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Eating disorders (EDs) have severe physical and mental health implications that, if left unattended, are likely to have adverse effects on quality of life, and may even cause death.1-4 The literature underscores the critical role of difficulties of emotional processing among those with disor- dered eating (DE).5 In this sense, DE (eg, self-star- vation, purging, excessive exercise) might be used as a dysfunctional way to regulate or provide an escape from aversive emotional arousal.6

Despite the growing research highlighting the role of emotion dysregulation in DE, and although emotion regulation and emotional intelligence (EI), or the ability to recognize one’s own emotions and those of others, are important aspects of emo- tional management,7 few studies have addressed the role of EI in disordered eating. EI is known to aid in the development of subjective well-being (SWB)8 and as such, may play a role in ameliorat- ing the conditions of DE. A relatively new research concept, self-compassion (SC), also has a positive effect on SWB, including among people with an

ED.9 However, there is a lack of information on the interconnection of these concepts among those with DE.

We aimed to assess the differences in levels of SC, SWB, and EI for those who self-identify as having disorder(DEPs)ed eating perceptions and those who do not. To this end, we tested a correla- tion model showing the interactions of SC, EI, and SWB with DEPs and suggesting which variable (SC or EI) predicts SWB. We did so by comparing 2 populations, one with, and one without disor- dered eating perceptions. One aspect of DE is per- ceptual. DE perceptions include obsessive thinking about food and dieting, body image dissatisfaction, overweight preoccupation, and fear of fatness and dieting. Although most attitudes are benign, their presence is strongly associated with an increased risk of developing clinical eating disorders.10

In the next section of the paper, we give a review of the literature on our main variables – EI and SC. We then describe the study and explain our results. We conclude with a discussion of our findings.

Vered Shenaar-Golan, Senior Lecturer, Social Work Department, Tel Hai Academic College, Tel Hai, Israel. Ofra Walter, Senior Lecturer, Depart- ment of Education, Tel Hai Academic College, Tel Hai, Israel Correspondence Dr Shenaar-Golan: [email protected]

Do Emotional Intelligence and Self-compassion Affect Disordered Eating Perceptions?

Vered Shenaar-Golan, PhD Ofra Walter, PhD

Background: Self-compassion (SC) allows people to cope with negative perceptions, and thus, may act as a buffer in people with disordered eating in terms of body image and eating be- haviors. Higher emotional intelligence (EI) may play a similar role. However, few studies have explored their association. Objective: In this study, we tested a correlation model to determine how SC, EI, and subjective well-being (SWB) interact and affect disordered eating (DE) percep- tions and which variables (SC, EI) predict SWB. Method: Overall, 156 participants completed a questionnaire assessing their levels of SC, EI, and SWB. Results: Participants who perceived themselves as having DE had significantly lower levels of SWB and SC but a significantly higher EI level. SWB was predicted by high scores in SC and low scores in EI. Conclusion: We propose a mediating model explaining the contribution of EI and SC to the SWB of those with DE percep- tions.

Key words: self-compassion; emotional intelligence; subjective well-being; disordered eating Am J Health Behav.™ 2020;44(4):-384-391 DOI: https://doi.org/10.5993/AJHB.44.4.2

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Am J Health Behav.™ 2020;44(4):384-391 385 DOI: https://doi.org/10.5993/AJHB.44.4.2

Literature Review Emotional intelligence. EI has been investigated

for several years as a major way to explain and op- erationalize emotion-related individual differences and to examine their impact on individuals’ lives. The perception, understanding, regulation, and use of one’s own emotions, as well as those of others, constitute the core of EI.55 Those with EI have the ability to carry out accurate reasoning on emotions and can use emotions and emotional knowledge to enhance thought.11 EI has been positively cor- related with other measures of psychological well- being, such as life satisfaction and happiness, and negatively correlated with depression, loneliness, and stress.12 People with higher EI may be more likely to understand, regulate, and use emotional information to cope with daily stressors and there- fore adapt better to their environment and have better health.13 High EI scores have also been as- sociated with lower levels of psychopathological symptoms, emotional and behavioral difficulties,14 and attempted self-harm.15

