Emotional regulation and eating behaviors -
And this cycle of disordered eating can further exacerbate emotional dysregulation, creating a vicious cycle that is difficult to break.
Indeed, the link between emotion regulation difficulties and eating disorders is complex and multifaceted. But understanding this connection is essential for effective treatment and recovery. Emotion dysregulation is a common aspect of many mood disorders, eating disorders, and other mental health conditions.
Broadly, the term refers to poorly managed emotional responses, which fall outside the typically accepted range of emotional reactions. While the outward signs of emotion dysregulation may be easier to spot, the condition can also lead to a number of more private signs, symptoms, and struggles, including:.
People who struggle with these intense emotions on a regular basis also frequently turn to coping mechanisms to help. Unfortunately, this can include maladaptive coping mechanisms, such as binge eating episodes , purging, diet limitation, or self-harm.
It can serve as a primary condition, which contributes to the development of disordered eating behaviors, or develop along with the disorder, and eventually help drive the condition. Mood disorders involving depression and anxiety and low self-esteem are frequently co-occurring conditions with eating disorders.
To help them cope with these intense emotions, many people turn to food. An array of eating disorder symptoms, including binge eating, purging episodes, or extreme diet limitations, may be utilized to help someone either release these unpleasant emotions or feel some sense of control over them.
What starts out as a coping mechanism can easily develop into a full-blown eating disorder. When these essential factors are out of balance, it can send off a cascade of hormonal reactions, which can result in mood swings, irritability, trouble sleeping, fatigue, and other issues commonly associated with emotion dysregulation.
Emotion dysregulation is a major driver of many mental health conditions. As such, there have been a number of therapies and strategies developed to help people regulate emotions or achieve more regular emotional functioning.
While these techniques vary in approach and philosophy, the common factor among them is helping someone learn to recognize their negative emotions, and finding healthier ways to manage these intense feelings.
Dialectical behavior therapy DBT was expressly developed to help people better regulate their emotions. While first conceived to help people struggling with borderline personality disorder, a mental health condition defined by extreme emotion dysregulation, the therapy has since been adapted to help people with eating disorder diagnoses.
While DBT aims to help individuals develop a more balanced relationship with their emotions, it can also help address the complex psychological issues that are often at the heart of eating disorders. This approach operates on the idea that unhelpful behaviors stem from unhelpful thoughts. It helps individuals learn to first identify, then redirect, and, eventually, change these unhelpful thoughts, which hopefully leads to a positive change in behavior.
When used to treat emotional dysregulation, this approach can help individuals identify and change the thoughts and behaviors contributing to their emotional distress. The hope is that learning to identify these patterns can help someone more clearly understand their reactions and more effectively manage their emotions.
In particular, CBT is commonly used for treating emotional dysregulation associated with an array of eating disorders, anxiety disorders, and other mood disorders. Rather than attempting to stop or change certain thoughts or thought patterns, the method instead encourages patients to understand and accept their less-pleasant thoughts as part of a normal spectrum of emotions.
The energy that would be used to redirect these thoughts is then instead directed toward building healthier and more positive hobbies, habits, and interests. This newfound psychological space is then used to help them have more measured, healthy, and positive reactions to situations.
The strategy has also been found to increase psychological flexibility, which is an underlying factor of many eating disorders and mental disorders in general.
These conditions are dangerous, and can be deadly if left untreated. This can include your primary care physician, therapist, psychiatrist, or another trusted medical professional. These experts are often educated in a number of disordered eating and mental health conditions, and they can help assess symptoms, make an official diagnosis, or recommend the best next steps for finding treatment.
These services are generally free and almost always anonymous, providing additional information and resources on certain eating disorder behaviors, emotion regulation strategies, and ideas on where to find help.
Regardless, finding support for emotional dysregulation and eating disorders is essential for recovery.
The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals. We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors.
