Introducing the Diathesis-Compassion Layered Care Model (DCLCM): an IPA study of dissociation and complex trauma in...

Eating disorders (EDs) frequently co-occur with trauma-related symptomatology, including dissociative experiences. While international research has examined associations between EDs and trauma frameworks such as the dissociative subtype of Post-Traumatic Stress Disorder and Complex Post-Traumatic Stress Disorder, little is known about how therapists in non-Western contexts conceptualize the trauma-dissociation-ED linkage or integrate trauma-informed and compassion-focused approaches in practice.

Interpretative Phenomenological Analysis (IPA) was applied to explore Iranian therapists' lived experiences in managing ED presentations involving dissociation comorbidity, with a focus on the therapeutic role of self-compassion. Semi-structured interviews were conducted with three therapists working with adolescents and young adults.

Analysis generated 11 superordinate and 58 subordinate themes. Findings were organized in five interlinked layers: Symptom Recognition, describing multifaceted ED presentations with dissociative features such as trance-like eating, emotional numbing, depersonalization, and identity disruption; Trauma and Vulnerability, highlighting early relational adversity, chronic invalidation, and dispositional traits including perfectionism and low self-esteem; Cultural and Social Context, reflecting body-surveillance norms, gendered expectations, family hierarchy, and stigma; Therapeutic interventions, capturing phased, safety-oriented, integrative treatment strategies; and Self-Compassion as a Transformative Healing Pathway, emphasizing compassion-focused processes for reducing shame and enhancing affect regulation. A Cross Layer Reflective Theme, appraised the utility of stress-vulnerability formulation in structuring case-conceptualisation and psychoeducation within Iranian practice. These themes informed the Diatheses-Compassion Layered Care Model (DCLCM), a five-layer conceptual framework grounded in therapists' narratives.

Therapists frequently interpreted ED presentations involving dissociative features through trauma-informed and diatheses-stress lens. DCLCM offers a culturally embedded conceptual framework that integrates symptom recognition, trauma and vulnerability pathways, sociocultural context, therapeutic sequencing, and self-compassion processes. The model is intended to organize clinical reasoning in culturally sensitive settings and requires empirical evaluation in future research.