Structural Relationships of the Personality Organization, Object Relations and Defense Mechanisms with Pathological Eating Disorder

Document Type : Original Article

Authors

1 Department of Psychology, Science and Research branch, Islamic Azad University, Qom Branch.

2 islamic azad university Qom

3 Assistant Professor, Department of Psychology, Science and Research branch, Islamic Azad University, Qom Branch, Iran.

Abstract

Introduction: The present study aims to Explaining model of pathological eating patterns on the basis of Primary Object Relation, personality organization and defense mechanisms.
Method: The research method was descriptive and correlational. The statistical population of the study consisted of all undergraduate students of Payame Noor University and Islamic Azad University in Qom in the second half of the school year they were in 2017-18. For this purpose, 888 of these students were selected using multi-stage cluster random sampling. In order to collect data, the Subject Relations Questionnaire (1995), The Kernberg‎ Personality Inventory Questionnaire (IPO), the Iranian Form of Defense Styles (Andrews et al., 1989) and Garner et al. (1982) Eating Attitudes Questionnaire (1982) were used to analyze the data. A confirmatory and exploratory factor analysis was used.
Results: The results showed directly that 16.81% of the dispersion of the scores of pathological eating patterns was explained ‎through the Primary object relation and 6 % through the defense mechanisms. Also, in this model, 24.01% of dispersion of personality ‎organization were explained through the defense mechanisms. In addition, the results of this study, estimating the structural model in which object relations and personality organization as a variable of defense and defense mechanisms were introduced into the middle eagle, showed that this model explains 41.07% of pathological eating patterns.
Conclusion: The pathological eating patterns both directly and indirectly could be interpreted by defense mechanisms via primary object relations and personality organization.

