The subjective symptoms experience: clinical implications for the prognosis and the treatment of the eating disorders patients

In the last years, many limits about the clinical utility of ED (Eating disorders) diagnostic categories are pointed out: they don’t take consider the clinical variability in the same diagnostic category, the turning from one category to another and between subtypes, and the resources of patients (Anderluh et al., 2009; Eddy et al., 2002; Keel et al., 2005). Personality features evidenced a powerful capacity to capture the ED complexity (Westen, Harnden-Fisher, 2001; Thompson- Brenner et al., 2005, 2008). In the light of these considerations, in the same way of personality, we assumed that the focus on subjective symptoms experience in ED patients have a major clinical and therapeutic utility. We developed ESSE (Eating Symptoms Subjective Experience, Nassisi, Speranza, 2012), a clinician report composed by 34 items on a five point Likert scale. 118 clinicians assessed their ED female patients (mean age 27.8; ds 10.8; 18 to 57) on clinical variables, Global Assessment of Functioning (GAF), personality (SWAP-200, Westen, Shedler, 1999a,b) and attachment (AAQ, Westen, Nakash, 2005). The 69.3% of patients were anorexic, the 20.8% were bulimic and 9.9% EDNOS. A factor analysis with a varimax rotation pointed out three factors (46,6% of the overall variance): Omnipotent control (21.9%; 15 items), Dysregulation of negative affects (16.9%; 12 items), Relational manipulation (7.8%; 7 items). The Omnipotent control correlated with dismissing attachment (r=.34; p=.000) and with preoccupied too (r=.22; p=.026). For the Dysregulation of negative affects no results were found. The Relational meaning correlated with the GAF (r=-.27; p=.007) and preoccupied attachment (r=.34; p=.000); it also predicted a lower general functioning (β=-.191; p=.05), the presence of personality disorders (β=.233; p=.024) and sexual abuse (β=.238; p=.018). This study highlights the importance of considering subjective experience in managing ED patients for identifying prognostic and therapeutic features.