Skip to main content
SpringerLink
Log in

Eating Disorders as Clinical Examples of Impaired Mentalizing

Theory and Descriptions

  • Chapter
  • First Online:
Hunger

  • 890 Accesses

Abstract

How can the mentalizing model be applied to describe symptoms and the central pathology in eating disorders? In this chapter we will further present the theoretical model and elucidate central concepts through clinical examples. Mentalizing is both about oneself and others. Minding oneself—“know thyself”—is often one of the major impairments in severe eating disorder. Hence, patients often refer to “inner chaos”, “unrest” and “being out of control”.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 99.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Association, Washington, DC

    Book  Google Scholar 

  • Asen E, Fonagy P (2012) Mentalization-based family therapy. In: Bateman A, Fonagy P (eds) Handbook of mentalizing in mental health practice. American Psychiatric Publishing Inc, Arlington, VA, pp 107–128

    Google Scholar 

  • Barry RA, Kochanska G, Philibert RA (2008) G x E interaction in the organization of attachment: mothers’ responsiveness as a moderator of children’s genotypes. J Child Psychol Psychiatry 49(12):1313–1320

    Article  Google Scholar 

  • Bateman A, Fonagy P (2004) Psychotherapy for borderline personality disorder. Oxford Medical Publications, Oxford

    Book  Google Scholar 

  • Bateman A, Fonagy P (2016) Mentalization based treatment for personality disorders: a practical guide. Oxford University Press, Oxford

    Book  Google Scholar 

  • Bateman AW, Brown D, Pedder J (2000) Introduction to psychotherapy: an outline of psychodynamic principles and practice, 3rd edn. Routledge, London

    Google Scholar 

  • Belsky J (2006) The development and evolutionary psychology of intergenerational transmission of attachment. In: Carter CS, Ahnert L, Grossmann KE, Hardy SB, Lamb ME, Porges SW, Sachser N (eds) Attachment and bonding: a new synthesis. MIT Press, Cambridge, pp 169–198

    Google Scholar 

  • Bourke M, Taylor GJ, Parker JD, Bagby RM (1992) Alexithymia in women with anorexia nervosa. A preliminary investigation. BJPsych 161:240–243

    CAS  PubMed  Google Scholar 

  • Brothers L (1990) The social brain: a project for integrating primate behaviour and neurophysiology in a new domains. Concepts Neurosci 2:27–51

    Google Scholar 

  • Bruch H (1962) Perceptual and conceptual disturbances in anorexia nervosa. Psychosom Med 24:187–194

    Article  CAS  Google Scholar 

  • Bruch H (1970) Psychotherapy in primary anorexia nervosa. J Nerv Ment Dis 150:51–66

    Article  CAS  Google Scholar 

  • Bruch H (1973) Eating disorders. Obesity, anorexia nervosa, and the person within. Basic Books, New York

    Google Scholar 

  • Bruch JH (1996) Unlocking the golden cage. An intimate biography of Hilde Bruch, MD. Gürze Books, Carlsbad, CA

    Google Scholar 

  • Cochrane C, Brewerton TD, Wilson DB, Hodges EL (1993) Alexithymia in the eating disorders. Int J Eat Disord 14(2):219–222

    Article  CAS  Google Scholar 

  • Connan F, Campbell IC, Katzman M, Lightman SL, Treasure J (2003) A neurodevelopmental model for anorexia nervosa. Physiol Behav 79(1):13–24

    Article  CAS  Google Scholar 

  • Deborde A, Berthoz S, Wallier JM, Fermanian J, Falissard B, Jeammet P, Corcos M (2008) The Bermond-Vorst Alexithymia Questionnaire cutoff scores: a study in eating-disordered and control subjects. Psychopathology 41:43–49

    Article  Google Scholar 

  • Enckell H (2002) Metaphor and the psychodynamic functions of the mind. (Doctoral dissertation), Kuopion Yliopisto, Kuopio, Finland

    Google Scholar 

  • Espeset EM, Gulliksen KS, Nordbo RH, Skårderud F, Holte A (2012) Fluctuations of body images in anorexia nervosa: patients’ perception of contextual triggers. Clin Psychol Psychother 19(6):518–530. https://doi.org/10.1002/cpp.760

    Article  Google Scholar 

  • Fairburn CG, Cooper Z, Doll HA, Welch SL (1999) Risk factors for anorexia nervosa: three integrated case-control comparisons. Arch Gen Psychiatry 56(5):468–476

    Article  CAS  Google Scholar 

  • Fertuck EA, Jekal A, Song I, Wyman B, Morris MC, Wilson ST, Stanley B (2009) Enhanced ‘Reading the Mind in the Eyes’ in borderline personality disorder compared to healthy controls. Psychol Med 39(12):1979–1988. https://doi.org/10.1017/S003329170900600X

