Actual problems of eating disorders and ways to solve them

Source: compiled by the author

Actual problems of eating disorders and ways to solve them. Thus, it can be noted that intrapersonal aspects, such as the perception of food and one's own body, emotional sphere, and self-esteem, dominate among the deep psychological factors of ED.

The identified intrapersonal factors point to the internal dynamics of the individual as a key component in the development of ED. In contrast, interpersonal factors related to interaction with others do not have such a strong influence, which indicates that the main dynamics of the disorder are determined by internal experiences and attitudes towards oneself. This aspect indicates a significant relationship between ED and personal experiences, which include perceptions and emotions, and suggests that in order to understand and effectively treat ED, it is necessary to pay special attention to the internal mental processes and emotional state of the individual.

Methods of reducing the influence of deep-psychological factors of ED: Psychodynamic approach and Gestalt therapy. Gestalt therapy and psychodynamic approaches can be useful in reducing or eliminating the underlying psychological factors associated with an eating disorder, but they approach this task from different perspectives.

Psychodynamic therapy may focus on understanding unconscious aspects of the individual and uncovering subconscious conflicts that may be related to eating disorders. The use of dream and association analysis can help to uncover the underlying mental processes that are at the root of the disorder. Psychodynamic eating disorder treatment focuses on helping patients understand the meaning of their symptoms in the context of their lives in order to find ways to overcome unhealthy coping strategies and improve their overall quality of life. Many people who experience problems with binge-eating, body image disorders, or restricted eating may remain ill even after trying various treatments. In such cases, an eating disorder may be a clear manifestation of a complex psychiatric problem. Psychodynamic interventions aim to uncover potential predisposing factors, such as childhood and adult trauma and unprocessed losses.

The approach is to understand each person's unique personal history. Clinicians using the psychodynamic approach listen carefully to patients, helping them to better understand disturbing memories, feelings and broken relationships that may arise when telling their life story. As emotional pain in such cases is often difficult to experience, defence mechanisms such as denial, splitting, dissociation, projective identification and repression can be temporarily used by the mind to cope with internal discomfort (Zerbe, 2001).

Studies of the effects of cognitive behavioural therapy (CBT) and psychodynamic psychotherapy on eating disorders have shown that CBT has demonstrated consistent remission rates for all types of eating disorders, but has left a significant number of patients without achieving remission. In contrast, psychodynamic therapy has not always been effective in achieving remission in patients with eating disorders, although this conclusion may be uncertain due to the limited number of relevant studies.

A group of patients with eating disorders may require therapy aimed at strengthening their own functioning deficits, which are not easily addressed by cognitive behavioural methods alone (Moberg et al., 2021).

Gestalt therapy can help a person to become aware of their emotions, interactions with food, bodily sensations and general lifestyle, and the focus on the “here and now” can help to uncover imbalances in eating behaviour and reveal underlying psychological conflicts. Working with consciousness and attention can help clients identify their own needs and respond to them in a more adaptive way. Gestalt therapy focuses on the process of contact between a person and his or her environment, as well as on the awareness of this process.

The main idea is that psychological disorders arise from unconscious needs, desires, emotions, and mental fixations that have not become the object of attention or the purpose of contact. In Gestalt therapy, the therapist, together with the patient, identifies and works on disorders of awareness and perception, contact abilities, ways of acting and integrating experience into the here-and-now.

The therapist in Gestalt therapy interacts with the patient in a dialogue process where various aspects of the personality and disturbing experiences are identified and discussed. The therapist responds to the patient's immediate experiences, helping them to become aware of their own blockages, fixations, blind spots, and other aspects that may be implicit. Such emotional resonance and interaction facilitate joint efforts in reflection and processing of psychological processes occurring in the here-and-now (Description of Gestalt..., 2023).

In the Gestalt approach to working with EDs, the focus is on exploring the emotions that underlie overeating or undereating and trying to understand the experiences that are expressed in this type of behaviour. In Gestalt therapy, the therapist encourages the client to express their emotions and helps them to become aware of and express their feelings in the context of events and situations. The Gestalt approach also facilitates reactions to one's own feelings. Clients are taught to express their experiences and relate them to specific events. In addition, art therapy techniques such as drawing can be used to help clients express their feelings and events symbolically.

This can help in developing mindfulness and expressing emotional experiences through the creative process. These approaches aim to uncover and understand how emotions and experiences shape eating behaviour, which can serve as a basis for further work on changes in this aspect of the client's life (Salgirieva et al., 2022). Within Gestalt therapy, there is a newer method - fissiotherapy. It is aimed at revealing the processes of awareness of the ED radical, its role and relationship with the client's personality. This approach is also aimed at developing proflexion to create healthy relationships between parental figures in the form of a therapist and a client. A key aspect of fissiotherapy is the introduction of the concept of the “eating behaviour radical”, which is innovative in the world of psychotherapy.

