Skip to main content

Listening to Words, Hearing Feelings: Links Between Eating Disorders and Alexithymia

Abstract

Research suggests that eating disorders often involve difficulty with affect regulation and processing of emotions. Studies also show that many individuals with these difficulties suffer from alexithymia, or an impaired ability to use language to tolerate or process emotions. Many clients with eating disorders are highly verbal, able to talk about feelings and even have good insight into the causes of their behaviors. Yet their verbal and cognitive strengths may disguise their inability to use thoughts to manage their emotions. Such clients often have a lifelong experience of appearing more capable and competent than they feel. Self-criticism and negative self-image concretized in a negative body image are part of their eating disorder. Therapeutic exploration can increase anxiety and self-criticism, aggravating feelings of inadequacy and the concomitant need for self-soothing. Techniques that focus on affect regulation have been shown to be effective, yet a psychodynamic approach can be an important tool in such an integrative practice. In this article, clinical material and theory will illustrate some of the ways that incorporating an understanding of alexithymia into the work can enhance the use of both psychodynamic exploration of meaning and also tools to manage affect and change behavior.

This is a preview of subscription content, access via your institution.

References

  1. Arkell, J., & Robinson, P. (2008). A pilot case series using qualitative and quantitative methods: Biological, psychological and social outcome in severe and enduring eating disorder (anorexia nervosa). International Journal of Eating Disorders, 41, 650–656. doi:10.1002/eat.20546.

    Article  PubMed  Google Scholar 

  2. Barth, F. D. (2014a). Integrative clinical social work practice: A contemporary perspective. New York, NY: Springer.

    Book  Google Scholar 

  3. Barth, F. D. (2014b). Putting it all together: An integrative approach to psychotherapy with eating disorders. Psychoanalytic Social Work, 21, 19–39.

    Article  Google Scholar 

  4. Barth, F. D. (2015). Alexithymia, affect regulation, and binge drinking in college students. Journal of College Student Psychotherapy, 29, 132–146.

    Article  Google Scholar 

  5. Bromberg, P. (2001). Standing in the spaces: Essays on clinical process, trauma and dissociation. London: Routledge Press.

    Google Scholar 

  6. Bruce, G., Curren, C., & Williams, L. (2011). Alexithymia and alcohol consumption: The mediating effects of drinking motives. Addictive Behaviors,. doi:10.1016/j.addbeh.2011.11.024.

    PubMed  Google Scholar 

  7. Castanier, C., & Le Scanff, C. (2009). The influence of personality and emotional style on engagement in risky sports: A review of the literature. Science & Motricite, 2, 39–78.

    Article  Google Scholar 

  8. Connors, M. (2006). Symptom-focused dynamic psychotherapy. Hillsdale, NJ: Analytic Press.

    Google Scholar 

  9. de Maat, S., de Jonghe, F., Schoevers, R., & Dekker, J. (2009). The effectiveness of long-term psychoanalytic therapy: A systematic review of empirical studies. Harvard Review of Psychiatry, 17, 1–23.

    Article  PubMed  Google Scholar 

  10. Eshkevari, E., Rieger, E., Longo, Matthew R., Haggard, P. & Treasure, J. (2012). Increased plasticity of the bodily self in eating disorders. Psychological Medicine, 42, 819–828. ISSN 0033-2917.

  11. Fernández-Aranda, F., Jiménez-Murcia, S., Álvarez-Moya, E. M., Granero, R., Vallejo, J., & Bulik, C. M. (2006). Impulse control disorders in eating disorders: Clinical and therapeutic implications. Comprehensive Psychiatry, 47, 482–488.

    Article  PubMed  Google Scholar 

  12. Fonagy, P., Gyorgy, G., Jurist, E., & Target, M. (2003). Affect regulation, mentalization and the development of the self. London: Karnac Books.

  13. Frank, K. A. (1999). Psychoanalytic participation: Action, interaction, and integration. London, England & New York, NY: Routledge.

    Google Scholar 

  14. Gowers, S. G., & Shore, A. (2001). Development of weight and shape concerns in the aetiology of eating disorders. British Journal of Psychiatry, 179, 239–242.

    Article  Google Scholar 

  15. Hagman, G. (2014). Creative analysis: Art creativity and clinical process. London & New York: Routledge.

    Google Scholar 

  16. Kohut, H. (1971). The analysis of the self. New York: International Universities Press.

    Google Scholar 

  17. Kohut, H. (1977). The restoration of the self. New York: International Universities Press.

    Google Scholar 

  18. Krueger, D. W. (2001). Body self: Development, psychopathologies, and psychoanalytic significance. Psychoanalytic Study of the Child, 56, 238–259.

