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Beginning at least with the pioneering work of Hilde Bruch (1971, 1973, 1978), it has been recognized that patients with eating disorders often have a diminished capacity to accurately identify and articulate their emotional experience. Not only do they exhibit a profound disturbance in their ability to recognize and discriminate between feelings, they also struggle to distinguish between emotional states and bodily sensations. For this reason, these patients are often described as alexithymic, a term originated by Sifneos (1973), derived from the Greek (a = lack, lexis = word, thymus = emotion) and referring to a cluster of features including difficulty identifying and describing subjective feelings, a circumscribed fantasy life, and an externally oriented thinking style (Taylor & Bagby, 2013). These descriptive criteria stem from a disruption in the capacity to represent and symbolize (Lecours & Bouchard, 1997) affect in images and words. Alexithymia is best understood as a dimensional construct instead of an all-or-none phenomenon with significant state variation (Matilla et al., 2010; Parker et al., 2008; Waller & Meehl, 1998).
Empirical research has since established that alexithymia co-occurs with eating disorders of all subtypes (Westwood et al., 2017) and with eating disorder symptomatology that does not rise to the level of an eating disorder diagnosis (e.g., De Berardis et al., 2007; Ridout et al., 2010). Even in the mainstream empirical literature, it is accepted that patients with eating disorders may use maladaptive eating behaviors (e.g., bingeing, purging, restricting) to regulate their emotions (Cooper, 2005). Alexithymia appears to decrease significantly posttreatment