How enduring and multi-faceted self-disgust threatens psychological recovery from anorexia nervosa: a qualitative enquiry
| Date | 13 August 2024 |
| Pages | 301-317 |
| DOI | https://doi.org/10.1108/MHRJ-06-2022-0039 |
| Published date | 13 August 2024 |
| Author | Katie Bell,Helen Coulthard,Diane Wildbur,Iain Williamson |
How enduring and multi-faceted self-disgust
threatens psychological recovery from
anorexia nervosa: a qualitative enquiry
Katie Bell, Helen Coulthard, Diane Wildbur and Iain Williamson
Abstract
Purpose –Self-disgust appears to bea prominent feature in anorexia nervosa (AN), which mighthelp
explain why AN is often sucha persistent disorder. Little is known about how this emotioncan impact on
recovering from this disorder. This study aims to developour understanding of how people experience
the emotionof self-disgust after physical recoveryfrom AN.
Design/methodology/approach –Twelve female participantswho reported previously having had a
clinical diagnosis of AN but had physically recovered according to their EDE-Q scores took part in a
semi-structuredinterview to explore their experiencesof recovery and the role self-disgust played within
this. Interpretativephenomenologicalanalysis was used to explore the data.
Findings –Three themes were identified within the data to explain the experiences of self-disgust in
those with AN: continued self-disgust following physical ‘‘Recovery’’, multiple manifestations of self-
disgustin recovery and increasing self-disgust in recoveryas a driver for relapse.
Practical implications –Self-disgust was something each participant appeared to experience often,
despite beingphysically recovered from AN. Disgust-basedreactions to the self are enduring and highly
resistant to change even whilst otheraspects of the disorder become less potent. Self-disgust is multi-
faceted andmay trigger relapse as the signs of improvement and behavioursinherent in recovering were
generallyviewed as disgusting to the individuals.
Originality/value –Self-disgust is an emotionthat continues to affect people with AN despite physical
recovery. The recovery process itself is not linear and self-disgust is enduring and may cause those
affected to relapse. Considering this emotion within therapeutic intervention may encourage those with
AN to accept theirrecovered self.
Keywords Eating disorders, Recovery, Anorexia nervosa, Self-disgust
Paper type Research paper
Introduction
Disgust is characterised by a feeling of revulsion or strong disapproval aroused by
something unpleasant or offensive and results in distinctive facial, behavioural and
physiological responses (Rozin et al., 1999). Originating as a mechanism for disease
avoidance, which motivates a person to distance themselves from an object of disgust
(Curtis et al., 2004;Oaten et al., 2009), externally driven disgust can be explained by
many broad and multifaceted elicitors with a diverse range of response patterns
(Powell et al., 2014;Simpson et al., 2006). Literature suggests that disgust plays a
significant role in several psychopathologies (Overton et al.,2008;Mayer et al., 2011),
including eating disorders (Anderson et al., 2021). Women with eating disorders may
display higher momentary disgust of food images, higher disgust sensitivity and higher
self-disgust compared to those who do not have an eating disorder (Bektas et al.,
2022).
Katie Bell is based at the
Department of Psychology,
De Montfort University,
Leicester, UK and
University of Birmingham,
Birmingham, UK.
Helen Coulthard is based at
the Department of
Psychology, De Montfort
University, Leicester, UK.
Diane Wildbur and Iain
Williamson are both based
at the Division of
Psychology, De Montfort
University, Leicester, UK.
Received 21 June 2022
Revised 21 November 2023
24 June 2024
Accepted 26 June 2024
DOI 10.1108/MHRJ-06-2022-0039 VOL. 29 NO. 32024, pp. 301-317, ©Emerald Publishing Limited, ISSN 1361-9322 jMENTAL HEALTH REVIEW JOURNAL jPAGE 301
The idea that disgust can be directed towards the self originates within clinical psychology.
