Emotional differentiation and parental bonding in inpatients suffering from eating disorders

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.

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).

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.

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.