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Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity
https://doi.org/10.1007/s40519-020-00968-7
REVIEW
Emotional intelligence andeating disorders: asystematic review
JuanaRomero‑Mesa1· MaríaAngelesPeláez‑Fernández1 · NatalioExtremera1
Received: 17 February 2020 / Accepted: 17 July 2020
© Springer Nature Switzerland AG 2020
Abstract
Background Prior research indicates that deficits in emotional abilities are key predictors of the onset and maintenance of
eating disorders (ED). As a relatively new emotion-related construct, emotional intelligence (EI) comprises a set of basic
emotional abilities. Preliminary research suggests that deficits in EI are linked with disordered eating and other impulsive
behaviours. Also, previous research reveals that emotional and socio-cognitive abilities, as well as ED symptomatology,
varies across lifespan development. However, while the findings suggest promising results for the development of potential
effective treatments for emotional deficits and disordered eating, it is difficult to summarise the relationship between EI and
ED due to the diversity of theoretical approaches and variety of EI and ED measures.
Objective Our study, therefore, aimed to systematically review the current evidence on EI and ED in both the general and
clinical populations and across different developmental stages.
Methods The databases examined were Medline, PsycInfo and Scopus, and 15 eligible articles were identified. Preferred
Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used.
Results All the studies reviewed indicated negative associations between EI and the dimensions of ED. Additionally, several
mechanisms involved, namely adaptability, stress tolerance and emotional regulation were highlighted.
Conclusion The systematic review suggests promising but challenging preliminary evidence of the associations between
EI and the dimensions of ED across diverse stages of development. In addition, future research, practical implications and
limitations are discussed.
Level of evidence I Systematic review.
Keywords Emotional intelligence· Eating disorder· Systematic review· General population
Introduction
The impact of negative emotions on eating behaviours has
been examined extensively, although due to its variability, it
is difficult to predict how emotion will affect people’s eating
habits [1]. Some studies have found that specific emotions,
such as anger, fear, sadness and joy, in addition to more last-
ing and enduring moods, affect food responses during the
ingestion process [2, 3]. According to Polivy and Herman,
deficits in processing emotions play an important role in the
development and maintenance of eating disorders (ED) [4].
As reported by Agras and Telch, difficulties in the regula-
tion of negative affective states might cause an increase in
binge-eating behaviour [5]. Theory and empirical research
over the last two decades suggest that emotional intelli-
gence (EI), or the ability to process emotional information
and regulate emotion adaptively, may be a crucial protective
factor in ED, but no systematic review has examined the
association between EI and ED and other related behaviours.
Synthesising the available evidence on the empirical rela-
tionship between ED and EI through a systematic review
would allow one to know the state of research in this incipi-
ent field of study. Understanding the relationship between
The article is part of the Topical Collection on Personality and
Eating and Weight Disorders.
* María Angeles Peláez-Fernández
mapelaez@uma.es
Juana Romero-Mesa
juaniromero70@gmail.com
Natalio Extremera
nextremera@gmail.com
1 Department ofSocial Psychology, Social Work, Social
Anthropology andEast Asian Studies, Faculty ofPsychology
andLogopedics, University ofMálaga, Campus de Teatinos,
s/n. 29071, Málaga, Spain
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity
1 3
EI and ED is critical to guide prevention programmes and
treatment approaches for subjects with ED or those at risk
of ED. Because of the heterogenous and restricted number
of published articles, a systematic review instead of a meta-
analysis was conducted.
Emotional intelligence
Two theoretical frameworks are the most commonly
accepted in the research literature: mixed models and ability
models [6]. The mixed-trait model conceives of EI as a com-
pendium of stable personality traits, socio-emotional compe-
tences, motivational aspects and diverse cognitive abilities
[7–9]. Drawing upon these models, Bar-On [10] defines EI
in terms of an array of emotional and social attributes and
abilities that influence the overall ability to effectively cope
with environmental demands. It is composed of five com-
ponents: (1) intrapersonal (emotional self-understanding,
assertiveness, self-concept, self-realisation, independence);
(2) interpersonal (empathy, interpersonal relationships,
social responsibility); (3) adaptability (problem-solving,
reality testing, flexibility); (4) stress management (stress tol-
erance, impulse control); and (5) general mood (happiness,
optimism). In this mixed EI approach, self-report measures
are the measures most typically used.
In Mayer and Salovey’s [11] ability model, EI comprises
four interrelated and basic abilities: the ability to perceive,
assess and express emotions accurately; the ability to access
or generate feelings that facilitate thinking; the ability to
understand emotions and emotional knowledge; and the
ability to regulate emotions promoting emotional and intel-
lectual growth. This theoretical approach encompasses a set
of conceptually related emotional abilities to reason about
emotions and to process emotional information to enhance
cognitive processes, in which one fundamental and most
effective predictor is the emotion regulation ability [12].
Conforming to EI theorists, the EI research tradition is more
outcome-oriented in the sense that it seeks to capture the
consequences of emotion regulation on health, social and
life outcomes and to examine—among other dimensions—
individual differences in emotion regulation. In contrast, the
emotion regulation research tradition aims to examine issues
in a more process-oriented way; that is, it is more focused on
the processes by which individuals modify the trajectory of
the components of an emotional response. This tradition is
more interested in examining the emotion regulation strate-
gies that individuals use to manage their emotions [13, 14].
Regarding age, there are several measures of EI—both the
trait and ability approach for the adult population and their
respective adaptations for the child and adolescent popula-
tion. Some authors have reported an increase over time in
emotional self-efficacy [15–17] and EI ability that become
more stable across the age spectrum [18–20].
