edaw17: emotions in eating disorder
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E AT IN G, W E I GH T AN D B E H AVI OU R C H AN GE UN I T
DR LAURA RENSHAW-VUILLIER
Emotions in eating disorders
Eating disorder help
If you feel distressed after this lecture, you can: Come and talk to me to discuss things that may bother you Contact RESTORED, a local eating charity
https://restoredcharity.wordpress.com/ 07590 378822
Contact BEAT, the UK, national ED charity https://www.b-eat.co.uk/support-services 0345 634 1414
Contact the Student Wellbeing service here at BU https://www1.bournemouth.ac.uk/students/health-wellbeing/student-wellbeing
Contact your GP
Plan
I. Introduction of the conceptsII. How emotions affect your eating…..and vice-versa!III. Emotional functioning in EDsIV. Role of emotions in EDs
I. Definitions
Eating Disorders
DSM-5 (Diagnostic Statistic Manual of Mental Disorders) defines THREE main EDs: Anorexia Nervosa (AN) (restrictive and binge-purge type) -15% Bulimia Nervosa (BN) -45% Binge Eating Disorder (BED) -30% Other Specified Feeding or Eating Disorder (OSFED) -10%
Eating Disorders
• Common symptoms are: Extreme concern with body weight and shape
Body weight shape = self-worth If I’m fat, people won’t like me Distorted body image
Unhealthy relationship with food Extreme fasting (AN, BN) Bingeing (for BN, BED and ANbp) Purging or other compensatory mechanisms (for BN and ANbp) Obsession with food
‘I would spread my paper out in front of me, set the yogourt aside, check my watch. I’d read the same sentence over and over, to prove that I could sit in front of food without snarfing it up, to prove it was no big deal. When 5 minutes had passed, I would start to skim my yogourt… You take the edge of your spoon and run it over the top of the yogourt, being careful to get only the melted part. Lick it, wait, be careful, you have to only lick a teeny bit at a time, the sheen should last four or five licks, and you have to lick the back of the spoon first, with the tip of your tongue. Then set the yogourt aside again. Read a full page, but don’t look at the yogourt. Repeat. Repeat.’
(Hornbacher, 1998, pp. 254-255)
Eating Disorders
What is an emotion?
What is an emotion?
Basic Properties of Emotions
BriefSpecific Cause
A B
Physiological
Help achieve goals
Behavioural Experiential
“Emotion regulation refers to the processes by which individuals influence which emotions they have, when they have them, and how they experience and express these emotions”. (Gross, 1998)
What is emotion regulation?
AWARENESS
ACCEPTANCE
STRATEGIES
II. How emotions can affect your eating.... And vice versa!
How do emotions affect YOUR eating
Discuss with a neighbour…. Do you think emotions affect your eating? If so, what aspect?Do you think your eating affect your emotions? If so, how?
Think about things such as:-The quantity and type of food you eat when you experience certain emotions-Whether some emotions affect your eating more than others-What other strategies are you using to make you feel better when you are upset?
Emotions can affect eating
Emotion induction-Joy-Sadness-Anger-Fear
Participants: 48 healthy men
Taste of the foodMotivation to eat
Food deprivation
Emotions can affect how pleasant the food feels
Taste pleasantness0
10
20
30
40
JoySadnessAngerFear
(Macht, Roth, & Ellgring, 2002)
Emotions can affect eating
Appetite Desire to eat
Hunger01234
PrePost
Joy
Appetite Desire to eat
Hunger0
1
2
PrePost
Sadness* * * *
Appetite Desire to eat
Hunger0123
PrePost
Anger* * *
Appetite Desire to eat
Hunger0123
PrePost
Fear
(Macht, Roth, & Ellgring, 2002)
Emotions can affect eating
Appetite Desire to eat
Hunger01234
PrePost
Joy
Appetite Desire to eat
Hunger0
1
2
PrePost
Sadness* * * *
Appetite Desire to eat
Hunger0123
PrePost
Anger* * *
Appetite Desire to eat
Hunger0123
PrePost
Fear
Emotions can affect motivation to eat.