EI appears to be an important variable in the health of both the general population16 and pa- tients with mental disorders.17,18 However, there seems to be a fundamental difference in the inter- personal EI dimension in clinical and non-clinical populations; the former tend to report lower scores on intrapersonal dimensions than the latter, espe- cially emotion regulation. They pay attention to emotions, but they lack the ability to repair their negative moods in daily life.19 For instance, young women with DEPs may feel certain negative emo- tions, but they cannot find adaptive strategies to modulate them,20 leading to non-adaptive eating attitudes and behaviors used in a dysfunctional way to regulate and provide an escape from aversive emotional arousal.6

Explorations of the ED experience suggest the important role of DEPs in emotional regulation and coping,19 with several authors reporting that people with DEPs show deficits in emotional pro- cessing, regulation, and awareness.20-22 However, despite the growing research highlighting the role of emotion dysregulation in EDs, and although emotion regulation and EI are important aspects of emotional management,7 few studies have ad- dressed the role of EI in DEPs and its effect on SWB.

Self-compassion and subjective well-being. There is growing interest in SC and its potential benefits, including decreased psychopathology and increased well-being.23-28 SC may assist in devel- oping coping positive behaviors and attitudes to the self,26 given its strong empirical formulation as an adaptive affect regulation and coping strat- egy.29,30 As Neff defined,26 SC represents a balance between increased positive and decreased negative self-responses to personal struggle. Those with SC are comforted by the recognition that suffering is an essential part of the shared human condition. They treat themselves with kindness, are less judg- mental and more supportive of themselves, and can hold painful thoughts and emotions in balanced awareness.26,31

SC has been linked consistently with positive mental health. It appears to be an important source of strength and resilience in the face of life stress- ors, such as health problems,32 problems with in- terpersonal relationships,33 and poor physiological functioning.34 Thus, self-compassion may repre- sent a protective factor/ potential buffer in people with DE in terms of body image and eating be- haviors. A systematic review of 28 studies in both non-clinical and clinical populations with EDs35 supports the role of self-compassion as a protec- tive factor against poor body image and notes the significantly lower levels of SC and greater fear of SC among people with DE. Other researchers have similarly found that SC predicts less DE.36,37 One study of undergraduates31 found greater SC was as- sociated with less concurrent ED psychopathology. However, these researchers point out that little is known about the mechanisms behind the associa- tion between SC and ED psychopathology and DE attitudes and behaviors.

In short, SC provides a unique way of relating to the self when the tendency to engage in nega- tive self-evaluation and the corresponding desire to avoid the experience of negative emotions are par- ticularly salient.26,38 A better understanding of the relationship of SC to DE behaviors and the poten- tial contribution of EI to their interaction can ex- pand our understanding of the emotional processes behind disordered eating perceptions and better inform the treatment of those who have developed an ED.

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METHODS Objectives

The study’s first objective was to look for statisti- cally significant differences between levels of SC, SWB, and EI in those who self-identified as hav- ing DEPs and those who did not. We expected to find significant differences; that is, people who per- ceived themselves as having DE would score lower in SC, EI, and SWB than those who did not. The second objective was to build and test a correlation model to study how SC, EI, and SWB interact and affect DEPs. The final objective was to determine which variables (EI, SC, DEP) could predict SWB.

Sample The study included 156 participants, 30 men

(19.2%) and 123 women (78.8%). The age range was 18-80 years, with a mean age of 33.92 (SD = 12.16). Overall, 66 participants (42.3%) report- ed DE perceptions and 90 (57.6%) did not. Par- ticipants were divided into 2 groups: (1) “Do not think I have an eating disorder;” and (2) “Think I have an eating disorder.” Demographic characteris- tics examined were age, weight, height, and marital status.

Measures A demographic questionnaire completed by the

participants included personal details, ie, sex, age, weight, height, and marital status, as well as per- ceived DE behaviors and attitudes. The participants were asked to answer the following questions: (1) “Do you see yourself as having disordered eating?” (2) “Do you often think of your weight?” 3) “Do you have feelings of dissatisfaction, or preoccupa- tion with and fear of fatness and dieting?” Each question had a yes/no answer. Participants were classified as having disordered eating perceptions if they answered yes to at least 2 questions.

