Metacognitive Interpersonal Therapy-Eating Disorder (MIT-ED) in the Case of a Woman With Binge Eating Disorder and Avoidant and Obsessive-Compulsive Personality Disorders
Corresponding Author
Gloria Fioravanti
Centro di Trattamento Integrato Disturbi Alimentari e Obesità, Verona, Italy
Correspondence: Gloria Fioravanti ([email protected])
Search for more papers by this authorRaffaele Popolo
Centro di Terapia Metacognitiva Interpersonale, Rome, Italy
Search for more papers by this authorGiancarlo Dimaggio
Centro di Terapia Metacognitiva Interpersonale, Rome, Italy
Search for more papers by this authorCorresponding Author
Gloria Fioravanti
Centro di Trattamento Integrato Disturbi Alimentari e Obesità, Verona, Italy
Correspondence: Gloria Fioravanti ([email protected])
Search for more papers by this authorRaffaele Popolo
Centro di Terapia Metacognitiva Interpersonale, Rome, Italy
Search for more papers by this authorGiancarlo Dimaggio
Centro di Terapia Metacognitiva Interpersonale, Rome, Italy
Search for more papers by this authorABSTRACT
Binge Eating Disorder (BED) needs more effective empirically supported treatments, given problems with attrition from and response to available options. One avenue to improve adherence and response is considering comorbid personality disorders, given their impact on the therapy relationship and on patients' capacities to comply with homework, for example, regularizing eating habits or abstaining from bingeing. We describe here the case of a woman in her thirties suffering from BED, and avoidant and obsessive-compulsive personality disorders, treated with Metacognitive Interpersonal Therapy for Eating Disorders (MIT-ED), a psychotherapy that has begun to gather empirical support. Silvia is a 34 year old married woman with two children. She begins psychotherapy to lose weight but she oscillates between restriction and daily binges, in the last 2 years she has gained 30 kg. During 20 sessions of MIT-ED Silvia realized that she tended to binge because she thought she was unworthy and unable to put boundaries to her mother's criticism and intrusions. The therapist helped her realize that following psychoeducation about eating made her feeling controlled, and that was the reason for initial noncompliance with behavioral tasks. During the therapy she formed more adaptive ideas of herself as worthy and autonomous and become able to put boundaries to her mother. At the end of the therapy, Silvia no longer suffered from BED as evident from Eating Disorder Examination Questionnaire (Fairburn and Beglin 2008) and from the Binge Eating Scale (Gormally et al. 1982). Implications for further application of MIT-ED across ED are discussed.
Open Research
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
References
- Aloi, M., M. Rania, M. Caroleo, et al. 2020. “How Are Early Maladaptive Schemas and DSM-5 Personality Traits Associated With the Severity of Binge Eating?” Journal of Clinical Psychology 76, no. 3: 539–548. https://doi.org/10.1002/jclp.22900.
- American Psychiatric Association (APA). 2023. DSM5-TR. Manuale diagnostico e statistico dei disturbi mentali, quinta edizione text revision, tr. it. Milano: Raffaello Cortina. https://doi.org/10.1176/appi.books.9780890425787.
- Beck, A. T., R. A. Steer, R. Ball, and W. F. Ranieri. 1996. “Comparison of Beck Depression Inventories-IA and-II in Psychiatric Outpatients.” Journal of Personality Assessment 67, no. 3: 588–597. https://doi.org/10.1207/s15327752jpa6703_13.
- Bohn, K., and C. G. Fairburn. 2008. “ The Clinical Impairment Assessment Questionnaire (CIA).” In Cognitive Behavior Therapy and Eating Disorders edited by C. G. Fairburn, 315–317. Oxford.
- Derogatis, L. R., and R. Unger. 2010. “ Symptom Checklist-90-Revised.” In The Corsini Encyclopedia of Psychology, edited by I. B. Weiner and W. E Craighead, 1–2. https://doi.org/10.1002/9780470479216.corpsy0970.
10.1002/9780470479216.corpsy0970 Google Scholar
- Dimaggio, G., A. Montano, R. Popolo, and G. Salvatore. 2015. Metacognitive Interpersonal Therapy for Personality Disorders: A Treatment Manual ( 1st ed. Routledge).
