Emotional intelligence and eating disorders. A talk provided for the Early Intervention in Eating Disorders Conference.

1. "The body is a battleground for unwanted
and unexpressed emotion”
EXPLORING THE ROLE OF EMOTIONAL INTELLIGENCE AS A TOOL IN TREATMENT
AND PREVENTION

2. Outline
 Introduction
 What is emotional intelligence and why does it matter?
 Applying emotional intelligence to eating disorders:
 The research
 The lived experience
 Applying knowledge to practice

3. Who am I?
 Young Persons Project Officer at Adapt Eating Distress Association
 Development Officer at EDA-NI
 Advisor for The Laurence Trust
 PhD at Ulster University
 Partner to someone recovered from Anorexia

4. What is early
intervention…?
AND HOW CAN WE ACHIEVE IT
WHEN KEEPING TRUE TO DSM
CRITERIA AND MEDICAL
SYMPTOMS?

5.  According to this diagnostic model you either have an eating disorder or you
don’t
People with
ED’s
People
without ED’s

6.  By the time an eating disorder is diagnosable
and symptomology is spotted is this too late?
 Can we apply traditional models of prevention
to the changing body of eating disorders
where body image interventions and ‘the thin
ideal’ are becoming less relevant?
Eating Disorder
Social
Psychological
Biological

7. Disordered eating as a spectrum
 Rather than viewing eating disorders within this diagnostic model, research and
practice has moved towards terms such as
 Disordered eating attitudes and behaviours
 Eating Distress
 These terms are more inclusive of subclinical and early stages of diagnostic/
medical criteria disorders
 This allows early intervention stages to be considered before thoughts and
behaviours become engrained

8. Why…?
 Help early recognition
 Earlier interventions – to help avoid chronic, severe and enduring eating disorders
 Opens treatment to the spectrum of disordered eating observed in the community
 Recovery and treatment works better and outcomes increase when the disorder is
detected in its first year…
 currently on average this is 4-5 years, with enduring disorders spanning a lifetime

9. What causes an eating disorder?
 Genetics
 Brain chemistry
 Media pressures
 The thin ideal
 Self-esteem
 Size Zero Models
 Cheryl Cole
 Poor relationship with your mother
 Attachment
 The list could go on…
 Perfectionism
 Bullying
 Abuse
 Trauma
 Skinny jeans
 Vanity
 Greed
 OCD
 Emotional difficulties
 Pro-ana websites

10. The Biopsychosocial model of eating disorders
It has been empirically established
that an eating disorder is “caused”
by a range of factors that interact.
This follows the biopsychosocial
model which helps explain mental
health as an interplay of all three.
This helps us understand the
complexity and uniqueness of
eating disorders

11. “It’s hard to put your finger on one thing. It’s very
unique and individual... it’s not clear cut”
 Whether or not a person develops an eating disorder will
depend on their individual vulnerability, consequent on the
presence of biological or other predisposing factors, their
exposure to particular provoking risk factors and on the
operation of protective factors. Following the establishment of
the disorder a further combination of risk and protective
factors may act to maintain the condition or determine
whether an individual recovers (NICE, 2004)

12. To achieve
meaningful early
intervention we
must target core
psychopathology
rather than the
symptoms…
WITHIN THIS, DO WE NEED TO
MOVE BEYOND SOME OF THE
CURRENT INTERVENTION
POINTS SUCH AS SELF-
ESTEEM?

13. While self-esteem is an important factor within the development of disordered
eating attitudes and behaviours it is not as relevant for all presentations
 Males
 Binge Eating Disorder
Not everyone with low self-esteem has an eating disorder;
And not everyone exposed to high media pressures to be thin develops an eating disorder…

14. Placing a Focus on Psychological
Vulnerability
 It is suggested that while low self-esteem may underpin disordered eating attitudes
and behaviours individuals who develop clinical eating disorder have additional
psychological vulnerabilities
 One theory suggests that this may a results of emotional dysfunction (Bruch, 1988)
 Recent studies have shown that eating disorders act as having a functional purpose
related to emotional regulation and coping (Schmidt & Treasure, 2006; McNamara,
Chur-Hannsen & Hay, 2008; Reid, Burr, Williams & Hammersley, 2008).
 As a result, emotional dysfunction may be considered at the core of anorexia
(Oldershaw, DeJong, Hambrook, Broadbent, Tchanturia, Treasure & Schmidt, 2012;
Treasure, Corfield & Cardi, 2012).

