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Abstract: There is a need for a new perspective on treatment for adolescents and adults with extreme recurring anorexia, underlying prenatal and perinatal trauma, early childhood trauma (or Adverse Childhood Experiences), and complex multi-problems. Current evidence-based therapies are successful with 66% of patients suffering from anorexia with a BMI higher than 17.5. An approach is suggested that regards the eating disorder as a coping strategy for underlying emotional pain. We advocate this approach, which is based on principles like those from CBT, the Self-Determination Theory, and trauma therapy: Past Reality Integration (PRI). The following initial results of a PRI pilot study with 13 clients appear promising.
Keywords: severe/extreme recurring anorexia, prenatal and perinatal trauma, early childhood trauma, Adverse Childhood Experiences (ACES), Past Reality Integration
Anorexia Nervosa is a multifaceted, multidimensional problem. The current DSM-5 criteria (American Psychiatric Association, 2014) are described in Box 1. Severe/extreme recurring anorexia is characterized by an individual being underweight with a very low Quetelet's body mass index (BMI) of approximately < 17.5 kg/M2 (Lay et al., 2002).
Various personal characteristics play a role in the development and maintenance of anorexia, including biological, psychological, and social aspects (Engel, 1977).
Causal mechanisms can be explained in terms of the vulnerability-stress model (Graham et. al., 2018; Guerry & Prinstein, 2010). According to Woods-Jaeger et al. (2018), "toxic stress" impairs nervous system development and growth in parts of the brain responsible for planning, problem-solving, and self-regulation of emotions and behaviors. A review by Raevuori, Linna, and Keski-Rahkonen (2014) showed small effects of prenatal and perinatal trauma on eating disorders. However, a recent study of 1,167,043 subjects who experienced premature birth found more robust relations with eating disorders (Larsen et al., 2020).
First of all, there is a broad consensus about biological aspects such as a genetic vulnerability and pre- and perinatal trauma (Attia, 2010; Bulik et al., 2016; Kaye, 2008; Keel & Klump, 2003; Sherag, 1968). Sherag (1968) showed that genes on chromosomes 3 and 4 determine an anorectic predisposition. Anorexia affects the functioning of the hypothalamus. This part of the brain plays a role in saturation and energy management. During anorexia, this energy management becomes too tightly adjusted (Delfos 2011; Swaab, 2004). Pre- and perinatal problems also play an important role, which...