Keywords

Main Subjects


1- American Psychiatric Association. Diagnostic and statistical manual of mental health disorders: DSM-5, 5th edn. American Psychiatric Publishing, Washington, DC. 2013.
2- Gabbard GO. Gabbard's treatments of psychiatric disorders: American Psychiatric Pub; 2007.
3- Crow S. Eating disorders and risk of death. Am Psychiatric Assoc. 2013.
4- Johnson C, Tobin D, Enright A. Prevalence and clinical characteristics of borderline patients in an eating-disordered population. The Journal of clinical psychiatry. 1989.
5- Arcelus J, Mitchell AJ, Wales J, Nielsen S. Mortality rates in patients with anorexia nervosa and other eating disorders: a meta-analysis of 36 studies. Archives of general psychiatry. 2011; 68(7): 724-31.
6- Sadock BJ, Sadock VA. Kaplan and Sadock's synopsis of psychiatry: Behavioral sciences/clinical psychiatry: Lippincott Williams & Wilkins. 2011.
7- Hartmann AS, Greenberg JL, Wilhelm S. The relationship between anorexia nervosa and body dysmorphic disorder. Clinical psychology review. 2013; 33(5): 675-85.
8- Kollei I, Brunhoeber S, Rauh E, de Zwaan M, Martin A. Body image, emotions and thought control strategies in body dysmorphic disorder compared to eating disorders and healthy controls. Journal of Psychosomatic Research. 2012; 72(4): 321-7.
9- Ruffolo, J. S., Phillips, K. A., Menard, W., Fay, C., & Weisberg, R. B. Comorbidity of body dysmorphic disorder and eating disorders: Severity of psychopathology and body image disturbance. International Journal of Eating Disorders. 2006; 39(1): 11–19.
10- Kaplan BJ. Kaplan and Sadock’s Synopsis of Psychiatry. Behavioral Sciences/Clinical Psychiatry. Tijdschrift voor Psychiatrie. 2016; 58(1): 78-9.
11- Hrabosky JI, Cash TF, Veale D, Neziroglu F, Soll EA, Garner DM, et al. Multidimensional body image comparisons among patients with eating disorders, body dysmorphic disorder, and clinical controls: A multisite study. Body image. 2009; 6(3): 155-63.
12- Duffy ME, Henkel KE. Non-specific terminology: Moderating shame and guilt in eating disorders. Eating disorders. 2016; 24(2): 161-72.
13- Schulte SJ. Predictors of binge eating in male and female youths in the United Arab Emirates. Appetite. 2016; 105: 312-9.
14- Tan ES, Hawkins RM. Psychological and behavioural characteristics of females with anorexia nervosa in Singapore. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity. 2017; 22(4): 657-66.
15- Miniati M, Benvenuti A, Bologna E, Maglio A, Cotugno B, Massimetti G, et al. Mood spectrum comorbidity in patients with anorexia and bulimia nervosa. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity. 2018;23(3):305-11.
16. Hoek HW. Distribution of eating disorders. Eating disorders and obesity: A comprehensive handbook. 2002; 2: 233-7.
17- Perez M, Ohrt TK, Hoek HW. Prevalence and treatment of eating disorders among Hispanics/Latino Americans in the United States. Current opinion in psychiatry. 2016; 29(6): 378-82.
18- Nobakht M, Dezhkam M. An epidemiological study of eating disorders in Iran. International Journal of Eating Disorders. 2000; 28(3): 265-71.
19- del Pozo MA, Harbeck S, Zahn S, Kliem S, Kröger C. Cognitive distortions in anorexia nervosa and borderline personality disorder. Psychiatry research. 2018; 260: 164-72.
20- Szalai T. The relationship of attachment features and multi-impulsive symptoms in eating disorders. Orvosi hetilap. 2017; 158(27): 1058-66.
21- Huprich SK, Nelson SM, Paggeot A, Lengu K, Albright J. Object relations predicts borderline personality disorder symptoms beyond emotional dysregulation, negative affect, and impulsivity. Personality Disorders: Theory, Research, and Treatment. 2017; 8(1): 46.
22- Hansson E, Daukantaitė D, Johnsson P. Typical patterns of disordered eating among Swedish adolescents: associations with emotion dysregulation, depression, and self-esteem. Journal of eating disorders. 2016; 4(1): 28.
23- Münch AL, Hunger C, Schweitzer J. An investigation of the mediating role of personality and family functioning in the association between attachment styles and eating disorder status. BMC psychology. 2016; 4(1): 36.
24- Westen D, Harnden-Fischer J. Personality profiles in eating disorders: rethinking the distinction between axis I and axis II. American Journal of Psychiatry. 2001; 158(4): 547-62.
25- Miranda B, Louzã MR. The physician’s quality of life: Relationship with ego defense mechanisms and object relations. Comprehensive psychiatry. 2015; 63: 22-9.
26- Iorgulescu G. Low self–esteem in women with eating disorders and alcohol abuse as a psycho–social factor to be included in their psychotherapeutic approach. Journal of medicine and life. 2010; 3(4): 458.
27- Patton CJ. Fear of abandonment and binge eating: A subliminal psychodynamic activation investigation. Journal of Nervous and Mental Disease. 1992.
