Psychotic-like anomalous self-experiences in feeding and eating disorders: Their role in eating psychopathology through the mediation of body uneasiness and embodiment and identity disorders.
Massimo Ballerini, Eleonora Rossi, Emanuele Cassioli, Livio Tarchi, Carlo Marchesi, Matteo Tonna, Giovanni Stanghellini, Valdo Ricca, Giovanni Castellini
Early intervention in psychiatry November 1, 2024 Peer reviewed DOI: 10.1111/eip.13527 via PubMed
Summary
People with anorexia nervosa and bulimia nervosa report psychotic-like anomalous self-experiences (ASEs) at levels comparable to those with schizophrenia spectrum disorders. A study of 90 individuals with anorexia nervosa, 41 with bulimia nervosa, and 92 general-population controls found that ASEs are strongly linked to feeling estranged from one's own body and to disordered eating symptoms. Statistical modeling showed that disturbances in embodiment and identity mediate how ASEs contribute to eating disorder psychopathology. Anomalous interoceptive processes may be an early step in a maladaptive cascade affecting selfhood and identity in these conditions.
Study at a glance
| Design | cross-sectional study |
|---|---|
| Sample size | 223 |
| Population | persons with anorexia nervosa, bulimia nervosa, and general population controls |
| Key finding | Psychotic-like anomalous self-experiences are elevated in feeding and eating disorders and impact eating disorder symptomatology through the mediation of embodiment/identity disorders and body image. |
Abstract
Psychotic-like anomalous self-experiences (ASEs) are core and early features of schizophrenia spectrum disorders, which have been recently also postulated to underlie embodiment disturbance in feeding and eating disorders (FEDs). The present study was aimed at investigating the interplay between ASEs and specific psychopathology in FED. Ninety persons with Anorexia Nervosa and 41 with Bulimia Nervosa were evaluated with the inventory of psychotic-like anomalous self-experiences (IPASE), identity and eating disorders (IDEA), body uneasiness test (BUT), and eating disorder examination questionnaire (EDE-Q). The same assessment was performed for 92 subjects recruited from the general population. Structural equation modelling was employed to test the role of embodiment/identity disorders in mediating the relationship between ASEs and ED psychopathology. Patients with FED displayed high scores on IPASE, comparable with people with schizophrenia spectrum disorders. A significant correlation was also demonstrated between IPASE, BUT and EDE-Q. All IPASE domains were strongly related to feeling extraneous from one's own body by IDEA. All IPASE domains demonstrated a high relationship with BUT Depersonalization scale. A strong correlation was also reported between total scores of IPASE and IDEA. The mediation model confirmed that ASEs impact on FED symptomatology through the mediation of both embodiment/identity disorders and body image. Anomalous interoceptive processes may represent the first step of a maladaptive process-impairing embodiment, selfhood, and identity in FED. Assessment of ASEs might be a valid tool to identify an early-shared vulnerability of severe disorders characterized by embodiment alterations.