Significance of overvaluation of shape and weight in an ethnically diverse sample of obese patients with binge-eating disorder in primary care settings

Undue influence of shape or weight on self-evaluation--referred to as overvaluation--is a core feature across eating disorders, but is not a diagnostic requirement for binge-eating disorder (BED). This study examined overvaluation of shape/weight in ethnically diverse obese patients with BED seeking treatment in primary care. Participants were a consecutive series of 142 (105 female and 37 male) participants with BED; 43% were Caucasian, 37% were African-American, 13% were Hispanic-American, and 7% were of "other" ethnicity. Participants categorized with overvaluation (N=97; 68%) versus without clinical overvaluation (N=45; 32%) did not differ significantly in ethnicity/race, age, gender, body mass index, or binge-eating frequency. The overvaluation group had significantly greater levels of eating disorder psychopathology, poorer psychological functioning (higher depression, lower self-esteem), and greater anxiety disorder co-morbidity than the group who did not overvalue their shape/weight. The greater eating disorder and psychological disturbance levels in the overvaluation group relative to the non-overvaluation group persisted after controlling for psychiatric co-morbidity. Our findings, based on an ethnically diverse series of patients seeking treatment in general primary care settings, are consistent with findings from specialist clinics and suggest that overvaluation does not simply reflect concerns commensurate with being obese or with frequency of binge-eating, but is strongly associated with heightened eating-related psychopathology and psychological distress. Overvaluation of shape/weight warrants consideration as a diagnostic specifier for BED as it provides important information about severity.     

Benign and disruptive disturbances of the supervisory field1

Inspired by Baranger, Baranger and Mom’s notion of psychoanalytic bastion, we describe an unconscious collusion between analytic supervisors and supervisees. This collusion’s purpose is to avoid the anxiety inherent in the psychoanalytic field and that enters unprocessed into the supervisory field. The supervisor/supervisee dyad’s emotional experience can be fleeting, with moderate intensity, but can slow down the process. This can happen sometimes in any supervisory situation. Or it can become permanent and with greater intensity and bring the entire process to a standstill and to a disruption of the supervisory field. We call the first situation a ‘benign disturbance of the supervisory field’, the second a ‘disruptive disturbance of the supervisory field’. We illustrate both disturbances using supervisory material. Our purpose is to show how to detect these disturbances, understand them, and manage them.     

THE EMPATHIC EMOTIONS AND SELF-LOVE IN BISHOP JOSEPH BUTLER AND THE NEUROSCIENCES

In Joseph Butler, we have an account of human beings as moral beings that is, as this essay demonstrates, being supported by the recently emerging findings of the neurosciences. This applies particularly to Butler's portrayal of our empathic emotions. Butler discovered their moral significance for motivating and guiding moral decisions and actions before the neurosciences did. Butler has, in essence, added a sixth sense to our five senses: this is the moral sense by means of which we perceive what we ought or ought not do. The moral sense yields relatively reliable moral perceptions when we love our neighbors as ourselves, and when our love for ourselves is genuine. Accurate moral perceptions will be thwarted by self-deceit—that is, by a self-partiality devoid of neighbor love, a condition that thwarts genuine self-love. This essay explores the parallels between Butler's understanding of self-deceit and Robert J. Lifton's understanding of "doubling."