Self-image and eating disorders

Negative self-image is considered typical of eating disorders. The present thesis aimed to study clinically relevant aspects of self-image in adult patients taking part in a large naturalistic and longitudinal project at specialist units for eating disorders in Sweden. Self-image was measured using the Structural Analysis of Social Behavior (SASB), and examined together with clinical and background variables at initial presentation and at follow-up. Important aspects of treatment, such as diagnosis, treatment satisfaction, outcome and dropout were the focus of four studies. In Study I, eating disorder patients were found to have more negative interpersonal profiles compared to controls. When diagnostic groups were compared, patients with anorexia nervosa were more self-controlling, self-hating and self-blaming, as well as less self-emancipated and self-loving. Patients with binge eating disorder were more self-affirming than patients with anorexia nervosa and bulimia nervosa, as well as less self-controlling than patients with anorexia nervosa and patients with atypical eating disorders. In Study II, patients who became unsatisfied with treatment were characterised by significantly more negative self-image, as well as higher levels of eating disorder and psychiatric symptoms compared to satisfied and highly satisfied patients. Unsatisfied patients expressed higher expectations of treatment interventions focusing on insight and lower expectations of interventions focusing on control. Overall satisfaction with treatment was predicted by interventions focusing on support and control of eating problems. In Study III, high levels of self-hate were significantly related to poor outcome; other variables related to poor outcome included low occupational status, problematic interpersonal relationships, eating disorder symptoms, high levels of self-emancipation, and psychiatric symptoms. In Study IV, patients who dropped out had less negative self-image and fewer psychological problems at intake compared to patients who had completed treatment or who were still in treatment; low levels of self-blame predicted dropout. Results of these studies suggest that eating disorder patients have significant problems with negative self-image. Examining self-image at initial assessment may help to identify patients at risk for negative therapeutic interactions. It may be especially important for therapists to pay attention to underlying interpersonal dynamics, to avoid being drawn into interactions that confirm negative self-image and are detrimental to treatment