Abstract

To capture the core pathology of eating disorders (EDs) in the context of multiple childhood trauma, the aim of this study was to describe variation and common features in the lived experiences of ED patients with childhood physical, emotional, and/or sexual abuse and neglect. Semi-structured interviews were conducted post-treatment with nine participants aged 25-59; data was analyzed with Interpretative Phenomenological Analysis. Four master themes emerged across EDs and trauma categories: 1) Shape and weight as regulators of closeness and distance, 2) ED as a sanctuary for counteracting feelings of helplessness and incompetence, 3) ED as a designated caregiver, and 4) ED filling an existential emptiness while emptying unwanted emotions. Informants emphasized interpersonal aspects through the overarching core theme of the ED as protective, self-preservative strategies in relationships with others. ED onset was described as related to the failure of parental figures and their functions, whereas ED maintenance related to the highly isolative and self-perpetuating nature of the disorder. The hypothesized model may have important clinical implications, especially in terms of the therapeutic working alliance, and we suggest that developmental issues are considered when developing future treatments for this ED subgroup.

抽象的

为了捕获儿童多发性创伤背景下的饮食失调（ED）的核心病理学，本研究的目的是描述儿童期遭受身体，情感和/或性虐待的ED患者的生活经历中的变异和共同特征，以及忽视。治疗后对9名年龄在25-59岁之间的参与者进行了半结构式访谈。数据采用解释现象学分析进行分析。在急诊室和创伤类别中出现了四个主要主题：1）形状和体重作为亲密和距离的调节者； 2）急诊室作为抵制无助和无能的感觉的庇护所； 3）急诊室作为指定的照顾者； 4）急诊室填补了存在的空虚，同时排泄不必要的情绪。信息提供者通过ED的总体核心主题强调人际关系，这是保护性的，与他人关系中的自我保护策略。ED的发作被描述为与父母身材及其功能的衰竭有关，而ED的维持与疾病的高度隔离和自我延续的性质有关。假设的模型可能具有重要的临床意义，尤其是在治疗工作联盟方面，我们建议在开发此ED亚组的未来治疗方法时考虑发展问题。