The Body as a Battlefield: Identity Development and Psychosomatic Expression in Eating Disorders Across Childhood and Adolescence

TL;DR

Eating disorders in young people are linked to identity issues, which can be addressed through identity-focused therapies to improve recovery.

Contribution

The paper introduces identity disturbance as a unifying framework linking early adversity and eating disorder symptoms, suggesting new therapeutic approaches.

Findings

Identity vulnerability mediates the link between early adversity and eating disorder symptoms.

Neurocognitive studies show altered self-referential processing in individuals with eating disorders.

Identity-focused therapies like CBT-E and mentalization-based therapy improve outcomes in young patients.

Abstract

What are the main findings?
Identity disturbance links early adversity to eating disorders.Low self-concept clarity and self-objectification maintain symptoms.

Identity disturbance links early adversity to eating disorders.

Low self-concept clarity and self-objectification maintain symptoms.

What is the implication of the main finding?
Identity-focused therapies may enhance recovery in young patients.Early identity screening can improve prevention and treatment.

Identity-focused therapies may enhance recovery in young patients.

Early identity screening can improve prevention and treatment.

Background/Objectives: Eating disorders (EDs) frequently emerge during critical stages of childhood and adolescence, when identity development and emotional regulation are still maturing. Disturbances in self-concept clarity and identity integration may transform the body into a symbolic battlefield for autonomy, belonging, and self-worth. This review synthesizes developmental, psychosocial, neurocognitive, and therapeutic perspectives on the role of identity disturbance in EDs. Methods: A narrative review was conducted (2010–2025) using combinations of terms related to identity, self-concept clarity, self-discrepancy, objectification, interoception, and eating disorders (anorexia nervosa, bulimia nervosa, and binge-eating disorder). Results: Findings indicate that identity vulnerability (expressed as low self-concept clarity, heightened self-discrepancies, and self-objectification) mediates the association between early adversity, sociocultural pressures, and ED symptoms. Neurocognitive studies reveal altered self-referential processing, default mode network connectivity, and interoceptive signaling. Clinically, comorbid borderline personality features further exacerbate identity disturbance and complicate recovery. Evidence-based treatments such as enhanced cognitive-behavioral therapy (CBT-E) effectively target core maintaining mechanisms, while adjunctive interventions (mentalization-based therapy, schema therapy, narrative approaches, and compassion- or acceptance-based methods) show promise in addressing identity-related processes and improving outcomes. Conclusions: Identity disturbance provides a unifying framework for understanding why ED symptoms become entrenched despite adverse consequences. Integrating identity-focused approaches with nutritional and medical care may enhance recovery and reduce chronicity in youth. Future research should adopt longitudinal and mechanistic designs to clarify pathways linking identity change to clinical improvement and test identity-specific augmentations to standard ED treatments.

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