We assessed SWB using the Personal Well-Being Index (PWI-A).39 The PWI-A is comprised of one question inquiring about satisfaction with life as a whole (SWB1) and 8 items measuring satisfaction in specific life domains: standard of living, person- al health, achievements in life, personal relation- ships, personal safety, community-connectedness, future security, and religion (SWB2-8). All items were rated on a Likert-type scale, ranging from 0 =

completely dissatisfied to 10 = completely satisfied. Internal reliability was high, α = .94

We assessed SC using the scale developed by Neff25 who conceptualized self-compassion as com- prising 3 interrelated dimensions: (1) self-kindness, ie, being kind towards and understanding of one- self, not engaging in self-judgment and criticism; (2) mindfulness, ie, holding aversive thoughts and feelings in balanced awareness rather than over- identifying with them; and (3) common humanity, ie, viewing one’s experiences as a natural exten- sion of those experienced by all individuals rather than as isolated and separate. Subscale scores were computed by calculating the mean of subscale item responses. There were 6 dimensions: self-kind- ness, self-judgment, common humanity, isolation, mindfulness, and over-identification. Internal reli- ability was high, α = .91

We assessed EI using the Self Report Emotional Intelligence Test (SREIT),40 a 33-item question- naire assessing various aspects of EI. Responses are based on a 5-point Likert scale, from 1 = strongly disagree to 5 = strongly agree and are assessed on 3 broad dimensions: the appraisal and expression of emotions, 13 items; the regulation of emotions, 10 items; and the utilization of emotions, 10 items. The SREIT has good predictive and discriminant validity and high reliability, with a Cronbach’s al- pha of .90. Internal reliability for this study was α = .85.

Research Procedure We used non-probability sampling methods to

recruit participants. Possible participants were ap- proached by the researchers and healthcare provid- ers in the community and invited to participate on a voluntary basis. All who responded were included. They were also asked to forward the questionnaire to family, friends and acquaintances, neighbors, colleagues, and others (snowball sampling). Par- ticipants were asked for their consent and invited by email to respond to the study’s questionnaires; additional invitations were disseminated through social media networks around the country. The questionnaire was answered online using the Qual- trics® online survey system to ensure anonymity and easy access to the questionnaire. The research was performed in accordance with the ethical stan- dards of the Tel Hai Academic College research

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committee. Informed consent was obtained from all participants.

RESULTS To examine the effect of EI and SC on the SWB

of participants who identified as having DEPs com- pared to participants who did not, we performed multivariate variance analysis (MANOVA). Table 1 shows these results.

As the table suggests, we found significant differ- ences in SWB for participants who reported DEPs and those who did not. For the question on sat- isfaction with life as a whole (SWB1), there was a statistically significant difference between the self-reported DE and non-DE group (F (1,154) = 21.237, p < .000, Eta2 = .12). The answers to the questions on the 8 items in specific life domains (eg, standard of living etc.; SWB2-8 index) also re- vealed a statistically significant difference between the groups (F (1,154) = 37.949, p < .001, Eta2 = .20), confirming our hypothesis that people with

perceived DE have a significant lower level of SWB. We also found a statistically significant difference

between the 2 groups for SC, as measured by the Self-Compassion Questionnaire. SC was higher (F (1,154) = 46.860, p < .000, Eta2 = .23) among par- ticipants who did not perceive themselves as having DE. Contrary to our expectations, the DE group reported a statistically significant higher level of EI (F (1,154) = 9.486, p < .002, Eta2 = .06) than the control group. However, there were differences in the various components of EI. The “ability to assess and express emotions” was not statistically signifi- cant (F (1,154) = 1.054, p < .306, Eta2 = .00), but the “ability to regulate and control emotions” was (F (1,154) = 13.497, p < .000, Eta2 = .08), as was the “ability to benefit from emotions” (F (1,154) = 10.115, p < .002, Eta2 = .06).