    PubMed  Google Scholar 

  19. Krystal, H. (1988). Integration and self-healing: AFFECT, trauma, and alexithymia. Hillsdale, NJ: Analytic Press.

    Google Scholar 

  20. Levander, S., & Werbart, A. (2012). Personality-related responses to the psychoanalytic process: A systematic multicase study. Psychoanalytic Psychology, 29, 1–16.

    Article  Google Scholar 

  21. McClintock Greenberg, T. (2009). Psychodynamic perspectives on aging and illness. London/New York: Springer.

    Book  Google Scholar 

  22. McDougall, J. (1989). Theaters of the body: A psychoanalytic approach to psychosomatic illness. New York: W.W. Norton & Company.

    Google Scholar 

  23. Petrucelli, J. (Ed.). (2015). Body states: Interpersonal and relational perspectives on the treatment of eating disorders. New York: Routledge.

    Google Scholar 

  24. Pinaquy, S., Chabrol, H., Simon, C., Louvet, J.-P., & Barbe, P. (2003). Emotional eating, alexithymia, and binge-eating disorder in obese women. Obesity Research, 11, 195–201. doi:10.1038/oby.2003.31.

    Article  PubMed  Google Scholar 

  25. Renik, O. (2006). Practical psychoanalysis for therapists and patients. New York: Other Press.

    Google Scholar 

  26. Sands, S. (1991). Bulimia, dissociation and empathy: A self psychological view. In C. L. Johnson (Ed.), Psychodynamic treatment of anorexia nervosa and bulimia (pp. 34–50). New York: Guilford.

    Google Scholar 

  27. Sands, S. (2003). The subjugation of the body in eating disorders: A particularly female solution. Psychoanalytic Psychology, 20, 103–116.

    Article  Google Scholar 

  28. Schore, A. N. (1994). Affect regulation and the origin of the self. Hillsdale, NJ: Lawrence Erlbaum Associates.

    Google Scholar 

  29. Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65, 98–109.

    Article  PubMed  Google Scholar 

  30. Siegel, D. (1999). The developing mind: Toward a neurobiology of interpersonal experience. New York and London: Guilford Books.

  31. Siegel, D. (2013). Brainstorm: The power and purpose of the teenage brain. New York, NY: Penguin Publishing Co.

  32. Sifneos, P. E. (1973). The prevalence of alexithimic characteristics in psychosomatic patients. Psychotherapy and Psychosomatics, 22, 255–262.

  33. Stewart, S. H., Svolensky, M. J., & Eifert, G. H. (2002). The relations of anxiety sensitivity, experiential avoidance, and alexithymic coping to young adults’ motivations for drinking. Behavior Modification, 26, 274–296.

    Article  PubMed  Google Scholar 

  34. Stolorow, R. (1975). The narcissistic function of masochism (and sadism). International Journal of Psycho-Analysis, 56, 441–448.

    PubMed  Google Scholar 

  35. Telch, C. F. (1997). Skills training treatment for adaptive affect regulation in a woman with binge-eating disorder. International Journal of Eating Disorders, 22, 77–81. doi:10.1002/(SICI)1098-108X(199707)22:1<77:AID-EAT10>3.0.CO;2F.

    Article  PubMed  Google Scholar 

  36. Wachtel, P. (1997). Psychoanalysis, behavior therapy and the relational world. Washington, D.C.: American Psychological Association.

    Book  Google Scholar 

  37. Winnicott, D. (1965). The maturational processes and the facilitating environment. New York: International Universities Press.

    Google Scholar 

  38. Wood, R., & Williams, C. (2008). Inability to empathize following traumatic brain injury. Journal of the International Neuropsychological Society, 14, 289–296.

    Article  PubMed  Google Scholar 

  39. Woodman, T., Huggins, M., Le Scanff, C., & Cazenave, N. (2009). Alexithymia determines the anxiety experienced in skydiving. Journal of Affective Disorders, 116, 134–138.

    Article  PubMed  Google Scholar 

  40. Zerbe, K. (2008). Integrated treatment of eating disorders: Beyond the body betrayed. New York and London: W.W. Norton & Company.

    Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to F. Diane Barth.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Barth, F.D. Listening to Words, Hearing Feelings: Links Between Eating Disorders and Alexithymia. Clin Soc Work J 44, 38–46 (2016). https://doi.org/10.1007/s10615-015-0541-6

Download citation

Keywords

  • Eating disorders
  • Body image
  • Eating disorders and alexithymia
  • Eating disorders and failure to process affects
  • Eating disorders, language and affects
  • Eating disorders and lack of signal emotions