Emotional intelligence andeating disorders
Previous studies have found inverse associations between
ED symptoms and various psychological factors that medi-
ate emotional deficit management [21]. For instance, there
is evidence that low self-concept and emotion dysregulation
are key factors in the appearance and maintenance of ED
[22–25]. Similarly, individuals with high ED scores report
low self-esteem and dissatisfaction with body image [26,
27]. Eating disorder symptoms have also been associated
with interpersonal problems [28, 29], low levels of assertive-
ness [29] and more difficulties in recognising facial emo-
tional expression [30]. Furthermore, compared to healthy
subjects, ED patients are found to have significantly higher
impulsivity scores [31].
On the other hand, in terms of early age, some studies
indicate that childhood obesity could predict the risk of ED.
In a longitudinal study, it was concluded that 40% of the
overweight girls and 20% of the overweight boys—13.4%
and 4.7%, respectively—were involved in at least one altered
eating behaviour, and they had more than one related behav-
iour [32]. Other research suggests that a high body mass
index (BMI), body comparison, and sociocultural pressure to
reduce weight were risk factors for engaging in weight-loss
behaviours [33]. In addition, along with their developmen-
tal capacities and chronicity, the symptomatic expression
of ED varies across infancy and adolescence [34]. Children
and adolescents differ from adults both physiologically and
emotionally as they make the transition from child to adult
and, thus, with significant advances in the development of
emotional self-control. Literature in developmental psychol-
ogy reveals that emotional abilities constitute an important,
continuing topic throughout childhood, adolescence, and
adulthood and that each developmental transition is associ-
ated with change in one’s affective skills. These processes
are present in infancy but continue improving throughout
adolescence into adulthood and may underlie the emer-
gence and prevalence of ED in different stages. In short,
compared to adults, children and adolescents report more
limited verbal skills, lower abstracting problem-solving
abilities, less awareness of emotions, and reduced cogni-
tive control of impulsive behaviour [34]. These develop-
mental differences highlight the difficulties in diagnosing
ED and its correlates and symptoms in children and ado-
lescents. Likewise, a recent study carried out with 30,000
individuals with ED across five different developmental
stages (early adolescence, late adolescence, young adult-
hood, early-middle adulthood, and middle–late adulthood)
[35] revealed that, beyond similarities in central symptoms,
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity
1 3
the network structure or interconnectivity of ED symptoms
vary significantly from adolescence to adulthood. Moreover,
the potential deficits in emotional skills might interfere with
these necessary developmental transitions in a manner that
might increase the risk of appearance of ED, accounting
for differences in prevalence and intensity across different
developmental stages.
Using Preferred Reporting Items for Systematic Reviews
and Meta-analyses (PRISMA) guidelines [36], the present
work aims to systematically review the studies on EI and
ED to obtain a broader understanding of the empirical link
between ED and EI through different theoretical concep-
tualisations of EI, different stages of lifespan development
(childhood, adolescence, youth and adulthood) and several
types of population (general and clinical). Reviewing and
summarising this corpus of knowledge could allow the
development of a clear image of the current state of research
and propose future lines of research to complement the exist-
ing gaps in the field.
Methods
Exhaustive searches were conducted in the PsycINFO, Med-
line and Scopus databases between 6–13 November 2019.
We handled a computerised literature search, locating arti-
cles published in English or Spanish without any limitation
of time or age. The term ‘emotional intelligence’ was used
as a keyword or term in the title or summary, along with
the following expressions: ‘eating disorders’, ‘binge eating’,
‘bulimia’, ‘anorexia’ and ‘body mass index’. We also per-
formed manual searches of reference lists that allowed us to
complement our study’s database.
The articles that met the following criteria were included
in our review. The first criterion was that the studies had
to be based on empirical research; so, theoretical studies
and reviews were excluded. The second criterion was that
the articles had to examine the association between EI and
ED or symptoms of ED as related variables. The third cri-
terion was that the EI evaluation tools had to be based on a
theoretical EI model, and that they must assess at least one
dimension of EI. Studies based on other theoretical perspec-
tives (e.g., dysregulation of emotion or emotional function-
ing) were, therefore, excluded.
We identified 84 potentially eligible studies in the initial
searches: 22 in PsycINFO, 16 in Medline and 46 in Scopus.
Forty-nine relevant studies remained after eliminating the
35 duplicates. In this phase, two independent researchers
examined the titles and abstracts against the inclusion and
exclusion criteria, and a third researcher was consulted in
cases of disagreement. At this stage, our review led to the
exclusion of studies, because: (1) they did not study EI and
ED as the main variables; (2) they were not based on an EI
framework, or (3) they were not empirical studies. At the end
of this selection process, 38 studies were excluded, resulting
in 11 articles that fulfilled all the inclusion criteria. We also
included four articles found through manual searches that
met all the criteria. These 15 documents were examined in
their entirety and formed our final set of studies that actually
investigated EI and ED as the main variables. There was
only one study with children that examined the link between
EI and emotional eating behaviour (Fig.1).
Instruments
The instruments used to measure ED in the studies were as
follows:
– Eating Attitudes Test (EAT-26) [37] is the most fre-
quently used test in the included studies [6 of 15]. It is
a 26-item questionnaire that comprises three subscales:
dieting, bulimia and food preoccupation, and oral control.
Acceptable internal consistency reliability estimates for
the subscales are as follows: dieting—0.92, bulimia/food
preoccupation—0.86, and: oral control—0.71 [38].
– Bulimia Test Revised (BULIT-R) [39] is a 36-item self-
report that measures the degree of bulimic attitudes and
behaviours, with excellent internal consistency: 0.98
[40].
