Evidence Basis for Psychodynamic Self Psychology in Eating Disorders

Through cross-sectional and prospective longitudinal studies, this chapter presents the empirical basis for self-psychology theory's capability to predict both the development of and the remission from eating disorders. It further presents the effectiveness of self-psychology treatment in a randomized control study over two other techniques. The Selflessness Scale was developed to quantify the tendency of the eating disordered patient to ignore her own needs for the sake of fulfillment of others' – selflessness position. In a prospective longitudinal study, the Selflessness Scale was found to correctly predict the development of an eating disorder in 82% of the cases, hence supporting the theoretical conceptualization of self psychology, that points to the etiological role of the selflessness position and being selfobject for others in eating disorders. Furthermore, a study comparing selflessness levels of mothers found that selflessness levels of mothers of daughters with anorexia nervosa (AN) were significantly lower than the levels found in mothers of normal ado¬lescents, hence providing evidence for the difficulties of the former to fulfill the expected role of a selfobject for their daughters. Finally, a randomized control study which compared a self-psychological approach to cognitive orientation treatment and a control/nutritional counseling only treatment, over a one-year period, showed that self-psychological treatment achieved significantly better results, both in removing the ED symptomatology and in an intra-psychic variable of the cohesion of the self.