The Interconnection between Eating Disorders and Narcissistic Trauma
DOI:
https://doi.org/10.64074/4dp40m77Keywords:
Narcissistic Trauma, Eating Disorders, Perfectionism, Shame, Compassion-Focused Therapy, Paradoxical CommunicationAbstract
This theoretical review proposes a conceptual model of the links between narcissistic trauma and eating disorders, focusing especially on how young adults with such trauma use defensive communication in relationships. Building on the psychoanalytic views of Kohut (1971) and Kernberg (1975), this paper argues on psychoanalytic and empirical grounds, that narcissistic vulnerability develops from early failures in empathic mirroring and is later organised around chronic shame. Social pressures, intensified by social media and socially prescribed perfectionism (Hewitt & Flett, 1991; Twenge et al., 2014), often push this trauma into the body through strict control of weight and shape. Eating disorders are understood here as psychosomatic defences that give a temporary sense of control while hiding deeper feelings of emptiness and vulnerability (Fairburn, 2008; Garner, 2004). This formulation is conceptual; the review synthesises associations reported in empirical work rather than claiming a single proven causal pathway. Paradoxical communication helps maintain distance from others and protects against expected criticism or rejection. The paper suggests that an integrated approach combining enhanced cognitive behavioural therapy for eating disorders (CBT-E), strategic paradoxical techniques, and compassion-focused therapy (CFT) can address both the behavioural symptoms and the underlying shame. Clinical implications are considered. The model is illustrated with four anonymous individual cases, who are included as illustrations rather than as evidence of narcissistic trauma.
References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425763 DOI: https://doi.org/10.1176/appi.books.9780890425787
American Psychiatric Association. (2023). The American Psychiatric Association practice guideline for the treatment of patients with eating disorders (4th ed.). American Psychiatric Association Publishing. DOI: https://doi.org/10.1176/appi.books.9780890424865
Bardone-Cone, A. M., Wonderlich, S. A., Frost, R. O., Bulik, C. M., Mitchell, J. E., Uppala, S., & Simonich, H. (2007). Perfectionism and eating disorders: Current status and future directions. Clinical Psychology Review, 27(3), 384–405. https://doi.org/10.1016/j.cpr.2006.12.005 DOI: https://doi.org/10.1016/j.cpr.2006.12.005
Bills, E., Greene, D., Stackpole, R., & Egan, S. J. (2023). Perfectionism and eating disorders in children and adolescents: A systematic review and meta-analysis. Appetite, 187, 106586. https://doi.org/10.1016/j.appet.2023.106586 DOI: https://doi.org/10.1016/j.appet.2023.106586
Dahlenburg, S. C., Gleaves, D. H., & Hutchinson, A. D. (2019). Anorexia nervosa and perfectionism: A meta-analysis. International Journal of Eating Disorders, 52(3), 219–229. https://doi.org/10.1002/eat.23009 DOI: https://doi.org/10.1002/eat.23009
Dane, A., & Bhatia, K. (2023). The social media diet: A scoping review to investigate the association between social media, body image and eating disorders amongst young people. PLOS Global Public Health, 3(3), e0001091. https://doi.org/10.1371/journal.pgph.0001091 DOI: https://doi.org/10.1371/journal.pgph.0001091
de Valle, M. K., Gallego-García, M., Williamson, P., & Wade, T. D. (2021). Social media, body image, and the question of causation: Meta-analyses of experimental and longitudinal evidence. Body Image, 39, 276–292. https://doi.org/10.1016/j.bodyim.2021.10.001 DOI: https://doi.org/10.1016/j.bodyim.2021.10.001
DeJong, H., Broadbent, H., & Schmidt, U. (2012). A systematic review of dropout from treatment in outpatients with anorexia nervosa. International Journal of Eating Disorders, 45(5), 635–647. https://doi.org/10.1002/eat.20956 DOI: https://doi.org/10.1002/eat.20956
Di Pierro, R., Di Sarno, M., Gargiulo, I., & Madeddu, F. (2021). Traits of pathological narcissism and dysfunctional eating in women: The role of perfectionistic discrepancy. Current Psychology, 41, 5350–5357. https://doi.org/10.1007/s12144-020-01054-y DOI: https://doi.org/10.1007/s12144-020-01054-y
Erickson, M. H. (2014). Excerpts from special techniques of brief hypnotherapy. InterAction, 6(1), 56–65.
