Paper read at Eating Disorders Alpbach 2012,
Health Promotion and Prevention in Eating
Disorders and Obesity, The 20th International
Conference, October 18-20, 2012
Funded by Fonds Gesundes Österreich
University of Social Sciences and Humanities
Interoceptive awareness,
body size estimation and
emotional eating among
women with anorexia and
bulimia nervosa
Anna Brytek-Matera
The 20th International Conference
Eating Disorders Alpbach 2012
INTRODUCTION
Interoceptive awareness is defined as:
 the confidence of one s internal states which includes the awareness
of both physical (sensations) and emotional states, particularly as they
refer to specific visceral sensations relating to feelings of hunger or
satiety (Garner, Olmstead and Polivy, 1983);
 the human capacity to identify and describe personal and other
people s emotions (Ciarrochi, Caputi and Mayer, 2003);
 an individual sensitivity to stimuli originating within the body (Brown,
2010), to the signals of the body (Pollatos et al., 2007);
 uncertainty in the recognition of emotional states and difficulties to
distinguish sensations linked to hunger and satiety (Fassino et al., 2004).
Interoceptive awareness includes acceptance of affective experience as
well as clarity regarding emotional responses (Merwin et al., 2010).
INTRODUCTION
The cognitive components of body image, that is self-estimation of
one s own body image are defined on the basis of the (iggins selfdiscrepancy theory. This theory describes relationships that occur
between the cognitive and emotional-motivational states of the self.
The ideal self
The actual-ideal
self discrepancy
The actual self
The ought self
The actual-ought
self discrepancy
INTRODUCTION
Eating style refers to eating as a
result of experiencing and feeling
negative emotions or the inability
to deal with them and it is not a
response to internal stimuli
(emotional eating).
AN - R
AN - P
BN
Ricca et al., 2012
Eating style can also involve eating
as a result of non-biological factors
related to the need to satisfy
hunger (eating in response to
external stimuli).
Obesity
Ogden, 2010
OBJECTIVE
The aims of the presented study was to analyse:
 interoceptive awareness, body size estimation and eating style
(emotional or in response to external stimuli) in women with
and without eating disorders (comparison model);
 the relationship between interoceptive awareness, body size
estimation and eating styles in patients with eating disorders
(correlation model).
HYPOTHESES
H1. Having difficulties recognising bodily sensations will be higher in
patients with anorexia and bulimia nervosa than in healthy women.
H2. In women with eating disorders there will be a relationship between
interoceptive awareness and emotional eating.
H3. Self-state representations, that is the actual-ideal self-discrepancy and
the actual-ought self-discrepancy, will be higher in patients with eating
disorders than in the control group.
H4. The actual-ideal self-discrepancy will be lower and the actual-ought
self-discrepancy will be higher in patients with anorexia nervosa
compared to patients with bulimia nervosa.
POPULATION
Table 1: Characteristics of women with and without eating disorders
Patients with
anorexia
Variables
M
(SD)
Patients with
bulimia
M (SD)
Control
group
M
(SD)
ANOVA
F
p
12.37
ns
Age (in years)
20.13 (3.05)
21.37 (2.70)
19.27 (1.04)
Body Mass Index
17.42 (1.63)
21.58 (3.58)
20.57 (2.20) 17.16
Duration of illness
4.00 (2.61)
4.30 (2.25)
(in years)
-
.497
.001
ns
RESEARCH METHODS
The Interoceptive Awareness scale from the Eating Disorders
Inventory (Garner et al., 1983) measures difficulties identifying and
responding to emotional (e.g. When I am upset, I don t know if I am sad,
frightened, or angry and visceral states, the latter including feelings of
hunger and satiety (e.g. ) get confused as to whether or not ) m hungry .
 10-item subscale.
 Participants appraise their agreement with a series of statements on a
6-point Likert scale ranging from always to never.
 The most maladaptive response receives the highest score.
RESEARCH METHODS
The Contour Drawing Rating Scale (Thompson and Gray, 1995)
consists of nine female (for female participants) and nine male (for male
participants) silhouettes ranging in size from very thin (1) to obese (9).
The female participant was instructed to :
 pick the body figure that best represents how she feels she looks most
of the time (the actual self) .
 choose the figure that best represents her own ideal (the ideal self)
 select the figure that matched what she thought she looked like (the
ought self; Which of these figures would your family and friends like
you to resemble
RESEARCH METHODS
The Eating Styles Test (Brytek-Matera, 2010)
(1) Emotional eating - eating as a result of experience and feeling
negative emotions or the inability to cope with them. In this case, eating is
diminishing negative emotional states and does not result from
physiological hunger (scale contains 5 items, e.g. I only eat when I am
sad );
(2) Eating in response to external stimuli - refers to eating as a
result of non-biological factors related to the need to satisfy hunger (scale
contains 4 items, e.g. I only eat when someone informs me that it is
mealtime ).