If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help. Updated on September 19, , on EatingDisorderHope. The information contained on or provided through this service is intended for general consumer understanding and education and not as a substitute for medical or psychological advice, diagnosis, or treatment.
All information provided on the website is presented as is without any warranty of any kind, and expressly excludes any warranty of merchantability or fitness for a particular purpose. Need Help - Find A Treatment Program Today. This entry was posted in Eating Disorder Discussions , Featured on Sep 19 by Chandler.
What is Emotion Dysregulation? These reactions can manifest in a number of ways, including: Intense emotions: Anger, anxiety, sadness, or irritability are common emotional reactions, which may come on quickly and powerfully and feel difficult to manage.
Impulsivity: Difficulties in emotion regulation often lead to impulse control difficulties, which can take the form of abrupt or even involuntary decisions or behaviors.
Second, to test the hypothesised relationship between variables, a mediation analysis was performed. Estimates of the indirect effects of multiple mediators, along with standard errors SE and confidence intervals CI , were obtained.
The means, standard deviations, and intercorrelations between the variables are shown in Table 1 , which also includes internal consistency measures for each composite measure in the present sample. Since there are many different criteria for deciding on the acceptable limits of skewness and kurtosis, we also visually examined each variable distribution, as suggested by Tabachnick and Fidell , and concluded that there are no major deviations from normality.
All the variables had satisfactory reliability coefficients. It is worth noting that all mean values shifted towards lower values because the sample did not include individuals with known ED problems, but a general high school population. The results of the correlation analysis are presented in Table 2.
Girls in our sample reported more difficulties in emotion regulation, uncontrolled and emotional eating, and more ED symptoms. In the present study, we hypothesised that difficulties in emotion regulation and perfectionism would affect ED symptoms both directly and indirectly through cognitive eating patterns emotional eating, uncontrolled eating, and cognitive restraint.
The direct, indirect, and total effects of emotional dysregulation, perfectionism, cognitive eating patterns, and ED symptoms are shown in Table 3. The analyses of indirect effects suggested significant paths from difficulties in emotion regulation to ED symptoms through cognitive restraint and emotional eating.
Similar to perfectionism, the analysis revealed significant paths from perfectionism to ED symptoms, through cognitive restraint and emotional eating. For both emotion regulation difficulties and perfectionism, the indirect effect of uncontrolled eating on ED symptoms was insignificant.
Regarding total effects, both difficulties in emotion regulation and perfectionism had significant total effects on ED symptoms. The total indirect effect was also significant for both the variables. A path model showing the effects of difficulties in emotion regulation, perfectionism, and cognitive eating patterns on ED symptoms is shown in Fig.
Effects of Difficulties in Emotion Regulation, Perfectionism, and Cognitive Eating Patterns on Eating Disorder Symptoms. Standardized path coefficients values are shown. The results indicated that cognitive eating patterns cognitive restraint, emotional, and uncontrolled eating mediated the relationship between ED symptoms and emotion dis regulation and perfectionism, with cognitive restraint having the strongest path coefficients and the path for uncontrolled eating being insignificant.
Adolescents with emotion regulation difficulties reported more emotional and uncontrolled eating. Furthermore, difficulties in emotion regulation are directly associated with ED symptoms. In contrast, perfectionism showed weaker relationships with cognitive eating patterns and ED symptoms.
The present study aimed to examine the mediating role of cognitive eating patterns emotional eating, uncontrolled eating, and cognitive restraint in the relationship between difficulties in emotion regulation and perfectionism and ED symptoms in a sample of adolescent girls and boys.
The data analysis partially confirmed the research hypotheses. In addition, only emotional eating and cognitive restraint but not uncontrolled eating mediated the relationship between difficulties in emotion regulation, perfectionism, and ED symptoms. As expected from previous studies Forrester-Knauss et al.
Adolescent girls frequently report poorer body image, a stronger desire for thinness and weight loss, the need for diets, and similar behaviours in order to control their own body shape and weight Pokrajac-Bulian et al.
