A subset of people with severe mental health conditions feels they are on the verge of losing control, even in the absence of external threats or triggers. Some go to extreme ends to avoid affective arousal and associated expectations of a possible, impending catastrophe. We have learned about such phenomenological, emotional challenges in a group of individuals with severe, composite mental health problems and psychosocial disabilities. These individuals have had long treatment histories in the mental health care system. They have (...) been encountered at a specialized inpatient ward offering exposure-based therapy that aims at restoring self-regulation and recovery. We describe the phenomenology of anxiety and fear presented by these service users, a fear we have coined existential catastrophe anxiety. We also suggest a set of underlying, interacting, psychological mechanisms that may give rise to ECa, before comparing ECa with three other constructs previously described in the literature—annihilation anxiety, ontological insecurity, and affect phobia. These comparisons show several similarities, but also unique qualities with ECa and its suggested underlying mechanisms. The conceptualization of ECa may aid clinicians in addressing extreme experiential turmoil and engage service users in empowering therapeutic projects. (shrink)

Anorexia Nervosa (AN) is widely considered to be a bodily disorder accompanied by unrealistic perceptions about one’s own body. Some researchers thus have wondered whether deficits in interoception, a conscious or non-conscious sense of one’s own body, could be a primary cause of AN. In this paper, we make the case that rather than interoception being a primary cause, deficits in interoception may occur as by-products of emotions that arise upstream in the pathogenesis of AN and interact with feelings of (...) a loss of self-control. We consider interoception, emotion, and self-control as a dynamical triad involved in the explanation of AN, with emotions as the central aspect of their interactions. We begin with a critical analysis of recent empirical literature on AN and differentiate three types of interoceptive processes. We then consider the role of self-control in AN. We go on to evaluate recent empirical and philosophical work on the role of emotions in AN and assess their importance in both interoception and self-control dynamics. We develop a testable integrative model that we believe best captures how self-control, emotional and interoceptive processes causally interact in the pathogenesis of AN. In this model, AN behaviors are not caused by interoceptive abnormalities, but rather interact with changes in emotional regulation and feelings of loss of self-control, subsequently leading to interoceptive deficits downstream. To capture a later stage in the pathogenesis of AN, we show how AN behaviors are maintained as a result of feedback among components in the model. We briefly explain future plans to further complement the model using a semi-structured interview to probe patient perspectives in AN. To develop a more valid understanding of AN, this model will have to be integrated into pluralistic approaches that include patient perspectives. (shrink)

This paper aims at considering the conceptual status of feeding and eating disorders (FEDs). Now that the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has changed the classification and some relevant criteria of FEDs, it is particularly relevant to evaluate their psychiatric framework and their status as mental disorders. I focus my efforts on address- ing only one specific question: Do FEDs fit the DSM-5 general definition of mental disorder? In DSM-5 a mental disorder is defined as a syndrome (...) that reflects a dysfunction and is usually associated with significant distress or disability. More importantly, there is an explicit statement saying that all mental disorders listed in the manual must meet the requirements highlighted by the general definition. Thus, I evaluate whether or not FEDs are really meant to reflect a dysfunction and are usually associated with significant distress or disability. (shrink)

This paper aims at considering the conceptual status of feeding and eating disorders (FEDs). Now that the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has changed the classification and some relevant criteria of FEDs, it is particularly relevant to evaluate their psychiatric framework and their status as mental disorders. I focus my efforts on addressing only one specific question: Do FEDs fit the DSM-5 general definition of mental disorder? In DSM-5 a mental disorder is defined as a syndrome that (...) reflects adysfunctionand is usually associated with significantdistress or disability. More importantly, there is an explicit statement saying thatallmental disorders listed in the manual must meet the requirements highlighted by the general definition. Thus, I evaluate whether or not FEDs are really meant to reflect a dysfunction and are usually associated with significant distress or disability. (shrink)