Mentalization Based Therapy for Eating Disorders

Mentalizing is an integrative mental mechanism, allowing individuals to make sense of themselves and others in terms of intentional mental states, like feelings, thoughts, and beliefs. It has been shown that people with borderline personality disorder and eating disorders can have more mentalizing difficulties than controls. Mentalization Based Treatment focuses on improving mentalizing abilities; it was originally created for borderline personality disorder and has been adapted for eating disorders and other conditions. Eating disorders are very complex and serious psychiatric conditions, with a high rate of comorbidities, that can present a challenge for existing treatments. MBT for eating disorders (MBT-ED) is a modified version of MBT, addressing the core mentalizing difficulties linked to the eating disorder origin and maintenance and allowing the increase of epistemic trust, promoting social learning, and improving interpersonal functioning. More observational and RCT studies are needed to establish efficacy of MBT for eating disorders. We propose that MBT-ED can be used when there is comorbidity with borderline personality disorder or in the case of inadequate response to standard treatments, if mentalizing deficits, interpersonal difficulties, and attachment insecurity are clearly related to the clinical presentation.