Fairburn, C. G. (2008). Cognitive behaviour therapy and eating disorders. Guilford Press.
Fassino, S., Pierò, A., Tomba, E., & Abbate-Daga, G. (2009). Factors associated with dropout from treatment for eating disorders: A comprehensive literature review. BMC Psychiatry, 9, Article 67. https://doi.org/10.1186/1471-244X-9-67 DOI: https://doi.org/10.1186/1471-244X-9-67
Garner, D. M. (2004). Eating Disorder Inventory-3 (EDI-3). Professional manual. Psychological Assessment Resources.
Gilbert, P. (2010). An introduction to compassion focused therapy in cognitive behavior therapy. International Journal of Cognitive Therapy, 3(2), 97–112. https://doi.org/10.1521/ijct.2010.3.2.97 DOI: https://doi.org/10.1521/ijct.2010.3.2.97
Gilbert, P. (2014). The origins and nature of compassion focused therapy. British Journal of Clinical Psychology, 53(1), 6–41. https://doi.org/10.1111/bjc.12043 DOI: https://doi.org/10.1111/bjc.12043
Goss, K., & Allan, S. (2009). Shame, pride and eating disorders. Clinical Psychology & Psychotherapy, 16(4), 303–316. https://doi.org/10.1002/cpp.627 DOI: https://doi.org/10.1002/cpp.627
Goss, K., & Allan, S. (2014). The development and application of compassion-focused therapy for eating disorders (CFT-E). British Journal of Clinical Psychology, 53(1), 62–77. https://doi.org/10.1111/bjc.12039 DOI: https://doi.org/10.1111/bjc.12039
Haedt-Matt, A. A., & Keel, P. K. (2011). Revisiting the affect regulation model of binge eating: A meta-analysis of studies using ecological momentary assessment. Psychological Bulletin, 137(4), 660–681. https://doi.org/10.1037/a0023660 DOI: https://doi.org/10.1037/a0023660
Haley, J. (1976). Problem-solving therapy. Jossey-Bass.
Hewitt, P. L., & Flett, G. L. (1991). Perfectionism in the self and social contexts: Conceptualization, assessment, and relation to psychopathology. Journal of Personality and Social Psychology, 60(3), 456–470. https://doi.org/10.1037/0022-3514.60.3.456 DOI: https://doi.org/10.1037/0022-3514.60.3.456
Holland, G., & Tiggemann, M. (2016). A systematic review of the impact of the use of social networking sites on body image and disordered eating outcomes. Body Image, 17, 100–110. https://doi.org/10.1016/j.bodyim.2016.02.008 DOI: https://doi.org/10.1016/j.bodyim.2016.02.008
Jackson, J. B., Pietrabissa, G., Rossi, A., Manzoni, G. M., & Castelnuovo, G. (2018). Brief strategic therapy and cognitive behavioral therapy for women with binge eating disorder and comorbid obesity: A randomized clinical trial one-year follow-up. Journal of Consulting and Clinical Psychology, 86(8), 688–701. https://doi.org/10.1037/ccp0000313 DOI: https://doi.org/10.1037/ccp0000313
Kelly, A. C., Wisniewski, L., Martin-Wagar, C., & Hoffman, E. (2017). Group-based compassion-focused therapy as an adjunct to outpatient treatment for eating disorders: A pilot randomized controlled trial. Clinical Psychology & Psychotherapy, 24(2), 475–487. https://doi.org/10.1002/cpp.2018 DOI: https://doi.org/10.1002/cpp.2018
Kernberg, O. F. (1975). Borderline conditions and pathological narcissism. Jason Aronson.