    Article  CAS  Google Scholar 

  • Fonagy P, Target M (1996) Playing with reality: I. Theory of mind and the normal development of psychic reality. Int J Psychoanal 77:217–233

    PubMed  Google Scholar 

  • Fonagy P, Target M (2003) Psychoanalytic theories: perspectives from developmental psychopathology. Whurr, London

    Google Scholar 

  • Fonagy P, Edgcumbe R, Moran GS, Kennedy H, Target M (1993) The roles of mental representations and mental processes in therapeutic action. Psychoanal Study Child 48:9–48

    Article  CAS  Google Scholar 

  • Fonagy P, Leigh T, Steele M, Steele H, Kennedy R, Mattoon G, Target M, Gerber A (1996) The relation of attachment status, psychiatric classification and response to psychotherapy. J Consult Clin Psychol 64:22–31

    Article  CAS  Google Scholar 

  • Fonagy P, Target M, Steele H, Steele M (1998) Reflective function manual, version 5.0 for application to adult attachment interviews. University College, London

    Google Scholar 

  • Fonagy P, Gergely G, Jurist EL, Target M (2002) Affect regulation, mentalization, and the development of self. Karnac Books, London

    Google Scholar 

  • Gergely G (2001) The obscure object of desire: “Nearly, but clearly not, like me”. Contingency preference in normal children versus children with autism. In: Allen J, Fonagy P, Gergely G (eds) Contingency, perception and attachment in infancy (Special issue of the Bulletin of The Menninger Clinic). Guilford Press, New York, pp 411–426

    Article  CAS  Google Scholar 

  • Gergely G, Watson J (1996) The social biofeedback model of parental affect-mirroring. Int J Psychoanal 77:1181–1212

    PubMed  Google Scholar 

  • Goodsitt A (1997) Eating disorders: a self-psychological perspective. In: Garner D, Garfinkel PE (eds) Handbook of treatment for eating disorders. The Guilford Press, New York, pp 205–228

    Google Scholar 

  • Guarda AS (2008) Treatment of anorexia nervosa: insights and obstacles. Physiol Behav 94(1):113–120

    Article  CAS  Google Scholar 

  • Higbed L, Fox JR (2010) Illness perceptions in anorexia nervosa: a qualitative investigation. Br J Clin Psychol 49.(Pt 3:307–325. https://doi.org/10.1348/014466509x454598

    Article  Google Scholar 

  • Lang K, Larsson EE, Mavromara L, Simic M, Treasure J, Tchanturia K (2016) Diminished facial emotion expression and associated clinical characteristics in anorexia nervosa. Psychiatry Res 236:165–172. https://doi.org/10.1016/j.psychres.2015.12.004

    Article  PubMed  Google Scholar 

  • Lidz T (1994) Foreword. In: Bruch H (ed) Conversations with anorexics. Jason Aronson, London, pp vi–xiv

    Google Scholar 

  • Main M, Goldwyn R (1995) Adult attachment classification system. In: Main M (ed) Behavior and the development of representational models of attachment: five methods of assessment. Cambridge University Press, Cambridge

    Google Scholar 

  • Merleau-Ponty M (1962) The phenomenology of perception. Routledge and Kegan Paul, London

    Google Scholar 

  • Oldershaw A, Hambrook D, Tchanturia K, Treasure J, Schmidt U (2010) Emotional theory of mind and emotional awareness in recovered anorexia nervosa patients. Psychosom Med 72(1):73–79. https://doi.org/10.1097/PSY.0b013e3181c6c7ca

    Article  Google Scholar 

  • Papezová H, Yamamotová A, Uher R (2005) Elevated pain threshold in eating disorders: physiological and psychological factors. J Psychiatr Res 39:431–438

    Article  Google Scholar 

  • Pollatos O, Kurz A-L, Albrecht J, Schreder T, Kleemamnm AM, Schöpf V, Kopietz R, Wiesmann M, Schandry R (2008) Reduced perception of bodily signals in anorexia nervosa. Eat Behav 9(4):381–388

    Article  Google Scholar 

  • Robinson P, Skårderud F (2018 in press) Mentalization based therapy for eating disorders (MBT-ED): minding the body. In: Bateman A, Fonagy P (eds) Handbook of mentalizing in mental health practice, 2nd edn. American Psychiatric Publishing, Washington DC

    Google Scholar 

  • Rothschild-Yakar L, Levy-Shiff R, Fridman-Balaban R, Gur E, Stein D (2010) Mentalization and relationships with parents as predictors of eating disordered behavior. J Nerv Ment Dis 198(7):501–507. https://doi.org/10.1097/NMD.0b013e3181e526c8

