ArticleJournal of eating disorders2026
Introducing the Diathesis-Compassion Layered Care Model (DCLCM): an IPA study of dissociation and complex trauma in eating disorders in Iran.
Article in Journal of eating disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundEating disorders (EDs) frequently co-occur with trauma-related symptomatology, including dissociative experiences. While international research has examined associations between EDs and trauma frameworks such as the dissociative subtype of Post-Traumatic Stress Disorder and Complex Post-Traumatic Stress Disorder, little is known about how therapists in non-Western contexts conceptualize the trauma-dissociation-ED linkage or integrate trauma-informed and compassion-focused approaches in practice.
methodInterpretative Phenomenological Analysis (IPA) was applied to explore Iranian therapists' lived experiences in managing ED presentations involving dissociation comorbidity, with a focus on the therapeutic role of self-compassion. Semi-structured interviews were conducted with three therapists working with adolescents and young adults.
resultsAnalysis generated 11 superordinate and 58 subordinate themes. Findings were organized in five interlinked layers: Symptom Recognition, describing multifaceted ED presentations with dissociative features such as trance-like eating, emotional numbing, depersonalization, and identity disruption; Trauma and Vulnerability, highlighting early relational adversity, chronic invalidation, and dispositional traits including perfectionism and low self-esteem; Cultural and Social Context, reflecting body-surveillance norms, gendered expectations, family hierarchy, and stigma; Therapeutic interventions, capturing phased, safety-oriented, integrative treatment strategies; and Self-Compassion as a Transformative Healing Pathway, emphasizing compassion-focused processes for reducing shame and enhancing affect regulation. A Cross Layer Reflective Theme, appraised the utility of stress-vulnerability formulation in structuring case-conceptualisation and psychoeducation within Iranian practice. These themes informed the Diatheses-Compassion Layered Care Model (DCLCM), a five-layer conceptual framework grounded in therapists' narratives.
conclusionsTherapists frequently interpreted ED presentations involving dissociative features through trauma-informed and diatheses-stress lens. DCLCM offers a culturally embedded conceptual framework that integrates symptom recognition, trauma and vulnerability pathways, sociocultural context, therapeutic sequencing, and self-compassion processes. The model is intended to organize clinical reasoning in culturally sensitive settings and requires empirical evaluation in future research.
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