John R. E. Fox

eating disorders and multi-level models of emotion: an integrated model

This paper examines the relationship between emotions, depression and eating disorders. Initially, a review is undertaken of the current state of the research and clinical literature with regard to emotional factors in eating disorders. This literature is then integrated within a version of the multi-level model of emotion proposed by Power and Dalgleish. The aim of this paper is to incorporate a basic emotions, multi-modal perspective into developing a new emotions-based model that offers a theoretical understanding of psychological mechanisms in eating disorders. Within the new Schematic Propositional Analogical Associative Representation System model applied to eating disorders, it is argued that the emotions of anger and disgust are of importance in eating disorders and that the eating disorder itself operates as an inhibitor of emotions within the self. It is hoped that the development of a multi-levelled model of eating disorders will allow for the construction of number of specific testable hypotheses that are relevant to future research into the psychological treatment and understanding of eating disorders.

Altered social hedonic processing in eating disorders

OBJECTIVE Exploring social anhedonia in eating disorders (ED) was the main objective of this study. Social anhedonia relates to a reduced feeling of pleasure from social stimulation. Researching the exact nature of problems in interpersonal relationships is an important topic for clinicians and researchers in the field. METHOD The revised social anhedonia scale was completed by 148 participants: anorexia nervosa (AN) n = 72; bulimia nervosa (BN) n = 19; recovered AN n = 14; healthy controls (HC) n = 43. Participants also completed mood related measures and the Toronto Alexythimia scale. RESULTS People with AN and BN had higher self-reported social anhedonia than people without ED. Recovered AN had an intermediate profile in between AN and HC. Clinical severity and alexithymia were strongly associated with social anhedonia scores. DISCUSSION Difficulty identifying and expressing feelings could be related to this diminished drive for social pleasure. Tackling these interpersonal maintaining factors in treatment is likely to be a worthwhile endeavor.

A qualitative exploration of the perception of emotions in anorexia nervosa: a basic emotion and developmental perspective.

Difficulties in emotional processing have long been regarded as a core difficulty within anorexia nervosa. Recent research and theory have started to highlight how eating disorder symptoms are often used to regulate painful emotions. However, there has been a lack of theoretical sophistication in how emotions have been considered within the eating disorders. This study was designed to use qualitative methodologies to address these inadequacies and provide a richer, more thorough account of emotions within anorexia nervosa. It used a grounded theory methodology to gather and analyse interview data from 11 participants who had a diagnosis of anorexia nervosa, being seen at a regional eating disorder service (both inpatient and day patient). The results highlighted two main overarching themes regarding the perception and management of emotions within anorexia nervosa: (1) development of poor meta-emotional skills; and (2) perception and management of emotion in anorexia nervosa. These two categories comprised of a significant number of components from the qualitative analysis, including difficulties with anger, meta-emotional skills and poverty of emotional environments while growing up. Once the data had been collected and analysed, links were made between the findings of this research and the current literature base.

Eating disorders: a basic emotion perspective.

Recent research and theory have started to highlight how eating disorder symptoms are often used to regulate painful emotions. However, there has not been one study that has looked at the contributory effect of all the basic emotions onto disordered eating patterns. This study was designed to address this gap within the literature with a detailed examination of the five basic emotions (anger, sadness, disgust, fear and happiness) in relation to disordered eating patterns. This study used the Basic Emotions Scale and the Hospital Anxiety and Depression Scale to explore levels of emotions within 53 female participants with disordered eating patterns who were recruited from the B-EAT research database. The results showed strong correlations between disordered eating and the four negative emotions, but only anger and sadness were left as significant contributors to disordered eating within the regression analysis. These findings were discussed in relation to the literature, with particular reference being made to the new Schematic Propositional Analogical Associative Representation System for Eating Disorders (SPAARS-ED) model.

An exploration of the perceptions and experiences of living with chronic anorexia nervosa while an inpatient on an Eating Disorders Unit: an Interpretative Phenomenological Analysis (IPA) study.

Chronic anorexia nervosa (cAN) is a challenging presentation for the clinician. Motivation to recover is low, and outcomes are often poor. Within this study. six participants, currently in treatment, were interviewed. These interview transcripts were analysed using Interpretative Phenomenological Analysis. The results highlighted five superordinate themes resulted from the analysis and these referred to the following points: (1) ‘making sense of AN’, (2) ‘experience of treatment/treatment’, (3) ‘interpersonal relationships’, (4) ‘battling with anorexia’ and (5) ‘staff pessimism in the treatment of cAN’. These results highlighted how the self is entwined with anorexia nervosa and thus making it incredibly difficult to perceive a life without cAN.

