Psychosocial Risk Factors in the Development, Maintenance and Treatment Outcome of Eating Disorders

Book excerpt: Eating disorders (EDs) are mental disorders characterized by altered eating habits and excessive concerns about weight and body shape. They arise mainly during adolescence and predominantly affect females. The three most common types of EDs are: •Anorexia nervosa (AN), which is characterized by restriction of food intake, significant low body weight, an intense fear of gaining weight and disturbances in body shape and weight experience; •Bulimia nervosa (BN), which is characterized by recurrent binge-eating episodes followed by behaviors that compensate for the overeating (i.e., self-induced vomiting, excessive exercise, or extreme use of laxatives, enemas or diuretics), and self-evaluation based on body shape and weight; •Binge eating disorder (BED), which is characterized by the recurrence of binge-eating episodes without the use of compensatory behaviors for weight control, and feelings of distress, embarrassment and guilt. To date, researchers and clinicians agree that a multifactorial model is the most suitable for explaining the onset and maintenance of EDs. For example, a risk factor for BED may be lower parental care, as it may trigger greater confusion and uncertainty in responding to unpleasant emotional experiences. This contributes to an impaired personality development, more severe psychopathological symptomatology, and greater difficulty in both identifying and distinguishing feelings of hunger and satiety from other emotions. Attachment styles have also been explored in patients with EDs. According to the attachment theory, attachment insecurity could disrupt the ability to identify and express emotional states and might impair affect regulation skills (i.e. emotional dysregulation). Within the two main dimensions of attachment insecurity (i.e., attachment anxiety and avoidance), higher attachment anxiety is related to greater symptom severity in patients with AN and BN. Moreover, prior studies have examined impaired emotional competences (ECs), theory of mind (ToM) and metacognition, which refer to how individuals identify, express, understand, regulate, and use their emotions or those of significant others. These skills may also explain why attachment insecurity places individuals at greater risk of EDs. Although particular personality traits (i.e. impulsivity, perfectionism, self-esteem), attachment styles, trauma, and metacognition clearly play a role in the onset and maintenance of EDs, little is known about their associations and underlying mechanisms.