15. Emotional Dysfunction
 Individuals with eating disorders have been found to have
significant impairments in;
 deficits in emotional processing (Bruch, 1973)
 emotional perception (Rozenstein, Latzer, Stein & Eviatar, 2011)
 emotional facial processing (Jones, Harmer, Cowen & Cooper,
2008)
 emotional awareness (Lawson, Emanuelli, Sines & Waller, 2008)
 an inability to differentiate distressing emotions or control
emotions (Leon, Fulkerson, Perry & Cudeck, 1993)

16. Alexithymia: “without words for emotions” (Sifneos, 1973)
 Alexithymia describes a deficit in representing emotions symbolically,
understanding, processing and describing emotions (Miller, Vandome &
McBrewster, 2009)
 23%-77% for AN patients
 40%-63% in BN patients
 0%-28% in non-clinical samples
 Alexithymic patients were found to have lower
success rates within psychotherapy treatments
(Horney, 1952; Bar-On & Parker, 2000)

17. Emotional Intelligence (EI)
Emotional Intelligence refers to the overarching rules and laws
employed within our emotional processes
 The ability to perceive accurately, appraise and express emotion
 The ability to access or generate feelings when they facilitate
thought
 The ability to understand emotion & emotional knowledge
 The ability to regulate emotions to promote emotional &
intellectual growth
(Salovey & Mayer, 1990)

18. Emotional Intelligence
 Individuals with low EI scores have been found to have
significantly lower
 Emotional awareness (of ones own emotions and others emotions)
 Empathy
 Difficulty in establishing relationships
 Inability to cope with and regulate distress
 Poor stress management skills

20. Emotional
Awareness

21. Feeling lost, confused and frustrated by
emotional arousal.
 Physical arousal that is associated with emotional arousal is
rarely connected, e.g. symptoms of panic attacks (lump in the
throat), without the awareness of what these physical and
emotional reactions were food was used as a maladaptive
coping strategy to literally stuff the feelings back down.
 “Sometimes I would think my body isn’t my own, that my
thoughts aren’t my own because I was so disconnected from
myself.”

22.  “He didn’t understand what he was feeling. That’s it. It’s like
he had a ball of rage and anger and emotion and he didn’t
know where to put it, he didn’t know where to go with it and
he would sometimes direct it at others but mostly at himself
– that’s why he would try and kill himself.” Carer

23. Emotional
Expression

24. Without an emotional voice were do our
emotions go?
 “I was invisible to the world; I was a ghost, voiceless. No
matter how bad it got I couldn’t get it out or show it...
Whether it was visible ribs or scars on my skin, I just didn't
know how else to express it and this was my way of showing
that I was hurting...”

25. Ambivalence or lack of emotional voice?
 Without this engaging in a talking therapy, understanding the empathy of the
therapist necessary to building trust, can create difficulties and emotional
connections would be lost where a mutual understanding of each other was not
present.
 Sometimes we need to think beyond the idea of talking therapies!
 Look at alternative to allow us to engage individuals who lack the “insight” that is
needed for talking before the physical problem comes up.

26. “Our patients are
starving,
sometimes
literally, to make
an emotional
connection”
WHEN WE DON’T HAVE AN
EMOTIONAL LANGUAGE THE
PHYSICAL SIGNS AND SYMPTOMS
BECOME A SIGN OF DISTRESS AND
A UNSPOKEN LANGUAGE.
EARLY INTERVENTION MUST
INCLUDE EQUIPPING YOUNG
PEOPLE WITH AN EMOTIONAL
LANGUAGE TO REPLACE PHYSICAL
ACTIONS AS A REPLACEMENT, E.G.
SELF-HARM, PROTRUDING BONES,
ETC

27.  “It isn’t that I don’t want to talk or engage with therapy, its
more I don’t know how to. I knew there was something
wrong but couldn’t find the words, couldn’t connect the dots,
and when your faced with knowing somethings wrong and
not knowing why – what can you do?”