– Praeger Questionnaire Emotional Eating (PQEE) [41]
evaluates emotional feeding through 16 items of food
consumption, with adequate internal reliability ranging
from 0.72 to 0.85 in previous studies [41].
– Eating Disorders Examination Questionnaire (EDE-Q)
[42] is a 36-item self-report measure of ED symptoma-
tology and behaviours across four subscales: dietary
restraint, weight concern, shape concern and eating con-
cern. Test–retest correlations ranged from 0.66 to 0.94
for scores on the four subscales [43].
– Eating Disorders Diagnostic Scale (EDDS) [44] is a
9-item self-report scale for diagnosing anorexia nervosa
(AN), bulimia nervosa (BN) and binge-eating disorder.
Average internal consistency is 0.89 [44].
– Eating Disorder Inventory II (EDI-II) [45] is a 9-item
self-report that assesses the behavioural and cognitive
patterns associated with ED. Cronbach’s alpha for ano-
rexia scale is 0.90 and for bulimia, it is 0.83 [45].
– Food Preoccupation Questionnaire (FPQ) [46] is a
28-item self-report that evaluates rigidity, excess partici-
pation and concern for food, and food consumption. The
questionnaire demonstrated good reliability and construct
validity [46].
– Millon Adolescent Clinical Inventory-ED Scale
(MACI) [47] evaluates a clear tendency to AN or BN
and image perception, conditioned by fear of obesity.
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity
1 3
The reliability of the scales has been proven interna-
tionally on repeated occasions [48].
– Eating Disorder Inventory 3 (EDI-3) [49] contains 12
main scales: three specific ED—obsession with thin-
ness, bulimia and body dissatisfaction—and nine psy-
chological/general ones. It has shown good internal
consistency (0.91 for girls and 0.84 for boys) [49].
– Mini International Neuropsychiatric Interview Eat-
ing Disorder (module of the DSM-IV; M.I.N.I. Kids
6.0) [50] is a diagnostic interview based on DSM-IV
criteria. For any eating disorder, the area under curve
(AUC) ranges between 0.81 and 0.96, and the Kappa
coefficient ranges between 0.56 and 0.87 [50].
– Child Eating Behaviour Questionnaire (CEBQ) [51]
is a multidimensional, parent-report questionnaire
measuring children’s eating behaviour and is designed
to assess eating styles related to obesity risk. The
instrument is composed of 35 items and eight scales
(responsiveness to food, enjoyment of food, satiety
responsiveness, slowness in eating, fussiness, emo-
tional overeating, emotional undereating and desire for
Recordsidenfiedthrough database
searching(n=84)
PsycINFO: 22
Medline: 15
Scopus:46
Screenin
g
IncludedEligibilityIdenficaon
Addionalrecords idenfied
throughother sources
(
n=4
)
Recordsaer duplicatesremoved
(n =53)
Recordsscreened
(n =53)
Recordsexcluded
(n =0)
Full-text arclesassessed
foreligibility
(
n=53
)
Full-textarcles excluded,
withreasons
(
n=38
)
Studiesincludedin
qualitavesynthesis
(
n=15
)
Fig. 1 Flow chart of selection process
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity
1 3
drinks). The scale’s internal consistency was accept-
ably high (Cronbach’s alpha: 0.83) [51].
To measure IE, the following instruments were used:
– Bar-On Emotional Quotient Inventory (original ver-
sion) (EQ-i) [52] is a self-report measure with 133
items and includes five factors: intrapersonal, inter-
personal, adaptability, stress management and general
mood. EQ-i’s global internal consistency coefficient is
0.97 [52].
– Bar-On Emotional Quotient Inventory (short version)
(EQ-i:S) [53] is a self-report measure with 51 items and
includes the five factors of its original version [52]. Stud-
ies of reliability have yielded a Cronbach’s alpha ranging
from 0.76 to 0.93 [53].
– Bar-On Emotional Quotient Inventory (youth version)
(EQ-i: YV) [54] is a self-report measure with 60 items
and also includes the five factors of its original version
[52]. Estimates of internal consistency ranged from 0.65
to 0.90 [54].
– Trait Meta Mood Scale (TMMS-30) [55] is a self-report
questionnaire that measures trait EI and consists of 30
items with three intrapersonal dimensions: attention,
clarity and emotional repair. Acceptable values for Cron-
bach’s alpha in attention: 0.86, clarity: 0.88 and repair:
0.82 were reported [55].
– Wong and Law Emotional Intelligence Scale (WLEIS)
[56] is a self-report questionnaire that measures trait
EI and contains 20 items comprising four subscales:
evaluation of emotion in oneself, evaluation of emo-
tion in others, use of emotion and regulation of emotion.
The WLEIS was used in its Hebrew version [55] which
showed adequate Cronbach’s alpha internal reliability
ranging from 0.72 to 0.85 in previous studies [56] and
also in its Chinese version [57], whose Cronbach’s alpha
internal consistency was 0.89 [56].
– Schutte Emotional Intelligence Scale (SEIS) [58] is a
self-report test of 33 items composed of four subscales:
evaluation, expression, regulation and use of emotion,
with an adequate internal consistency of 0.90 [58].
– Audio–Visual Test of Emotional Intelligence (AVEI) [59]
consists of a 27-item skills test, based on the recognition
and analysis of emotions through images and short vid-
eos, which are framed in two of the four branches defined
by Mayer etal. [6] It has good reliability and predictive
validity [59].
– Multidimensional Emotional Intelligence Evaluation
Scale (MEIA) [60] evaluates self-perceived personality
traits in emotional functioning. It is composed of 116
items based on Salovey and Mayer’s original model [61].
The overall Cronbach’s alpha of the factor-based scale
representing the entire test was 0.96 [62].
