Emotional processing in eating disorders

Research into emotional processing in eating disorders (ED) is still very much in its infancy. Milligan and Waller (2000), Waller et al (2003) and others have shown that there is difficulty with the emotion of anger, especially in its expression. Whilst others (e.g. Troop et al, 2000) have demonstrated an increased sensitivity for disgust with an ED population. In recent years, there has been significant development in CBT models of eating disorders; in particular, bulimia nervosa and these models have started to suggest that eating disorder symptomatology acts as an emotional regulator (e.g. Cooper et al, 2004; Waller et al, 2007). Although these models are a useful start in understanding emotions in eating, there is a lack of a theoretical understanding of why people with eating disorders have particular difficulties with certain emotions. This thesis presented a detailed consideration of the literature that has attempted to understand the relationship between emotions and eating disorder symptomatology by proposing a new model of eating disorders that is based upon the recent theoretical developments in emotional processing (i.e. SPAARS model, Power and Dalgleish, 1997, 1999). This SPAARS-ED model was used as the theoretical backdrop for the thesis, and the data from the four studies were designed to test some of the key hypotheses stemming from the model. The first study was a grounded theory study that investigated perceptions of the basic emotions and the developmental histories of emotions within a group of 11 people with severe anorexia nervosa. The results highlighted themes of anger and sadness being suppressed, and were often regarded as being 'toxic'. Furthermore, themes were also explored that focused on metaemotional skills and participants recollections of how their parents, peers and caregivers used to respond to their emotions. The second study directly tested the theoretical idea of 'coupled emotions', and this study found data that demonstrated increased levels of disgust following an anger induction for people with bulimic symptoms, in comparison to control participants. The third study was a survey based study that quantitatively looked at both the predictive power of each of the basic emotions for disordered eating patterns, and also how certain emotion response styles from carers (e.g. punitive, dismissive, etc towards an emotion) were related to disorder eating. The results showed that anger and sadness predicted eating disorder symptoms, and the effect was large. However, there were no significant associations between emotion response styles and disordered eating.The final study was a hybrid study that was based on the two quantitative studies in this thesis. In a cross sectional study, a group of participants with anorexia nervosa were compared to control participants. This study had two parts, with the first part focusing on emotion regulation styles and core beliefs, whilst the second part repeated and developed the experimental methodology from study 2. The results showed that people with anorexia nervosa had significantly more internal dysfunctional emotion regulation style, and significantly more negative beliefs about the self and others when compared to controls. Interestingly these core beliefs patterns were significantly correlated with state emotions, with negative other beliefs being correlated to state anger, whilst negative internal beliefs were significantly correlated to state emotions of disgust and sadness. The second part of this study showed that, following an induced anger emotion, people with anorexia nervosa showed significantly higher levels of disgust, and estimation of body size. This was taken as further evidence of a potential coupled emotion effect, between anger and disgust within eating disorders. These findings were then discussed, in relation to both the SPAARS-ED model, and the general literature