RESULTS
Table 2: Comparisons on the EDI-IA for women with and without eating disorders
Interoceptive
awarenness
Patients with
anorexia [AN]
Patients with
bulimia [BN]
Control group
[CG]
14.91 (± 8.12)
14.78 (± 8.25)
1.60 (± 2.54)
Significance
p < .001
AN > GC
BN > GC
RESULTS
Table 3: Comparisons on the CDRS for women with and without eating disorders
Patients with
anorexia [AN]
Patients with
bulimia [BN]
Control group
[CG]
Actual self
5.13 (± 2.00)
5.70 (± 1.77)
4.47 (± 1.35)
p < .05
BN > GC
Ideal self
1.38 (± .57)
2.48 (± 1.25)
3.70 (± .95)
p < .001
AN < BN ; AN < GC
BN < GC
Ought self
4.88 (±1.89)
3.74 (± 1.48)
4.00 (± 1.14)
p < .01
Actual-ideal
discrepancy
3.75 (± 2.06)
3.22 (± 1.67)
0.77 (± 1.33)
p < .001
AN > CG ; BN > CG
Actual-ought
discrepancy
0.25 (± 2.34)
1.96 (± 2.21)
0.47 (± 1.33)
p < .01
p < .01
Significance
AN > BN
AN < BN
BN > CG
RESULTS
Table 4: Comparisons on the EST for women with and without eating disorders
Patients with
anorexia [AN]
Patients with
bulimia [BN]
Control group
[CG]
Emotional eating
10.29 (± 3.45)
12.20 (± 2.70)
7.63 (± 3.09)
p < .01
AN < BN
BN > CG
Eating in
response to
external stimuli
9.08 (± 1.84)
8.41 (± 1.67)
8.17 (± 1.62)
ns
Significance
RESULTS
Figure 1: Correlations between interoceptive awareness
and psychological variables among patients with anorexia nervosa
Intoreceptive
awareness
r = -.57
p < .01
Emotional
eating
RESULTS
Figure 2: Correlations between interoceptive awareness
and psychological variables among patients with bulimia nervosa
r = .39*
r = .44*
Intoreceptive
awareness
r = -.63*
* p < .05
Ought self
Ideal self
Emotional
eating
RESULTS
Table 6: Component Loadings Cronbach s total Alpha
patients with anorexia nervosa
Variable
Dimension
1
Variable
Dimension
2
Actual self
.99
Emotional eating
.95
Actual-ideal discrepancy
Actual-ought discrepancy
Ought self
Eating in response to external stimuli
.88
.76
.52
-.74
Interoceptive awareness
Ought self
Ideal self
.86
-.45
-.46
Proposed denomination of dimensions:
Dimension
.800) : self-representation / actual conduct
Dimension
= .627) : focus on emotion and sensation / focus on fantasy
Table 7: Component Loadings Cronbach s total Alpha
patients with bulimia nervosa
Variable
Ought self
Ideal self
Actual-ideal discrepancy
36)
Dimension
Variable
1
.79
Actual self
Actual-ideal discrepancy
.57
-.49
Ideal self
Actual-ought discrepancy
-.60
Eating in response to external stimuli
-.73
Emotional eating
Interoceptive awareness
-.73
-.75
Dimension
2
.98
.76
.52
Proposed denomination of dimensions:
Dimension
: fantasy / emotional dissatisfaction and eating habits
Dimension
: self criticism
CONCLUSION
Difficulties in identifying bodily sensations, feelings (including hunger and
satiety) and emotional states in people with eating disorders have an
influence on the degree to which the patient experiences body reaction.
In patients with anorexia and bulimia nervosa who have difficulties
descriminating bodily sensations and feelings, psychotherapeutic
treatment should focus on body-oriented psychotherapy and/or body
awareness therapy.
Psychotherapists might focus on broadening awareness of the feelings
related to the patients body, changing their body image assessment,
increasing the awareness of one s own body (e.g. through relaxation
exercises and/or kinesthetics), so that the body is no longer experienced
as alien but as an integral part of the self.
REFERENCES
Brown A.J. (2010). The role of interoceptive awareness in an Eating Disorders Prevention Program.
Thesis. Faculty of the James T. Laney School of Graduate Studies of Emory University.
Brytek-Matera A. (2010). Awareness of bodily sensations in person with eating disorders. In:
A. Brytek-Matera (ed.), Body in the contemporary times. Selected aspects of the body image issue.
(p. 68-90). Warsaw: Difin.
Ciarrochi J., Caputi P., Mayer J. (2003). The distinctiveness and utility of a measure of trait
emotional awareness. Personality and Individual Differences, 34, 1477-1490.
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REFERENCES
Higgins, E.T. (1987). Self-discrepancy: a theory relating self and affect. Psychological Review, 94,
319-340.
Merwin, R. M., Zucker, N. L., Lacy, J. L., & Elliott, C. A. (2010). Interoceptive awareness in eating
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Emotion, 24, 892-902.
Ogden J. (2012). The Psychology of Eating: From Healthy to Disordered Behavior. Wiley-Blackwell.
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Ricca V, Castellini G, Fioravanti G, Lo Sauro C, Rotella F, Ravaldi C, Lazzeretti L, Faravelli C. (2012).
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Thank you for your attention
Photography author: Marta Bauza