Managing Emotions in an Inpatient Setting

People with anorexia nervosa (AN) have a particularly hard time dealing with their emotions and have difficulty dealing with others’ expression of emotion. They will also suppress their own needs in order to meet those of others (Int J Eat Disord 2000; 28:8). According to L. Bell, people with eating disorders relate to themselves and to others in an idealized caring, neglecting, and criticizing way (Clin Psychol Psychother 1999; 6:29). In other words, they expect others to be perfectly caring (and themselves to be perfectly caring toward others), but instead often feel neglected and criticized.

To better understand factors that are important in the care and emotional management of people with eating disorders on an inpatient unit, Drs. Kathryn Pemberton and John R. E. Fox, of Lancaster University and the University of Manchester, UK, interviewed 7 women and 1 man with diagnoses of AN recruited from two specialist eating disorders services in Northern England (Clin Psychol Psychother 2011 Dec 14. doi: 10.1002/cpp.794. [Epub ahead of print]. All had body mass indexes lower than 16 kg/m.² A semi-structured interview was developed and all subjects were interviewed during eight sessions that lasted 30 to 45 minutes; all sessions were audiotaped. Observations about the staff’s experiences of their own and patients’ emotions were inferred from patients’ comments and from informal discussions with members of the staff but were not formally studied.

All patients interviewed reported having difficulties dealing with their emotions, such as suppressing emotion, difficulties in recognizing emotion, and tendencies to limit the expression of emotion. This active suppression of emotion was accompanied by feelings of frustration and hostility and these feelings would typically grow until an event triggered emotion, which would then be viewed as overwhelming. As one participant noted, ‘…I just back off; I close down, then (pause)…And then it boils and it boils and I’ll explode at something. Something minor.’

Distrust toward the staff

It also became apparent that there was a significant amount of distrust toward the inpatient staff, and this distrust seemed to be related to the patients’ feelings that they were being defined by their eating disorder. In addition, during the interviews the participants stated that a significant motivating factor in the management of difficult or negative emotions on the ward was the staff’s need to retain control. It also appears that staff members perceived the expressed emotions of patients to be synonymous with a challenge to this control. The researchers also found that difficulties in staff-patient relations appeared to be implicitly linked with difficulties to the perceived nature of the relationship that the participant had with individual staff members. Interestingly, according to Dr. Pemberton, these reported interactions between staff and patients were characterized by difficulties in recognizing, tolerating, and managing emotions from both patients and staff.

The participants tended to define staff by their role as opposed to their individual identities. In a type of “black and white” thinking, the participants determined that staff were good/caring if they treated the participant well, but more often than not the staff were perceived as not being that ‘caring’ or even as being neglectful.

According to the authors, the results of their study show the importance of inpatient staff having more training and an up-to-date understanding of the current medical literature surrounding eating disorders, to help them better understand and deal with inpatients’ everyday behavior.