Different emotions affect eating differently
(Macht, Roth, & Ellgring, 2002)
Eating can affect your emotions
Emotion induction-Sad-Happy-Neutral
Food manipulation Measure of
moodParticipants: 48 healthy volunteers (21 men 27 women)
Eating chocolate helped improve the mood of participants
Sad Happy Neutral
-4-3-2-101234
ChocolateWater
Eating can affect your emotions
* *
(Macht & Mueller, 2007)
Emotions and Eating: individual differences
Stress inductionAnticipation of speech performance
Participants: 68 healthy volunteers (27 men 41 women)
Questionnaire:
->Restrained eaters->Emotional eaters
Buffet
(Oliver, Wardle, & Gibson, 2000)
Emotions and Eating: individual differencesLo
w R
estr
aint
Hig
h R
estr
aint
Low
Res
trai
nt
Hig
h R
estr
aint
Stress Group Control Group
280290300310320330340350360370
Total intake
Low Emotional Eating
High Emotional Eating
Low Emotional Eating
High Emotional Eating
Stress Group Control Group
0
10
20
30
40
50
60
70Sweet fatty food
Restrained eaters Emotional eaters
(Oliver, Wardle, & Gibson, 2000)
Emotions and Eating: individual differencesLo
w R
estr
aint
Hig
h R
estr
aint
Low
Res
trai
nt
Hig
h R
estr
aint
Stress Group Control Group
280290300310320330340350360370
Total intake
Low Emotional Eating
High Emotional Eating
Low Emotional Eating
High Emotional Eating
Stress Group Control Group
0
10
20
30
40
50
60
70Sweet fatty food
Restrained eaters Emotional eaters
Restrained eaters eat more under stress
Emotional eaters eat more sweet fatty food under stress
(Oliver, Wardle, & Gibson, 2000)
Emotions and Eating summary
Emotions can: Affect your food choice
NEGATIVE: Sweet and fatty food POSITIVE: Healthy food
Affect the amount of food you ingest Intense emotions can decrease food intake In restrained eaters, emotions can increase food intake
Impair your cognitive control over eatingEating can regulate your emotions: two way relationship!Individual differences
Macht, 2008
III. Emotional functioning in ED
Higher overall negative affectHigher emotional intensityHigher levels of depressive symptomsHigh rate of neuroticismHigh rates of co-occurring mood and anxiety disorders
Elevated negative emotionality
(Lavender et al., 2015)
Elevated negative emotionality
Alexithymia: TAS
Questionnaire: Toronto Alexithymia Scale Hypothesis: ED will score higherParticipants: 19 AN, 52 BN, 370 HC
Difficulties identifying and describing feelings in ED
TAS total404550556065707580
ANBNHC
(Cochrane, Brewerton, Wilson, & Hodges, 1993) Review paper: Nowakowski, Mcfarlane, & Cassin (2013)
Emotion recognition: Read the Mind in the Eye
Task: Read the Mind in the EyeHypothesis: Lower score on the test Participants: AN = 50; BN= 50; HC= 90
Emotion recognition deficit in ED
RMET72
74
76
78
80
82
EDHC
(Harrison, Sullivan, Tchanturia, & Treasure, 2010)
Emotion regulation deficits: DERS
Questionnaire: DERSHypothesis: Higher score for ED vs HCParticipants: AN = 50; BN= 50; HC= 90
Emotion regulation deficits in ED
Harrison, Sullivan, Tchanturia and Treasure, 2010Non
acce
ptan
ceGoa
ls
Impu
lsivit
y
Awaren
ess
Stra
tegies
Clarity
0
5
10
15
20
25
30
ANBNHC
Emotion regulation dimensions
Risk factors?
Vuillier, Oakley, Voon, in preparation
Task: DERS, TAS Participants: 9 BN, 22 sometimes binge, 33 never binge. Cross-sectional!
DERS Total0
20406080
100120140160 BN
Sometimes bingeNever Binge
TAS total0
10203040506070
Difficulties with emotions risk factors for binge eating
Issues
Most are cross-sectional studiesMost studies are on females apply to males?A lot of studies focus on food, and not on emotions directly.
