Participants spoke about their negative perceptions of emotions and thinking that emotions were dangerous. For some, emotions were overwhelming or were associated with negative consequences. Anger, for example, was often associated with violence.
“It [anger] has serious repercussions on the person it’s directed at... usually violent in some way”. [Sue]
In other cases, emotions were perceived as futile, a weakness, or something that interfered with participants’ struggles to survive. For those participants with particularly powerful and aversive beliefs about emotions, this seemed to be linked with adversity. Nadine, who has a long-term physical health problem, explained that she has always just had to ‘get on with it’.
“I think if I was to be a really emotional person then I would get nowhere in life.”
[Nadine]
This appeared to pose a barrier to reaching out and talking about feelings that was part of recovery and growth for other participants.
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The expression of emotions was seen as socially unacceptable and participants were conscious of how their emotions might be perceived by others, for example as melodramatic, selfish or attention seeking. Many could relate this to family narratives.
“I think in my family there was a bit of distain for people who were kind of perceived as being melodramatic or attention seeking.” [Maddie]
There was a sense that participants felt they just should not be feeling whatever they were feeling. Rachel linked this with being made to feel that she couldn’t have emotions from a young age and being very conscious of the impact it might have on others.
“Growing up I felt I couldn’t have any emotions […] because she [Mum] even said […] Rachel if you get down while I’m out and can’t cope it will make me down. So I feel I can’t always be myself.” [Rachel]
3.2.2 Category 2: Avoiding emotions
All participants spoke of not wanting to experience emotions and of blocking their emotions. Participants recounted how as anorexia developed and they became emaciated, they became numb to emotions altogether.
“When I was like very thin like emaciated I didn’t feel anything” [Mo]
Sue, who has an extensive history of abuse, described how she had become so cut-off that she didn’t even know what emotions felt like. For others, it was more of a reactive process, but even here it was experienced as automatic.
“I’m quite good at shutting them [emotions] off quite quickly… you just do it without thinking. So it’s like dancing you know. I have movement memory […] So I think part of it is actually habitual for me now”. (May)
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Participants spoke of using behaviours to avoid emotions, for example distracting themselves from their emotions (i.e. listening to music), displacing emotions (i.e. harming self to cause physical pain), and responding physically (i.e. running off energy). Behaviours associated with anorexia played a significant role in this. For example, they spoke of exercise and restriction distracting them from all other worries, and purging and laxative use leading to a feeling of emptiness.
“So I think I linked the feeling full with the feeling of being full with emotion […] And
just getting that with purging it’s just out it’s out of my body.” (Grace)
Although anorexia was perceived to be associated with its own anxieties, these somehow seemed preferable to other anxieties.
“It (anorexia) like reduces your anxiety and worry to that [numbers on a scale] instead of like the irreducible complexity of worries about relationships or your place in the
world.” [Maddie]
3.2.3 Category 3: Experiencing self-doubt
There was an overriding sense that participants questioned themselves regularly in multiple ways. They spoke about questioning the legitimacy of their experience and of needing a reason to feel a certain way. They questioned their judgement, particularly in relation to food. “Should I have had that to eat? Should I have not had it? Do I need that to eat? Do I
not need it? Have I had too much?” [Rachel]
Self-doubt also occurred in relation to other things.
“[..] constantly needing somebody […] to check that my keys and purse are in my bag
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Participant’s self-doubt appeared to be linked to feeling dependent on, or even subservient to, others. Handing over responsibility to parents, partners and professionals seemed to feel safer or easier than being responsible for oneself.
“I mean when I’m in hospital it’s very easy to just do the eating part because someone else is taking the responsibility for it. I’m just doing it.” [May]
Participants gave examples of feeling confused about their experiences and their behaviour, and having little confidence in their autonomy or self-control. They also spoke about not understanding their emotions and feeling ill-equipped to manage them.
“Yeah when I can’t deal with emotions I can’t seem to get my head straight to be able
to think about what I’m feeling.” [Grace]
3.2.4 Category 4: Creating a more predictable and less uncertain world
Participants talked about the importance of routine and structure in their lives, which they associated with reducing uncertainty. Anorexia and other things, including shopping, work, and obsessive and compulsive behaviours, gave participants routine and structure. They spoke about the sense of safety and security this provided.
“…like having to have the structure and doing exercise continuously. I just felt like it
kept me safe even though it was incredibly unsafe.” [Claire]
May spoke about the lack of routine in her life after moving to university as being a direct precipitator to her obsessions around eating. Planning and predictability appeared to be important for participants in achieving a sense of control.
“I suppose complete and utter control[…] definitely in terms of going out to eat […] I
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Other aspects of creating more predictability and reducing uncertainty were filling time, particularly to avoid thinking and worrying, keeping things simple, and sticking to the rules.
“Suddenly there wasn’t anyone to give me any rules so I had to create my own […] But
now I have my rules and I can stick to them”. [Sue]
In many ways, creating their own rules enabled participants to develop a greater sense of independence from other people. However, in contrast to category 10 described below, this also appeared to stifle the development of a more intrinsic sense of autonomy in which
participants would be able to trust their instinct and be more spontaneous.