Psychopathology of eating disorders

G. Castellini1,2, F.Trisolini3, V. Ricca1

1 Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Italy; 2 Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Italy; 3 DiSPUTer – “G. d’Annunzio” University of Chieti, Italy


Eating disorders are severe psychiatric syndromes that most likely result from, and sustained by, sociocultural, psychological and biological factors. According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Feeding and Eating Disorders encompass three main diagnoses, namely anorexia nervosa, bulimia nervosa, and binge eating disorder. However, the collection of disturbances of eating attitudes and behaviours includes several other conditions such as pica, rumination disorder, purging disorder, atypical anorexia and bulimia nervosa, subthreshold binge eating disorder and night eating syndrome. In a trans-diagnostic perspective, all these conditions underscore key similarities across the eating disorders, including dietary restraint, binge eating, compensatory purging, body checking and weight preoccupation. There is a general agreement on considering behavioural anomalies – which are required for DSM diagnosis – as secondary epiphenomena to a more profound psychopathological core, defined by excessive concerns about body shape and weight. In particular, patients with eating disorders overvalue their body shape and weight. Furthermore, the body image disturbance has been associated with a more profound disturbance consisting in disorders of the way persons experience their own body and shape their personal identity. In other words, whereas most people evaluate and define themselves on the basis of the way they perceive their performance in various domains, patients with eating disorders judge their self-worth largely, or even exclusively, in terms of their shape and weight and their ability to control them. According with a phenomenological perspective, the core dimension of the disease of subjects with proneness to eating disorder behaviours also encompasses the perception of space, as well as the subjective experience of time. Several behaviours and cognitive distortion can be derived from a basic sense of spatial metamorphosis that is deeply associated with the disorder of corporeality. In the same way, the subjective perception of time in eating disorder patients appears to be connected with the temporal discontinuity of the representation of one’s own body, and the need of predictability of one’s own life, which is achieved/failed according to control of eating and weight. The psychopathological core, rather than behavioural abnormalities, plays a crucial role in the onset and persistence of these disorders. Indeed, it has been associated with different responses to psychological treatment in several reports, and some authors have pointed out that the threshold to define the full recovery process might be body shame, appearance schemas and thin-ideal internalisation. Therefore, these may be fruitful targets of intervention among those on a recovery trajectory. In line with this perspective, a comprehensive assessment of a person with EDs should include: the way of perceiving once own body and the lived corporeality, the significance of the illness and the body in the inter-subjective interactions as well as the identity definition, the space perception and the way of experiencing time associated with several EDs features (such as binge eating, weight control).

Scarica il PDF