Zehr et al. Results showing that girls have more ED symptoms than boys have been found in numerous studies e. Bento et al.
Significantly more female adolescents and young women in comparison to men reported that they often felt that they could not control what or how much they ate; however, more men than women reported overeating Striegel-Moore et al. In our study, BMI was positively correlated with cognitive restraint and ED symptoms.
Megalakaki et al. Studies on the relationship between cognitive restraint and BMI e. Anglé et al. It is difficult to determine whether cognitive restraint preceding weight gain is an antecedent of cognitive restraint. However, a longitudinal study by de Lauzon-Guillain et al.
In our study, we also found that cognitive restraint had the strongest correlation with ED symptoms. More longitudinal research is needed to examine the complex relationship between BMI and cognitive eating patterns, particularly cognitive restraint.
Higher BMI was related to an increase in ED symptoms, which has been confirmed in other studies e. Rø et al. A study conducted on a random sample from the general population found that increases in body shape and weight concerns are mainly responsible for elevated EDE-Q scores and appear to be normative among people with obesity Rø et al.
It does not seem unusual that overweight people, or at least some of them, are dissatisfied with their weight and body shape and are uncomfortable in front of other people e. in locker rooms, during physical education classes and then want to lose weight in different ways, such as, for example, the exclusion of certain foods and following certain dietary rules, attempts at fasting, and intentional restriction of eating.
This may especially apply to adolescents, who are already in a very sensitive developmental phase. We found a significant positive correlation between difficulty in emotion regulation and perfectionism.
Adolescents who reported more problems with emotion regulation also reported more uncontrolled and emotional eating, cognitive restraint, and ED symptoms. Adolescents who set very high standards for themselves or feel that others are setting high standards for them can sometimes direct such standards toward their own bodies.
In an effort to achieve a perfect appearance, a person may end up developing ED symptoms. Byrne et al. Perhaps, some individuals who struggle to regulate emotions may use perfectionism as a maladaptive attempt of emotional control.
Perfectionism had a significant indirect effect on ED symptoms only through cognitive restraint and emotional eating. This is not surprising because perfectionism is recognised as a risk factor for ED in many studies e.
Boone et al. Eating concerns include, but are not limited to, preoccupation with food and calories similar to cognitive restraint , fear of losing control during meals similar to uncontrolled eating , and guilt over eating possibly associated with emotional eating.
A significant direct effect was found between difficulties in emotion regulation and ED symptoms but not between perfectionism and ED symptoms. Emotion regulation is considered an important factor in the development and maintenance of ED. ED symptoms may foster emotions that are difficult to regulate and accept, especially in adolescence Whiteside et al.
Racine and Wildes underline four links or similar characteristics between difficulties in emotion regulation and ED. First, problems in recognising and understanding emotions were present in both the cases.
Second, individuals with ED, especially AN, have maladaptive beliefs about emotions, particularly those that contribute to strategies for avoiding or changing emotions. Third, people with overeating or purgative disorders often have control problems in the presence of strong emotions, and the inability to prevent inappropriate behaviours when experiencing strong emotions is one of the characteristics of emotional dysregulation.
Lack of skills and strategies for emotion regulation may mean that individuals, in order to cope with emotions, will resort to inappropriate eating habits Donahue et al. Other studies have also shown a correlation between emotional regulation difficulties and ED symptomatology Donahue et al.
The present findings should be interpreted in the light of some limitations. Similar to many other community-based studies, we relied on self-report questionnaires to measure ED symptoms, eating habits, emotion regulation, and perfectionism.
Students filled in paper-and-pencil forms of the questionnaires in a group, which might have affected the sincerity of their answers. In addition, owing to the large number of questionnaires, fatigue may have occurred. The participants were first-grade high school students, most of whom were not used to completing such questionnaires.
