Etology and management of eating disorders - psychological theories

Glavni oblici poremećaja hranjenja su anoreksija i bulimija nervoza, oba karakterizirana trajnim i patološkim promjenama u prehrambenim navikama. Etiologija ovih poremećaja je multifaktorska, a u psihološke faktore nastanka ubrajamo proces razvoja, odnose s roditeljima, tip privrženosti, stresne i traumatske događaje te adaptaciju na životne faze kroz koje osoba prolazi. Proučavanje tih faktora doprinijelo je razvoju različitih psihoterapijskih metoda liječenja ovih poremećaja. Američka psihijatrica i psihoanalitičarka, Hilde Bruch definirala je teorijski i deskriptivno forme poremećaja hranjenja kao deficite selfa. Radila je na povezivanju simptoma poremećaja hranjenja s unutrašnjim svijetom i davanju simbolike istima. Autorica je antologijske knjige „Golden cage“ koja prikazuje psihodinamiku anoreksije nervose, a aktualna je i danas. Učenja Hilde Bruch zadržana su i nadopunjena konceptom oštećene mentalizacije i prementalizacijskih modela funkcioniranja koji su prisutni u poremećajima hranjenja. U mentalizacijskom pristupu poremećaji hranjenja shvaćeni su kao poremećaji selfa i regulacije afekta. Prema Fonagyu, jednom od tvoraca koncepta mentalizacije, za stvaranje selfa bitan je odnos privrženosti i usklađeno zrcaljenje kao proces kroz koji on nastaje. Nastanku poremećaja hranjenja mogu doprinijeti i obiteljski odnosi, pa je tako Minuchin sa svojim suradnicima opisao i izdvojio skupinu karakteristika koje obilježavaju tzv. „psihosomatsku obitelj“. U toj obitelji dijete koristi simptom poremećaja hranjenja kao odraz roditeljskih konflikata i neizrečenih poruka koje se odnose na isprepletenost, pretjeranu rigidnost, protektivnost i izbjegavanje sukoba.The main forms of eating disorders are anorexia and bulimia of nervosa, both characterized by permanent and pathological changes in feeding habits. The etiology of these disorders is multifactorial, and psychological factors include developmental process, relationship with parents, type of attachment, stressful and traumatic events, and adaptation to the life stages through which the person passes. Studying these factors contributed to the development of various treatment psychotherapeutic techniques. The American psychiatrist and psychoanalyst, Hilde Bruch, defined theoretical and descriptive forms of eating disorder as deficits of self. She was working on linking the symptoms of eating disorder to the inner world and and attributing them symbolic meaning. She is the author of the anthology book "Golden cage" showing psychodynamics of anorexia nervosa, which is still current today. Hilde Bruch's teachings are retained and complemented by the concept of impaired mentalization and pre-existing functional patterns that are present in eating disorders. In the mentalization approach, eating disorders are perceived as selfdisturbances and affective regulation. According to Fonagy, one of the creators of the concept of mentalization, for development of healthy self a secure attachment and synchronized mirroring with parental figures is needed Family-related relationships can also contribute to the emergence of eating disorders, so Minuchin described and distinguished a group of characteristics that characterize so-called "family relationships" and "psychosomatic family". In this family the child symbollicaly uses symptoms of eating disorder that reflect parental conflicts and unexpressed messages related to intertwining, excessive rigidity, protectionism, and conflict avoidance