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Emotional expression, self-silencing, and distress tolerance in anorexia nervosa and chronic fatigue syndrome

Authors

  • David Hambrook,

    1. Division of Psychological Medicine and Psychiatry, Section of Eating Disorders, King's College London, Institute of Psychiatry, UK
    2. Division of Psychological Medicine and Psychiatry, Section of General of Hospital Psychiatry, King's College London, Institute of Psychiatry, UK
    3. Doctorate in Clinical Psychology, Department of Psychology, Royal Holloway, University of London, UK
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  • Anna Oldershaw,

    1. Division of Psychological Medicine and Psychiatry, Section of Eating Disorders, King's College London, Institute of Psychiatry, UK
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  • Katharine Rimes,

    1. Division of Psychological Medicine and Psychiatry, Section of General of Hospital Psychiatry, King's College London, Institute of Psychiatry, UK
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  • Ulrike Schmidt,

    1. Division of Psychological Medicine and Psychiatry, Section of Eating Disorders, King's College London, Institute of Psychiatry, UK
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  • Kate Tchanturia,

    1. Division of Psychological Medicine and Psychiatry, Section of Eating Disorders, King's College London, Institute of Psychiatry, UK
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  • Janet Treasure,

    1. Division of Psychological Medicine and Psychiatry, Section of Eating Disorders, King's College London, Institute of Psychiatry, UK
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  • Selwyn Richards,

    1. Poole Hospital NHS Foundation Trust, UK
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  • Trudie Chalder

    Corresponding author
    1. Division of Psychological Medicine and Psychiatry, Section of General of Hospital Psychiatry, King's College London, Institute of Psychiatry, UK
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Professor Trudie Chalder, Academic Department of Psychological Medicine, King's College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK (e-mail: trudie.chalder@kcl.ac.uk).

Abstract

Objectives. Difficulties in processing emotional states are implicated in the aetiology and maintenance of diverse health conditions, including anorexia nervosa (AN) and chronic fatigue syndrome (CFS). This study sought to explore distress tolerance, self-silencing, and beliefs regarding the experience and expression of emotions in individuals diagnosed with AN and CFS. These conditions were chosen for this study because their clinical presentation is characterized by physical symptoms, yet cognitive behavioural models suggest that emotional processing difficulties contribute to the aetiology and maintenance of both.

Design. A between-subjects cross-sectional design was employed.

Methods. Forty people with AN, 45 with CFS, and 48 healthy controls (HCs) completed the Distress Tolerance Scale (DTS), Silencing the Self Scale (STSS), Beliefs about Emotions Scale (BES), and measures of clinical symptomatology.

Results. Initial group comparisons found that both AN and CFS participants scored higher than HCs on a subscale measuring difficulties in distress tolerance. AN and CFS participants were also more likely to judge themselves by external standards, endorse statements reflecting a tendency to put the needs of others before themselves, and present an outwardly socially compliant image of themselves whilst feeling hostile within. Relative to HCs, AN participants reported more maladaptive beliefs regarding the experience of having negative thoughts and feelings and revealing these emotions to others, with CFS participants showing a non-significant trend in the same direction. After controlling for differences in age, anxiety, and depression the only significant difference to remain was that observed for the STSS care as self-sacrifice subscale. More maladaptive beliefs about the experience and expression of emotions were associated with greater degree of eating disorder symptomatology in the AN group.

Conclusions. Differences in emotional processing are present in AN and CFS compared to HCs, with some disorder-specific variation, and may be associated with greater clinical symptomatology. These findings support current explanatory models of both AN and CFS, and suggest that emotional processing should be addressed in the assessment and treatment of individuals with these illnesses.

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