This concept reveals both many mechanisms of the formation of eating disorders and the possibilities of treating these disorders. The definition and classification of the background as mortal or vital is another new characteristic that opens up new opportunities for physiotherapists. This approach allows for the development of individualized interventions that are not only targeted at the client, but also at their social environment and life context. Fissiotherapy opens up new perspectives in the study and treatment of eating disorders, providing a comprehensive and individualized approach to psychotherapy. Thus, the psychodynamic approach and Gestalt therapy can be effective in addressing the underlying psychological factors of eating disorders, but they approach this task from different perspectives. Both approaches aim to develop awareness and identify mental conflicts, but use different methods, such as dream analysis in psychodynamic therapy and a focus on the here and now in Gestalt therapy. Fissiother- apy in Gestalt therapy complements these approaches by providing a new and innovative method for working with the radical of the ED.

Discussion

It is important to note that the results of this study represent only one part of a wide range of research conducted on this topic. However, they do indicate that it is important to pay attention to the internal mental processes and emotional state of the individual in order to understand and effectively treat mental health disorders. A study conducted by I.S. Colmsee et al. (2021), which aimed to understand the importance of low self-esteem in the development of disordered eating, found a practically significant effect of self-esteem on ED.

This effect was particularly pronounced in women and manifested over shorter periods between measurements. The overall conclusion is that low self-esteem is a universal risk factor for various types of eating disorders. Based on qualitative analysis, the authors' study also found a strong correlation between low self-esteem and eating disorders. However, the German study relied on secondary processing of existing empirical studies, which are predominantly based on quantitative methods. The fact that low self-esteem correlates with ED in both qualitative and quantitative studies indicates that this factor is really important in ED.

Researchers H. Jebeile et al. (2021) from Australia identified risk factors for ED, including body dissatisfaction, low self-esteem, depression, and dieting. Dieting to control weight may increase the risk of ED, while structured and supervised weight management is likely to reduce the risk of ED for most adolescents. However, some adolescents may present to an obesity treatment service with undiagnosed ED or may develop ED during or after treatment. The authors conclude that a risk management approach that includes screening or monitoring for risk factors and behaviours associated with ED should be used to identify those at risk. Unlike the authors' study, the focus is on adolescents rather than adults, but similar factors were found to influence ED: low self-esteem and body dissatisfaction.

The Spanish and Belgian researchers M. Rabito-Alcon et al. (2021) note that many people with ED report experiencing trauma in childhood, and this condition is the basis for many studies aimed at investigating the factors mediating the relationship between traumatic experiences and the development of ED. In their systematic review of published work, they used the PsycInfo and PubMed databases, combining keywords and applying inclusion and exclusion criteria. A total of 18 articles were identified, and the analysis revealed a set of factors that may mediate the relationship between childhood trauma and the development of ED, including pathological dissociation, difficulties with emotion self-regulation, body dissatisfaction, negative affect/depression, anxiety, general distress, self-criticism, and alexithymia.

The study emphasizes the importance of considering these possible factors when planning treatment, and the role of early detection of trauma and PTSD symptoms in preventing more serious psychopathology in adulthood. Researchers A. Monteleone et al. (2022) found that childhood maltreatment was associated with elevated ED. The study included 325 individuals with ED who completed the Childhood Trauma Questionnaire to assess their early traumatic experiences. It was found that the association between emotional abuse and ED differed by disorder: in people with bulimia nervosa, the association included ineffectiveness, while in people with binge-eating disorder, it included impulsivity. The findings support the idea that emotional abuse conveys an association with eating disorder risk across the different major diagnoses of ED. Ineffectiveness and impulsivity may represent specific psychopathological dimensions associated with emotional abuse that contribute to the development of specific symptoms characteristic of Eating Disorder. Two independent studies based on meta-analysis and empirical quantitative methods also identified family factors as a predictor of ED. In the author's study, the family environment ranks first in the hierarchy of interpersonal factors, so it can be acknowledged that the data are consistent with the author's study. However, these two studies also detail the correlation between ED and trauma in the family environment, with particular attention paid to the emotional sphere. physical therapy eating disorder behavioral

Researchers J. Romero-Mesa et al. (2021) indicate that deficits in emotional abilities are a key factor in the onset and maintenance of ED. The study conducted a systematic review of current data on emotional intelligence and ED in both general and clinical populations at different stages of development. A search of Medline, PsycInfo, and Scopus databases identified 15 relevant articles, all of which indicated a negative association between emotional intelligence and ED. In addition, several mechanisms were identified, including adaptability, stress tolerance, and emotional regulation.

In summary, the systematic review provides promising but challenging preliminary evidence for the link between emotional intelligence and ED across developmental stages. The study indicates that emotional problems are strongly associated with ED, and a high level of emotional influence on ED was also found, but in this case, this pattern was captured using a qualitative methodology. Researchers T. Mason et al. (2021) indicates that low levels of positive affect associated with loss of interest or pleasure in activities (anhedonia) may contribute to the onset and maintenance of binge-eating. They present a theoretical model in which anhedonia increases the risk of overeating through its relationship with disordered eating and weight gain.

