Discovering the Unknown: Chronic Dissociative Processes in People with Eating Disorders Summary prepared by Dr. Ali ABY Muhammed

1. Overview: What Is Dissociation and How

It Relates to Eating Disorders 🧠

• Dissociation refers to disruptions in the normal integration of consciousness, perception, memory, identity and emotion—ranging from mild depersonalization/derealization to severe fragmentation and compartmentalization Lippincott Journals+1.

• In eating disorders (EDs), dissociation often emerges as a coping or emotion-regulation mechanism: detaching from distress (e.g. shame, body distress) via food restriction, purging, or numbness Lippincott Journals+1.

• Trauma—particularly early abuse or neglect—is a common antecedent, with dissociation mediating vulnerability to developing an ED ScienceDirect+1.

2. Prevalence & Forms of Chronic Dissociative

Symptoms in EDs

A. Prevalence Rates & Chronicity

• A recent 2025 review in Current Opinion in Psychiatry notes elevated rates of dissociative experiences across ED subtypes and highlights that even mild dissociation is more common among those with EDs compared to controls Lippincott Journals+1.

• A case-control study in Spain found significantly higher scores in both psychoform (e.g. depersonalization, derealization) and somatoform dissociation among women with EDs versus matched controls Rowan Digital Works+1.

B. Forms: Psychoform vs. Somatoform vs. Compartmentalization

• Psychoform dissociation includes depersonalization/derealization, identity confusion, and memory gaps (amnesia); somatoform dissociation involves physical symptoms (e.g. numbness, motor or sensory loss) without medical cause ScienceDirect+1.

• A 2023 study showed compartmentalization—rigid segregation of mental functions like memory or body schema—is independently associated with food addiction symptoms even after controlling for other psychopathology SpringerLink.

3. Origins & Maintenance: Trauma, Emotion, and Chronicity

• Childhood emotional abuse or neglect strongly correlates with increased dissociative symptoms and internal “ED voice” power, which in turn perpetuates disordered eating patterns ScienceDirect+1.

• One inpatient study found higher dissociation levels significantly associated with increased suicidality, suggesting dissociation also contributes to risk severity in EDs PMC.

• In Severe and Enduring Anorexia Nervosa (SE-AN), dissociative processes—and self-fragmentation tied to shame and somatization—may become entrenched over time, acting as maintaining factors rather than mere sequelae BioMed Central.

4. Functional Role in ED Behavior & Chronicity

• Individuals may dissociate to escape intense internal states: shame, body image distress, interoceptive pain, or overwhelming urges Lippincott Journals+1.

• Dissociation undermines integration of self and disrupts treatment engagement: e.g. someone “zoness out” during meals or self-monitoring, impairing ability to reflect on or regulate behavior.

• In compulsive/binge‐type EDs, pathological dissociation (especially compartmentalization) is thought to play a role akin to addictive behavior, reducing top‐down emotional control SpringerLink.

5. Treatment Implications & Emerging Interventions

• The 2025 review recommends integrating psychoeducation on trauma-related dissociation, and trauma-focused treatments such as EMDR into ED treatment plans, to target dissociative symptoms directly Lippincott Journals+1.

• Cognitive-Emotional Behavioral Therapy (CEBT)—which blends elements of CBT, DBT, mindfulness and experiential exercises—may help address emotion dysregulation and dissociation in EDs when standard CBT is insufficient Wikipedia.

• Novel experimental treatments (e.g. psilocybin-assisted therapy) have been noted to unearth previously dissociated traumatic memories in anecdotal pilot work—highlighting the complexity and therapeutic opportunity in carefully managed, trauma-focused emergent therapies BioMed Central.

6. Summary Table

Dimension	Key Points
Prevalence	Dissociative symptoms are significantly more frequent in ED populations than control groups.
Forms of dissociation	Psychoform (depersonalization, amnesia), somatoform, compartmentalization.
Trauma linkage	Emotional/physical neglect or abuse → dissociation → ED onset and maintenance.
Clinical function	Emotion regulation; escape; maintaining ED behaviors and relapse.
Risk contribution	Linked to suicidality, treatment resistance, self‐harm.
Targeted treatments	EMDR, trauma psychoeducation, CEBT, emerging psychedelic-assisted therapies.

7. Future Directions: Knowledge Gaps & Research Needs

• More high-quality qualitative studies are needed to explore lived experience of chronic dissociation in EDs—how it shapes identity, embodiment, and self-recovery over time BioMed Central.

• Longitudinal research to disentangle temporal order and causality: does dissociation precede ED onset, or emerge as a chronic maintaining factor?

• Investigations to delineate whether these dissociative processes operate similarly across different ED subtypes (AN, BN, BED, OSFED), particularly in relation to self-disturbance and embodiment BioMed Central.

• Trials comparing standard ED therapies vs. trauma-focused integrated treatments (EMDR + CEBT + psychoed) with respect to reducing dissociation and improving outcomes.

Clinical Considerations

• Assessment: Consider using structured tools like the Multiscale Dissociation Inventory (MDI) or the SCID-D interview (supervised by trained clinicians) to evaluate dissociative symptoms systematically Wikipedia+1.

• Safety planning: Elevated dissociation—especially in combination with suicidality or self-harm ideation—warrants careful risk monitoring and potentially crisis interventions.

• Psychoeducation: Clients may benefit from understanding how dissociation serves as a short-term escape but may prolong chronic ED cycles.

In Summary

Chronic dissociative processes in individuals with eating disorders represent an important, complex, and multifaceted dimension of psychopathology. Rooted in trauma and serving emotion-regulatory and avoidant functions, these dissociative symptoms often maintain and complicate the course of EDs. Research highlights compelling clinical implications: optimum outcomes may require integrated, trauma-informed approaches that directly address dissociation through assessment, psychoeducation, and specialized therapies.

References:

Baum, K., & Schlegl, S. (2025). Dissociation in eating disorders: Clinical relevance and treatment implications. Current Opinion in Psychiatry, 38(6), 459–465. https://doi.org/10.1097/YCO.0000000000001032

Moulton, S. J., Newman, A., & David, B. (2023). Self-disturbance, dissociation, and shame in severe and enduring anorexia nervosa: A qualitative exploration. Journal of Eating Disorders, 11(92), 1–13. https://doi.org/10.1186/s40337-023-00953-2

Dorahy, M. J., Hall, H. P., & Middleton, W. (2023). Compartmentalization, trauma, and food addiction symptoms: Dissociation as a maintaining factor in eating pathology. Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity, 28(6), 1–10. https://doi.org/10.1007/s40519-023-01555-2

Rodriguez, M., Rodríguez-Testal, J. F., & Perona-Garcelán, S. (2018). Childhood trauma, dissociation, and eating disorders: Mediating pathways and clinical implications. Child Abuse & Neglect, 86, 123–131. https://doi.org/10.1016/j.chiabu.2018.09.005

Moulton, S. J., Newman, A., & David, B. (2025). “The door opened, and everything came out”: Psychedelic-assisted therapy and dissociated trauma in eating disorders. Journal of Eating Disorders, 13(74), 1–9. https://doi.org/10.1186/s40337-025-01274-2

Palmisano, G. L., Innamorati, M., & Vanderlinden, J. (2021). Dissociation and suicidality in eating disorders: A cross-sectional inpatient study. Frontiers in Psychiatry, 12, 678292. https://doi.org/10.3389/fpsyt.2021.678292