– Mayer–Salovey–Caruso Emotional Intelligence Test Ver-
sion 2.0 (MSCEIT) [63] includes 141 items and is framed
within the EI ability model. It includes the four areas
proposed in the Mayer and Salovey model: perception,
facilitation, understanding and emotional management.
The overall EI test score reliability was r = 0.93 for con-
sensus and 0.91 for expert scoring [64].
– Trait Emotional Intelligence Questionnaire—Adolescent
Short Form (TEIQue-ASF) [65] (Spanish version) is a
30-item self-report instrument that measures the global
trait EI. The test has exhibited an internal consistency of
0.82 [65].
– Karolinska Directed Emotional Faces (KDEF) [66] is
based on the ability model of Mayer etal. [6]. This task
involves recognising facial emotions with 20 standard-
ised colour photographs of the faces of young European
adults showing four types of facial expressions: happy,
angry, sad and neutral. The average success rate skewed
was 72% [67].
Results
Fifteen articles were included in our review and were clas-
sified into five developmental stages of subjects included in
the studies: (1) adults and young adults; (2) young adults and
adolescents; (3) adolescents; (4) adolescents and children,
and (5) children. Some of these categories overlapped due
to the sample ages of included studies. Of the 15 studies, 14
were performed in general population samples and one was
performed in a clinical sample.
Seven studies were identified as examining EI and ED in
an overlapping adult population with a young adult popula-
tion, all of them using cross-sectional designs.
Three used EI self-report measurements, three combined
EI self-report measures with performance-based instru-
ments, and only one used performance-based EI measures
exclusively. The description of the 7 studies, the EI assess-
ment tools and the main findings are presented in Table1.
Findings inadults andyoung adults using
self‑report EI measures
Costarelli, Demerzi and Stamou [68] used the EQ-i [52].
Their results showed that women who reported ED attitudes
demonstrated lower levels of EI compared to counterparts
who did not have ED attitudes. In addition, they found sig-
nificant positive associations between anxiety levels and EI.
Zysberg and Rubanov [69] used the Hebrew version of
the WLEIS [56]. The results indicated a strong association
between EI and emotional eating, in such a way that the
highest EI scores are associated with a lower tendency to
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity
1 3
Table 1 Studies on EI and ED (Adult and young adult population)
Study Sample (N) EI scale Examined variables Statistical analyses Principal results Statistics
Costarelli etal. [68] 92 female students
Age range = 18 - 30
(M = 23, SD = 3.53)
EQ-i Bar-On – Eating attitudes (EAT-26)
– Body image (MBSRQ)
– Anxiety (STAI)
– Mann–Whitney test – Women in the ED attitudes
group had lower levels
of EI compared to the
control group (in factors:
emotional self-awareness,
empathy, interpersonal
relationships, stress man-
agement and happiness)
M = 25.52 (± 4.129 vs.
M = 28.54 (± 4.78),
p < .05
M = 27.86(± 6.78) vs.
M = 31.41(± 4.03);
p < .01
M = 38.71(± 5.26) vs.
M = 42.79(± 3.93);
p < .001
M = 54.86(± 5.69) vs.
M = 58.55(± 8.41);
p < .05
M = 34.00(± 4.70) vs.
M = 36.71(± 5.15);
p < .05
Zysberg and Rubanov [69] 90 adults (50 women and 40
men)
Age range = 21 - 62
(M = 42.3, SD = 11.8)
WLEIS – Emotional eating (PQEE) – Pearson’s correlation coef-
ficient
– Strong association between
EI and emotional eating r = − .72; p < .001
Foye etal. [70] 355 adults (84% women and
16% men)
Age: > 18
83 with ED background
272 without ED background
SEIS – Eating attitudes (EAT-26) – Pearson’s correlation coef-
ficient
– Mann–Whitney test
–Significant negative cor-
relations between total
scores of ED and overall EI
and EI facets (appraisal of
one’s emotions, emotional
regulation, emotional
utilisation and optimism).
These relationships were
significant only for those
with an ED background
r = − .371; p < .001
r = − .363; p < .09
r = − .477; p < .001
r= − .346; p < .004
r = − .379; p < .001
Zysberg and Tell [72] 130 adults (93 women and
37 men)
Age range: 21-31
(M = 26.67, SD = 3.47)
SEIS
AVEI
– Tendency to ED (EDI-II)
– Perceived control (PCS)
– Pearson’s correlation coef-
ficient
– The perceived control
mediated the associations
between the score in EI
and ED for AN and BN
r = .17; p < .03
Zysberg [73] 126 students (31 men and 95
women)
(M = 24.07, SD = 2.43)
SEIS
AVEI
– Food preoccupation (FPQ)
– Body weight, image and
self-esteem (B-WISE)
– Appearance (ASI)
– Personality traits (Big-5)
– Pearson’s correlation coef-
ficient
–High levels of EI correlate
with lower levels of food
concern
r = − .15; p < .05
r = − .27; p < .01
Gardner etal. [74] 235 women; age range:
18-79
(M = 36.20, SD = 11.72)
MEIA
MSCEIT
– Bulimic symptoms
(EDDS)
– Bivariate correlations –The EI global trait was
negatively correlated with
binge eating and global
bulimic symptoms
r = − .21; p < .001
r = − .22; p < .001
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity
1 3
eat emotionally and vice versa. When using a hierarchical
regression model, it was observed that age and sex had no
significant effect on emotional eating, and education had a
moderate effect.
