Eating one's words, Part I: ‘concretised metaphors’ and reflective function in anorexia nervosa—an interview study

Abstract

Anorexia nervosa still qualifies for the designation as an enigma, with an unclear aetiology and a psychopathology poorly understood. A striking clinical feature is the concreteness of symptoms. The concept ‘concretised metaphor’ refers to instances where there is a psychic equivalence between physical and psychic reality. Emotions are concretised. Objective To contribute in a more precise language about the body's symbolic role—embodiment in anorexia nervosa. Method 10 female patients (age 16–35 years) with anorexia nervosa describe in interviews how they conceive mind–body relations in their own lives. Results Different ‘concretised metaphors’ are described and categorised, covering a wide range of bodily experiences and corresponding emotions. Discussion The occurrence of various ‘concretised metaphors’ in these cases suggests reduced symbolic capacity and impaired reflective function as a core psychopathological trait in anorexia nervosa. This is the first of three companion papers. Part II develops theory on reflective function in anorexia nervosa. Part III presents an outline for psychotherapy for anorexia nervosa. Copyright © 2007 John Wiley & Sons, Ltd and Eating Disorders Association.