Kohut, H. (1971). The analysis of the self: A systematic approach to the psychoanalytic treatment of narcissistic personality disorders. International Universities Press.
Linardon, J., Hindle, A., & Brennan, L. (2018). Dropout from cognitive-behavioral therapy for eating disorders: A meta-analysis of randomized, controlled trials. International Journal of Eating Disorders, 51(5), 381–391. https://doi.org/10.1002/eat.22850 DOI: https://doi.org/10.1002/eat.22850
Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.
Linehan, M. M. (2015). DBT skills training manual (2nd ed.). Guilford Press.
Lunbeck, E. (2014). The Americanization of narcissism. Harvard University Press. DOI: https://doi.org/10.4159/harvard.9780674726147
MacDonald, P. J. (2014). Narcissism in the modern world. Psychodynamic Practice, 20(2), 144–153. https://doi.org/10.1080/14753634.2014.894225 DOI: https://doi.org/10.1080/14753634.2014.894225
McWilliams, N. (2011). Psychoanalytic diagnosis: Understanding personality structure in the clinical process (2nd ed.). Guilford Press.
Nardone, G., & Barbieri, R. B. (2010). Advanced brief strategic therapy: An overview of interventions with eating disorders to exemplify how theory and practice work. European Journal of Psychotherapy and Counselling, 12(2), 113–127. https://doi.org/10.1080/13642531003784438 DOI: https://doi.org/10.1080/13642537.2010.482743
Nardone, G., & Watzlawick, P. (2005). Brief strategic therapy: Philosophy, techniques, and research. Jason Aronson.
Nardone, G., Milanese, R., & Verbitz, T. (2005). Prison of food: Research and treatment of eating disorders. Karnac.
Nechita, D. M., Bud, S., & David, D. (2021). Shame and eating disorders symptoms: A meta-analysis. International Journal of Eating Disorders, 54(11), 1899–1945. https://doi.org/10.1002/eat.23583 DOI: https://doi.org/10.1002/eat.23583
Neff, K. D. (2003). Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self and Identity, 2(2), 85–101. https://doi.org/10.1080/15298860309032 DOI: https://doi.org/10.1080/15298860309032
Neff, K. D. (2023). Self-compassion: Theory, method, research, and intervention. Annual Review of Psychology, 74, 193–218. https://doi.org/10.1146/annurev-psych-032420-031047 DOI: https://doi.org/10.1146/annurev-psych-032420-031047
Oberleiter, S., Stickel, P., & Pietschnig, J. (2025). A farewell to the narcissism epidemic? A cross-temporal meta-analysis of global NPI scores (1982–2023). Journal of Personality, 93(4), 884–894. https://doi.org/10.1111/jopy.12982 DOI: https://doi.org/10.1111/jopy.12982
Omoregie, J., & Amanze, R. U. (2025). The mediating role of self-compassion and forgiveness in the effect of negative metacognitive beliefs on repetitive negative thinking in those with PTSD symptoms. JORMA International Journal of Health and Social Sciences, 1(1), 1–13. DOI: https://doi.org/10.64074/jorma000
Paranjothy, S. M., & Wade, T. D. (2024). A meta-analysis of disordered eating and its association with self-criticism and self-compassion. International Journal of Eating Disorders, 57(3), 473–536. https://doi.org/10.1002/eat.24166 DOI: https://doi.org/10.1002/eat.24166
Robinson, K., & Wade, T. D. (2021). Perfectionism interventions targeting disordered eating: A systematic review and meta-analysis. International Journal of Eating Disorders, 54. https://doi.org/10.1002/eat.23483 DOI: https://doi.org/10.1002/eat.23483
Safer, D. L., Telch, C. F., & Chen, E. Y. (2009). Dialectical behavior therapy for binge eating and bulimia. Guilford Press.
