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From Deficits in Emotional Intelligence to Eating Disorder ORIGINAL RESEARCH published: 18 August 2021 doi: 10.3389/fpsyg.2021.713070 From Deficits in Emotional Intelligence to Eating Disorder Symptoms: A Sequential Path Analysis Approach Through Self-Esteem and Anxiety María Angeles Peláez-Fernández*, Juana Romero-Mesa and Natalio Extremera Department of Social Psychology, Social Work, Social Anthropology, and East Asian Studies, Faculty of Psychology, University of Málaga, Málaga, Spain Past studies have reported emotional intelligence (EI) as a relevant factor in development and maintenance of eating disorders (ED), as well as in increasing self-esteem and reducing anxiety. Similarly, research has showed that anxiety and self-esteem are positively and negatively associated to ED criteria, respectively. However, no prior studies Edited by: have yet tested the multiple intervening roles of both self-esteem and anxiety as potential Atsushi Oshio, mediators of the association between EI and ED symptomatology. The present study Waseda University, Japan aims to bridge these gaps by testing a sequential path model. Specifically, we examine Reviewed by: Stefania Cella, the potential sequential mediation effects of self-esteem-anxiety on the link between EI University of Campania Luigi and ED. A sample composed of 516 Spanish undergraduate students and community Vanvitelli, Italy Sylvie Berthoz, adults completed measures of EI, self-esteem, anxiety, and ED symptomatology. The Institut National de la Santé et de la results show that high levels of EI were positively associated with self-esteem and Recherche Médicale negatively associated with anxiety and ED symptoms. Anxiety was positively associated (INSERM), France to ED symptoms, while self-esteem levels were negatively linked to ED symptoms. *Correspondence: María Angeles Peláez-Fernández Moreover, path analyses showed that self-esteem and anxiety fully mediated the [email protected] relationship between EI and ED symptoms in sequence. These findings suggest that EI plays a key role in reducing symptomatology of ED through increased self-esteem Specialty section: This article was submitted to and reduced anxiety symptoms, providing novel evidence regarding psychological Personality and Social Psychology, mechanisms through which EI contributes to a reduction of ED symptomatology. a section of the journal Frontiers in Psychology Implications for assessing and improving these psychological resources in ED preventive Received: 21 May 2021 programs are discussed. Accepted: 23 July 2021 Keywords: emotional intelligence, eating disorders, anxiety, self-esteem, path analysis Published: 18 August 2021 Citation: Peláez-Fernández MA, INTRODUCTION Romero-Mesa J and Extremera N (2021) From Deficits in Emotional Eating disorders (ED) are persistent disturbances of eating or eating-related behaviors that result Intelligence to Eating Disorder in significant impairments in psychosocial functioning and physical health (American Psychiatric Symptoms: A Sequential Path Analysis Approach Through Association (APA), 2013). In the last two decades, the worldwide prevalence of ED has increased Self-Esteem and Anxiety. from 3.5 to 7.8% (Galmiche et al., 2019), and the rate remains significantly higher among females Front. Psychol. 12:713070. (American Psychiatric Association (APA), 2013). Anxiety disorders and depression are among the doi: 10.3389/fpsyg.2021.713070 most common comorbid diagnoses in ED (Godart et al., 2002, 2007). Frontiers in Psychology | www.frontiersin.org 1 August 2021 | Volume 12 | Article 713070 Peláez-Fernández et al. From EI Deficits to ED Theoretical background and empirical evidence have provide some preliminary support for the role of emotions in supported the idea that deficits in the processing and managing disordered eating attitudes with a view to the prevention and of emotions play a key role in the development and maintenance management of ED and point to the potential use of EI measures of ED (Polivy and Herman, 1993) and that difficulties with the to identify individuals at risk of ED. regulation of emotions are related with ED psychopathology (Corstorphine, 2006; Fox, 2009; Haynos and Fruzzetti, 2011; Lavender et al., 2015; Rowsell et al., 2016). For example, some Self-Esteem and Anxiety as Mediators meta-analytic findings have confirmed that high levels of Beyond this direct association between EI and ED symptoms, negative emotionality increase the risk of eating pathology other potential underlying processes have been theorized (Stice, 2002). Accordingly, consistent with the transdiagnostic through which EI might impact ED symptoms. Two of cognitive-behavioral model for ED (Fairburn et al., 2003), mood these individual psychological mechanisms considered to be changes (along with external