Emotional processing in recovered anorexia nervosa patients: A 15 year longitudinal study

Castro, Telma Fontão; Miller, Kelsey A.; Araújo, Maria; Brandão, Isabel; Torres, Sandra

doi:10.1002/erv.2858

Cited by 17 publications

(12 citation statements)

References 61 publications

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“…Results corroborate broad themes of empowerment and reconciliation in the process of recovery from anorexia that have been identified elsewhere, where recovery from anorexia was described as a search for identity and truth, and a repossessing of personal control, power and "self " (26). This acknowledgment of "whole self " change necessary for recovery is in keeping with reports that only improving weight is not sufficient for emotion regulation change (41) and that some difficulties with emotion can persist even after resolution of most eating-related difficulties, representing a potential vulnerability for relapse (42). Taken together, we argue this highlights the need for a broader understanding of recovery and therapeutic goals in terms of emotion and ED difficulties.…”

Section: Discussionsupporting

confidence: 66%

Seeing Through the Façade of Anorexia: A Grounded Theory of Emotional Change Processes Associated With Recovery From Anorexia Nervosa

Drinkwater¹,

Holttum²,

Lavender³

et al. 2022

Front. Psychiatry

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ObjectivesDifficulties in managing emotions have been implicated in the development and maintenance of anorexia nervosa (AN), and psychological treatment models seek to address this in putative targets of change. Yet the field of psychotherapy remains unclear and insufficiently evidenced about the process of change and how this is actually achieved, including in what steps and in what order within clinical treatment. This qualitative study sought to develop theory about the process of emotional change during recovery from anorexia.MethodsSemi-structured interviews were carried out with nine women currently engaged in psychological treatment for anorexia. Interviews included questions pertaining to participants’ experience of anorexia, emotions, and emotion management. A constructivist version of grounded theory was employed.ResultsThe analysis produced 10 major categories, comprising over 60 focused codes. Categories were clustered together into three super categories, reflecting 3 distinct but interrelated phases of participants’ journeys toward recovery. The phases were: (1) Coping in a world of uncertainty, (2) Seeing through the façade of anorexia, and (3) Recovery and growth. Whilst movement toward later positions often appeared to be contingent on earlier ones, the analysis suggests that this was not an entirely linear process and that participants moved between positions as they grappled with the process of change. Participants came to view behaviors associated with anorexia as emotion-management strategies that were not working and as a façade. As they moved toward recovery and growth, they became less confined by their need for safety, and to see emotions as meaningful and valuable. Becoming more connected to emotional experience and expression, coincided with positive shifts in their intra and interpersonal relationships.ConclusionThese findings support the recent shift toward emotion-focused models of anorexia. They also highlight an important focus in supporting individuals with AN to connect with, and be guided by, emotional experiences in their relationships with themselves and the world around them. This new grounded theory offers a putative process of change that could be utilized to guide intervention development.

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Section: Discussionsupporting

confidence: 66%

Seeing Through the Façade of Anorexia: A Grounded Theory of Emotional Change Processes Associated With Recovery From Anorexia Nervosa

Drinkwater¹,

Holttum²,

Lavender³

et al. 2022

Front. Psychiatry

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“…Traits refer to stable patterns of behavioural thoughts and emotions over a longer period. Indeed, literature demonstrates a higher prevalence of anxietyrelated personality traits in both individuals with AN as well as in those recovered from AN [10,14,34,47]. One could speculate that in individuals who have recovered from AN, treatment might have helped them breaking through this pattern of habits that may have developed during the first stages of the illness by frequently using these safety behaviours such as body checking and body avoiding.…”

Section: Discussionmentioning

confidence: 99%

Understanding relations between intolerance of uncertainty and body checking and body avoiding in anorexia nervosa