To test the hypothesis that the relationship be- tween SWB and SC was mediated by EI, we used PROCESS Macro for Model no. 4, as Hayes56 out- lines. SWB was positively related to SC (total ef-

Table 1 Emotional Intelligence (EI) and Subjective Well-being (SWB) for Those with and

without Perceived Disordered Eating Do not think I have an eating disorder

N = 90

Think I have an Eating disorder

N = 66

Variable M (SD) M (SD) F(1,154) Eta2 p

SWB1 8.32 (1.72) 6.48 (3.21) 21.237 0.121 .000

SWB2-8 8.07 (1.36) 6.10 (2.58) 37.949 0.198 .001

Self-kindness 3.18 (0.78) 2.33 (1.13) 31.299 0.169 .000

Self-judgment 3.20 (0.77) 2.23 (1.07) 42.911 0.218 .000

Self-humanity 3.25 (0.84) 2.81 (1.04) 8.464 0.052 .004

Mindfulness 3.35 (0.90) 2.48 (1.02) 31.681 0.171 .000

Isolation 3.43 (0.87) 2.65 (1.01) 26.933 0.149 .000

Over-identification 3.10 (0.78) 2.16 (0.90) 42.196 0.215 .000

Self-compassion 3.25 (0.64) 2.42 (085) 46.860 0.234 .000

EI expression 2.07 (0.53) 2.17 (0.65) 1.054 0.007 .306

EI regulation 2.04 (0.58) 2.42(0.72) 13.497 0.081 .000

EI utilization 2.00 (0.55) 2.33 (0.75) 10.115 0.062 .002

EI 2.04 (0.49) 2.31 (0.60) 9.486 0.058 .002

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fect: b = 0.26, EI = 0.02, p < .001) and negatively related to EI (b = -.16, SE = .01, p < .001). EI was negatively related to SC (b = -0.39, EI = .11, p < .001). After controlling for EI as a mediator, the relationship between SWB and SC decreased (b = 0.19, SE = 0.02, p < .001). Bootstrapping showed that the unstandardized indirect effect of SWB on SC was significant at 0.05 and 95% confidence intervals ranging from 0.02 to 0.16, providing support that SWB exerts an indirect effect on SC through EI.

To test whether the relationship between SWB and SC was moderated by EI – perception of DE, we used Andrew Hayes’ Process Macro Model no. 1.56 We found EI did not moderate the relation- ship of SWB and SC, as the interaction term was not statistically significant. We also found the per- ception of DE did not moderate the relationship of SWB and SC, as the interaction term was not statistically significant.

Next, we conducted a multiple regression analy- sis to determine which variables (EI or SC) could predict SWB. Table 2 shows these results.

The results of the regression analysis indicated that SC and EI explained 61% of the variance (R2 = .61, F(3,151) = 78.769, p < .01). The results sug- gested the SWB of the participants could be pre- dicted by high scores in SC and low scores in EI. Perceptions of having an eating disorder did not predict SWB in this sample.

DISCUSSION The study contributes to the literature by examin-

ing the relationship of SC, SWB, and EI of persons

who perceived themselves as having DE compared to those who did not. We also tested whether the relationship between SWB and SC was mediated by EI and conducted further analysis to see if we could predict which of our variables (SC, EI) con- tributed to SWB.

In general, the mean SWB was lower than the av- erage set-point of 75 for Western populations.41,42 The differences between our 2 groups could be ex- plained by the 2 distinctive components of SWB: a cognitive component, related to appraisals of life satisfaction, and an affective component, referring to the individual’s positive and negative emotions, moods, and experiences.43 Participants who per- ceived themselves as having DE had a significantly lower level of SWB than their non-DE counter- parts, something found by other researchers as well.44,45 Their lower level of life satisfaction may be explained, in part, by their constant struggle with intrusive perceptions of eating and dissatisfaction and preoccupations with body and weight.

SC was significantly lower for participants with DEPs, a finding also reported by previous stud- ies.26,46,47 If those with DEPs are indeed less self- compassionate, they are more likely to judge themselves harshly for their shortcomings and to be less supportive of themselves, thereby adding to their suffering and perpetuating a cycle of non- adaptive response to stress which, in turn, affects their sense of SWB.

