Emotional differentiation and parental bonding in inpatients suffering from eating disorders
Authors: Rommel Delphine , Nandrino Jean‐Louis , Antoine Pascal , Dodin Vincent 
Published: December 2012

Objectives

This study aimed (1) to determine whether inpatients with eating disorders (EDs) have difficulty differentiating their emotions and being aware of the emotions of others; (2) to investigate the link between actual skills in emotional awareness and the sense of self‐efficacy concerning these skills; and (3) to assess the impact of the quality of parental bonding on patients' levels of emotional awareness.

Methods

A sample of 44 inpatients with EDs, including a subgroup of 25 patients with restricting type anorexia nervosa (AR) and a subgroup of 19 patients with purging symptoms (PUR), were compared with 37 controls. All participants completed measures on emotional awareness (using the Level of Emotional Awareness Scale [LEAS]), alexithymia (using the Toronto Alexithymia Scale‐20 [TAS‐20]), and parental bonding (using the Parental Bonding Inventory).

Results

Inpatients with EDs reported difficulties in identifying and describing their feelings when using the self‐report questionnaire (TAS‐20). However, using a performance‐based instrument (LEAS), inpatients with ED exhibited no deficits in differentiating their emotional states, although AR patients experienced difficulties when differentiating the emotional states of others. Moreover, there was no significant association between the TAS‐20 and the LEAS scores, suggesting that the two measurements provide insight into different aspects of emotional processing. Regression analyses showed that maternal care had a positive influence on emotional awareness in the AR subgroup, whereas maternal overprotection had a negative influence on emotional awareness in PUR subgroup.

Conclusions

Inpatients with EDs do not present with deficits in personal emotional awareness despite their self‐perception. AR patients showed deficits in the emotional awareness of others. In patients with EDs, perceived maternal bonding influenced the development of emotional awareness, and this influence was dependent on the type of ED. Psychotherapies that focus on maternal bonding and emotional communication within the family unit may enhance emotional awareness in patients with anorexia or subclinical eating pathologies as an alternative.

Practitioner Points

Inpatients suffering from eating disorders do not have a deficit in emotional awareness despite their self‐perception.

Inpatients suffering from anorexia nervosa have deficits in recognizing the emotions of others.

Maternal care positively influences the levels of emotional awareness in patients with restricting type anorexia nervosa.

Maternal overprotection negatively influences the level of emotional awareness in bulimia nervosa and anorexia nervosa purging type.

Because it is important to explore emotional processes based on the type of eating disorders, our study is limited by its small sample size.

The use of the LEAS in this study is a limitation, as it does not take into account the accuracy of the patients' ability to label their own emotions.