alexithymia

Ruminating on emotions rather than processing them.

This study (1) is an excellent one which looks at both emotion processing deficits and also emotional dysregulation in eating disorders. It also importantly  demonstrates how  these are mediated by distress. This is an important aspect to our conceptualisation of addictive behaviours.

We suggest that if emotions are undifferentiated and difficult to label and thus processed, this gives rise to a feeling state or somatic confusion, registered as an unpleasant or distressing feeling state which propels the addicted individual or person with eating disorder to act or rather react to this distress. To act impulsively/compulsively to relieve this distress. Those there is a sequel here – lack of differentiation of emotion, so emotion unprocessed, registers as a distress state which then leads to a maladaptive reaction, a compulsive to relieve distress which in other words is emotions not being regulated, i.e. emotional dysregulation.

This emotional dysregulation can appear in the mind, or in cognition, as repetitive, worry or anxiety based thoughts.  In terms of emotional dysregulation this is known as rumination, the constant returning to negative emotions and churning them over in the mind, in a viscous cycle that only worsens the negative emotions and thoughts associated.

In our next blog we will wee how this emotional processing deficit, alongside distress (negative urgency) can actually  turn into obsessive thinking, the type of obsessive thinking that many addicted individuals are well aware of and engage in on a regular basis, even in recovery.

This shows, as does this article (1) that there is a link between emotion processing deficits, mediated by distress which gives rise to emotional dysregulation as measured by levels of rumination.

“The literature on emotional processing among women with eating disorders (EDs) has focused on two main issues. The first is the specificity of the
relationship between anorexia nervosa and bulimia nervosa on the one hand, and emotional processing deficiency on the other.

Studies on emotional awareness and EDs emphasize the relationship between alexithymia and anorexia nervosa [Bruch, 1973; Jimerson et al., 1994]. Alexithymia is defined as three core affective–cognitive deficiencies: (1) difficulty in identifying feelings; (2) difficulty in describing feeling; and (3) limited imagination capacity and externally oriented thinking [e.g.,
Bagby et al., 1994; Taylor et al., 1992, 1996].

Alexithymia has been almost exclusively assessed using the Toronto Alexithymia Scale [TAS; Bagby et al., 1994]. Since Bruch’s [1973] description of the cognitive and emotional difficulties apparent in women with anorexia nervosa (ANs), deficiencies in emotional awareness have been viewed as one of the main characteristics of this condition. Indeed, Taylor et al.
[1996] have found significant differences between ANs and normal controls (NCs) on the affective factors of the TAS. Specifically, ANs reported greater difficulty in identifying their emotions and in describing their feelings to others. No significant differences were found between ANs and NCs on the cognitive aspect of externally oriented thinking So far, studies examining emotional awareness in EDs have relied solely on the concept of alexithymia as
measured by the TAS. However, several recent investigations have highlighted the need to rely on additional measures of emotional awareness (e.g.,
Zonnevylle-Bender et al., 2004; Lundh et al., 2002].

As noted by Lundh et al., the notion of alexithymia relies on a deficit model of emotional processing in that it emphasizes difficulties in identifying and describing feelings (and in differentiating between feelings and bodily sensations) and is assumed to involve an impaired capacity to construct mental representations of emotions, a capacity needed for both the cognitive processing of emotional experiences and the verbal communication of such experiences to others. 

Emotional Dysregulation – Difficulty in regulation of negative mood has been
linked almost entirely to bulimia nervosa [Cooper et al., 1988; Leon et al., 1993; Stice et al., 1998; Telch, 1997]. Emotional regulation refers to the processes by which individuals influence how they experience and express their emotions. Emotional regulation involves changes in the temporal unfolding of emotional states: the latency, rise time, magnitude, and duration of responses in behavioral, experiential, and physiological reactions [Gross, 2002]. The association between emotional regulation difficulties and bulimia nervosa is based on the bingeing–purging cycles characteristic of this disorder, because the bingeing and purging episodes are seen as methods of regulating negative affect. Specifically, these cycles might enable a lowering of consciousness to painful mental and cognitive states [Everill et al., 1995; Heatherton and Baumeister, 1991].

The bingeing–purging behavioral cycle does not exist in the restrictive subtype of anorexia. However, findings from a recent study suggest that excessive exercising in anorexics may be an alternative mechanism replacing the bingeing–purging cycles typical to bulimia, and might serve as a strategy for emotional regulation in anorexia [Pen˜ as-Lledo´ et al., 2002]. In addition, there is evidence indicating that ANs use strict food restriction
to regulate dysphoric affective states. Polivy and Herman [2002] claim that by refocusing the attention on weight, figure, and food consumption, a certain
sense of emotional control can be achieved.

The deficient emotional processing hypothesis forwarded by this study and
the distress mediation hypothesis were fully supported.

Data suggest that eating disorders may not be pathologies restricted to domains of eating behavior and body image but may also be related
to significant difficulties in affective functioning.

We also found that rumination was associated with eating disordered pathology over and above the influence of emotional distress. (Rumination is linked to emotional dysregulation as mentioned above).

The link between eating disordered pathology and rumination may be mediated by the experience of shame.”

References

Gilboa‐Schechtman, E., Avnon, L., Zubery, E., & Jeczmien, P. (2006). Emotional processing in eating disorders: specific impairment or general distress related deficiency?. Depression and anxiety, 23(6), 331-339.

 

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