Understanding inner self-states in eating disorders: preliminary findings from a structured elicitation study.

Abstract

Purpose: Eating disorders are frequently associated with fragmented self-experiences, including harsh self-criticism, shame, and withdrawal, which may be difficult to articulate using standard clinical interviews. Structured elicitation tools may support the exploration of these internal self-states in a clinically meaningful way.

Methods: A total of 14 women receiving treatment for eating disorders at a specialised Italian centre participated in a structured elicitation interview using nine visual-symbolic self-part cards developed for clinical use. For each card, participants provided a numeric endorsement rating (0-10) and open-ended explanations following fixed prompts. Data were analysed using an inductive thematic approach with cross-case comparison.

Results: Higher endorsement was observed for cards reflecting self-rejection, internal criticism, and concealment. Across participants' accounts, four cross-cutting themes emerged: (1) persecutory self-criticism linked to internalised relational judgement; (2) shame-based body rejection as a core self-reference; (3) protective withdrawal associated with emotional invisibility and (4) developmental discontinuity characterised by forced maturity and unmet childhood needs.

Conclusions: This brief report suggests that structured elicitation using visual-symbolic prompts can facilitate the exploration of clinically relevant self-states in people with eating disorders. Findings are preliminary but highlight the potential value of this approach for assessment and psychotherapy formulation.

Level of evidence: Level V, qualitative descriptive study based on clinical interviews.