Alexythymia and narratives in the psychoterapy of eating disoeders. Correlations between psychometric scales and the narrative indices of the referential process

Introduction: Since we know the difficulties in the “talking cure” of patients with eating disorders (Farrell, 2000) and the importance of the concept of alexithymia (Taylor, 1996; Bruch, 1973), we present the first results of the study “Alexithymia and emotional regulation in the psychotherapy of EDs patients” taking place at the Specialist services for eating disorders, San Gerardo Hospital, Monza. This project, in the field of psychotherapy research, aims to evaluate, in a series of 8 patients with EDs, changes in emotional expression through the language using the application of Italian computer measures of referential process-I-DAAP (Maskit, Bucci, et al., 2004) - developed on the Bucci’s Multiple Code Theory of Bucci (Bucci, 1997). Through an evaluation of the outcome of the therapeutic process and a qualitative analysis of the same, we will examine the modification and/or the influence of the alexithymic condition in the course of psychotherapy of anorexic-bulimic frameworks. Method: The effectiveness of the therapeutic process will be measured by repeated administration of self-report scales related to symptoms, subjective experience, cognitive and relational aspects. The qualitative study will be made with the I-DAAP which allows to evaluate the expression of emotional content through the overall organization of the sentence and the semantic contents. The sample consists of 8 patients with eating disorders in psychotherapy with three experienced therapists. The collection of data (self-report scales and verbatim transcribed of 8 sessions per patient) will be carried out in three stages. In this first analysis on the collected material at time T1 (psychometric scales and 25 transcripts), we have calculated the indices of correlation (r Pearsons) among the variables tested with the self-report instruments (TAS20 for alexithymia, EDI2 for the characteristics of the eating disorder, SCL90 for general psychopathology, PBI for the representation of parental bonding, BUT for body image disorder, WDQ for brooding, MPS for perfectionism, DES for dissociative episodes, WAI for therapeutic alliance), and between these ones and the average narrative indexes of I-DAAP (RA indices - MIWRAD2, MHIWRAD2, HPIWRAD2 -, Reflection - MIRef, Disfluency - MIDIF, Affect - MIAffP, MIAffN, MIAffZ -, Sensorysomatic MISenS). For all values we have also evaluated the correlation with the index of high-functioning of SWAP200 (AF PD_T, AFQ-T), applied to assess the personality of the patients. Data processing was performed using the statistical program STATA. Results and Discussion: The correlations between the variables measured by self-report scales confirm some expected and confirmed by the literature results. We found: Negative correlation between TAS20 and Maternal Care (PBI) (p =.04) and positive correlation between TAS20 and maternal overprotection (p =.03), confirming the relationship between alexithymia and the parenting style. Because of the important role of the caregiver in the process of emotional regulation, both neglect and overprotection seem to contribute to difficulties of identification and expression of one's emotional experience. This is in agreement with the work of Thorberg (2011) and De Panfilis (2008). A positive correlation between TAS20 and EDI2 Drive for thinness (p =.04) and Interoceptive Awareness (p =.03), confirming the link between lack of emotional expression and the symptoms of eating disorders, as well as a tendency to express misunderstood stimuli by means of the body. This finding is consistent with the one reported by Taylor (1996), Schmidt (1993). A positive correlations between EDI2 and the psychometric scales for the evaluation of brooding, perfectionism and body image disorder, confirming the relationship between the EDs specific traits and the monomorphic tendence induced by the anorexic process on the symptoms and on the psychic functioning. Particularly, we can notice. A positive correlation (p<.05) between EDI2 (Global, Drive for thinnes, Bulimia, Body Dissatisfaction, Asceticism), BUT (Body Uneasiness) and WDQ (Brooding). A positive correlation (p<.05) between EDI2 (Insecurity, Interpersonal Distrust, Interoceptive awareness, Maturity fears, Impulse Regulation, Social insecurity) and WDQ. A positive correlation between EDI2 (Perfectionism), SWAP200 High functioning (p=.01) and MPS (Perfectionism) (p=.01). A positive correlation between EDI2 (Interpersonal Distrust, Social Insecurity) and SCL90 (General psychopathology) (p =.008 and p =.01). The analysis of the correlation between TAS20 and the Referential Activity measures showed: A negative correlation (p=.01) between MIDF and TAS20. The high disfluency may indicate an emotional arousal (Campanelli, 2009): the greater fluency in the language of alexithymic subjects shows a difficulty to remain with thought and words in complex narratives involving such activation. A positive correlation between (p=.008) MHIWRAD2 and TAS20, due in particular to the second factor of the scale (DDS, Difficulty Describing Feelings) (p=0.01). MHIWRAD2 measures the density in the emotional connection and reflects how the speaker is connected to a relevant emotional experience. The association between this factor and the high difficulty of describing feelings may suggest strong phases of emotional activation due to emotional dysregulation. We can assume the presence of peaks of emotional activation disconnected from the emotional content in which the subject fails to orientate himself, as if the immersion in his own inner world resulting in a state of oppression (Krystal, 1988), numbness or freezing (Petterson, 2004; Ben Meir 2007). Correlation between RA measure and alexithymia were investigated and found also by Di Trani (2009). The analysis of the significant correlations between the PBI and the RA measures indicate that parenting styles are related to language. We found: A positive correlation between the RA measures - MIWRAD2 (p= .01) - MHIWRAD2 (p=.001) - HPIWRAD2 (p=.02) - and maternal overprotection. Maternal overprotection may be associated to strong emotional activation which is in turn characterized by emotional dysregulation. This finding is consistent with attachment theory (Bowlby, 1988) and refers to the approaches of the post-Freudian psychoanalytic authors (Klein, Bion, Winnicott, Fonagy) and to their revision in the Polacco Williams’s anorexia theory (1999). We studied the correlation between the average narrative measures and the personality functioning evaluated with SWAP200. We observed: a positive correlation between MIREF and AF PD and Q (p = .04) and a negative correlation between MHIWRAD2 and AF PD and Q (p = .04). These results suggest that the reflexive components is related to high functioning; on the contrary emotional dysregulation, as expressed by the variability in RA peaks, seems to be connected to low functioning.