Previous research has demonstrated that people with anorexia nervosa (AN) experience difficulties in processing emotional states and affective information. Recent explanatory and treatment models of AN and other eating disorders (EDs) hypothesise that these difficulties may contribute to the maintenance of EDs and influence outcome. However, much of the existing literature is based on self-report data, experimental tasks that have questionable ecological validity, and has often not adequately explored potentially confounding effects of IQ and current affective distress. The current study sought to build on existing research and explore emotional processing in AN using a theoretically derived, performance-based measure of emotional intelligence (El). Specifically, this study explored the abilities of people with AN to identify emotions in themselves and others, to understand emotional meaning, use emotions to facilitate thought, and manage their own and others' emotions through their behaviour. A cross-sectional design was employed. Thirty two women with AN and 32 age- and IQ-matched healthy control (HC) women were compared regarding their performance on the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT), along with measures of EO symptomatology, indices of clinical severity, anxiety and depression, social functioning, and the Big Five personality dimensions. Results indicated that women with AN demonstrated El scores within the broadly average range compared to normative data, but exhibited significantly lower overall El compared to HCs in the current study. The two groups did not differ with regard to specific branches of El. El in people with AN was not related to EO symptomatology or indices of illness severity, but it was with anxiety and Agreeableness. Regression analyses indicated that both anxiety and Agreeableness significantly predicted El over and above diagnostic status. The current study suggests that people with AN may not experience particular difficulties in their abilities to reason about emotions and use emotional knowledge to guide their behaviour. Anxiety was highlighted as important in influencing El. 4

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Background: Anorexia nervosa is (AN) an eating disorder characterised by the egosyntonic nature of symptoms, denial of illness and d ambivalence about treatment engagement. Thus, AN is a complex and serious psychiatric disorder that is associated with substantial chronicity, mortality and poor treatment outcomes. It Is poorly understood and the evidence-base for effective treatment remains sparse. This study explored illness perceptions in AN using a qualitative design, which was not restricted by a physical illness model.

A broad spectrum of disordered eating is recognised , from body image dissatisfaction and disordered eating at a sub-clinical level, to severe and chronic eating disorders such as anorexia nervosa (AN). Many factors are implicated in the development and maintenance of disordered eating. The first paper is a systematic review of 25 studies evaluating the impact of appearance-related peer experiences on body image and disordered eating in children and adolescents. The review found relatively strong evidence suggesting that exposure to several appearance-related peer experiences, including appearance conversations, peer body dissatisfaction and pressure to change one's appearance from peers, is associated with body image dissatisfaction and disordered eating in children and adolescents. The impact of appearance-related peer factors should be addressed in clinical settings, and targeted prevention programmes are indicated. The second paper reports a qualitative study investigating compulsive exercise as an important and under-researched feature of AN. The study used modified grounded theory methodology to investigate the role of compulsive exercise in AN. Ten women with AN or eating disorder not otherwise specified-AN type were interviewed. A theoretical model was developed, which suggests that individuals vulnerable to compulsive exercise move through a process in which exercise becomes engrained and integrally linked to dietary restriction, leading to exercise feeling inescapable and developing a central role in their eating disorder. The initial role for compulsive exercise seems to be managing body weight and shape, however later roles include affect regulation, modifying a negative self-view, and feeling in control. The study findings offer a developmental explanation of compulsive exercise in AN, and provide rich information about the felt experience of compulsive exercise, and the complex relationship between exercise and dietary restriction.

Anorexia nervosa remains one of the most challenging mental health difficulties to understand and respond to effectively. Decades of clinically led quantitative research have provided theoretical models, treatment approaches and outcome data, but evidence suggests that the prevalence of anorexia nervosa (and our ability to influence it) remains stubbornly resistant to significant and meaningful change. Qualitative research, meanwhile, has valuable and under-utilised potential to inform and enlighten our knowledge base and clinical practice. The following thesis explores the power of qualitative methods to bring new understanding to two major issues confronting the academic, clinical and non-professional community concerning anorexia nervosa: transition between services and recovery. The first paper is an integrative review of qualitative research into service users' descriptions of recovery from anorexia nervosa. It provides an overview and critical appraisal of the evidence base and thematically explores current knowledge in relation to the wider service user recovery model and movement. The findings offer a valuable insight into how people with anorexia nervosa see and understand their own recover and suggest several important areas for clinical change and further research. The second paper reports on a qualitative investigation of the experience of transition between child and adult services for women with anorexia nervosa. Interviews with eight women were analysed using Interpretive Phenomenological Analysis. The finding. of the study span procedural, individual and systemic domains and have significant an meaningful implications for service design, future research and the understanding of anorexia nervosa as a whole during this key stage of development.

Severe and enduring anorexia nervosa (SE-AN) is a chronic and debilitating illness with a large detrimental impact on quality of life (QoL) in its sufferers. Treatments for SE-AN remain inadequate and full recovery is often illusive. Despite the growing literature on QoL in anorexia nervosa (AN), it remains unclear why chronicity of AN does not have a greater impact on QoL and there remains mixed findings on the relationship between QoL and full recovery. The present study aimed to address these gaps by conducting an in-depth exploration of perceptions of how SE-AN affects QoL, what full recovery means to individuals who have SE-AN and how QoL might be affected if an individual with SE-AN were to achieve clinical recovery. Furthermore, the study aims to build on current conceptualizations of recovery. Seven outpatients with SE-AN receiving treatment from a specialist eating disorders team were interviewed and the data was analysed using Interpretative Phenomenological Analysis (IP A). Three master themes emerged from the analysis with many similarities between the participants' responses. These themes were 'Experience of treatment and the therapeutic relationship', 'Life with AN' and 'Perceptions of full recovery'. The study provides insight into the relationship between subjective QoL and recovery and builds on current conceptualizations of recovery. It was found that participants with SE-AN may adjust to life with their illness so it becomes the norm for them. Participants may then rate their subjective QoL as higher, despite the severe objective impact of SE-AN on QoL. This could reduce motivation to recover. Furthermore, clinical recovery was often perceived as unachievable. These findings support the use of a recovery model in the treatment of individuals with SE-AN as the use of social definitions of recovery and a focus on improving QoL during treatment may best address the needs of individuals with SE-AN.