Some complained about the length and repetitiveness of the items and often asked for explanations. We can assume that some participants were too ashamed to ask for clarification or were not interested in the task, so the answers should be interpreted with caution.
Nevertheless, the research included a relatively large sample of first-grade high school students from the two cities. The sample was balanced by sex, which is often not the case. Furthermore, collaboration with school physicians has enabled the inclusion of medical data and more accurate measurements of height and weight rather than a self-reported details, which often tend to be unreliable.
This study has implications for both future clinical work and clinical research. Maladaptive perfectionism as a specific risk factor for eating disorder behaviours already has its well-established place in the protocols of preventive programs and psychotherapy treatments, especially cognitive-behavioural ones e.
The results of our research indicate that perfectionism should also be considered in the context of other variables, such as cognitive restraint and emotional eating. In working with adolescents who manifest symptoms of eating disorders, it is necessary to focus on education on emotion regulation skills as an adaptive way of coping with the pressure imposed by social ideals of body appearance.
Consequences of eating disorders can reduce the quality of life and impair the physical and mental health of the person and should be taken seriously. The results of this research enable a better theoretical understanding of the ED symptoms and their correlates, focusing on psychosocial factors that should be included in early interventions with adolescents.
Although high levels of self-reported perfectionism were often found in individuals with ED Egan et al. When adolescents experience problems in emotion regulation in combination with emotional or uncontrolled eating, they may be at a higher risk of experiencing concerns about weight while also being prone to a variety of eating disorders.
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Poor Allergy-free home remedies regulation, behvaiors with elevated Emotional regulation and eating behaviors, is recognised as a risk factor Autophagy and aging the development bwhaviors eating disorder ED symptoms. Regualtion, the Emotionao of our study was to examine the relationship aand emotion regulation Emotional regulation and eating behaviors and perfectionism with ED symptoms, while controlling for emotional eating, uncontrolled eating, and cognitive restraint as mediators. Participants also answered the Difficulties in Emotion Regulation Scale, Multidimensional Perfectionism Scale, Three-Factor Eating Questionnaire, and Eating Disorder Examination Questionnaire. According to the results obtained, adolescent girls in our sample reported more difficulties in emotion regulation, more uncontrolled and emotional eating, and more ED symptoms. A significant direct effect was found for difficulties in emotion regulation and ED symptoms but not for perfectionism.Emotional regulation and eating behaviors -
Thirty-eight studies examined associations between emotional awareness and ED symptomatology. Nine different measures were used to assess awareness of emotions Table 1 , eight of which were self-report questionnaire measures. One of the measures used, the Levels of Emotional Awareness, is a performance based measure assessing participants' awareness of their own and other's emotions.
Although this review builds on the previous meta-analytic review by Prefit et al. We found that very few measures assessed clarity and those that did used methods that were very similar to ones used to evaluate emotional awareness. For instance the Attention and Clarity of One's Feelings and the Feelings of Others ACF questionnaire is described as measuring emotional self-awareness and includes questions about a persons awareness of and clarity about their own emotions.
Therefore, for the sake of simplicity, emotional awareness and clarity were combined and in the case of the DERS questionnaire, which assesses both separately, only the lack of emotional awareness subscale was used.
Studies assessing mindfulness were also combined with those investigating emotional awareness and clarity as the measures used were deemed to be very similar, examining similar underlying construct of paying attention to one's feelings and knowing what are the emotions one is feeling.
As above, the correlations that included measures of emotional awareness, were reversed, while those that included measures of lack of awareness or difficulties in emotional awareness were kept as is.
Therefore, this review ended up assessing associations between lack of emotional awareness and ED symptomatology.
Thirty-four studies examined associations between the impact of emotions on participant's problem solving abilities and ED symptomatology Table 1.
One of the measures, the Means-Ends Problem-Solving Test [MEPS; ], was a performance-based measure used to evaluate the effectiveness of participants problem solving strategies. In this task participants are given the beginning and end of four different scenarios and they are then asked to provide the middle part connecting the beginning and ending.