Foye, Hazlett and Irving [70] used the SEIS [58] to meas-
ure EI. They used additional subscales conforming to the
analysis of Lane etal. [71] to provide a six-faceted EI score
(appraisal of others’ emotions, appraisal of own emotions,
emotional regulation, social skills, emotional utilisation and
optimism). The findings indicated negative associations
between overall EI and EAT-26 [37] total scores. These
associations stayed significant for only four features of the
EI construct: appraisal of own emotions, emotional regula-
tion, emotional utilisation and optimism. For those report-
ing a history of ED, these associations remained significant,
whereas for those with no background of ED, correlations
between EAT-26 and emotional regulation and emotional
utilisation were not significant.
Findings inadults andyoung adults using
self‑report andability EI measures
Zysberg and Tell [72] used the SEIS [58] to test for EI and
the AVEI to measure EI ability [59]. Based on the prelimi-
nary evidence indicating an association between EI and ED,
they examined the mediation role of perceived control in the
EI-ED link. In general, the results indicated that perceived
control mediated the association between the EI and risk of
ED scores for both AN and BN.
Zysberg [73] also used the SEIS and the AVEI. The
author reported a correlation between the SEIS and two of
the three indexes of ED; after controlling statistically for the
potential shared variance, results showed a non-significant
association between SEIS and body dissatisfaction. No asso-
ciation was found with any of the variables, except for a
moderate association with body image. Although consider-
able adjustment was made for potential confounding vari-
ables, the AVEI showed a statistically moderate association
with disordered eating patterns.
Gardner, Quinton and Qualter [74] evaluated EI con-
structs with two different measures: a trait EI measure,
namely the MEIA [60] and a skill EI measure, the MSCEIT
Version 2.0 [63]. For both instruments, they used the total
score to measure the upper level, the factors to measure the
average level and the concrete facets to measure the lowest
level of EI. Their findings revealed a negative correlation
between the global trait EI and global bulimic symptoms,
and binge eating at the upper level of EI; however, they
found no correlation between bulimic symptoms and the
highest level of EI skill. At the intermediate and lower levels
of EI (factors and facets), they found negative correlations
with bulimic symptoms for both trait EI and EI skill.
Table 1 (continued)
Study Sample (N) EI scale Examined variables Statistical analyses Principal results Statistics
Hambrook etal. [75] 64 women; 32 AN group
(M = 31.63; SD = 11.46)
32 HC group
(M = 28.38; SD = 11.31)
MSCEIT – Eating disorders (EDE-Q)
– General Intelligence
(WAIS)
– Independent t tests –The control group had a
significantly higher EI total
score compared to the AN
group
[t (62) = − 2.25; p < .05]
EQ-I Emotional Quotient Inventory [52]; EAT-26 Eating Attitudes Test [37], WLEIS Wong and Law Emotional Intelligence Scale [56], PQEE Praeger Questionnaire Emotional Eating [41],
SEIS Schutte Emotional Intelligence Scale [58], AVEI Audio–Visual Test Emotional Intelligence [59], EDI-II Eating Disorder Inventory II [45], FPQ Food Preoccupation Questionnaire [46],
MEIA Multidimensional Emotional Intelligence Assessment [60], MSCEIT 2.0 Mayer-Salovey-Caruso Emotional Intelligence Test [63], EDDS Eating Disorders Diagnostic Scale [44], EDE-Q
Eating Disorders Examination Questionnaire [42]
*p < .05; **p < .01; ***p < .001
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity
1 3
Findings inadults andyoung adults using
ability EI measures
Hambrook, Brown and Tchanturia [75] used the MSCEIT
Version 2.0 [63], in a clinical trial with control group. The
main finding was that the AN group had a significantly
lower performance than the control group in terms of their
overall EI. The AN group also demonstrated a significantly
poorer EI in the MSCEIT change task, which measures the
understanding of how specific emotions can result from the
intensification of another feeling.
In agreement with Cohen’s [76] standard, the correlation
coefficients represent effect sizes from small (r = − .477;
p < .001) between emotional regulation and ED [70] to large
(r = .72; p < .001) between EI and emotional eating [69].
Findings intheyoung adults andadolescent
population
Our search identified four articles that analysed the relation-
ship between EI and ED in the young adults and adolescent
population following cross-sectional designs. All used self-
reported measures of EI traits. The description of the four
studies, the EI assessment tools and the main findings are
presented in Table2.
Findings inyoung adults andadolescents
using self‑report EI measures
Markey and Vander Wal [77] used the EQ-i: S [53]. The
results showed that a lower EI predicted significantly greater
bulimic symptomatology.
Filiare, Laure and Rouveix [78] also used the EQ-i [52].
They found that men with ED attitudes (athletes and control)
had lower levels of EI compared to groups without ED, in
the following factors: intrapersonal, adaptability, tolerance
to stress and general mood. They also found that athletes had
higher levels of EI subscale scores compared to the control
group (interpersonal and impulse control) and that athletes
with ED had significantly lower scores on the subscales of
happiness, flexibility, empathy and emotional self-awareness
in comparison with athletes without ED. In the group of
ED attitudes (athletes and control), the EAT-26 [37] was
negatively correlated with tolerance to stress, emotional
self-awareness and general mood, and positively with body
dissatisfaction.
Pettit, Jacobs, Page and Porras [79] evaluated EI with the
reduced version of the TMMS-30 [55]. Their findings revealed
an inverse relationship between EI factors (clarity and repair)
and food concern/bulimia. Perception of EI factors combined
with gender was also significantly related to diet, food concern/
bulimia and general eating attitudes.
Li [80] used the WLEIS [56] in a version adapted to the
Chinese population [57]. The results showed a negative cor-
relation of moderate magnitude between EI and ED risk as
measured by the subscales of EAT-26 [37]. As main effects,
the results found that the girls and the obese group had a
significantly higher risk of ED than the boys and the under-
weight, normal and overweight groups. After controlling for
gender and body size as potential confounding variables, EI
predicted the risk of ED negatively; that is, subjects who
showed higher scores in EI scored lower in ED on the EAT-
26 questionnaire.
