Correlations between bodily dissatisfaction, alexithymia, and dissociation in eating disorders

Correlazioni tra insoddisfazione corporea, alessitimia e dissociazione nei disturbi del comportamento alimentare

A. Carano*, E. Totaro**, D. De Berardis***, L. Mancini*, F. Faiella*, I. Pontalti*, M. Vizza*, G. Mariani*

* Dipartimento Salute Mentale, Ascoli Piceno; ** Istituto di Psichiatria, Università "G. d'Annunzio", Chieti; *** Dipartimento Salute Mentale, Teramo


This study investigated the relationships between body image, alexithymia and dissociative symptoms in a sample of patients with eating disorders (EDs).


Self-rating tests were filled-out by 107 patients with a DSM-IV eating disorder diagnosis (Diagnostic and Statistical Manual of Mental Disorders, 4th edition) 1. Alexithymia has been assessed through the Toronto Alexithymia Scale (TAS-20), dissociative symptoms through the Dissociative Experiences Scale (DES), eating disorder symptoms were assessed through the Eating Disorder Inventory-2 (EDI-2), and beliefs about the body through the Body Shape Questionnaire (BSQ). Additional assessment comprised the Whiteley Index, the State-Trait Anxiety Inventory (STAI) and the Beck Depression Inventory (BDI).


Our sample consisted of 37 patients with anorexia nervosa (AN), 38 with bulimia nervosa (BN), and 30 patients with binge eating disorder (BED). The prevalence of alexithymia in our sample was 18.1% (n = 19); people with alexithymia scored higher on all self-rating scales (Table III). Patients with AN and BED showed more dissociative symptoms (45.9 ± 20.1; 44.3 ± 20.1) compared to patients with BN, and patients with BED scored higher also on the BSQ (71.1 ± 26.5) (Table II). Adult age, higher body dissatisfaction, alexithymia, depressive symptoms, and dissociative experiences are predictive of a higher risk for developing an ED according to the linear regression analysis (Table V).


There is evidence for an association between dissociative tendency and alexithymia in EDs. Dissociative tendency would represent a coping style to deal with a negative body image in patients with alexithymia. Furthermore, alexithymic people with a negative body image showed a stronger trend toward the development of an ED, compared to patients who score lower on the TAS-20. Finally, an association between more dissociative symptoms and an alexithymic trait could possibly suggest a body image disorder or a subsyndromal ED.

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