Saiphoo, A. N., & Vahedi, Z. (2019). A meta-analytic review of the relationship between social media use and body image disturbance. Computers in Human Behavior, 101, 259–275. https://doi.org/10.1016/j.chb.2019.07.028 DOI: https://doi.org/10.1016/j.chb.2019.07.028
Szymczak, P., Talbot, D., Gritti, E. S., & Jonason, P. K. (2023). Narcissus’ belief about his body: Aspects of narcissism, body image, and eating disorder symptoms. PLOS ONE, 18(11), e0293578. https://doi.org/10.1371/journal.pone.0293578 DOI: https://doi.org/10.1371/journal.pone.0293578
Turk, F., & Waller, G. (2020). Is self-compassion relevant to the pathology and treatment of eating and body image concerns? A systematic review and meta-analysis. Clinical Psychology Review, 79, 101856. https://doi.org/10.1016/j.cpr.2020.101856 DOI: https://doi.org/10.1016/j.cpr.2020.101856
Twenge, J. M., Konrath, S. H., Cooper, A. B., Foster, J. D., Campbell, W. K., & McAllister, C. (2021). Egos deflating with the Great Recession: A cross-temporal meta-analysis and within-campus analysis of the Narcissistic Personality Inventory, 1982–2016. Personality and Individual Differences, 179, Article 110947. https://doi.org/10.1016/j.paid.2021.110947 DOI: https://doi.org/10.1016/j.paid.2021.110947
Twenge, J. M., Konrath, S. H., Foster, J. D., Campbell, W. K., & Bushman, B. J. (2008). Egos inflating over time: A cross-temporal meta-analysis of the Narcissistic Personality Inventory. Journal of Personality, 76(4), 875–902. https://doi.org/10.1111/j.1467-6494.2008.00507.x DOI: https://doi.org/10.1111/j.1467-6494.2008.00507.x
Twenge, J. M., Miller, J. D., & Campbell, W. K. (2014). The narcissism epidemic in the 21st century: Cross-temporal evidence and sociocultural foundations. Journal of Personality, 82(6), 465–478. https://doi.org/10.1111/jopy.12094 DOI: https://doi.org/10.1111/jopy.12094
Vacca, M., Ballesio, A., & Lombardo, C. (2023). Perfectionism and binge eating association: A systematic review and meta-analysis. Journal of Eating Disorders, 11, Article 101. https://doi.org/10.1186/s40337-023-00817-9 DOI: https://doi.org/10.1186/s40337-023-00817-9
Vinchenzo, C., Lawrence, V., & McCombie, C. (2022). Patient perspectives on premature termination of eating disorder treatment: A systematic review and qualitative synthesis. Journal of Eating Disorders, 10, Article 39. https://doi.org/10.1186/s40337-022-00568-z DOI: https://doi.org/10.1186/s40337-022-00568-z
Waller, G., Sines, J., Meyer, C., Foster, E., & Skelton, A. (2007). Narcissism and narcissistic defences in the eating disorders. International Journal of Eating Disorders, 40(2), 143–148. https://doi.org/10.1002/eat.20345 DOI: https://doi.org/10.1002/eat.20345
Watzlawick, P., Beavin, J. H., & Jackson, D. D. (1967). Pragmatics of human communication: A study of interactional patterns, pathologies, and paradoxes. W. W. Norton & Company.
Watzlawick, P., Weakland, J. H., & Fisch, R. (1974). Change: Principles of problem formation and problem resolution. W. W. Norton & Company.
Wonderlich, S. A., Peterson, C. B., Crosby, R. D., Smith, T. L., Klein, M. H., Mitchell, J. E., & Crow, S. J. (2014). A randomized controlled comparison of integrative cognitive-affective therapy (ICAT) and enhanced cognitive-behavioral therapy (CBT-E) for bulimia nervosa. Psychological Medicine, 44(3), 543–553. https://doi.org/10.1017/S0033291713001098 DOI: https://doi.org/10.1017/S0033291713001098
World Health Organization. (2022). International classification of diseases (11th rev.). https://icd.who.int/
Yaniv, D. (2012). Dynamics of creativity and empathy in role reversal: Contributions from neuroscience. Review of General Psychology, 16(1), 70–77. https://doi.org/10.1037/a0026493 DOI: https://doi.org/10.1037/a0026580
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