The doctoral thesis deals with eating disorders in the fields of family, experiencing emotions, regulation of feelings and dissatisfaction with the body. The dissertation consists of several parts. The first part presents an overview of important literature and research dealing with the area of eating disorders: forms of eating disorders, development and the course of disorder, risk factors and predictors of eating disorders, epidemiology of eating disorders, co–morbidity with other mental disorders, health complications and mortality, and the process of change when dealing with people with eating disorders. What follows is an overview of the research and literature in the field of family relations, where the emphasis is placed on the treatment of autonomy and intimacy in the family, attachment, and for the deeper understanding of the depth of connections of family relationships with the development of eating disorders, animal studies are also presented. We stop at emotional abuse, which has been explored more in recent times and has proven to be an important predictor of eating disorders. We continue with an overview of research, which deals in more detail with experiencing positive and negative emotions in people with eating disorders, and regulation of emotions, as more and more research confirms the accepted fact that the behaviour in eating disorders are the strategies for dealing with unsustainable emotions that people try to push away, repress. In more detail, we look at the reviews of research regarding body dissatisfaction with people with eating disorders. We continue with the presentation of the basic concepts of relational family therapy and conclude with the section Spirituality and eating disorders..
There are several science–based approaches that effectively help people with eating disorders (e.g. cognitive behavioural, psychodynamic, including different family therapies), but there is no research that would involve relational family approach when dealing with people with eating disorders.
The empirical part consists of two parts. In the first part, we compared a sample of 47 people with symptoms of eating disorders with a group of 57 people without symptoms of eating disorders, and found that people with symptoms of eating disorders come from families with less functional relationships in the family of origin (Family of Origin Scale), they are experiencing significantly more often all of the negative emotions considered and, more importantly, there is a lack of all positive emotions (Basic Emotions Scale). The greatest difference between the samples was revealed in the emotions of guilt, shame, and being worthy of scolding, that is in emotions that are self–conscious, in which a person experiences himself/herself or his/her actions as poor. An important contribution to understanding the experience of people with symptoms of eating disorders has been shown on results that show that people with symptoms of eating disorders experience positive emotions less rarely. The author proposes strategies based on neurological insights that give more attention and time for awareness, experiencing and deepening of positive emotions. People with symptoms of eating disorders have more problems with regulation of emotions compared to the sample of people without symptoms of eating disorders, and experience a higher level of dissatisfaction with the body.
In the second part of our research, we examined changes in the areas of eating disorders behaviour, dissatisfaction with the body, the presence of emotions and the regulation of emotions in 8 people who joined the process of relational family therapy for 3 months. The results show that there has been a statistically significant improvement regarding body dissatisfaction, some negative emotions have decreased (frustration, irritability, aggression, shame, guilt, humiliation, the feeling of being worthy of scolding, nervousness, tension, anxiety, disgust), statistically important have problems in dealing with certain emotions been reduced, while the questionnaire, which measures the general regulation of emotions, does not show statistically significant differences. Nevertheless, we conclude that differences have occurred, as indicated by the measure of the size of the effect. The eating disorders behaviour has decreased slightly in some people with symptoms of eating disorders, but the difference is not statistically significant. This also coincides with some of the results that indicate that a longer treatment time is needed for these behaviours to fall or disappear.
All of the above areas, dissatisfaction with the body, the presence of negative emotions and the regulation of emotions, are important factors in eating disorders, which suggests that relational family therapy is an effective approach that, in an innovative way, combines work in intra–psychic, interpersonal and systemic levels, in which it follows the fundamental affect and resolves affective psychic constructs. In this way it contributes to the fact that people with symptoms of eating disorders raise awareness, process painful fundamental affects and reduce body dissatisfaction.
In the third part, out of eight people who were involved in the process of relational family therapy, four people were selected and analysed in more detail. All four people experienced positive changes in the fields of emotion (awareness, identification, awakening of new, deeper emotions, reducing the frequency of experiencing certain negative emotions) and family relationships. There were no significant changes in eating disorder behaviour, and dissatisfaction with the body was associated with changes in body weight in three people, with one person improving irrespective of his/her weight. Changes that have begun to occur during the therapeutic process are both small and at the same time large, as there is a different quality of experience, a better recognition of their inner world, a greater understanding of relationships with the family and outside the family.
In analysing the counter–transference feelings of a therapist, it is moreover indicated that the more serious form the eating disorder (e.g., anorexia) is, the stronger experience with a therapist and the stronger body sensations are.
From the analysis of the characteristics of the process of relational family therapy with persons with symptoms of eating disorders, it has been shown that each person has their own emotional process and the ability to regulate the affect, to which it is necessary to adjust the interventions and to evaluate when and how much to open painful affects, when to pay more attention to balancing diet and reducing self–destructive behaviour, or when a person needs a more intensive, hospital treatment.