10.4324/9781315744124 Google Scholar
- Dimaggio, G., P. Ottavi, R. Popolo, and G. Salvatore. 2020. Metacognitive Interpersonal Therapy: Body, Imagery and Change. Routledge. https://doi.org/10.4324/9780429350894.
10.4324/9780429350894 Google Scholar
- Dimaggio, G., G. Salvatore, A. MacBeth, P. Ottavi, L. Buonocore, and R. Popolo. 2017. “Metacognitive Interpersonal Therapy for Personality Disorders: A Case Study Series.” Journal of Contemporary Psychotherapy 47: 11–21. https://doi.org/10.1007/s10879-016-9342-7.
- Dimaggio, G., A. Semerari, A. Carcione, G. Nicolō, and M. Procacci. 2007. Psychotherapy of Personality Disorders: Metacognition, States of Mind and Interpersonal Cycles. Routledge.
10.4324/9780203939536 Google Scholar
- Eielsen, H. P., K. Vrabel, A. Hoffart, Ø. Rø, and J. H. Rosenvinge. 2022. “Reciprocal Relationships Between Personality Disorders and Eating Disorders in a Prospective 17-Year Follow-Up Study.” International Journal of Eating Disorders 55, no. 12: 1753–1764. https://doi.org/10.1002/eat.23823.
- Fairburn, C. G., and S. J. Beglin. 2008. “Eating Disorder Examination Questionnaire.” Cognitive Behavior Therapy and Eating Disorders 309: 313. http://www.psych.ox.ac.uk/credo/cbt_and_eating_disorders.
- Fairburn, C. G., Z. Cooper, and R. Shafran. 2003. “Cognitive Behaviour Therapy for Eating Disorders: A “Transdiagnostic” Theory and Treatment.” Behaviour Research and Therapy 41, no. 5: 509–528. https://doi.org/10.1016/S0005-7967(02)00088-8.
- Fioravanti, G., A. MacBeth, R. Popolo, F. Travagnin, M. Nicolis, and G. Dimaggio. 2025. “Metacognitive Interpersonal Therapy-Eating Disorders (MIT-ED) Versus CBT-E for Adults: A Proof-Of-Concept Randomized Controlled Trial.” International Journal of Eating Disorders. https://doi.org/10.1002/eat.24408.
- Fioravanti, G., M. Nicolis, A. MacBeth, G. Dimaggio, and R. Popolo. 2023. “Metacognitive Interpersonal Therapy-Eating Disorders Versus Cognitive Behavioural Therapy for Eating Disorders for Non-Underweight Adults With Eating Disorders: Study Protocol for a Pilot Pre-Registered Randomized Controlled Trial.” Research in Psychotherapy: Psychopathology, Process, and Outcome 26, no. 2: 690. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10519278/.
- First, M. B., J. B. Williams, R. S. Karg, and R. L. Spitzer. 2017. SCID-5-CV. Intervista Clinica Strutturata per i Disturbi del DSM-5. Versione Per Il Clinico Ed Italiana a cura Di Andrea Fossati e Serena Borroni. Raffaello Cortina Editore Milano.
- Gazzillo, F., F. Genova, F. Fedeli, et al. 2019. “Patients' Unconscious Testing Activity in Psychotherapy: A Theoretical and Empirical Overview.” Psychoanalytic Psychology 36, no. 2: 173–183. https://doi.org/10.1037/pap0000227.
- Gordon-King, K., R. D. Schweitzer, and G. Dimaggio. 2018. “Metacognitive Interpersonal Therapy for Personality Disorders Featuring Emotional Inhibition: A Multiple Baseline Case Series.” Journal of Nervous & Mental Disease 206, no. 4: 263–269. https://pubmed.ncbi.nlm.nih.gov/29377848/.
- Gormally, J., S. Black, S. Daston, and D. Rardin. 1982. “The Assessment of Binge Eating Severity Among Obese Persons.” Addictive Behaviors 7, no. 1: 47–55. https://doi.org/10.1016/0306-4603(82)90024-7.
- Hartmann, A., A. Zeeck, and M. S. Barrett. 2010. “Interpersonal Problems in Eating Disorders.” International Journal of Eating Disorders 43, no. 7: 619–627. https://doi.org/10.1002/eat.20747.
