DClinPsy Portfolio Volume 1 of 3 - University of Hertfordshire ...

Low self esteem involves an unconditional pervasive negative view of the self which is
seen as part of the individual’s permanent identity. This low self esteem is thought to
create hopelessness in patients about their capacity to change, which may make
adherence with treatment less likely, and further promote a persistence in their pursuit of
control over eating, shape and weight (Fairburn, et al, 2003). Furthermore, these patients
show particularly pronounced negative cognitive processing biases, including overgeneralisation;
with the result that any perceived “failure” is interpreted as confirmation
that they are failures as people. This thereby reaffirms their overall negative view of
themselves. It may be that having inflexible emotional processing causes or maintains the
low self esteem as cognitive fusion may make it more likely that these individuals will
believe their biased views of themselves and act upon these. This study design does not
allow for this question to be answered sufficiently but it is important to consider.
Inflexibility also appears to relate to Fairburn, et al’s, (2003) other maintaining factors
(i.e. mood intolerance). Experiential avoidance involves seeking to escape emotions,
thoughts or physical sensations found to be overwhelming (these can be negative or
positive). This concept seems to relate to ‘mood intolerance’ and both theories propose
that disordered eating can become a habitual means of mood modulation. As regards
interpersonal difficulties, inflexibility could make relationships more difficult due to
cognitive fusion whereby thoughts are believed and acted on discounting alternative
thoughts of others. The concept of mentalisation also appears to have much to offer as
regards the interpersonal difficulties found across the eating disorders and appears to
share similarities to cognitive fusion.
Mentalisation has been defined as the ability to understand feelings, cognitions, meanings
and intentions in oneself and in others. It is considered a key determinant of self
organisation and emotional regulation with impairment considered a central
psychopathological feature of AN (Skarderud, 2007). It holds that inner and outer reality,
mind and body are isomorphic in individuals with AN. This concretisation may be similar
to the fusion proposed by ACT.
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