Understanding inner self-states in eating disorders: preliminary findings from a structured elicitation study

Eating disorders are frequently associated with fragmented self-experiences, including harsh self-criticism, shame, and withdrawal, which may be difficult to articulate using standard clinical interviews. Structured elicitation tools may support the exploration of these internal self-states in a clinically meaningful way.

A total of 14 women receiving treatment for eating disorders at a specialised Italian centre participated in a structured elicitation interview using nine visual-symbolic self-part cards developed for clinical use. For each card, participants provided a numeric endorsement rating (0-10) and open-ended explanations following fixed prompts. Data were analysed using an inductive thematic approach with cross-case comparison.

Higher endorsement was observed for cards reflecting self-rejection, internal criticism, and concealment. Across participants' accounts, four cross-cutting themes emerged: (1) persecutory self-criticism linked to internalised relational judgement; (2) shame-based body rejection as a core self-reference; (3) protective withdrawal associated with emotional invisibility and (4) developmental discontinuity characterised by forced maturity and unmet childhood needs.

This brief report suggests that structured elicitation using visual-symbolic prompts can facilitate the exploration of clinically relevant self-states in people with eating disorders. Findings are preliminary but highlight the potential value of this approach for assessment and psychotherapy formulation.

Level V, qualitative descriptive study based on clinical interviews.