In all but two of the measures a higher score indicated better problem solving and thus, the correlation coefficients were reversed for the meta-analysis to assess association between problem solving difficulties and ED symptomatology.
The Social Problem-Solving Inventory-Revised [SPSI-R; ] includes the negative problem orientation subscale and the DERS includes difficulties with goal directed behaviors subscale, both of which assess negative approach that prevents effective problem solving.
This subscale was used in the present review. Eight studies examined associations between cognitive reappraisal of emotions and ED symptomatology Table 1.
In both questionnaires, higher scores indicated greater use of cognitive reappraisal and thus, the correlation coefficients were reversed to assess associations between lack of cognitive reappraisal and ED symptomatology. Forty-seven studies investigated associations between emotional avoidance and ED symptomatology Table 1.
One of the measures, the Anagram solution task, used a behavioral measure of avoidance of threatening words. In this task, participants were given a set of anagrams to solve and the time taken to reach the correct solution was used to measure avoidance. In all measures, higher scores indicated more avoidance.
Seven studies examined associations between rumination and ED symptomatology Table 1. Four different measures were used to assess rumination, all of which were self-report questionnaires. One of the questionnaires used was adapted from the RSS to assess ED specific rumination In all measures used, higher scores indicated more rumination.
Thirteen studies investigated association between emotion suppression and ED symptomatology Table 1. In the Evoked facial affect task, participants were presented with emotionally provoking stimuli and their evoked facial expressions were analyzed.
In this task, higher scores indicated more emotion expression and less suppression, and thus, the correlation coefficients were reversed to reflect reverse scoring of the task.
In all self-report measures, higher scores indicated more emotion suppression. Quality assessment was conducted by J. and D. Question relating to exposures were not considered as they were not relevant for the purpose of the present review, which focused on correlations prior to any potential interventions or exposures.
Any disagreements were resolved through group discussion. All included studies were deemed to be high enough quality to be included in the meta-analysis and the sum of the quality scores were included in a meta-regression to examine whether the study quality could explain any potential network inconsistency.
We conducted a Bayesian network meta-analysis to examine which aspects of emotion regulation were most closely associated with ED symptomatology. The meta-analysis was conducted in R using the packages gemtc and metafor First, all relevant correlation coefficients of the association between an aspect of emotion regulation and ED symptomatology were extracted from the included studies.
The Pearson's r coefficients were then adjusted using sample-size weights to approximate population correlation and Fisher's r-to-z transformed was conducted using the function escalc from the package metafor.
We converted the correlation coefficients to z-scores for the purposes of the network meta-analysis as z-scores are not bounded and come from a normal distribution. We then calculated standard error for each study from the sample size adjusted variance using the following steps.
where v is the estimated, sample size adjusted variance, σ is the standard deviation, and n is the sample size. The sample size adjusted correlation coefficients and standard errors were then taken forward to conduct the network meta-analysis.
First, we generated an initial network of the data where edge thickness represents the number of studies that reported that correlation. The generated network object was then taken forward to specify and compile the random effects model with four Markov chains and a normal likelihood function with an identity link.
Next, a Markov Chain Monte Carlo MCMC simulation was conducted to estimate the posterior probabilities. To ensure convergence we specified 1,00, iterations with 5, burn-in iterations.
The Gelman-Rubin plots are presented in Supplementary Figure 1. The parameter estimation is conducted by utilizing Just Another Gibbs Sampler JAGS. We then generated rank probability and forest plots to visualize the direct comparisons between different aspects of emotion regulation and to examine which aspect was the most closely associated with ED symptomatology.
Additionally, we also calculated Surface Under the Cumulative Ranking SUCRA score to evaluate which aspect of emotion regulation is most relevant in terms of ED symptomatology and might serve a useful target for interventions. As we included studies with adolescent and adult participants of any gender who had any ED diagnosis, meta-regressions were conducted to explore if any possible network inconsistency could be explained by between-study heterogeneity in study quality score, age, BMI, and whether the studies had female only or mixed samples.