events) play a relevant role in both relevant mediators might be self-esteem and anxiety. A growing the maintenance and relapse of ED. In fact, a broad form of body of research has supported the theory that deficits in enhanced cognitive-behavioral therapy (CBT-Eb; Fairburn et al., emotional skills are significant predictors of reduced self- 2009), including mood intolerance, clinical perfectionism, low esteem domains (Fernández-Berrocal et al., 2006; Hasanvand self-esteem, and interpersonal difficulties, along with the well- and Khaledian, 2012; Bibi et al., 2016). Likewise, it has established cognitive-behavioral therapy (CBT) for ED (National been found that people with high levels of anxiety typically Institute for Clinical Excellence (NICE), 2004; Wilson, 2005) report difficulty in accurately perceiving, using, understanding, have shown better results compared to CBT alone, both for ED and managing their own emotions (Fernández-Berrocal et al., patients with minor and subclinical symptoms and for those with 2006; Connor and Slear, 2009; Kousha et al., 2018). Taken more relevant psychopathology symptoms (CBT-Eb; Fairburn together, these findings suggest that people with high levels et al., 2009). Similarly, the cognitive-emotional-behavioral of EI feel more security and less stress and also believe in therapy (CEBT) (Corstorphine, 2006), including assessment their abilities, showing higher feelings of self-worth, goodness, of emotions and emotional management techniques, has been and self-respect. shown to improve participants’ emotional eating behaviors, as On the other hand, there is some theoretical and empirical well as their self-esteem, depression, and anxiety (Campbell, support that self-esteem and anxiety are risk factors for ED 2012). symptoms. As mentioned above, improving self-esteem in combination with other components resulted in a more effective treatment for ED patients compared to CBT therapy alone. Emotional Intelligence and Eating In addition, several studies have consistently corroborated Disorders a negative relationship between self-esteem and ED criteria Emotional intelligence (EI) is a relatively new construct related (Silverstone, 1990, 1992; Silvera et al., 1998). Besides, numerous to emotions that comprises a set of basic emotional skills. studies have found that high levels of anxiety are a well- From an ability perspective, EI is defined as “the ability of recognized symptom in individuals with ED (Arnow et al., people to perceive, use, understand and manage emotions” 1995; Levinson and Rodebaugh, 2012; Menatti et al., 2015) (Mayer and Salovey, 1997; p. 532). This EI theoretical framework and that anxiety worsens the ED psychopathology (Brand- involves four basic emotional dimensions: emotional perception Gothelf et al., 2014). Given the high comorbidity between ED and expression, emotional facilitation, emotional understanding, and anxiety disorders and the fact that both disorders share and emotional regulation. From this perspective, emotional the same components (evaluative, affective, and somatic; Kaye regulation is defined as the ability to manage both positive et al., 2004), the robust relationship between ED and anxiety is and negative emotions in themselves and in others, integrating not surprising. emotion and cognition effectively (Mayer et al., 2016). These Along with the individual role of self-esteem and anxiety in emotional skills can be developed in clinical settings through ED symptomatology, several studies have tested the combined systematic and comprehensive EI training (Mayer et al., 2000; role of self-esteem and anxiety on ED. For example, a recent Kotsou et al., 2018). study found that self-esteem (together with mood dysregulation) In the last decade, an emerging line of research has typically moderated the association between levels of anxiety/depression shown the significant relationship between EI and ED symptoms. and greater deterioration of ED (Sander et al., 2021). In addition, For example, some prior research has found that individuals with Aloi and Segura-García (2016) found that low self-esteem had some EI deficits are more prone to display disordered eating an indirect effect on the risk of developing an ED through the attitudes and behaviors (Costarelli et al., 2009; Pettit et al., 2009; mediating action of anxiety. Filaire et al., 2010; Zysberg and Rubanov, 2010; Hambrook et al., There is also evidence that anxiety and self-esteem (considered 2012; Zavala and López, 2012; Zysberg, 2013; Zysberg and Tell, independently) play a relevant mediating role between EI and ED 2013; Gardner et al., 2014; Koch and Pollatos, 2015; Cuesta symptoms. For example, prior findings have found that social et al., 2017; Peres et al., 2018; Foye et al., 2019). In addition, anxiety mediated the relationship between
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