According to Cohen’s [76] standard, the correlation
coefficients represent small effect sizes (r = − .177; p < .01)
between clarity and bulimia/food concern [79] and large
ones (r = − .41; p < .001) between EI and ED risk [80].
Findings intheadolescent population
Our search identified two articles that analysed the rela-
tionship between EI and ED in the adolescent population,
following cross-sectional designs. Both studies used self-
reported measures of EI traits. The description of the two
studies, the EI assessment tools and the main findings are
presented in Table3.
Findings intheadolescent population using
self‑report EI measures
Zavala and López [81] used the EQ-I: YV to assess per-
ceived EI [54]. Their results showed significant negative
correlations between the total EI score and disposition to
ED, specifically in three of the four scales: intrapersonal,
stress management and adaptability. Findings also showed
significant differences between the sexes, with the disposi-
tion to ED being higher in women.
Peres, Corcos, Robin and Pham-Scottez [82] used the
EQ-I: YV [54] to analyse EI differences between a group
of girls diagnosed with AN, using interviews based on the
DSM-IV criteria and a control group. They found significant
differences between both groups on the scales for intraper-
sonal EI and general mood.
Findings intheadolescent andchild
population
We only found a single article that examined the relation-
ship between EI and ED in a sample of children and adoles-
cents between 10 and 17years of age. Cuesta, González and
García [83] used the Spanish version of the TEIQue-ASF
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity
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Table 2 Studies on EI and ED (Adolescent and young adult population)
EQ-I Emotional Quotient Inventory [52] (S = short version [53], BULIT-R Bulimia Test Revised [39], EAT-26 Eating Attitudes Test [37], TMMS–30 Trait Meta Mood Scale [55], WLEIS Wong
and Law Emotional Intelligence Scale [56]
*p < .05; **p < .01; ***p < .001]
Study Sample (N) EI scale Examined variables Statistical analyses Principal results Statistics
Markey and
Vander Wal
[77]
154 female students
Age range = 17–23
(M = 18.66)
EQ-i:S Bar-on – Bulimic attitudes (BULIT-
R)
– Alexithymia (TAS-20)
– Coping (COPE)
– Positive and negative
affect (PANAS-X)
– Affect Intensity (AIM)
– Multiple regression analyses With lower EI predicting
greater bulimic symptoma-
tology
[F (1,152) = 15.55, p < .001,
R2 = .09]
Filaire etal. [78] 45 men; 20 professional
judoists
(M = 19.5, SD = 0.9)
25 students (M = 20.08,
SD = 0.7)
EQ-i Bar-On – Eating attitudes (EAT-26)
– Body image (BIAS-BD)
– Spearman correlation coef-
ficient
– Men with ED attitudes
(athlete and control) had
lower levels of EI compared
to the groups without ED
in factors: intrapersonal,
adaptability, stress to toler-
ance and general mood
M = 143.5(± 3.55) vs.
M = 153.05(± 2.9); p < .01
M = 86.3(± 3.2) vs.
M = 93.55(± 4.45); p < .05
M = 30.7(± 2.45) vs.
M = 35.3(± 2.2); p < .04
M = 49.45(± 2.85) vs.
M = 57.35(± 4.1); p < .04
Pettit etal. [79] 402 students (222 women and
180 men)
Age range = 18–24
TMMS 30 – Eating attitudes (EAT-26) – Multiple regression analyses – There was an inverse rela-
tionship between EI factors
(clarity and repair) and
bulimia/food concern
r = − .177; p < .01
r = − .151; p < .01
Li [80] 784 students (402 girls and
382 boys)
Age range: 15–20
(M = 17.12, SD = 1.32)
WLEIS – Eating attitudes (EAT-26)
– Social anxiety (LSAS)
– Pearson’s correlation coef-
ficient
– EI correlated negatively
with social anxiety and ED
risk.
– Social anxiety correlated
positively with ED risk
r = − .44; p < .001
r = − .41; p < .001
r = − .55; p < .001
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity
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Table 3 Studies on EI and ED (Child and adolescent population)
EQ-I-YV Emotional Quotient Inventory-young version [54], MACI Millon Adolescent Clinical Inventory-ED Scale [47], M.I.N.I. Kid 6.0. Mini International Neuropsychiatric Interview Eat-
ing Disorder (module of the DSM-IV) [50], TEIQue-ASF Trait Emotional Intelligence Questionnaire-Adolescent Short Form [65], EDI-3 Eating Disorder Inventory 3 [49], KDEF Karolinska
Directed Emotional Faces [66], CEBQ Child Eating Behavior Questionnaire [51]
*p < .05; **p < .01; ***p < .001
Study Sample (N) EI scale Examined variables Statistical analyses Principal results Statistics
Studies on EI and ED (adolescent population)
Zavala and López (2012)
[81]
829 adolescents
(435 girls and 394 boys)
Age range: 13–15
(M = 13.6, SD = 0. 64)
EQ-i: YV Bar-On – Eating disorders
(MACI)
– Pearson’s correlation
coefficient
– Significant negative
relationship between EI
and total symptom score
ED. In scales: intraper-
sonal, stress manage-
ment, adaptability and
emotional coefficient
r =− .138**; p < .01
r = − 266**; p < .01
r = − .103**; p < .01
r = − .196**; p < .01
Peres etal. (2018) [82] 79 girls; 41 AN group
(M = 16.2, SD = 1.4)
Age range: 13.1–18.9
38 HC group (M = 15.84,
SD = 1.83)
Age range: 13.1–18.8)
EQ-i: YV Bar-On – Eating disorders
(M.I.N.I Kid.6.0)
– Depression and anxiety
(HADS)
– Interpersonal reactivity
(IRI)
– Alexithymia (TAS-20)
– t student
– Linear regression
– Significant differences
between the AN and
control groups in EI
scales: intrapersonal and
general mood
[t (77) = 2.34; p < .05]
[t (77) = 8.69; p < .001]
Studies on EI and ED (adolescent and child population)
Cuesta etal. [83] 762 students; 382 preado-
lescent
(51.8% girls, 48.2% boys)
Age range: 10–12
(M = 10.55, SD = 0.60)
380 adolescents (47%
girls, 53% boys)
Age range: 12-17
(M = 13.53, SD = 1.25)
TEIQue-ASF – Eating disorders (EDI-
3)
– Pearson’s correlation
coefficient
– EI correlates signifi-
cantly and negatively
with total symptom
score ED
r =− .55**; p < .001 (girls)
r = − .39*; p < .05 (boys)
Studies on EI and ED (child population)
Koch and Pollatos [84] 66 children (32 girls and
34 boys)
Age range: 6–10
Overweight/obesity
(M = 8.59, SD = 0.96)
Normal weight (M = 8.94,
SD = 0.79)
EQ-i:S: YV Bar-On
KDEF
– Emotional eating
(CEBQ)
– Fluid intelligence
(WISC)
– Pearson’s correlation
coefficient
– EI (intrapersonal and
interpersonal) did not
differ significantly
between the groups
(overweight/obesity and
normal weight).