28.  “It’s not that they don’t want to connect with (with you as a
therapist), they just don’t know how to do it correctly… they
might not want to be in the room with us but there is a drive
underneath to connect, they might not know what they want
or what is wrong or what to do or how to talk about it but
there is an intrinsic want to connect. They are still in that
room with you week after week.”

29. TASK
 Why is it good to have an eating disorder?

30. Emotional
Regulation
MY EATING DISORDER WAS
LIKE A GOLDEN KEY, IT HELPED
ME COPE WHEN THINGS WERE
TOO DIFFICULT

31. Emotional Intelligence and Eating Disorders
– explaining ambivalence
 The individual is unable to
effectively regulate their emotions
and cope with the distresses of
their life (e.g. low EI skills)
 The eating disorder acts as a means
to regulate emotions therefore it
has a positive purpose
“There’s a mash of emotions
squashed in together… I found
myself looking for a way to dull
that, to numb that, to quash all
of those emotions - to avoid
feeling, to get to a place of not
feeling. Something inside me
worked out that food could
bring about this numbing of
feelings... it’s all about numbing
the feelings.”

32. When we don’t
give alternative
to the negative
coping what else
do we expect
people to do?

33.  Eating disorder essentially had a “purpose” at that time to cope with life events. Such
descriptors were positive with a number of participants referring to the disorder as
helpful “… like a golden key”, “…a safe place” or “… a comfort blanket”.
 It can become a positive, something that works and something that effectively helps
that person manage the unmanageable and intense emotions they are constantly
faced with, leads to a difficult position for individuals in which professionals are asking
them to give up this “… wonderful thing that actually works”. The fact that these
behaviours have a purpose, that seemingly works for a period of time, directly impacts
of readiness to change, help seeking and treatment engagement as individuals are not
ready to let that golden key go.

34. “An eating disorder is a way of coping with
emotions”
Individuals will be unable to express their emotional distress, unable to
interpret bodily sensations and arousal states used to evoke change in
treatments and the therapeutic relationship may be less effective without the
awareness of empathy.
Individuals less able to express, manage and cope with their emotions have
been found to be less able to respond to therapeutic interventions with
research suggesting that such therapies being possibly damaging to these
individuals.
Horney (1952); Kelman (1952)

35. Why are you pointing this out…?
 If we don’t give people the ways to cope without the disordered behaviour why are
we surprised when they relapse, get worse or progress to having a full condition.
 These need to be real and helpful; moving beyond the tradition go for a walk, be
mindful and talk.
 Learning to recognise emotions, signs, triggers, having a safe plan… things many of us
don’t think!

36. Providing an alternative
This is not a simple solution but we need to make
it easier for people to understand and find their
solutions.
What is a health coping mechanism?
What does good mental health look like? Beyond
the absence of illness…
What is a good coping strategy?

37. What can we do?
HOW CAN WE DESIGN
INTERVENTIONS THAT
ADDRESS THIS ISSUE EITHER IN
RELATION TO PREVENTION OR
EARLY TREATMENT?

38. Implications to Practice
 Where individuals are less able to communicate their emotions the eating
disorder may become a means of expressing their distress physically
 This has implications to practice within counselling and treatment as we as
professionals rely on out clients or patients to express their emotions and
tell us what is wrong
 Horney (1952) found that such patients with difficulties expressing their
emotions became frustrated with psychotherapies and resulted in high
drop-outs

39.  We therefore need to address these issues in collaboration and provide a holistic
approach to addressing the multiple maintenance factors that challenge
engagement and behavioural change.
 In the classroom from an early age we need to address emotional life and teach kids an
emotional language, ways to express their emotions and how to regulate them
 Provide support at key trigger times, e.g. university transition
 Promote mental health not mental illness
 Create tangible EI tools beyond “self-help”

40. Thank you FOYE-U@EMAIL.ULSTER.AC.UK