An unexpected finding was that EI and its sub-di- mensions were significantly higher for participants who perceived themselves as having DE. Whereas we did not expect it, the finding is in line with most of the research.11,12,55 Other researchers have found

Table 2 Subjective Well-being Predictors

TSE BBVariables

5.88***.2021.86Self-compassion

-5.80***.275-1.59Emotional Intelligence

-1.788.276-493Disordered Eating

.61R2

78.769 ***F

*p < .05, **p < .01, ***p < .001

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Am J Health Behav.™ 2020;44(4):384-391 389 DOI: https://doi.org/10.5993/AJHB.44.4.2

that patients with a mental disorder, including DE populations, tend to report similar or even higher scores on interpersonal EI dimensions than control groups.48 In addition, populations  with DE may pay close attention to their emotions, but they lack the ability to repair their negative moods in daily life.48 This emotional profile may put the person at risk when confronted with difficulties.18 One study found women with DE tended to use maladaptive behaviors to try to relieve pain when confronted with stressful situations, and this compounded their problematic eating perceptions.18

Overall, the results suggest that people with per- ceptions of DE may be sensitive to other people’s emotions but lack the ability to regulate their own emotions.48 Negative behaviors toward the self- have a stronger relationship with certain types of well-being outcomes than others. However, little research has examined these issues systematically, especially in domains of well-being other than psychopathology. People with disordered eating perceptions may have higher emotional awareness which might affect their SC, but instead of leaning towards the positive end of the SC pole (compas- sion), high EI in this case may lean towards the negative pole (lack of compassion).26,46,47

Our findings support the suggestion that SWB exerts an indirect effect on SC through EI. Neff et al49 also provide evidence that EI works indirectly through SC and SWB, impacting disordered eat- ing perception scores. Although we only looked at perceptions of DE, our results suggest theoretically meaningful cognitive-affective self-regulatory qual- ities may serve as underlying mechanisms driving the inverse association between the dimensions of self-compassion and the SWB of DE populations. Greater self-compassion may result in people us- ing more adaptive self-regulatory pathways,26,50 with a concomitant effect on DE. Arguably, higher EI may increase emotional regulation by mak- ing people more self-judgmental instead of more self-compassionate.

In this study, an increase in SC and a decrease in EI and DE perceptions contributed to a high- er level of SWB. These results align with those of Neff,9 who found self-compassion was a signifi- cant positive predictor of SWB, and this, in turn, could explain a reduction in DEPs. SC may dis- rupt the common cognitive-affective perception

of DE, specifically by engaging adaptive emotion regulation skills and accepting (versus attempting to suppress or escape) unwanted aspects of the self unconditionally.26,50

Greater SC may be associated with less percep- tion of DE through the various adaptive self-regu- latory pathways. Other studies have found higher reports of SC are indicative of greater EI and cop- ing ability, in conjunction with less self-criticism and thought suppression, among undergraduate students.26,30,49 These results support our finding that high SC can predict higher SWB.

Limitations The research was exploratory, and  further re-

search is required to test the viability of the model empirically in both developmental and clinical populations. We did not include a measure of actu- al DE, only its perception. Future research should use valid research questionnaires, such as the ED- EQ-brief.54 In addition, ours was a convenience sample, thereby limiting the generalizability of our results. Future work should consider exploring this relationship in populations that are often under- represented (e.g., men) and replicating the work in clinical samples to shed more light on the poten- tially unique role EI and SC play in SWB for this group.

Conclusions Taken together, our findings have important im-

plications for healthcare professionals and thera- pists.50-53 They contribute to a better understanding of the interactions of SC, EI, and SWB among those who report disordered eating. First, and unexpect- edly, we found a higher EI score among those with perceptions of DE. Second, SC was the main com- ponent in coping with life stressors and life chal- lenges, but we found those with DEPs had more negative emotions about themselves and lacked the ability to be self-compassionate, thereby hindering their SWB. Third, the study proposes a mediating model that may explain the contribution of EI and SC to the SWB of those with perceptions of DE.

Human Subjects Approval Statement The study was conducted in accordance with

the local ethical committee of Tel Hai College.

Do Emotional Intelligence and Self-compassion Affect Disordered Eating Perceptions?

390

Written informed consent was obtained from all participants.

Conflict of Interest Disclosure Statement The authors declare that they have no conflicts

of interest.

Acknowledgements We thank the research assistants who helped re-

cruit participants for the study.

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