et al. 2022

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Background A key feature of anorexia nervosa is body image disturbances and is often expressed by dysfunctional body-related behaviours such as body checking and body avoiding. These behaviours are thought to contribute to both the maintenance and relapse of AN, yet empirical evidence is scarce. One variable that may contribute to the need for engaging in these behaviours is intolerance of uncertainty. This study aims to investigate body checking and body avoiding and its relations with intolerance of uncertainty in women with anorexia nervosa (AN-ill; 70), women recovered from AN (AN-rec; 85) and control group (127). Methods Three questionnaires were completed, measuring eating pathology, intolerance of uncertainty and body checking and body avoiding. One-way ANOVAS were used to test group differences. Moderation analyses were used to investigate associations between variables. Results Levels of intolerance of uncertainty, body checking and body avoiding were highest in AN-ill followed by AN-rec and, lastly, the control group, confirming group differences. Intolerance of uncertainty was associated with body checking in the AN-rec group and the control group but not in the AN-ill group. The association between intolerance of uncertainty and body avoiding was reported in the AN-rec group and only marginally in the control group. Conclusion Levels of intolerance of uncertainty, body checking and body avoiding were highest in AN-ill, however still elevated in AN-rec, confirming the presence of body image disturbances, even after recovery. The unique associations between intolerance of uncertainty and body checking and body avoiding within the studied groups may represent different stages of the illness. In the AN-rec group, the relation between intolerance of uncertainty, body checking and body avoiding may be driven by trait anxiety. For AN-ill group, body checking and body avoiding may eventually have grown into habitual patterns, rather than a strategy to ameliorate anxiety and uncertainty. Plain English summary Women with anorexia nervosa often experience disturbances in their body image and are expressed in body-related behaviours such as body checking and body avoiding. These behaviours are thought to contribute to both the maintenance and relapse of anorexia nervosa. Intolerance of uncertainty is defined as the incapacity to tolerate uncertainty and may contribute to the need for engaging in these behaviours. This study aims to investigate body checking and body avoiding and its relations with intolerance of uncertainty in women with anorexia nervosa (AN-ill; 70), women recovered from AN (AN-rec; 85) and control group (127). Three questionnaires were completed, measuring eating pathology, intolerance of uncertainty and body checking and body avoiding. Levels of intolerance of uncertainty, body checking and body avoiding were highest in AN-ill and still elevated in AN-rec, even after recovery. The associations between intolerance of uncertainty and body checking and body avoiding within the studied groups may represent different stages of the illness. In the AN-rec group, the relation between intolerance of uncertainty, body checking and body avoiding may be driven by trait anxiety. For AN-ill group, body checking and body avoiding may have grown into habitual patterns, rather than a strategy to ameliorate anxiety and uncertainty.

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“…This is especially important in case emotion processing and regulation difficulties are consequential to ED psychopathology as opposed to causal factors in its aetiology. While some studies suggest the malnourishment associated with EDs can exacerbate alexithymia [ 98 ] and affect the presentation of emotional dysregulation [ 99 ], other studies support the causal primacy of emotion processing and regulation deficits over ED psychopathology [ 22 ] and, as far as AN is concerned, the persistence of difficulties in these areas after weight-restoration [ 100 , 101 ]. Compelling evidence for this perspective comes from Racine and Wildes [ 102 ], whose longitudinal findings suggested emotion regulation difficulties were independent of BMI and predictive of changes in the severity of AN symptoms, while the reverse relationship (AN severity predicting emotion regulation difficulties) was unsupported.…”

Section: Limitations and Future Directionsmentioning

confidence: 99%

What about males? Exploring sex differences in the relationship between emotion difficulties and eating disorders

et al. 2022

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Objective While eating disorders (EDs) are more commonly diagnosed in females, there is growing awareness that men also experience EDs and may do so in a different way. Difficulties with emotion processing and emotion regulation are believed to be important in EDs, but as studies have involved predominantly female samples, it is unclear whether this is also true for males. Methods In a sample of 1604 participants (n = 631 males), we assessed emotion processing and emotion regulation in males with EDs (n = 109) and compared results to both females with EDs (n = 220) and males from the general population (n = 522). We also looked at whether emotion processing and emotion regulation difficulties predicted various aspects of eating psychopathology and whether this was moderated by sex. We assessed emotion processing with the Toronto Alexithymia Scale, emotion regulation with the Difficulties in Emotion Regulation Scale and the Emotion Regulation Questionnaire, and eating psychopathology with the Eating Disorder Examination Questionnaire. Results We found that males with ED, like their female counterparts, suffered from emotion processing and emotion regulation deficits. We did find some sex differences, in that males with EDs tended to report more difficulties with their emotions as well as a more externally oriented thinking style compared to females with EDs. Difficulties with emotion processing and emotion regulation were strongly predictive of various aspects of eating psychopathology in both sexes. Importantly, we found that sex moderated the relationship between cognitive reappraisal and eating restraint. As such, low use of reappraisal was found to be associated with higher levels of restraint in females but not in males. Discussion Difficulties with emotion processing and emotion regulation are associated with eating psychopathology in both males and females. Reappraisal was not found to be associated with reduced eating psychopathology in males, suggesting a cautious approach to interventions targeting this strategy. Research around explanatory mechanisms and interventions must adopt a broader viewpoint including those that are traditionally overlooked in EDs.

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Emotional processing in recovered anorexia nervosa patients: A 15 year longitudinal study

Cited by 17 publications

References 61 publications

Seeing Through the Façade of Anorexia: A Grounded Theory of Emotional Change Processes Associated With Recovery From Anorexia Nervosa

Seeing Through the Façade of Anorexia: A Grounded Theory of Emotional Change Processes Associated With Recovery From Anorexia Nervosa

Understanding relations between intolerance of uncertainty and body checking and body avoiding in anorexia nervosa

What about males? Exploring sex differences in the relationship between emotion difficulties and eating disorders

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