Alessitimia e regolazione emotiva nella psicoterapia di pazienti con DCA: Analisi empirica dell’Attività Referenziale di un campione in trattamento

Abstract Background Alexythimia represents an important deficit in patients with ED and it is a responsible factor for the poor response to treatment. The difficulties found by patients in psychotherapeutic treatments come from their peculiar cognitive, emotional, behavioural and personological attitude generated by their metapsycological specific nature and reflected in a language which is often factitious and nameless for the person’s experience: examining the language can be a fundamental element to detect this pathology and its possible treatments. Considering as theoretical references the theories on alexithymia, on the Emotional Regulation and on the Bucci’s Multiple Code, this study aims at evaluating the effectiveness of psychotherapy and at observing changes in emotional expression during 61 psychotherapy sessions undergone by a series of 8 ED patients. Methods The effectiveness of psychotherapy has been evaluated in terms of symptomatological improvements, attitudes relating to diet, weight, physical condition, ability in emotional reading and characteristic psychological features through three repeated administrations of a set of psychometric scales (Toronto Alexithymia Scale-20, Eating Disorder Inventory-2, Body Uneasiness Test, Symptom Checklist-90-R, Multidimensional Perfectionism Scale, Worry Domain Questionnaire, Parental Bonding Instrument, Dissociative Experience Scale, Working Alliance Inventory). Changes in the expression of emotional contents in the psychotherapeutic process have been studied through the application of computerized RA measures – I-DAAP (Italian Discourse Attribute Analyses Program); the time trend of narrative pattern in the sequence of sessions has been tested with Spearman’s correlation coefficient. Results The results support the efficacy of psychotherapy in terms of some key aspects – dissociative moments, impulsivity, body dissatisfaction – whereas, language indicators underline the problem of emotional states elaboration: a defensive rational attitude inactivates the emergence of dissociated emotional patterns and defenses of intellectualization set limits to the patient’s narration caused by the fear of falling into a state of emotional oppression. This narrative pattern, apparently little functional compared to an evolutionary project, is effective for the immediate reduction in the psychic distress that the subject needs to satisfy. Conclusions The knowledge of a psychotherapeutic process prototypical trend helps in managing actions, in adjusting the setting, in understanding defenses and moments of possible emotional connection with respect to dissociated emotional schemes. Future work will have to evaluate if and how improving emotional communication could be seen as the main focus of treatment.