TERAPIA METACOGNITIVA INTERPERSONALE PER I DISTURBI DEL COMPORTAMENTO ALIMENTARE (TMI DCA)

a cura di Gloria Fioravanti

I Disturbi del Comportamento Alimentare (DCA) sono malattie gravi con frequenti e significative comorbilità psichiatriche, associate ad alti tassi di mortalità, circa il 5%, e a compromissioni nella vita quotidiana con importanti conseguenze fisiche. 

La terapia TMI DCA (Fioravanti et al., 2023) tratta i disturbi alimentari cosiddetti complessi, ed è stata sviluppata a partire dalla terapia metacognitiva interpersonale (TMI) e dalla terapia cognitivo comportamentale per i disturbi alimentari (CBT-E). La TMI (Dimaggio et al., 2014, 2019) è un modello efficace per la cura dei disturbi di personalità e delle caratteristiche associate. La CBT – E è un modello efficace per la cura del sintomo alimentare (Fairburn et al., 2003).

Secondo il modello TMI-DCA (Popolo et al., 2023) il disturbo alimentare necessita di essere trattato assieme ad altri fattori che si pongono come fattori di mantenimento del disturbo, ovvero: difficoltà nella regolazione emotiva, bassa autostima, perfezionismo clinico e alessitimia (difficoltà a riconoscere le proprie emozioni). Aspetti che assieme alle difficoltà interpersonali, tipiche dei disturbi di personalità che nel 50% dei casi sono in comorbilità, costituiscono il cuore del disturbo. Il trattamento che ne consegue dunque, affinché possa ritenersi efficace, deve intervenire sia sulla regolarizzazione delle condotte alimentari disfunzionali, sia sugli aspetti in comorbilità che fungono da fattori di mantenimento del disturbo.

Secondo la TMI-DCA il disturbo alimentare e le altre caratteristiche in comorbilità, sono cristallizzate all’interno di schemi interpersonali maladattivi che si sono sviluppati a partire dalle prime esperienze relazionali della persona. All’interno di questi schemi, il disturbo alimentare è un coping, seppur maladattivo, che cerca di soddisfare un bisogno filogeneticamente determinato (ovvero selezionato da un punto di vista evoluzionistico), come il bisogno di essere amati, stimati o inclusi nel gruppo.

Chiarisco con un esempio, Anna, una nostra paziente, ha imparato che nel corso della vita può essere stimata e voluta bene solo se eccelle. Quando Anna ha interiorizzato quest’aspetto, ha iniziato a riconoscersi un valore solo quando riusciva ad eccellere in qualcosa, sviluppando tendenze perfezionistiche patologiche applicate ai vari domini della vita, tra cui il corpo. Quando Anna si ammalò anoressia, iniziò a pensare che il suo valore personale fosse legato a quanto riuscisse ad essere magra.

In conclusione, la terapia TMI-DCA affronta da subito il disturbo alimentare mentre in parallelo mira a creare una comprensione condivisa con il paziente del suo funzionamento, ovvero lo aiuta a riconoscere a quale bisogno il disturbo alimentare risponde.

Durante la terapia il sintomo viene trattato a partire da una attenta concettualizzazione del caso e agendo direttamente sulle disfunzioni metacognitive che mantengono il disturbo, come, ad esempio l’elevata egosintonicità con l’eccessiva importanza attribuita a peso e forme del corpo, per produrre un cambiamento che possa essere il più possibile sostanziale e duraturo.

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