Psychological factors affecting eating disorders.

Eating disorders (EDs) are representative of the relationship between psychosomatic and psychiatric disorders and have complex interactions in the body, mind, and brain. The psychosomatic issues of EDs emerge in the alterations of the body and its functioning, in personality traits, in the difficulty of recognizing and coping with emotions, and in the management of anger and impulsiveness. The Diagnostic Criteria for Psychosomatic Research used by the authors of this chapter (alexithymia, type A behavior, irritable mood, demoralization) represent an innovative instrument with therapeutic implications. When alexithymia is diagnosed, greater efforts will be made to increase the patients' awareness of the emotions underlying disordered eating behaviors. Moreover, in a comprehensive intervention, the diagnosis of demoralization and irritable mood increases the therapist's understanding of the patients' cognitive and relational patterns and suggests the use of an antidepressant. Alexithymia and type A behavior describe more stable traits in relation with the patients' personality. From this viewpoint, psychotherapy may be focused on the identification and expression of feelings, giving particular attention to anger, which is often unrecognized, excessively controlled, and self destructive in patients with EDs. Lastly, the correlation between personality traits assessed with the Temperament and Character Inventory and the Diagnostic Criteria for Psychosomatic Research suggests that the strengthening of character through psychodynamic psychotherapy might be useful also for the psychosomatic cores of the disorder.