Alexithymic features of eating disorder patients: Contributions of sexual abuse and borderline personality disorder.

Abstract

Clinical and research studies suggest a high prevalence of alexithymic features among eating disorder patients, mainly with regard to disturbances in interoceptive awareness and affective expression. Research evidence for this patient group is less clear in terms of cognitive aspects of alexithymia (such as poverty of imagination and concrete thought style), and in terms of the relationship between this symptom cluster and eating disorder patients' attentional narrowing to the body and food. The aims of this study were to: (1) confirm prior findings of interoceptive and affective deficits in eating disorder patients; (2) further assess cognitive style; and (3) explore the contributions of childhood incest and co-morbid borderline personality disorder to alexithymic features in eating disorder patients. Sixty-one inpatients and outpatients in 3 groups (eating disorder, borderline personality disorder, dual-diagnosed ED/BPD) and 10 non-patient control subjects completed the Eating Disorders Inventory (EDI), TAT, Early Memories Test, SCL-90-R, and Vocabulary and Picture Arrangement subscales, of the WAIS-R. Subjects were also interviewed about childhood abuse experiences using the Family Experiences Interview. To assess alexithymic features, subjects' TAT and EM narratives were coded for amount and quality of verbal expression across four dimensions of the alexithymia construct. A multiple regression model was used to examine the contributions of eating disorder diagnosis, incest history, depressive symptoms, and a co-morbid diagnosis of borderline personality disorder to variance in verbal ratings and EDI interoceptive awareness scores. Deficits in interoceptive awareness were explained mainly by depressive symptoms, and to a lesser but still significant extent by a diagnosis of eating disorder and history of childhood incest. Contrary to our hypotheses, expressive deficits and amount of verbal focus on the external body did not differ significantly across groups, although eating disorder patients were more likely to refer to food and eating on the Early Memories test. In addition, patients were found to be less likely than non-patients to refer to their <italic>own</italic> affective experiences on the TAT. Results did not support hypotheses that eating disorder patients are poorer in imagination or more concrete and operatory in their cognitive style. Implications for future research and clinical practice are discussed.