edaw17: emotions in eating disorder

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

https://restoredcharity.wordpress.com/



https://www.b-eat.co.uk/support-services


https://www1.bournemouth.ac.uk/students/health-wellbeing/student-wellbeing


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?

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)


Appetite Desire to eat

Hunger01234

PrePost

Joy


Hunger0

1

2

PrePost

Sadness* * * *


Hunger0123

PrePost

Anger* * *


Hunger0123

PrePost

Fear




Hunger01234

PrePost

Joy


Hunger0

1

2

PrePost

Sadness* * * *


Hunger0123

PrePost

Anger* * *


Hunger0123

PrePost

Fear

Emotions can affect motivation to eat.

Different emotions affect eating differently


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




0

10

20

30

40

50

60

70Sweet fatty food

Restrained eaters Emotional eaters


Emotions and Eating: individual differencesLo

w R

estr

aint

Hig

h R

estr

aint

Low

Res

trai

nt

Hig

h R

estr

aint


280290300310320330340350360370

Total intake






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


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)

edaw17: emotions in eating disorder

Education