[t (64) = .21; p = .838]
[t (64) = .41; p = .684]
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity
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[65], via a cross-sectional design. They used self-reported
measures of EI traits.
Their findings indicated that the EI trait was significantly
and negatively correlated with the total scores of ED symp-
toms and with all the subscales of the EDI-3 [49] in pre-
adolescent boys, preadolescent girls and adolescents. After
controlling for the effect of BMI as a potential confounding
variable, the EI trait was a significant and predictive variable
of ED symptoms in all groups: preadolescent girls (22%),
adolescent girls (23%), preadolescent children (17%) and
adolescents (13%) (see Table3).
Findings inthechild population
We only found one article that, although it did not specifi-
cally analyse the relationship between EI and EDs, compared
emotional eating behaviour (an eating practice associated
with obesity risk) with EI and identification of facial emo-
tions in a sample of children between 6 and 10years of age.
Koch and Pollatos [84] evaluated the relationship between
EI and food imbalances in a sample of children using two
of the five scales (intrapersonal and interpersonal) of the
EQ-i: YV [54] via a cross-sectional design. They also used
the task from the KDEF [66]. To measure emotional eat-
ing, they used the CEBQ [51]. It is a parent-report measure.
Their findings indicated that EI did not differ significantly
between the groups of overweight/obese and normal weight
children; however, the group of overweight/obese children
scored significantly higher on the CEBQ (i.e., they reported
a high degree of emotional eating behaviour) than the group
of normal weight children. They also found significant nega-
tive correlations between intrapersonal and interpersonal
EI and reaction time in the recognition of facial emotions.
Similarly, excessive emotional eating and the success rate
in recognising sad faces in the KDEF task were negatively
correlated (see Table3).
Discussion
In recent decades, a series of studies have examined the
impact of personality factors on the development and main-
tenance of ED [85]; more recently, the potential role of emo-
tions and emotional abilities in ED has attracted the atten-
tion of many researchers. The present review systematically
analysed fifteen articles published between 2007 and 2019
and examined the association between EI and ED in both
general and clinical populations. A negative relationship
between total EI dimensions and different ED symptoms was
reported; that is, individuals with high levels of EI reported
fewer eating behaviours and concerns than those with low
EI. As far as we know, this is the first study that summarises
the literature on associations between EI and ED. Reviewed
studies indicate a negative relationship between EI and ED
across different developmental stages, independently of
whether EI was measured by skill and self-report tests.
Mechanisms involved intherelationship
betweenEI andED
Our findings highlight some mechanisms involved in the
association of EI with ED. For example, Li [80] provided
results indicating that social anxiety partially mediates the
relationship between EI and the risk of ED. By adding social
anxiety to the model, the direct effect of EI on the risk of
ED decreased substantially, although it remained significant.
Emotionally intelligent individuals may be less afraid of
being evaluated negatively, thus decreasing the risk of ED.
Previous studies have indicated a close relationship between
social anxiety and ED [86–93].
Two studies in our review considered additional
approaches along with examining the association between EI
and ED. Both involved data supporting the mediation of anx-
iety in the relationship between EI and ED. Hambrook etal.
[75] found that the performance of EI was closely related
to the level of self-reported anxiety. Their data suggested
that anxiety mediated the observed relationship between the
diagnosis of AN and EI. Similarly, prior studies found that
differences in alexithymia between AN and control groups
disappear after statistically controlling for anxiety [94, 95].
Deficits in identifying and communicating emotions in indi-
viduals with AN might, therefore, be secondary to personal
distress, rather than being attributed to the presence of AN.
Lower EI in people with AN might be attributed to higher
experienced anxiety, which would interfere with the abil-
ity to reason accurately about emotions and use emotional
information to make adaptive decisions in a social context.
Peres etal. [82], reported difficulties in emotional processing
in the AN group compared to the healthy control group, find-
ing that some of the differences at the Intrapersonal, stress
management, and the total score of EI, might be explained
by anxiety or depression.