People with EDs experience strong negative emotions towards food and eating (McNamara, Hay, Katsikitis, Chur-Hansen, 2008) but makes results less clear cut
Rare experimental studies NO explicit emotion regulation tasks in ED Relying on self-report is tricky Alexithymia
Emotional experience? Emotional regulation deficits?
A B C
Is emotional experience too intense?Is it because of deficits in identification of emotions?Is it because of deficits in finding the best strategy?
Cause Emotional experience Behaviour
Emotional regulation
Summary of emotional functioning in ED
Heightened negative emotionality Difficulties identifying and describing feelings Difficulties recognising emotions in othersDifficulties regulating emotionsCould be risk and maintenance factors
III. What is the role of emotions in ED?
An affective model for ED? –Binge eating
Escape from awareness theory (Heatherton & Baumeister, 1991): binge to narrow attention to immediate environment to avoid negative thoughts about self
Masking theory (Polivy, 1988, 1998, 1999): binge serves as an attribution for negative affect that masks other problems. Negative emotions can be blamed on binge eating, which is perceived as more tolerable than other aspects of one’s life that may be the actual cause of distress
Affect regulation model (Berg et al., 2013): binge to regulate emotions and decrease negative affect.
NA as precursor of binge
Attribution of binges:-47.7% to how they felt-17.4% to broken a food rule-14.0% to hunger-20.9% to unknown
33 women with BED
1 week
EMA: 6 times a day
Emotions, hunger, binge status
NA is clear precursor of bingeDoes not support affect regulation
hypothesisMasking theory? Escape from self-awareness?
Positive Mood Negative Mood0
0.5
1
1.5
Non Binge timeBefore BingeAfter Binge
Stein et al. 2007
Affect regulation model
Berg, Crosby, Cao, Paterson, Engel, Mitchell, Wonderlich, 2013
133 women with BN
-4 -3 -2 -1 0 1 2 3 41.7
1.9
2.1
2.3
2.5
2.7
2.9
3.1
GuiltFearSadnessHostility
2 weeks
Binge episode
EMA: 7 times a day and after every episode of B/P
Guilt, Fear, Sadness, Hostility
Negative emotions decrease after bingeing
But not fully supported: See Haedt-Matt & Keel, (2011) for meta analysis
Treatments
(Corstorphine, 2006)
Cognitions (e.g. “I am going to keep
gaining weight”)
Behaviour(e.g. avoid food)
Emotions(e.g. anxiety)
DBT
CBT
Behavioural therapyAntidepressants
Cognitive Analytic therapy
Concluding slide
Emotions can affect your eating Eating can affect your emotions Individuals with an ED restrict their eating and are
emotional eaters even more impact of emotions on eating Individuals with an ED have difficulties identifying,
describing and regulating their emotions and have heightened negative affect
Negative emotions lead to binge/purge behaviour New treatment should focus on helping with emotional
experience and regulation
Distressed? Worried? TALK!
If you felt distressed during this lecture, you can: Come and talk to me to discuss things that may bother you Contact RESTORED, a local eating charity
https://restoredcharity.wordpress.com/ 07590 378822
Contact BEAT, the UK, national ED charity https://www.b-eat.co.uk/support-services 0345 634 1414
Contact the Student Wellbeing service here at BU https://www1.bournemouth.ac.uk/students/health-wellbeing/student-wellbeing
Contact your GP
Extra slides
They were in original power point I sent you last week but I removed them in this presentation.
Attentional bias: Pictorial Stroop task
Task: Name the colour. Hypothesis: Longer RT for emotional faces Participants: 35 AN, 35 recovered AN, 90 HC
Angry vs Neutral face-20
020406080
Acute ANRec ANHC
Emotional attentional bias in ED
Harrison, Tchanturia and Treasure, 2010
Masking theory
137 women with BN
Lab study
Difficult anagrams&Ice cream tasting
AnxietyDepression Hostility
• Restrained eaters more likely to attribute their negative feelings to the eating vs failed taskMasking theory
• Subjects reported that the amount they ate after anxiety induction was due to distress about the taskDistraction theory
• Restrained eaters in the anxious condition reported it was not worth trying to restrict their eating on the ice cream because they would fail anywayLearned helplessness
• Eating did not reduce distress No support for comfort hypothesis
(Polivy, Heatherton, & Herman, 1988)
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