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Emotional intelligence and eating disorders
The document discusses the importance of emotional intelligence (EI) in the prevention and treatment of eating disorders, arguing for early intervention that goes beyond traditional diagnostic models. It highlights how disordered eating behaviors can be seen as a means of coping with emotional distress and emphasizes the need to equip individuals with emotional language and coping strategies. Additionally, it calls for a holistic approach in practice to address the various factors that contribute to eating disorders, while encouraging education on emotional regulation from an early age.
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Emotional intelligence and eating disorders
- 1. "The body isa battleground for unwanted and unexpressed emotion” EXPLORING THE ROLE OF EMOTIONAL INTELLIGENCE AS A TOOL IN TREATMENT AND PREVENTION
- 2. Outline Introduction Whatis 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…? ANDHOW CAN WE ACHIEVE IT WHEN KEEPING TRUE TO DSM CRITERIA AND MEDICAL SYMPTOMS?
- 5. According tothis diagnostic model you either have an eating disorder or you don’t People with ED’s People without ED’s
- 6. By thetime 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 asa 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 earlyrecognition 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 aneating 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 modelof 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 toput 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 interventionwe 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 isan 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 Focuson 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 Individualswith 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 wordsfor 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) EmotionalIntelligence 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 Individualswith 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
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- 21. Feeling lost, confusedand 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’tunderstand 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
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- 24. Without an emotionalvoice 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 lackof 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’tthat 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 notthat 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 isit good to have an eating disorder?
- 30. Emotional Regulation MY EATING DISORDERWAS LIKE A GOLDEN KEY, IT HELPED ME COPE WHEN THINGS WERE TOO DIFFICULT
- 31. Emotional Intelligence andEating 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 givealternative to the negative coping what else do we expect people to do?
- 33. Eating disorderessentially 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 disorderis 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 youpointing 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 Thisis 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 wedo? 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 thereforeneed 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”
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Editor's Notes
- #18 Emotional Intelligence refers to the overarching rules and laws employed within our emotional processes, including our appraisals, management, understanding and awareness of both our own and others emotions. Key within these branches of EI is the regulation of emotions, i.e. Coping. Literature shows that those high in EI have high ability to facilitate and cope with stress and to effectively self-regulate distressing situations. Those low in EI however have been shown to be less able to do so and are likely to engage in avoidance strategies when faced with distressing situations. *The lower end of the EI construct has been closely associated with Alexithymia (via factor analysis) reflecting low emotional awareness and functioning resulting in emotional dysregulation and impairments. School based interventions using EI skills training aimed at increasing communication and coping found significant results in reducing risk behaviours such as bullying, teen pregnancy, smoking, violence and depression. Academic achievement and attendance improved in follow ups. Research has found EI as an important factor in subject well being and health behaviours with those high in EI reporting higher levels of life satisfaction and well being, and lower levels of smoking, alcohol use, gambling, self harm, and binge eating. Those low in EI had significantly higher levels of these behaviours. ** Theory suggests that those high in EI will having 1. better coping skills / management of emotions 2. will be more able to communicate & express distress to others (V & n/V) 3. better understand their own and others emotions 4. awareness of bodily sensations due to emotional arousal 5. effective self regulation of emotions EI is a spectrum of these abilities