**Predisposing and Maintaining Factors**

110 New Insights into the Prevention and Treatment of Bulimia Nervosa

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**8** 

*France* 

**The Quality of Depressive Experience** 

Mario Speranza, Anne Revah-Levy, Elisabetta Canetta,

*Centre Hospitalier de Versailles. Service de Pédopsychiatrie. Le Chesnay INSERM U669, Université Paris-Sud et Université Paris Descartes,* 

Maurice Corcos and Frederic Atger

**as a Prognostic Factor in Eating Disorders** 

There is overwhelming evidence that depression is one of the most common experiences of eating disorder patients (Herzog et al., 1992; Touchette et al., 2010). Individuals with anorexia or bulimia nervosa commonly display high levels of dysphoric affects, feelings of emptiness and ineffectiveness and emotions such as loneliness and desperation (Bruch 1973). Self-depreciating emotions associated with pathological eating behaviors may probably trigger depressive episodes (Nolen-Hoesema et al., 2007). However, several authors have suggested that eating behaviors themselves (whether starving, bingeing or purging) may serve as adaptive strategies to regulate negative emotions, such as those associated with identity and interpersonal disturbances, frequently seen in these patients

For these reasons, it seems worthwhile, in eating disorders, to look for depression not only in a categorical way but also in a dimensional way and to explore the subjective experience of depression of these patients. This is in line with recent conceptualizations on depression from different theoretical perspectives which converge towards the identification of two types of fundamental depressive experiences framed by personality development: the first one focused on concerns associated with disruption in relationships with others (with feelings of loss, abandonment and loneliness) and the second one centered on problems concerning identity (associated with low self-esteem, feelings of failure, culpability, lack of self-confidence) (Blatt and Zuroff 1992). According to Blatt (Blatt, 2004), maladaptive behaviors would emanate directly from an overemphasis and exaggeration of one of the two essential developmental lines of the personality: the Dependent/Anaclitic line, which concerns the establishment of satisfying interpersonal relationships, and the Selfcritical/Introjective line, which focuses on the achievement of a positive and cohesive sense

Blatt and colleagues have initially developed the Depressive Experience Questionnaire (DEQ) to assess these two dimensions which emerge as independent factors in analytic studies (Blatt et al., 1976). However, subsequent theoretical developments have suggested that different levels could be indentified, each following a developmental trajectory from immature to more mature forms of interpersonal relatedness and self-definition.

**1. Introduction** 

(Heatherton et Baumeister, 1991).

of self (Blatt and Zuroff 1992).
