, NA, Bifulco, A. Childhood social arena and cognitive sets in eating disorders. Br J Clin Psychol 2002; 41: 205–11.Google Scholar
Oldershaw, A, Lavender, T, Sallis, H et al. Emotion generation and regulation in anorexia nervosa: a systematic review and meta-analysis of self-report data. Clin Psychol Rev 2015; 39: 83–95.Google Scholar
Rothschild-Yakar, L, Levy-Shiff, R, Fridman-Balaban, R et al. Mentalization and relationships with parents as predictors of eating disordered behavior. J Nerv Ment Dis 2010; 198: 501–7.Google Scholar
Monteleone, AM, Corsi, E, Cascino, G et al. The interaction between mentalizing, empathy and symptoms in people with eating disorders: a network analysis integrating experimentally induced and self-report measures. Cognit Ther Res 2020; 44: 1140–49.Google Scholar
Corsi, E, Cardi, V, Sowden, S et al. Socio-cognitive processing in people with eating disorders: computerized tests of mentalizing, empathy and imitation skills. Int J Eat Disord 2021; 54: 1509–18.Google Scholar
Bird, G, Viding, E. The self to other model of empathy: providing a new framework for understanding empathy impairments in psychopathy, autism, and alexithymia. Neurosci Biobehav Rev 2014; 47: 520–32.Google Scholar
Happe, F, Frith, U. Annual research review: towards a developmental neuroscience of atypical social cognition. J Child Psychol Psychiatry 2014; 55: 553–7.Google Scholar
Saure, E, Laasonen, M, Lepisto-Paisley, T et al. Characteristics of autism spectrum disorders are associated with longer duration of anorexia nervosa: a systematic review and meta-analysis. Int J Eat Disord 2020; 53: 1056–79.Google Scholar
Kinnaird, E, Norton, C, Stewart, C, Tchanturia, K. Same behaviours, different reasons: what do patients with co-occurring anorexia and autism want from treatment? Int Rev Psychiatry 2019; 31: 308–17.Google Scholar
Goss, K, Gilbert, P. Eating disorders, shame and pride: a cognitive-behavioural functional analysis. In: Gilbert, P, Miles, J, eds. Body Shame: Conceptualisation, Research and Treatment. Hove, UK: Routledge, 2014; 233–69.Google Scholar
Asen, E, Fonagy, P. Mentalization-Based Treatment with Families. New York, NY: The Guilford Press, 2021.Google Scholar
Midgley, N, Ensink, K, Lindqvist, K et al. Mentalization-Based Treatment for Children: A Time-Limited Approach. Washington, DC: American Psychological Association, 2017.Google Scholar
Rossouw, T, Wiwe, M, Vrouva, I, eds. Mentalization-Based Treatment for Adolescents: A Practical Treatment Guide. Abingdon, UK: Routledge, 2021.Google Scholar
Midgley, N, Vrouva, I, eds. Minding the Child: Mentalization-Based Interventions with Children, Young People and Their Families. Hove, UK: Routledge, 2013.Google Scholar
Robinson, P, Skårderud, F, Sommerfeldt, B. Hunger: Mentalisation Based Treatments for Eating Disorders. Cham, Switzerland: Springer, 2019.Google Scholar
Bevington, D, Fuggle, P, Cracknell, L, Fonagy, P. Adaptive Mentalization-Based Integrative Treatment: A Guide for Teams to Develop Systems of Care. Oxford, UK: Oxford University Press, 2017.Google Scholar

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