- Horowitz, L. M., L. E. Alden, J. S. Wiggins, and A. L. Pincus. 2000. Inventory of Interpersonal Problems (IIP-32/IIP-64). London: Psychological Corporation.
- Inchausti, F., N. V. García-Poveda, A. Ballesteros-Prados, et al. 2018. “The Effects of Metacognition-Oriented Social Skills Training on Psychosocial Outcome in Schizophrenia Spectrum Disorders: A Randomized Controlled Trial.” Schizophrenia Bulletin 44, no. 6: 1235–1244. https://pubmed.ncbi.nlm.nih.gov/29267940/.
- Inchausti, F., L. Moreno-Campos, J. Prado-Abril, et al. 2020. “Metacognitive Interpersonal Therapy Ingroup for Personality Disorders: Preliminary Results From a Pilot Study in a Public Mental Health Setting.” Journal of Contemporary Psychotherapy 50, no. 3: 197–203. https://doi.org/10.1007/s10879-020-09453-9.
10.1007/s10879-020-09453-9 Google Scholar
- Lammers, M. W., M. S. Vroling, R. D. Crosby, and T. van Strien. 2022. “Dialectical Behavior Therapy Compared to Cognitive Behavior Therapy in Binge-Eating Disorder: An Effectiveness Study With 6-Month Follow-Up.” International Journal of Eating Disorders 55, no. 7: 902–913. https://doi.org/10.1002/eat.23750.
- Liotti, G., and P. Gilbert. 2011. “Mentalizing, Motivation, and Social Mentalities: Theoretical Considerations and Implications for Psychotherapy.” Psychology and Psychotherapy: Theory, Research and Practice 84, no. 1: 9–25. https://doi.org/10.1348/147608310X520094.
- Lysaker, P. H., S. Cheli, G. Dimaggio, et al. 2021. “Metacognition, Social Cognition, and Mentalizing in Psychosis: Are These Distinct Constructs When It Comes to Subjective Experience or Are We Just Splitting Hairs?” BMC Psychiatry 21: 329. https://doi.org/10.1186/s12888-021-03338-4.
- Lysaker, P. H., N. Chernov, T. Moiseeva, et al. 2023. “Contrasting Metacognitive, Emotion Recognition and Alexithymia Profiles in Bulimia, Anorexia, and Schizophrenia.” Journal of Nervous & Mental Disease 211, no. 5: 348–354. https://journals.lww.com/jonmd/abstract/2023/05000/contrasting_metacognitive,_emotion_recognition_and.2.aspx.
- Maher, A., L. Cason, T. Huckstepp, et al. 2022. “Early Maladaptive Schemas in Eating Disorders: A Systematic Review.” European Eating Disorders Review 30, no. 1: 3–22. https://doi.org/10.1002/erv.2866.
- Martinussen, M., O. Friborg, P. Schmierer, et al. 2017. “The Comorbidity of Personality Disorders in Eating Disorders: A Meta-Analysis.” Eating and Weight Disorders: EWD 22: 201–209. https://doi.org/10.1007/s40519-016-0345-x.
- Muran, J. C., C. F. Eubanks, and L. W. Samstag. 2021. “One More Time With Less Jargon: An Introduction to ‘Rupture Repair in Practice’.” Journal of Clinical Psychology 77, no. 2: 361–368. https://doi.org/10.1002/jclp.23105.
- Pasetto, A., D. Misso, P. Velotti, and G. Dimaggio. 2021. “Metacognitive Interpersonal Therapy for Intimate Partner Violence: A Single Case Study.” Partner Abuse 12, no. 1: 64–79. https://doi.org/10.1891/PA-2020-0016.
- Passarella, T., V. Galasso, and G. Dimaggio. 2024. “Working Through the Body in Metacognitive Interpersonal Therapy to Change Relational Patterns in Dependent Personality Disorder: The Case of Lia.” Journal of Clinical Psychology 80: 1568–1581. https://doi.org/10.1002/jclp.23680.
- Popolo, R., A. MacBeth, S. Brunello, et al. 2018. “Metacognitive Interpersonal Therapy in Group: A Feasibility Study.” Research in Psychotherapy (Milano) 21, no. 3: 338. https://doi.org/10.4081/ripppo.2018.338.
