Social Skills in Eating Disorders

Research Aims

An Introduction from Dr Amy Harrison

I’m really interested in social emotional skills in eating disorders and I’ve tried to summarise the scientific evidence in this area so far in this keynote talk that I gave at Bournemouth University in 2019. Watch it here.

I’ve been researching this field since my undergraduate degree which I completed in 2006 at the University of Manchester. My final year research project, supervised by Prof John Fox was on anger, disgust and bulimia nervosa. We found that in response to an anger provoking situation, people with this illness reported disgust, rather than anger. You can read about this work here.

I developed this research further in my PhD which I completed between 2007 and 2010 on cognitive styles and social emotional functioning at King’s College London, supervised by Prof Janet Treasure and Prof Kate Tchanturia. I found that people with eating disorders had difficulties than unaffected peers recognising and regulating emotions, regulating emotions in social situations and those with a more severe and enduring form of illness experienced the greatest difficulties.

The research I conducted as part of the Doctorate in Clinical Psychology also at King’s College London between 2010 and 2013, supervised by Prof Kate Tchanturia and Dr Vicky Mountford investigated this further and showed that people with eating disorders experience significant difficulties with their work and social functioning.

Why is this work needed now?

Eating disorders are characterised by social isolation. Many people with the illness have discussed how interpersonal difficulties were present in the lead up to their eating disorder and research suggests relationship difficulties perpetuate eating disorders.

Past research also suggests people with eating disorders have smaller social networks than peers without the illness.

As much of the existing evidence in this area has relied on questionnaires, we’ve been conducting experiments to understand whether these social difficulties could be explained by differences in the way people with eating disorders use vital social skills like eye contact and body language.

If we can understand more about how these skills are used differently, we can build packages of support to help people use them more efficiently in their recovery.

We’ve conducted experiments to measure eye-gaze in eating disorders

Eye-gaze is an important social skill. It gives us vital social information and indicates to others that we’re interested in what they have to say.

What did we do?

We asked 25 adult females with anorexia nervosa, 25 adult females recovered from anorexia nervosa and 25 adult females who had never had an eating disorder to complete three tasks:

1) View static photos of people displaying different emotions on a computer screen;

2) Watch a video of two actors talking about the week ahead;

3) Have a conversation with my research assistant.

During these three tasks, an eye tracker measured eye-gaze. It measured where the person looked as they interacted with these social stimuli and the duration of gaze on the social stimuli compared to elsewhere in the scene.

What did we learn?

Those currently unwell with anorexia nervosa fixed their eye-gaze on the eye region of the face significantly less often and for a significantly shorter duration than people without the illness. This was most pronounced in the task where they had to engage in a real-life social interaction. People who had recovered from an eating disorder attended more to the eyes than those currently unwell, but less than those who had never had the illness, showing a sort of intermittent profile.

What does this tell us?

One of the reasons why people with eating disorders like anorexia nervosa experience social difficulties might be because they are using this important social skill differently in comparison to those without the illness. When others’ brains detect reduced eye contact, this can signal that the person should be wary, as they may be less able to understand the person’s intentions. It might also inadvertently give the impression that the person is less interested in interacting with the individual. We think that this might explain some of the social difficulties and social rejection experienced by people with eating disorders.

Where can I read more?

The research discussed here was published in the International Journal of Eating Disorders. Click here to read the paper.

We’ve conducted experiments to measure non-verbal communication in eating disorders

Non-verbal communication, often referred to as ‘body language’ is another important social tool. We use our bodies to convey our intentions, thoughts and feelings to others. For example, we lean in towards our conversational partner when we’re really interested in the topic and we use gestures to help us get our ideas across to others.

We’ve conducted some experiments to understand whether the social difficulties experienced by many people with eating disorders might be explained by differences in their use of body language.

What did we do?

We asked 25 adult females with eating disorders and 25 adult females who had never had an eating disorder to have a conversation with a researcher. The conversation was recorded using two video cameras, so that we could observe what the participant and the researcher were doing during the conversation. During the social interaction, the researcher covered three different topics: 1) a positive topic where they discussed an act of kindness they’d seen recently in a coffee shop; 2) a negative topic where they discussed missing the train home, and 3) a neutral topic where they talked about the weather with the participant.

What did we learn?

The data showed that people with eating disorders used their body differently during the social interaction. In particular, they lent in towards their conversational partner less frequently. Regardless of the topic discussed, their hands were more inactive, and were more likely to be resting on their arms or trunk rather than being used to support their verbal communication through the use of gestures, than those without eating disorders.

This study involved us working with an industry partner, Tracksys who supplied the software used to measure the non-verbal behaviours and lent us a device which also allowed us to measure electrodermal activity, a biomarker of sympathetic nervous system arousal. During the social interaction, the participant wore small sensors on their hand and the data from these sensors indicated that people with eating disorders, compared to those without the illness were less aroused during the social interaction.

What does this tell us?

People with eating disorders experience social interactions differently those without the illness. They make less use of gestures and lean in less towards their partner which could erroneously indicate that they aren’t interested and prevent them to conveying their message clearly.

Where can I read more?

The research discussed here was published in the journal Psychiatry Research. You can read the article here

What we’re doing with this knowledge

We’re working on developing a brief social skills training package which seeks to train people to use their eye contact and body language more efficiently. We’re going to need some funding to get this up and running, as we plan to utilise technology to aid coaching of these social skills in vivo. Hang in there whilst we work to get this project funded and we’ll be back with more information soon.