Psychoanalysis and Treatment of Body Image Disturbances in Eating and Weight Disorders

Body and body image have long been studied in psychoanalysis and also the most recent brain imaging studies have focused on this important topic. These studies are particularly important for Eating Disorders (EDs) and for body image disturbance in eating and weight disorders. The central core in the psychopathology of EDs are overvaluation of body and shape concerns, low self-esteem, body dissatisfaction, its correlation with the internal world, attachment insecurity, and a distorted development of the self. Food and fasting are not just techniques for modifying the own bodily-self, but also ways to change the own state of consciousness, to “feel something,” to gain the own perception of self. In fact EDs, and in particular anorexia nervosa, are not only a constellation of eating symptoms, but they are underwhelmed by deeper and rooted disorders of the self or the personality. This concept is particularly important for the therapy of EDs: psychodynamic psychotherapy, in particular, is not focused on the symptoms of the disease, but, through the embodied simulation, the intentional attunement, the central role of the therapist, the mirror neurons, and the virtues of the therapist, is centered on the creation of a solid therapeutic relationship, through which a new and mature identity can be acquired, replacing the false-self of the patients with EDs. Another important topic, in particular for EDs’ therapy, is the resistance to treatment because patients with ED have an inner ambivalence towards the illness: eating symptoms produce discomfort, but they also mask the inner conflicts that occur during the illness. The shared implicit relationship between therapist and patient is the fulcrum of the change, representing in the hic and nunc a meaningful intersubjective encounter of the self with the other.