Powell et al. (2013) argue that self-disgust is a consuming, highly negative emotion
associated with multiple psychopathologies, such as depression, eating behaviour,
physical appearance and interpersonalrelationships. Clarke et al. (2019) define self-disgust
as “a psychologically destructive emotion, sometimes latent but easily triggered, with
visceral content and resulting ina desire/need both to avoid the disgusting aspect of the
self psychologically and behaviourally and to attempt to expunge it from the self” (p. 13).
Research has demonstrated that those with anorexia nervosa (AN) mayexperience higher
levels of self-disgust compared to those with no history of disordered eating (Bell et al.,
2017), and self-disgust has also been arguedto play a putative role in the development and
maintenance of AN (Kot et al.,2021). Furthermore, Visser (2022) suggests that disgust
propensity may lead to increased feelingsof self-disgust, which in turn may lead to the
development of eating disorder symptoms. However, self-disgust as a barrier to recovery
from psychopathology is an area of research in its infancy, and the current study aimed to
explore the role self-disgust may play in recoveringfrom AN.
Self-disgust is a neglected emotion in clinical approaches to eating disorders (Fox et al.,
2015). Theoretically, self-disgust has been suggested to drive disordered eating behaviour
(Espeset et al.,2012) and is also argued to underpin more severeand enduring eating
difficulties (Chu et al., 2015). Furthermore, Moncrieff-Boyd et al. (2014) theorised the
condition of AN as an inability to discriminate between the self and non/self, whereby a
disturbed sense of the self contributes to more experiences of the emotion of self-disgust
(Moncrieff-Boyd et al.,2014). Lastly, Glashouwer and de Jong (2021) posit that self-disgust
may remain unchanged after treatment for AN, which suggests individuals with this eating
disorder may be more vulnerable to relapse (Glashouwer anddeJong, 2021).
Research has also consideredthe relationship between self-disgust and other emotions
within eating disorders such as shame (Allan and Goss, 2012). Shame is referred to as a
self-conscious, painful emotion characterised by negative global evaluations of the self
(Tracy and Robins, 2004). Shame is believed to emerge from a failure to live up to ideals,
and it is suggested that a person mayexperience themselves as embodying an anti-ideal
(Rivera & Mascolo, 1995). Disgust, while beingadistinct emotion, is argued to be central to
the experience of shame and is believed to emotionally texture how someone will
experience themselves (Gilbert, 2018). A study proposed that disgust might be directed
towards the self when one failsto maintain certain societal standards inculturally normed
behaviours, and those with an eating disorder have reported significantly higherlevels of
shame than other clinical groups (Frank, 1991).When considering female body image and
eating disorders at a societal level, Fox et al. (2015) propose that females are at risk of
internalising objectification of their bodies, which in turn may predispose someone to be
critical, shameful and self-disgusted with their body. Furthermore, the SPAARS-Ed. Model
(Fox and Power, 2009) posits that self-disgust and shame are derivatives of the basic
emotion disgust and self-disgust, which has originated through adverse childhood
experiences, and later objectification of the female body and can elicit disgust towards
one’s own body and food.
From a qualitative perspective, thereis very limited research currently available that
explores the role self-disgustmay play in recovering from AN, with most studies focusing on
the quantifiable experience of externally elicited disgust within psychopathology (Fox et al.,
2015). Interestingly, the use ofavoidance as an emotional regulation technique has been
associated with self-disgust within AN. McNamara et al. (2016) argue that avoidance of
food is associated with the need to control, and participants with eating disorders
expressed a desire to avoid high-fat or “bad” foods. By doingso, feelings of positive control
were reinforced, whereas perceived indulgence, which was associated with a lack of
control, triggered feelings of disgust in oneself (McNamara et al.,2016, p. 119). Disgust-
induced avoidance has also been linked to persistent food restriction in those with AN, and
PAGE 302 jMENTAL HEALTH REVIEW JOURNAL jVOL. 29 NO. 32024
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