28- Herbert GL, McCormack V, Callahan JL. An investigation of the object relations theory of depression. Psychoanalytic Psychology. 2010; 27(2): 219.
29- Bers SA, Besser A, Harpaz–Rotem I, Blatt SJ. An empirical exploration of the dynamics of anorexia nervosa: Representations of self, mother, and father. Psychoanalytic Psychology. 2013; 30(2): 188.
30- Fist C. Fist GCRT. Personality Theories. Seyed Mohammadi translation. Tehran: Nashraravan; 2013.
31- Cole-Detke H, Kobak R. Attachment processes in eating disorder and depression. Journal of consulting and clinical psychology. 1996;64(2):282.
32- Humphrey LL. Relationships within subtypes of anorexic, bulimic, and normal families. Journal of the American Academy of Child & Adolescent Psychiatry. 1988; 27(5): 544-51.
33- Klump KL, Bulik CM, Pollice C, Halmi KA, Fichter MM, Berrettini WH, et al. Temperament and character in women with anorexia nervosa. The Journal of nervous and mental disease. 2000; 188(9): 559-67.
34- Kenny ME, Hart K. Relationship between parental attachment and eating disorders in an inpatient and a college sample. Journal of Counseling Psychology. 1992;39(4):521.
35- Summers F. Object relations theories and psychopathology: A comprehensive text: Routledge. 2014.
36-           Prochaska J, O., Nurcras, J.C. . Theories of Psychotherapy. Tehran: Roshd. 2006.
37- Freud A. The Ego and the Mechanisms of Defense. New York (International Universities Press) 1946.
38- Ward RM, Hay MC. Depression, coping, hassles, and body dissatisfaction: Factors associated with disordered eating. Eating behaviors. 2015; 17: 14-8.
39- Mohammadzadeh A NM, Rezaei A. . Comparing the Explanatory Role of Perfectionism in Obsessive Compulsive Features and Pathological Eating Attitudes. Journal of Clinical Psychology. 2013; 5(1): 17.
40- Sohlberg S, Norring C. Ego functioning predicts first‐year status in adults with anorexia nervosa and bulimia nervosa. Acta Psychiatrica Scandinavica. 1989; 80(4): 325-33.
41- Kernberg OF. Borderline (Patient) Personality. International Encyclopedia of the Social & Behavioral Sciences (Second Edition), International Encyclopedia of the Social & Behavioral Sciences (Second Edition), Personality Disorders Institute, New York Presbyterian Hospital, New York, NY, USA; Joan and Sanford. 2015; 755-59.
42- Lenzenweger MF, Clarkin JF, Kernberg OF, Foelsch PA. The Inventory of Personality Organization: Psychometric properties, factorial composition, and criterion relations with affect, aggressive dyscontrol, psychosis proneness, and self-domains in a nonclinical sample. Psychological Assessment. 2001; 13(4): 577.
43- Millon T, Millon CM, Meagher SE, Grossman SD, Ramnath R. Personality disorders in modern life: John Wiley & Sons. 2012.
44- Kaye WH, Bulik CM, Thornton L, Barbarich N, Masters K, Group PFC. Comorbidity of anxiety disorders with anorexia and bulimia nervosa. American Journal of Psychiatry. 2004; 161(12): 2215-21.
45- Halmi KA, Sunday SR, Strober M, Kaplan A, Woodside DB, Fichter M, et al. Perfectionism in anorexia nervosa: variation by clinical subtype, obsessionality, and pathological eating behavior. American Journal of Psychiatry. 2000; 157(11): 1799-805.
46- Kaye WH, Bulik CM, Thornton L, Barbarich N, Masters K, Group PFC. Comorbidity of anxiety disorders with anorexia and bulimia nervosa. American Journal of Psychiatry. 2004; 161(12): 2215-21.
47- Strober M, Humphrey LL. Familial contributions to the etiology and course of anorexia nervosa and bulimia. Journal of Consulting and Clinical Psychology. 1987; 55(5): 654.
48- Anderluh MB, Tchanturia K, Rabe-Hesketh S, Treasure J. Childhood obsessive-compulsive personality traits in adult women with eating disorders: defining a broader eating disorder phenotype. American Journal of Psychiatry. 2003; 160(2): 242-7.
49- Cook-Darzens S, Doyen C, Mouren M-C. Family therapy in the treatment of adolescent anorexia nervosa: current research evidence and its therapeutic implications. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity. 2008; 13(4): 157-70.
50- Dimitropoulos G, Carter J, Schachter R, Woodside DB. Predictors of family functioning in carers of individuals with anorexia nervosa. International Journal of Eating Disorders. 2008; 41(8): 739-47.
51- Kluck AS. Family factors in the development of disordered eating: Integrating dynamic and behavioral explanations. Eating Behaviors. 2008; 9(4): 471-83.
52- Kline RB. K. Principles and practice of structural equation modeling. New York: Guilford publications. 2015.
53- Bell M BR, Becker B. . A scale for the assessment of object relations: Reliability, validity, and factorial invariance. Journal of Clinical Psychology. 1986; 42(5): 733-41.
 