    Article  Google Scholar 

  • Schmidt U, Jiwany A, Treasure J (1993) A controlled study of alexithymia in eating disorders. Compr Psychiatry 34(1):54–58

    Article  CAS  Google Scholar 

  • Sharp C, Fonagy P, Goodyer I (2008) Social cognition and developmental psychopathology. Oxford University Press, Oxford

    Book  Google Scholar 

  • Sifneos P, Apfel-Savitz R, Frankel FH (1977) The phenomenon of alexithymia. Psychother Psychosom 28:193–198

    Article  Google Scholar 

  • Skårderud F (2007a) Eating one’s words, part II: the embodied mind and reflective function in anorexia nervosa—theory. Eur Eat Disord Rev 15(4):243–252. https://doi.org/10.1002/erv.778

    Article  Google Scholar 

  • Skårderud F (2007b) Eating one's words, part I: ‘concretised metaphors’ and reflective function in anorexia nervosa—an interview study. Eur Eat Disord Rev 15(3):163–174. https://doi.org/10.1002/erv.777

    Article  PubMed  Google Scholar 

  • Skårderud F (2013) Hilde Bruch (1904–1984)—the constructive use of ignorance. Adv Eat Disord 1(2):174–181

    Article  Google Scholar 

  • Skårderud F, Fonagy P (2012) Eating disorders. In: Bateman A, Fonagy P (eds) Handbook of mentalizing in mental health practice. American Psychiatric Publishing Inc, Arlington, VA, pp 347–384

    Google Scholar 

  • Slade P, Brodie D (1994) Body-image distortion and eating disorder: a reconceptualization based on the recent literature. Eur Eat Disord Rev 2:32–46

    Article  Google Scholar 

  • St-Hilaire A, Steiger H, Liu A, Laplante DP, Thaler L, Magill T, King S (2015) A prospective study of effects of prenatal maternal stress on later eating-disorder manifestations in affected offspring: preliminary indications based on the Project Ice Storm cohort. Int J Eat Disord 48(5):512–516. https://doi.org/10.1002/eat.22391

    Article  Google Scholar 

  • Taylor GJ, Bagby RM, Parker JDA (1997) Disorders of affect regulation. Alexithymia in medical and psychiatric illness. Cambridge University Press, Cambridge

    Book  Google Scholar 

  • Tronick E (2018) Still face experiment. https://www.youtube.com/watch?v=apzXGEbZht0Tr. Accessed 10 Feb 2018

  • Troop N, Bifulco A (2002) Childhood social arena and cognitive sets in eating disorders. Br J Clin Psychol 41:205–211

    Article  Google Scholar 

  • Weinberg MK, Beeghly M, Olson KL, Tronick E (2008) A still-face paradigm for young children: 2(1/2) year-olds’ reactions to maternal unavailability during the still-face. J Dev Process 3(1):4–22

    PubMed  PubMed Central  Google Scholar 

  • Wentz E, Gillberg C, Gillberg IC, Rastam M (2001) Ten-year follow-up of adolescent-onset anorexia nervosa: psychiatric disorders and overall functioning scales. J Child Psychol Psychiatry 42(5):613–622

    Article  CAS  Google Scholar 

  • Winnicot DW (1971) Playing and reality. Tavistock, London

    Google Scholar 

  • World Health Organization (1993) The ICD-10 classification of mental and behavioural disorders: diagnostic criteria for research. World Health Organisation, Geneva

    Google Scholar 

  • World Health Organization (2018) ICD-11 is here! (For endorsement by WHO in May 2019). http://www.who.int/classifications/icd/en/ Accessed 19/9/18

  • Zachrisson HD, Skårderud F (2010) Feelings of insecurity: review of attachment and eating disorders. Eur Eat Disord Rev 18(2):97–106. https://doi.org/10.1002/erv.999

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Nutrition Science Group, Division of Medicine, University College London, London, UK

    Paul Robinson

  2. Institute for Eating Disorders, Oslo, Norway

    Finn Skårderud & Bente Sommerfeldt

  3. Norwegian School of Sports Sciences, Oslo, Norway

    Finn Skårderud

Authors
  1. Paul Robinson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Finn Skårderud
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bente Sommerfeldt
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Robinson, P., Skårderud, F., Sommerfeldt, B. (2019). Eating Disorders as Clinical Examples of Impaired Mentalizing. In: Hunger. Springer, Cham. https://doi.org/10.1007/978-3-319-95121-8_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-95121-8_2

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-95119-5

  • Online ISBN: 978-3-319-95121-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation