In eating disorder patients, an impairment of emotional processing is clinically supposed. As quoted by Bruch (1985), anorexic patients not only show impaired differentiation between hunger and satiety, but they can hardly differentiate their physical sensations from their intimate emotions, which they often cannot describe. Bulimic patients often respond to stress with a bulimic crisis and vomiting, but they can hardly correlate their crisis with any emotional stimulus (Davis, Marsh, 1986).

Several studies suggest that alexithymia is a predominant factor in eating disorder.

Emotional awareness was defined by Lane and Schwartz in the late 1980s as the capacity of an individual to describe his or her own feelings and another person’s emotional experience (Lane & Schwartz, 1987). Lane and Schwartz  conceptualised emotional awareness as a cognitive process undergoing various structural transformations along a cognitive-developmental sequence (1987,
p. 134).

Lane and Schwartz focused on a way to measure the level of emotional awareness an individual has reached. For these authors, the degree of structural organization of emotional awareness is reflected by the verbal material individuals provide to describe their emotional experience. They pinpoint that emotional experience does not require language to be conscious, but that language helps to structure and
establish concepts, and therefore increases the ability to discriminate between differentiated emotional states.

From this point of view, Lane, Quinlan, Schwartz, Walker, and Zeitlan (1990) elaborated the Levels of Emotional Awareness Scale (LEAS), which is aimed at evaluating an individual’s capacity to describe not only his or her own emotional experience but also the emotional states of others. The scoring of this instrument is based on the analysis of the verbal contents the individual provides in response to a series of 20 short stories depicting a variety of emotional situations. The discriminant validity of this instrument has confirmed that the level of emotional awareness is independent of depression and anxiety (Bydlowski et al., 2002;
Lane et al., 1990).

 

Alexithymia was considered by Lane and Schwartz  as corresponding to the lower end of the emotional awareness continuum, that is, the preconceptual level of emotion organization and regulation within their hierarchical model. Indeed, alexithymia can be viewed as a deficit in the cognitive processes involved in the representation of emotional internal and external experiences, characterized by the
persistence of cognitive-affective modalities of the first levels of development, below the concrete operational level (where emotions are experienced somatically).

 

 

This study (1) in accordance with their initial hypothesis, demonstrated that patients suffering  from eating disorders showed evidence of an emotion-processing deficit independent of affective disorders, such as anxiety and depression.

In the current study, individuals with an eating disorder were characterized by a global emotion processing deficit, with impaired ability to identify their own emotions, as well as an impairment in judging others’ emotional experience.

In our study, anorexic patients had a significantly lower level of emotional awareness than bulimic patients, Our results are in line with those
of Smith, Amner, Johnsson, and Franck (1997), who showed a marked tendency of these patients to develop alternative strategies to avoid empathizing.
These strategies are not limited to the restricted use of emotional words. According to the authors, eating disorder patients have good verbal skills, but
cannot use them adequately to describe their emotional experience, indicating a pronounced in capacity for emotional understanding.

The current report is also consistent with clinical descriptions of the types of affective difficulties characteristic of anorexics and bulimics. Indeed, some authors consider the deficits in the processing of the subjective experience and the perception of oneself as the most fundamental difficulties of this type of disorder (Corcos, 2000; De Groot & Rodin,
1994; Jeammet, 1997).

These subjects seem to have a limited access to their emotional life and/or feel easily dominated and overwhelmed by their emotions  (Bruch, 1962). Thus, the ability to take into account one’s own emotions is diminished in individuals  with eating disorders, probably because body sensations cannot be related to affects, or because the perception of undifferentiated body impulses prevents understanding of how affects are elaborated. Lacking knowledge of their own emotions, these individuals are not able to represent another person’s emotional experience.

Because the capacity to differentiate one’s own and others’ emotions in a given context is associated with the ability to tolerate and manage a large number of emotional states, emotions that are not integrated remain global and undifferentiated, which leads to an incapacity to use affects to guide the selection of an adapted behavior (Krystal, 1974),

These emotion-processing deficits induce intense, often uncontrolled, affective reactions. The food related behavioral problems of anorexic and bulimic
patients have been conceptualized as a consequence of the incapacity to control distressing emotions through psychic processes (Taylor, 1997a).

Abnormal eating behaviors would thus represents a way of discharging negative affects.

With the demonstration of increased secretion of cerebral b-endorphin in patients with anorexia nervosa perhaps eating disorders should, therefore, be regarded as addictive behaviours, whose purpose is to control the subject’s affective inner turmoil (Jeammet-1997).

The finding that neither level of emotional awareness scores nor alexithymia scores were correlated with the duration of illness suggests that emotional internal life impoverishment is not due to the severity of the disorder. One may wonder whether this deficit predates the occurrence of the disease, potentially favoring the development of eating disorders. This hypothesis is in line with the point of view of some authors who consider alexithymia to be a predisposing factor in addictive behaviours (Taylor, 1997a, 1997b).

References

1. Bydlowski, S., Corcos, M., Jeammet, P., Paterniti, S., Berthoz, S., Laurier, C., Chambry, J. and Consoli, S. M. (2005), Emotion-processing deficits in eating disorders. Int. J. Eat. Disord., 37: 321–329.