The meta-regressions were conducted by taking the above steps with a specified regressor. The characteristics of each study included in the review are summarized in Table 1. Majority, 72, of the studies included only female participants and three studies did not report the participants' gender.
Additionally, most studies included a mixed ED sample and assessed emotion regulation across ED diagnoses while 50 studies examined emotion regulation within one diagnostic group.
The mean age across studies was The mean BMI across studies was The initial network graph, in Figure 2 , shows the eligible comparisons to identify emotion regulation strategy most strongly linked to ED symptomatology.
The thickness of the edges indicates the number of studies that evaluated a given association or comparison. Across the included studies, correlations contributed to the network. All emotion regulation strategies were compared with at least one other emotion regulation method in addition to the association with ED symptoms resulting in a well-connected network, which is more likely to produce reliable results Figure 2.
Initial network plot. Line thickness represents the number of studies reporting the association. The forest and SUCRA plots from the Bayesian random effects network meta-analysis are shown in Figure 3.
Each emotion regulation strategy represents a unit of analysis and is thus presented on the rows. Larger positive effect sizes indicate a stronger association between a given emotion regulations strategy and ED symptomatology. Figure 3. Forest and SUCRA plots.
A Forest plot showing the associations between the emotion regulation strategies and ED symptoms. B Bar plot showing the surface under the cumulative ranking SUCRA for each emotion regulation method.
ES, effect size; CrI, Credible Interval. Network inconsistency was evaluated using the node-split method Supplementary Figure 2. Therefore, three meta-regressions were conducted to examine whether these slight inconsistencies could be explained between-study differences in study quality score, BMI, age, or whether the study included only female participants or a mixed sample of participants.
The aim of the present review was to examine associations between various adaptive and maladaptive emotion regulation strategies and ED psychopathology trans-diagnostically to identify strategies that were most closely linked with psychopathology. We used network meta-analysis approach with a well-connected network, which identified rumination and non-acceptance of emotions to be most closely associated with ED symptomatology.
Difficulties in cognitive reappraisal was found to be the least connected with ED symptomatology of all emotion regulation strategies examined in this review. There was some evidence of network inconsistency which approached significance and two meta-regressions were performed to examine if this could be explained by the between-study variability in BMI or age.
The meta-regressions were non-significant suggesting the findings were consistent across age groups and BMI.
The present review adds to the steady accumulation of evidence highlighting the relationship between maladaptive emotion regulation based on rumination and ED symptomatology , Over the recent years, studies using ecological momentary assessments EMAs have reported that rumination and repetitive negative thinking predicts engagement in ED behavior, including body checking and binge eating — One EMA study also reported that excessive rumination also predicted higher levels of ED psychopathology at a 1 month follow-up assessment Moreover, it has been suggested that some ED symptoms, such as excessive focus on food, eating, and body weight and shape, are forms of illness specific rumination Indeed, a longitudinal study using EMA and biological assessments found that food-related rumination was linked to BMI status and leptin levels among people in treatment for anorexia nervosa This suggest that at least certain aspects of illness-specific rumination may be linked to under-nutrition and physiological signaling, explaining why weight restoration can have a positive impact on this type of rumination.
Overall, it appears that rumination, whether general repetitive negative thinking or illness-specific, is a key characteristic of the acute stage of an ED.
It is important to note that most of the studies included in the present review used the RRS questionnaire, which assesses brooding, depressive rumination, and reflection.
