RESEARCH ARTICLE Emotions in Eating Disorders: Changes of Anger Control After an Emotion-focused Day Hospital Treatment Giovanni Abbate-Daga * , Enrica Marzola, Carla Gramaglia, Annalisa Brustolin, Stefania Campisi, Carlotta De-Bacco, Federico Amianto & Secondo Fassino Eating Disorders Center, Department of Neuroscience, Section of Psychiatry, University of Turin, Italy Abstract Objective: Emotional states are key elements of eating disorders (EDs), with anger and aggressiveness playing an important role. This study aimed to investigate anger features in ED patients before and after an intensive day hospital (DH) specifically focused on emotions. Method: Forty-one ED patients were admitted to our DH, which specifically includes emotion-focused activities. They completed self-reported questionnaires at the beginning and after the intervention: Eating Disorders Inventory-2, State-Trait Anger Expression Inventory (STAXI) and Beck Depression Inventory (BDI). Results: Anger Control (Axcon) subscale of STAXI decreased significantly, and both BDI and body mass index – in case of underweight patients – significantly improved after completion of DH. Axcon decrease correlated with BMI improvement. The majority of individuals showing good outcome reported also a significant improvement in Axcon levels. Discussion: This study provided preliminary data about the effectiveness – mainly in anger coping – of an emotion-focused DH. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association. Keywords eating disorders; anger; DH treatment; cinematherapy; psychodynamic psychotherapy *Correspondence Prof. Giovanni Abbate-Daga, Via Cherasco 11, 10126 Turin, Italy. Tel.: +39 011 6335425; Fax: +39 011 6335749. Email: giovanni.abbatedaga@unito.it Published online 29 August 2012 in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/erv.2199 Introduction and aims Altered emotional processing is endemic to individuals affected by eating disorders (EDs) (Bruch, 1973; Fox & Power, 2009; Meyer, Leung, Barry, & De Feo, 2010), but despite the available body of literature (Bruch, 1973; Fassino, Pierò, Gramaglia, & Abbate-Daga, 2004; Skårderud, 2007a; Davies, Schmidt, Stahl, & Tchanturia, 2011; McLean, Miller, & Hope, 2007; Meyer et al., 2010; Wildes, Ringham, & Marcus, 2010; Ioannou & Fox, 2009), scant attention has been paid to recognition, regulation and expression of emotions in these disorders (Harrison, Sullivan, Tchanturia, & Treasure, 2009). Eating symptomatology relies on emotional disturbances, and EDs are considered a means of managing affect (Dolhanty & Greenberg, 2007; Dolhanty & Greenberg, 2009), regulating intense or relatively undifferentiated emotional states (Nordbø, Espeset, Gulliksen, Skårderud, & Holte, 2006), and facilitating avoidance of emotions (Wildes & Marcus, 2011; Oldershaw et al., 2012). Emotional inhibition and avoidance are more likely to happen in close relationships and when negative emotional states are experienced (Vanderlinden et al., 2004; Geller, Cockell, Hewitt, Goldner, & Flett, 2000; Ioannou & Fox, 2009; Corstorphine, Mountford, Tomlinson, Waller, & Meyer, 2007). In fact, ED patients often perceive social emo- tions as overwhelming and aversive, usually feeling unable to integrate emotional conflicts. Therefore, they tend to disown such fearful experiences and aspects of the self (Dolhanty & Greenberg, 2007, 2009). In ED literature, alexithymia and concreteness of symptoms have been proposed as underpinning impaired emotional proces- sing (Skårderud, 2007a). In fact, ED patients are usually unable to correctly label their emotions; as a result, they often mislabel their internal experiences with body sensations (i.e. feeling ‘fat’ instead of feeling ‘uneasy’) (Skårderud, 2007b; Fassino, Daga, Pierò, & Delsedime, 2007). The use of ED to avoid emotions may play a role in maintaining the disorder: on the other hand, recovery would be associated with more adaptive beliefs about emotions, a decrease in affect avoidance and improved tolerance of emotions (Oldershaw et al., 2012). It has been found that several emotions are related to EDs: anger, sadness, fear, happiness and disgust (Fox & Power, 2009; Fox & Froom, 2009). In particular, anger and aggressive- ness represent key elements in EDs; these emotions can be both antecedents and triggers of several eating-disordered behaviours (Fassino, Daga, Pierò, Leombruni, & Rovera, 2001; Krug et al., 2008; Truglia et al., 2006). ED individuals report stronger anger suppression when compared with controls (Waller et al., 2003; Fox & Harrison, 2008), and they usually struggle in expressing and regulating their anger-related emotions (Whiteside et al., 2007; Fox & Power, 2009; Truglia et al., 2006). Still, from a clinical standpoint, anger and aggres- siveness are important elements concerning therapeutic 496 Eur. Eat. Disorders Rev. 20 (2012) 496–501 © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.