Growing up means building a certain image of ourselves starting from the foundations we received when we were children and we interacted with adults and peers. In the course of development the body probably represents the centerpiece of future changes, the place where they become visible, and adolescence is maybe the time in which this column gets most deeply carved. During this period, in fact, the concept of self-esteem develops along with the establishment of a more defined psychological and physical identity compared to that deriving from the context of the family of origin. For instance, many girls feel very confident about their image before the menarche, whereas the natural increase of weight due to the menarche can cause a loss of confidence and a decrease in self-esteem[1]. It is during this delicate period of transition that Eating Disorders such as Anorexia and Bulimia can appear.
Anorexia Nervosa is mainly characterized by the refusal of food and by the obsessive fear of gaining weight. This pathology can also evolve in more serious forms that can lead to undernourishment, starvation, amenorrhea and emaciation. Bulimia, on the contrary, is an eating disorder characterized by events in which the patient eats large quantities of food followed by specific actions, such as self-induced vomiting, aimed to prevent the body from gaining weight (by metabolizing food).
In a recent study aimed to understand the cerebral origin of Anorexia nervosa, a group of Italian researchers [2] compared the quantity of grey matter (neurons) of the brain of 16 adolescents suffering from restrictive Anorexia Nervosa with that of 16 healthy adolescents. The analyses revealed that a significant reduction of the volume of the grey matter in patients suffering from anorexia especially in the parietal lobe (inferior and superior), an area that many researches connect to the formation and modification of mental images, especially concerning the self.
What role can hypnosis have in this delicate weaving of feelings, physical changes and brain circuits? Research highlights a difficulty in dealing with patients suffering from anorexia: such patients, in fact, are more difficult to “involve” in a hypnotic induction, because of their extreme controlling behaviors (that is with less possibility of involvement in the dialogue with the operator)[3]. Patients affected by bulimia nervosa, instead, seem more apt to a hypnotherapeutic process, as reported by many hypnotizability scales where they often obtain very high scores. Furthermore, some authors consider the dissociative states (psychological processes in which the thoughts of subjects disconnect from their behaviors) and the nervous eating episodes that characterize bulimic behaviors, as similar to some states that can be observed during hypnosis [3].
Many studies conducted on patients affected with anorexia nervosa date back to more than 10 years ago and refer to single cases. For instance, during the ‘90s, a successful late-onset anorexia treatment case was described: healing was achieved by alternating phases of active imagination of the patient and phases of relaxation, and by using inductions in every phase of the psychotherapeutic treatment[4]. Despite the above cited difficulties, these early works showed that using hypnotic techniques is advisable once the patient has reached (or is about to reach) a reasonable weight and after having built a solid therapeutic alliance (the relationship of trust between patient and therapist): this is necessary to facilitate the bypassing of the typical resistances due to the need of control of these patients.
Furthermore, in a study conducted in 2008, some single case examples of hypnotic treatment of anorexia nervosa were collected. In this study, examples of hypnotic inductions aiming to change the mental representation of the body image are described: such changes lead to an improvement of weight (an increase in BMI) and, above all, an improvement in self-esteem and in confidence about the patients’ own body [5].
Also in the field of eating disorders, more specifically for anorexia and bulimia, hypnosis, even if research is still in early stages, is described as an interesting technique especially when associated to a traditional psychotherapeutic program. Future studies will have to focus on the results of specific hypnotic techniques applied to big samples of subjects affected with eating disorders. A more rigorous collection of data will surely lead to a better precision in the definition of the efficacy of hypnosis in this field.
[1] Abraham S., Llewellyn-Jones D. (2001). Eating Disorders: the facts. Oxford, Oxford University Press.
[2] Gaudio S., Nocchi F., Franchin T., Genovese E., Cannatà V., Longo D., Fariello G. (2011). Gray matter decrease distribution in the early stages of Anorexia Nervosa restrictive type in adolescents. Psychiatry Research: Neuroimaging, 191:1,24-30.
[3] Mantle F. (2003). Eating disorders: The role of hypnosis. Nursing Children and Young People, 15:7, 42-45.
[4] Georgiou, E. H. (1995). Hypnotherapy in the treatment of anorexia tardive. Australian Journal of Clinical and Experimental Hypnosis, 23, 14–24.
[5] Walsh B. J. (2008). Hypnotic Alteration of Body Image in the Eating Disordered. American Journal of Clinical Hypnosis, 50:4, 301-310.