Therefore, it is possible that the observed strong association between rumination and ED psychopathology may be partially explained by known links between depression and ED symptoms , Indeed, one study reported that although food-related rumination was linked to stage of illness and under-nutrition, other aspects of illness-specific rumination including, body weight and shape, were more associated with negative mood than not ED symptoms Additionally, an experimental study has reported that induction of body shape related rumination had a direct negative impact on mood but not on ED cognitions among people with BED Another interpretation is that the above findings may reflect the mechanism through which rumination influences EDs: due to its repetitive nature of rumination forms a habitual relationship with depressive mood which in turn fuels ED symptomatology In support of this hypothesis, one longitudinal EMA study documented a bidirectional mediation between rumination, negative mood, and ED symptoms The authors found that rumination mediated the association between low mood and ED symptomatology and low mood in turn mediated the association between rumination and ED symptomatology.
Taken together these findings highlight the need to further examine the underlying processes through which rumination impacts EDs and how rumination may impact illness progression and recovery.
Difficulties in adaptive emotion regulation, specifically with accepting emotions, was another domain that was highly associated with ED psychopathology in the present review. This is in line with findings from the general population showing that reduced use of adaptive emotion regulation strategies, such as acceptance, and increased reliance on maladaptive methods, including suppression and avoidance, are associated with daily habit of food restriction Similarly, people who report objective binge eating episodes and loss of control over eating also report more difficulties accepting emotions than those who do not engage in disorder eating behaviors Additionally, a recent longitudinal study reported that a poor response to CBT-based ED treatment was associated with lack of change in the patients' self-reported ability to accept emotions and limited access to other effective emotion regulation strategies Moreover, another interventional study found that irrespective of treatment condition, changes in acceptance of emotions were associated with greater improvements in ED-related quality of life post-intervention These findings have led some authors to suggest that emotion regulation in general and acceptance of unwanted emotions in particular should be added to current standard ED treatments , While it seems that acceptance of emotions may have a strong role in disordered eating and the progression of EDs, further investigation of the underlying mechanism would be of interest to aid the development of evidence-based interventions.
Interestingly, difficulties accepting emotions has also been proposed to be linked to excessive reliance on other maladaptive emotion regulation strategies, including rumination, avoidance, and suppression , If unwanted emotions are deemed unacceptable, a person might put great effort in avoiding situations that give rise to such emotions or, if the emotions are already present, engage in suppression in an attempt to manage the unwanted emotions.
Findings from a review of experimental and self-report studies support this notion reporting links between suppression and non-acceptance of emotion among people with AN and BN Difficulties accepting and general dislike of emotions have been linked to greater general tendency to engage in rumination as well as worry and low mood Interestingly, difficulties in emotion regulation, including non-acceptance of emotions, have been found to mediate the association between experiential avoidance and ED psychopathology among people with a range of ED diagnoses Similar findings have been reported in the general population with reduced access to adaptive emotion regulation strategies, including acceptance of emotions and reappraisal, and increased reliance on maladaptive strategies based on suppression being associated with greater tendency to engage in ED-related behaviors Thus, further investigation of the mechanisms that might underlie this connection as well as examination of the impact of acceptance-focused interventions on the use of other emotion regulation strategies among people with EDs may be of interest.
Interestingly, our meta-regression also found a significant effect of BMI, such that the associations were generally weaker among those with lower BMI. This is somewhat in contrast with previous reviews suggesting that there are no significant differences in the associations between emotion regulation methods and ED psychopathology between different ED diagnostic groups characterized by low and high BMI 12 , However, some studies have reported that starvation impacts emotion regulation in such a way that those with very low BMI in the acute stage of AN report fewer difficulties Indeed, it has been suggested that self-starvation itself works as an emotion regulation strategy which reduces both the internal experience and external expression of emotions through By suppressing physiological responses and arousal, starvation can help the person escape and avoid unwanted emotions , If no alternative methods are available, the person may over time become reliant on starvation as their sole emotion regulation strategy due to its numbing effect , This mechanism could be one of the factors contributing to the present finding and it further highlights the complex relationship between emotion regulation and EDs.