- Popolo, R., A. MacBeth, F. Canfora, et al. 2019. “Metacognitive Interpersonal Therapy in Group (MIT- G) for Young Adults With Personality Disorders: A Pilot Randomized Controlled Trial.” Psychology and Psychotherapy: Theory, Research and Practice 92, no. 3: 342–358. https://doi.org/10.1111/papt.12182.
- Popolo, R., A. MacBeth, L. Lazzerini, et al. 2022. “Metacognitive Interpersonal Therapy in Group Versus TAU + Waiting List for Young Adults With Personality Disorders: Randomized Clinical Trial.” Personality Disorders 13, no. 6: 619–628. https://doi.org/10.1037/per0000497.
- Rossi, R., D. Corbo, L. R. Magni, et al. 2023. “Metacognitive Interpersonal Therapy in Borderline Personality Disorder: Clinical and Neuroimaging Outcomes From the CLIMAMITHE Study—A Randomized Clinical Trial.” Personality Disorders: Theory, Research, and Treatment 14, no. 4: 452–466. https://doi.org/10.1037/per0000621.
- Semerari, A., A. Carcione, G. Dimaggio, et al. 2003. “How to Evaluate Metacognitive Functioning in Psychotherapy? The Metacognition Assessment Scale and Its Applications.” Clinical Psychology & Psychotherapy 10, no. 4: 238–261. https://doi.org/10.1002/cpp.362.
- Semerari, A., L. Colle, G. Pellecchia, et al. 2014. “Metacognitive Dysfunctions in Personality Disorders: Correlations With Disorder Severity and Personality Styles.” Journal of Personality Disorders 28, no. 6: 751–766.
- Simonsen, S., R. Popolo, S. Juul, F. W. Frandsen, P. Sørensen, and G. Dimaggio. 2022. “Treating Avoidant Personality Disorder With Combined Individual Metacognitive Interpersonal Therapy and Group Mentalization-Based Treatment: A Pilot Study.” Journal of Nervous & Mental Disease 210, no. 3: 163–171. https://doi.org/10.1097/NMD.0000000000001432.
- Simpson, C. C., T. L. Towne, A. M. Karam, et al. 2021. “Predictors of Stepping Up to Higher Level of Care Among Eating Disorder Patients in a Partial Hospitalization Program.” Frontiers in Psychology 12: 12. https://doi.org/10.3389/fpsyg.2021.667868.
- Simpson, S., F. Azam, S. Brown, A. Hronis, and R. Brockman. 2022. “The Impact of Personality Disorders and Personality Traits on Psychotherapy Treatment Outcome of Eating Disorders: A Systematic Review.” Personality and Mental Health 16, no. 3: 217–234. https://doi.org/10.1002/pmh.1533.
- Spielberger, C. D. 1983. State-Trait Anxiety Inventory for Adults. https://doi.org/10.1037/t06496-000.
10.1037/t06496-000 Google Scholar
- Taylor, G. J., R. M. Bagby, and J. A. Parker. 1997. Disorders of Affect Regulation: Alexithymia in Medical and Psychiatric Illness. New York: Cambridge University Press.
10.1017/CBO9780511526831 Google Scholar
- Weiss, J. 1993. How Psychotherapy Works: Process and Technique. Guilford Press.
- Westwood, H., J. Kerr-Gaffney, D. Stahl, and K. Tchanturia. 2017. “Alexithymia in Eating Disorders: Systematic Review and Meta-Analyses of Studies Using the Toronto Alexithymia Scale.” Journal of Psychosomatic Research 99: 66–81. https://doi.org/10.1016/j.jpsychores.2017.06.007.
- Wilberg, T., G. Pedersen, K. Bremer, M. S. Johansen, and E. H. Kvarstein. 2023. “Combined Group and Individual Therapy for Patients With Avoidant Personality Disorder: A Pilot Study.” Frontiers in Psychiatry 14: 1181686. https://doi.org/10.3389/fpsyt.2023.1181686.
- Wright, A. G. C., W. R. Ringwald, C. J. Hopwood, and A. L. Pincus. 2022. “It's Time to Replace the Personality Disorders With the Interpersonal Disorders.” American Psychologist 77, no. 9: 1085–1099. https://doi.org/10.1037/amp0001087.