First-time fathers’ experiences of parenting during the first year

Objective: The objective of this study was to explore the experiences of fathers during their first year as parents to fully capture their experiences and transition to parenthood. Background: Becoming a parent for the first time has a life-changing impact for both the mother and the father, yet the factors implicated in the transition to fatherhood have been under-researched. Methods: In this qualitative study using an interpretative phenomenological approach (IPA), 10 first-time fathers were interviewed 7–12 months after the birth of their baby. Results: Two super-ordinate themes were uncovered: experiences during pregnancy and fatherhood – the early days, which are supported by six sub-ordinate themes. Fathers’ narratives can be understood within the theoretical framework of Draper’s Transition Theory; early fatherhood represents the continuation of a man’s transitory journey, which starts during pregnancy. Conclusion: Despite increasing public awareness and socio-political changes affecting paternal parenting culture, fathers still seem to feel undervalued and unsupported when it comes to antenatal support. The antenatal period is a critical time in which to engage with and support motivated expectant fathers; antenatal psycho-education classes can be adapted to accommodate the needs of men. The mental health of the man has an impact on the woman in the antenatal and post-natal periods; addressing the needs of men during pregnancy can function as an early intervention for his family system and could reduce the financial cost to health services in the long term.

EFFECTS OF KANGAROO MOTHER CARE ON MATERNAL MOOD AND INTERACTION PATTERNS BETWEEN PARENTS AND THEIR PRETERM, LOW BIRTH WEIGHT INFANTS: A SYSTEMATIC REVIEW

The birth of a premature infant can have adverse effects on the mood of mothers and on the interaction patterns between parents and their preterm babies. The aim of the present systematic review was to examine whether the Kangaroo Mother Care (KMC) intervention can attenuate these adverse psychological effects of a premature birth by ameliorating negative maternal mood and/or promoting more positive interactions between preterm infants and their parents. The results showed that although findings of studies were inconclusive, there is some evidence to suggest that KMC can make a positive difference on these areas. Specifically, it was found that KMC can improve negative maternal mood (e.g., anxiety or depression) and promote more positive parent-child interactions. Limitations and directions for future research are discussed.

Sense of self and anorexia nervosa: A grounded theory.

OBJECTIVES The aim of this study was to explore the nature of the relationship between the self and the eating disorder in individuals with a lifetime history of anorexia nervosa (AN). DESIGN A qualitative design was used, given the exploratory nature of the study and the need to gain rich and in-depth data regarding the topic under investigation. METHOD Semi-structured interviews were conducted with 11 women with a lifetime history of AN. Interview transcripts were analysed using constructivist grounded theory methodology. RESULTS A theoretical framework of the nature of the relationship between the self and AN was developed, which included five related categories: AN taking over the self, AN protecting the self, sharing the self with AN, being no one without AN, and discovering the real me (accepting the fear). CONCLUSION Participants described a process of the self being taken over by AN to the point where it was shared with the eating disorder. This led participants to fear being no one without AN and to be unable to let go of the disorder, appreciating ANs ability to protect the self. To recover from AN, participants had to discover the real self, by accepting the fear of the unknown and separating the self from AN. The findings have important implications for the target of therapeutic interventions to improve recovery rates. PRACTITIONER POINTS The self is shared with the eating disorder in AN, and separating the self from AN is crucial to recover from the disorder. Therapeutic interventions for AN need to target the enmeshed relationship between the self and the eating disorder, as opposed to focusing exclusively on weight and shape concerns.

The experience of postnatal depression in South Asian mothers living in Great Britain: a qualitative study

Background: As the experience of what is termed as ‘postnatal depression’ (PND) in South Asian mothers living in Great Britain has received comparatively little attention, this study used a grounded theory approach to examine their understanding of PND. Methods: Ten South Asian mothers were interviewed from within the Greater Manchester area in England. They scored above 12 on the Edinburgh Postnatal Depression Scale and were interviewed 8–12 weeks after giving birth. Data were analysed using techniques associated with constant comparison and a grounded theory approach. Results and findings: The analyses showed that their experiences of PND were extremely dynamic and complex. Three core categories were identified and termed “internalising misery”, “Others will judge me and I feel on my own” and “I talk to my health professional and they don’t understand”. Conclusions: Potential links between these categories were considered and a tentative model for PND in South Asian mothers has been proposed. Some issues were specific to the experience of PND, but this sample also experienced “cultural clashes”, somatisation, isolation, poor input from services and barriers to and from services. The methodological limitations, clinical implications and areas for further research are considered.

The pregnant male: a metasynthesis of first-time fathers’ experiences of pregnancy

Objective: To synthesise qualitative study findings in order to gain an understanding of fathers’ experiences of pregnancy. Background: As the transition to fatherhood can be challenging, awareness of the factors facilitating or hindering expectant fathers’ adjustment is important. Our aim was to better understand the experiences of men during this significant life cycle phase, and to use this knowledge to advise health care professionals on how best to support men during this transition. Methods: We used Noblit and Hare’s metasynthesis approach to review and synthesise 13 qualitative studies relating to expectant fathers’ experiences of pregnancy. Results: The synthesis revealed five super-ordinate themes, which captured the emotional, psychological and physiological experiences of the expectant fathers during pregnancy: (1) Reacting to early pregnancy; (2) On the outside looking in; (3) The pregnant male; (4) A journey of acceptance; and (5) Redefining self as a father. Conclusion: Possible clinical implications and limitations of the metasynthesis approach are discussed. Relevant recommendations on how health professionals and services can be more effectively supportive of men during this period are outlined.