54- Al Behbahani, Marjan, Mohammadi, Nouraleh. Review the psychometric properties of the Kronberg character organization log. Journal of Psychology. 2007; 11 (2): 195-185
55- Garner DM, Olmsted MP, Bohr Y, Garfinkel PE. 1982. The eating attitudes test: psychometric features and clinical correlates. Psychol Med. 1982 Nov; 12(4): 871-8.
56-           Amianto F, Abbate-Daga G, Morando S, Sobrero C, Fassino S. Personality development characteristics of women with anorexia nervosa, their healthy siblings and healthy controls: What prevents and what relates to psychopathology? Psychiatry Research. 2011; 187(3): 401-8.
57- Appledorn K. Object relations and identity disturbances in bulimic women. 1999.
58- Kochaki MM, N; Arj, A. . The role of attachment styles, the quality of thematic relations and the power of Ego in predicting irritable bowel syndrome. Feyz Scientific-Research Fellow. 2015; 19(3): 231-41.
59- Williams G. Reflections on some dynamics of eating disorders:'No entry'defences and foreign bodies. The International journal of psycho-analysis. 1997; 78(5): 927.
60- Reich G, Cierpka M. Identity conflicts in bulimia nervosa: Psychodynamic patterns and psychoanalytic treatment. Psychoanalytic Inquiry. 1998; 18(3): 383-402.
61- Baker L, Minuchin S, Liebman R, Rosman BL. Psychosomatic Families: Anorexia Nervosa in Context: Harvard university press. 1978.
62- Bruch H. Anorexia nervosa: therapy and theory. The American Journal of Psychiatry. 1982.
63. Bruch H. The golden cage: The enigma of anorexia nervosa: Harvard University Press. 2001.
64-           Bruch H. The changing picture of an illness: anorexia nervosa. Attachment and the therapeutic process. 1987:.205-22.
65- Wilson CP. The fear of being fat and anorexia nervosa. International Journal of psychoanalytic psychotherapy. 1982.
66- Rashn Sh M-HS, Rezaei AM, Tabatabaee M. The effect of long-term dynamic psychotherapy on the personality structure of patients with Dependent Personality Disorder. Journal of Clinical Psychology. 2018; 9(4): 36.
67- Kaplan AS, Woodside DB. Biological aspects of anorexia nervosa and bulimia nervosa. Journal of Consulting and Clinical Psychology. 1987; 55(5): 645.
68- Garner DM, Garfinkel PE. Handbook of psychotherapy for anorexia nervosa and bulimia: Guilford Press. 1985.
69- Bromberg PM. Treating patients with symptoms—and symptoms with patience: Reflections on shame, dissociation, and eating disorders. Psychoanalytic Dialogues. 2001; 11(6): 891-912.
70- Boris HN. On the treatment of anorexia nervosa. The International journal of psycho-analysis. 1984; 65: 435.
71- Freud S. The ego and the superego. Standard Edition. 1923; 19: 1926.
72- Sugarman A, Kurash C. The body as a transitional object in bulimia. International Journal of Eating Disorders. 1982; 1(4): 57-67.
73- Brenner C. Working alliance, therapeutic alliance, and transference. Journal of the American Psychoanalytic Association. 1979; 27: 137-57.
74- Goodsitt A. Self‐regulatory disturbances in eating disorders. International Journal of Eating Disorders. 1983; 2(3): 51-60.
75- Rashn Sh M-HS, Rezaei AM, Tabatabaee M. The effect of long-term dynamic psychotherapy on the personality structure of patients with Dependent Personality Disorder. Journal of Clinical Psychology. 2018; 9(4): 36.
76- Mohammadzadeh A NM, Rezaei A. . Comparing the Explanatory Role of Perfectionism in Obsessive Compulsive Features and Pathological Eating Attitudes. Journal of Clinical Psychology. 2013; 5(1): 17.
77- Vahedi, A., Makvand-Hosseini, Sh., Bigdeli, I. Diagnosis of Higher Level Personality Pathology by Using Short-Term Dynamic Psychotherapy.  Journal of Clinical Psychology. 2012; 4(3): 15.