The findings of Markey and Vander Wal [77] suggest that
there is a significant association between negative affect and
bulimic symptomatology, independent of EI association and
bulimic symptomatology. They did not find any significant
effect according to the level of EI between the association of
negative affect and ED. Previous research has identified neg-
ative affect as a predictor of binge eating [5] and coping as
a moderator in the relationship between negative affect and
binge eating [96]. Consequently, people with greater posi-
tive affect could face emotional situations in a more adaptive
way as a potential protective factor against developing ED.
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity
1 3
Beyond examining the association between EI and ED,
Zysberg and Tell [72] considered an additional approach.
They argued that EI could affect perceived control and that
this would be positively associated with AN and negatively
associated with bulimic symptoms. Their findings partially
supported the mediating model. Perceived control mediated
associations between the EI and ED scores for AN and BN.
Perceived control is positively associated with EI and is a
concept that revolves around the effective management and
regulation of emotional reactions [97, 98]. Therefore, per-
ceived control might be a factor to take into consideration in
further research. Individuals who perceive greater self-con-
trol may be more effective at emotional self-regulation, thus
emphasising its potential role as a protective factor against
the development of some dysfunctional eating behaviours
such as BN and binge eating, while other people who per-
ceive high self-control may be at higher risk of AN.
Limitations ofincluded studies
We found several limitations when analysing the literature in
this field. First, there were limitations involving the hetero-
geneity of the EI instruments used. Nine different question-
naires were used to evaluate EI—six for trait EI, and three
for ability. Trait EI measures were used in nine studies; only
one study used ability EI measures, and four studies used
trait and ability measures jointly. Second, most of the studies
have not used diagnostic instruments to assess specific types
of ED, but they have used a wide range of different and heter-
ogeneous questionnaires to detect the risk of ED (i.e., eating
attitudes or behaviours). In general, 11 different measures
were used to evaluate these eating behaviours. Therefore, it
was not possible to provide empirical associations between
specific types of ED and EI abilities. In addition, due to the
heterogeneity of the instruments used for measuring EI and
ED/ED risk, the variety of samples used at different stages
of life and the multiple theoretical EI approaches employed,
it was not possible to conduct a meta-analysis study. The
instruments used to measure ED/ED risk do not consider
the changes included in the DSM-5. Third, all studies used
a cross-sectional design. The lack of prospective research
in this field thus limits interpretations of the relationship
between variables, hampering any casual inference. Fourth,
the age ranges of the samples of some of the selected stud-
ies were not well adjusted to a developmental age category,
causing overlapping with other age categories and thus not
allowing for an exhaustive and homogeneous classification
of studies according to age group samples. Therefore, future
studies should include samples in consonance with the con-
text of the characteristics of normal development, especially
in early and late adolescence. Finally, no study was found
on the specific association of EI and ED in children. Only
one study to date has examined the association of EI with
emotional eating behaviour as an eating style associated with
the risk of obesity in children.
Future research andpractical directions
Our review proposes a series of methodological gaps that
should be considered in future research to deepen the current
understanding of EI and ED. Zysberg and Tell [72] suggest
that there may be essential differences in the dynamics of
personal factors associated with ED behaviour in clinical
and non-clinical samples. Future studies should, therefore,
compare both samples. Similarly, while there is a body of
research examining the role of eating behaviours in non-
clinical samples, more research is needed to analyse the role
of EI in clinical samples [77]. There are potential gender
and age differences in EI, so future studies should examine
in depth how EI is differently associated with ED in women
and men, and in different developmental groups [83]. As EI
involves different EI abilities, further research might exam-
ine which EI subdimensions are most strongly associated
with ED symptoms [68]. In the same sense, Gardner etal.
[74] question the usefulness of prolonged evaluations of EI.
The inclusion of diagnostic instruments and DSM-5 criteria
when evaluating ED could provide more homogeneous data
adapted to the current situation.
These findings can help to boost further research in the
field of the conceptual validation of EI and in the study of
ED risk factors and symptoms. Certainly, more consist-
ent findings are necessary in both clinical and non-clinical
samples. Identifying potential risk factors could contribute
to the development of simpler and more effective measure-
ment instruments that could help to better understand psy-
chotherapeutic interventions. This would provide clinicians
with a potential intervention guide for individuals suffering
from ED, assisting them in their early identification and in
a promising intervention. Our systematic review thus pro-
vides some insightful information for the development of
preventive programmes based on EI to minimise the risk of
ED in populations potentially at risk, such as children and
adolescents.
Conclusion
The present systematic review suggests promising but chal-
lenging preliminary evidence of the associations between
EI and ED/ED risk across different stages of development.
Future longitudinal cohort investigations might be useful
for a theoretical understanding of the nature of EI and its
associations with various eating-related behaviours. If the
proposed model is supported, it could potentially be used to
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity
1 3
guide prevention programmes for individuals at risk of ED
and more precise interventions than those currently available
for individuals who suffer from ED.
What isalready known onthis subject?
Individuals with ED and at risk of ED usually report dif-
ficulties managing their own emotions. These emotional
deficits lead to the maintenance and development of ED
symptomatology. However, no previous systematic review
has synthesised the available evidence on the empirical link
between ED and EI.
What does this study add?
A summary view of the existing research on the relationship
between EI and ED/ED risk across developmental stages. A
negative relationship between EI dimensions and different
ED symptoms and attitudes was found across the included
studies. These results underline the need for including emo-
tional abilities in the development of prevention programmes
and therapeutic interventions for individuals with ED or
in at-risk situations that complement the existing cogni-
tive–behavioural approach.
Compliance with ethical standards
Conflict of interest All the authors declare that they have No conflicts
of interest.
Research involving human participants and/or animals This article
does not contain any studies performed by any of the authors involv-
ing human participants or animals.
Informed consent For this type of study, formal consent is not required.
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