Implications and Suggestions for Future Research

In document The Role of Self-Disgust within Disordered Eating Behaviour (Page 181-185)

Chapter 6: A Qualitative Enquiry into the role of Self-Disgust within recovering from an Eating

7.5 Implications and Suggestions for Future Research

ACADEMIC IMPLICATIONS

Several academic implications can be taken from the overall findings. First, more research is needed to

investigate the role of self-disgust within disordered eating behaviours that include participants who

are male and also who identify as having a range of different types of ethnicities. The emotion of self-

disgust is particularly culturally and morally bound, in that the operationalisation and transmission of

182 Furthermore, the self-disgust response is argued to be an implicit appraisal of the self; as a repulsive

object to others into the broader socio-cultural group (Powell, Overton & Simpson, 2015). With this

in mind, people may be more likely to report disgust responses to particular aspects of themselves that

aline with the expectations of their sociocultural environment. This may include symptoms of poor

fertility (which is often viewed as unattractive) (Tybur et al., 2013), physical symptoms that mimic

disease (being overweight, acne) (Oaten, Stevenson & Case, 2011) or characteristics of the self that

defy or violate the moral domain of purity and the idealised body border (Horberg et al., 2009;

Gutierrez & Giner-Sorolla, 2007). How moral and cultural differences, concerning eating behaviours

vary across ethnicities and the role self-disgust may play in this, warrants further academic

investigation.

Second, more research is also needed that includes larger samples of males who suffer from disordered

eating behaviour. Some literature that has looked into levels of self-disgust in males suggests that men

in general experience less disgust towards themselves compared to females (Ille et al., 2014; Palmeria

et al., 2017). The presentation of disordered eating behaviour among men is often different to the

behaviours observed in females, and this difference is not yet accommodated within current diagnostic

and classification schemes (Murray, Griiffith & Mond, 2016); more research is needed to understand

how males with eating disorders define the emotion of self-disgust and whether this impacts on their

eating behaviour.

Third, the findings from this thesis suggest that those with specific sensory processing patterns may be

more vulnerable to experience higher levels of self-disgust, and this, in turn, is associated with

disordered eating behaviours. The demonstrated relationship between sensory processing and

disordered eating behaviour is novel, and only a few studies have demonstrated significant

associations between these two factors (Zucker et al., 2013; Bell et al., 2017) however there is an

increasing amount of literature that has focused on the role of sensory processing in Autistic Spectrum

Disorder (ASD) Traits and eating behaviour. For example, Engel-Yeger, Hardal-Nasser & Gal (2015)

183 intellectual developmental deficits and smell/taste sensitivity was found to predict food selectivity and

refusal significantly. In a recent review, Westwood and Tchanturia (2017) examined eight studies that

investigated the presence of ASD in those with a diagnosis of AN, with all findings reporting elevated

ASD symptoms within populations of people with this eating disorder. In line with this, interoceptive

deficits (i.e. one’s ability to recognise internal bodily states) are known to impact a person with an eating disorder and also in those who have recovered (Jenkinson, Taylor & Laws, 2018). Therefore,

more research is needed to understand further how sensory processing thresholds may make someone

with an eating disorder more predisposed to experiencing self-disgust and the role ASD traits and

interception may play within this.

Finally, the dynamic model put forward within this programme of research requires further testing and

confirmation of findings is required within more diverse samples of people who suffer from disordered

eating behaviour. Future research could examine the relationship between sensory processing and self-

disgust within younger, adolescent populations before the development of an eating disorder; to

examine whether these factors are contributors to the aetiology of disordered eating behaviour.

Research is also needed within other types of eating disorders as the sample included within all studies

of this programme of research were self-diagnosed with either AN or BN. Although it is argued that

self-disgust is something that occurs within the spectrum of disordered eating behaviour (Bell et al.,

2017) further evidence is needed to examine the role it may play within BED and OSFED. Given that

roughly 30% of people seeking treatment for disordered eating behaviour suffer from OSFED (APA,

2013), it is particularly pertinent to consider the role of self-disgust within this disorder.

CLINICAL IMPLICATIONS

The findings from this research programme support the notion that people with an eating disorder do

experience self-disgust more than people with no history of disordered eating behaviour (Moncrieff-

Boyd & Nunn, 2016; Bell et al., 2017; Palmeria et al., 2017) but add to knowledge by demonstrating

that this emotion is associated with difficulties in emotion regulation and particularly lack of

184 behaviour over time, and it appears to be something people with an eating disorder experience after

recovery. To date, self-disgust is not routinely checked or screened for within clinical practice. As

self-disgust is a meaningful and distinct phenomenon (Clark, Simpson & Varese, 2019) examining the

behavioural and psychological consequences of this emotion could inform the assessment, formulation

and interventions of disordered eating behaviour.

Experiencing self-disgust could potentially affect an individual who suffers from an eating disorder

presentation at assessment. For example, a person could be engaging in avoidant type behaviours,

have difficulty expressing or understanding their emotions or hold negative or critical thoughts about

their bodies or eating behaviour. These types of cognitions or behaviours could be considered within

their relationship to food or how their perceptions of how other people view them. Generation of

initial hypotheses in this area have the potential to inform future assessment. Furthermore, the

physiological, cognitive, behavioural and subjective emotion states associated with self-disgust

reactions could inform the formulation and subsequent interventions for disordered eating (Clark et al.,

2019).

Existing interventions have the potential to be developed and adapted to encompass the role of self-

disgust within disordered eating behaviour. Within this thesis, participants described how events such

as clothes shopping, gaining weight or being able to feel that their clothes were tighter were some of

the events that would trigger feelings of self-disgust. Self-disgust has been defined as an emotion

schema, which can be accompanied by a range of maladaptive cognitions and behaviours (Powell et

al., 2015). Focusing on “unlearning” maladaptive disgust responses and being able to recognise when those emotions may be triggered could be on avenue for future investigation.

Developing a tool that facilitates conversations around emotions and particularly discussions around

self-disgust is highly pertinent as self-disgust has been identified to have an impact on all stages of an

eating disorder and that it is associated with lack of emotional clarity. A particular focus could be

185 may have on their eating behaviour, however further qualitative work could be conducted to determine

precisely how participants would prefer to approach this conversation. Continuing those conversations

into recovery and supporting people with an eating disorder as they gain weight may not only help

them to understand self-disgust more but enable the person to build up to skills to regulate and manage

this distressing emotion as their bodies begin to change.

Powell, Simpson & Overton (2015) found that affirming psychological traits reduced feelings of

disgust towards physical appearance and there are already several therapeutic interventions that target

the high levels of self-criticism and shame experienced by those with an eating disorder (Goss &

Allan, 2014. For example, Compassion‐Focused Therapy for the treatment of Eating Disorders (CFT- E; Goss & Allan, 2014) was designed to address self-directed hostility, self-criticism and shame and

suggest that eating disorder behaviours serve a functional purpose in attempting to regulate the threat

associated with these negative emotions. Goss & Allan (2014) argue that focusing on increasing self-

compassion and activating clients ‘soothing systems’ may, in turn, may lower disordered eating behaviours and help someone move towards recovery. More traditional, cognitive-behavioural

treatments for eating disorders are effective; however, they do not necessarily target negative emotions

such as self-disgust or identify the impact these may have on disordered eating behaviour (Stiendle et

al., 2017). With this in mind, more research is needed to understand whether therapies using

compassion can lower self-disgust in those with an eating disorder and how this may compare to more

traditional forms of therapy (such as CBT).

In document The Role of Self-Disgust within Disordered Eating Behaviour (Page 181-185)