The researchers describe potential direct pathways (e.g., reward-related processes) and indirect pathways (e.g., effects on depression symptoms and physical activity) through which anhedonia may lead to adverse eating and weight-related outcomes. A momentary maintenance model is also proposed, in which the low positive affect and dysregulation of positive affect associated with anhedonia sustain overeating directly or indirectly through maladaptive health behaviours such as reduced physical activity, less healthy eating, and fewer social interactions, which in turn sustain anhedonia. In the present study, a link between anhedonia and ED was recorded, unlike in the author's study, this correlation was not recorded. It is possible to assume that anhedonia is included in the factor “negative emotional sphere” in the author's study, but this requires clarification and further research.

The study conducted by M. Kozybska et al. (2021) determined the prevalence of problematic Internet use and ED among Polish students and explored potential correlations between these phenomena. The study involved 1008 Polish students aged 18 to 40 years, who took the Problematic Internet Use Inventory (TPIU22) and the Eating Attitudes Test (EAT-26), as well as completed a socio-demographic and Internet use survey. The results show statistically significant differences between men and women. Men scored higher on the Problematic Internet Use Inventory (TPIU22), while women scored higher on the Eating Attitudes Test (EAT-26).

There was also a significant correlation between these two variables. The strongest predictors of ED were indicators of problematic Internet use, such as preoccupation with the Internet, neglecting sleep in favour of Internet use, less negative feelings while working online, and a higher average number of hours spent online on weekends for academic and work purposes and extracurricular activities. The findings highlight the link between problematic Internet use and ED among students in the Polish context. In contrast to the author's study, the present study uses a quantitative methodology to document the relationship between unhealthy Internet use and ED. The author's study focused more on the underlying psychological factors of ED.

The results of the study show that deep psychological factors, such as perception of food and body image, emotional sphere, and self-esteem, play a key role in the development of ED.

Studies by other authors using different methodologies confirm these findings. Low self-esteem, body dissatisfaction, childhood trauma, and emotional deficits have been found to be risk factors for developing ED. In addition, some studies have identified ED factors that were not found in the author's study. In particular, a link has been established between anhedonia (i.e., loss of interest or pleasure in activities) and ED, as well as between problematic Internet use and ED. Thus, it can be concluded that ED is a complex multifactorial disorder that develops under the influence of various internal and external factors.

Conclusions

Social factors, in particular media influence, have a significant impact on the development of ED. Depictions of the “thin ideal” and diet advertising, which are actively promoted through the media, create negative standards of beauty, and can cause body dissatisfaction. In particular, it is emphasized that this media influence is particularly vulnerable for women, who are often subjected to pressure regarding their appearance. It is also mentioned that socio-economic factors, contrary to expectations, do not have a significant impact on the development of body image disorders, which indicates the universality of this phenomenon in different social groups. At the same time, the role of the close social environment, such as peers and family, in the emergence and maintenance of unhealthy eating habits among adolescents is emphasized. Based on interviews with individuals with signs of anorexia nervosa and bulimia, it was found that among the deep psychological factors of anorexia nervosa, intrapersonal aspects, such as perception of food and one's own body, emotional sphere, and self-esteem, dominate, and they point to the internal dynamics of the individual as a key component in the development of anorexia nervosa. Interpersonal factors related to interaction with others do not have such a strong influence. There is a significant relationship between ED and personal experiences, which include perceptions and emotions. To understand and effectively treat ED, it is necessary to pay special attention to the internal mental processes and emotional state of a person.

However, the study of the deep psychological factors of ED through interviews had a number of limitations. One of them is the small sample size. Only four people took part in the study, which may not be sufficient to obtain representative results. In addition, the study participants were limited in age (41-46 years). This may also limit the overall conclusions that can be drawn from this study. Another limitation is the use of the interview method as a data collection tool. Interviews are a qualitative research method that allows for an in-depth understanding of participants' subjective experiences. However, interviews can also be a subjective method, and the results of the study may depend on the researcher's interpretation. These factors can lead to the development of ED and complicate its course, so for effective treatment, it is necessary to work with these aspects, which can be done with the help of psychodynamic and Gestalt psychotherapy. Gestalt therapy and the psychodynamic approach are effective methods of treating eating disorders. Both approaches are aimed at developing awareness and identifying mental conflicts that may underlie the disorder. The main differences between the psychodynamic approach and Gestalt therapy are as follows: the psychodynamic approach focuses on the past to understand how unconscious conflicts from childhood can lead to a disorder; Gestalt therapy focuses on the present to help patients become aware of their emotions and interactions with food. Prospects for further research should focus on the effectiveness of psychodynamic therapy, Gestalt therapy in general, and fissiotherapy. It is also necessary to focus on the study of the qualitative features of interpersonal interactions that occur in the immediate environment, as well as intrapersonal factors that are not necessarily related to the external environment. This will help to expand the understanding of the underlying psychological aspects of ED and contribute to the development of more effective approaches to the prevention and treatment of these disorders.

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