Over the recent years, several reviews have recommended the use of interventions aimed at reducing rumination and repetitive negative thinking, Metacognitive Therapy MCT and Rumination-Focused Cognitive Behavioral Therapy RFCBT , such as in the treatment of EDs 10 , 12 , , MCT and RFCBT have been successfully used to treat anxiety and depression among other psychiatric disorders, and there is some evidence suggesting that rumination-focused treatments may help reduce the risk of relapse in depression — Furthermore, one of the meta-analytic reviews found a very high correlation between rumination and ED symptomatology among the general population, which led the authors to suggest that rumination may be a useful target for interventions aiming to prevent EDs and other forms of disordered eating To date, very few studies examining the impact of interventional designed to target rumination in EDs have been conducted.
To our knowledge only one case series has explored the effects of MCT on binge eating behavior among three people with BED MCT aims to alleviate repetitive negative cognitions by increasing awareness and mindfulness, and modifying the metacognitions that underlie maladaptive behaviors, such as binge eating , The Robertson and Strodl found that MCT intervention significantly reduced binge eating frequency and improved cognitions related worry and rumination.
There improvements were maintained at a 2-month follow-up assessment. Together, these findings highlight the need to develop new interventions or adapt existing treatments to target rumination and repetitive negative thinking in EDs. Acceptance and mindfulness based interventions, such as Acceptance and Commitment Therapy ACT , have been proposed to target difficulties in coping with unwanted emotions in EDs , The purpose of ACT is to encourage people to accept and experience unwanted emotions without attempts to modify them, thus reducing avoidance and suppression of difficult emotions and embracing the use of adaptive emotion regulation strategies A number of small case series have reported that ACT can be effective in reducing ED symptomatology and behaviors among people with AN and BED — Another larger longitudinal treatment study found that ACT was more effective than treatment as usual in reducing residual ED symptoms and risk or relapse following standard ED treatment and the effects were maintained at a 2-year follow-up However, another interventional study found that ACT did not lead to greater improvements in ED related quality of life than treatment as usual Furthermore, a systematic review examining the use of ACT to treat body image disturbance and weight dissatisfaction reported that they could not determine the effectiveness of ACT due to the poor quality of current evidence These findings suggest that acceptance and mindfulness based interventions may be promising in the treatment of EDs, but more research into the mechanisms that underlie the relationship between emotion acceptance and ED psychopathology is needed to create evidence-based treatment strategies.
The main limitation of this review was the use of the network meta-analysis due to its use of indirect evidence, which relies on the assumption of transitivity According to the transitivity assumption, a given associations is exchangeable between studies even if a given study did not assess that association.
This assumption can be violated by individual differences in the samples between studies, which can be difficult to control resulting in network inconsistency.
Although we did not observe significant network inconsistency, there was evidence of near significant inconsistency in two comparisons.
Moreover, since we used the network approach to meta-analysis we were able to only include studies that reported correlation coefficients, which led to the exclusion of a substantial number of otherwise relevant studies. Although we attempted to contact the corresponding authors of all papers which did not report the relevant data, we were able to gain access to correlation coefficients from only 28 studies through personal correspondence.
Including only a subset of the available literature to the meta-analysis may have impacted the findings. Another limitation of this review is that majority of the studies included adult women with normal BMI.
Although the meta-regressions indicated that age did not have a significant impact on the results, findings from the present review may not be fully generalizable to all age groups. Additionally, even though we did find a significant effect of BMI, we were not able to examine the impact of diagnostic group as the gemtc package used in the present analysis does not presently handle categorical covariates.
To truly examine the potential transdiagnostic nature of emotion regulation difficulties in EDs, a direct comparison of different diagnostic groups would be needed rather than solely focusing on BMI.
Furthermore, the findings may not be fully generalisable to other genders. Gender identity can impact a person's experiences with the world around them and thus influence their emotion regulation habits , Thus, further exploration of the impact of gender and particularly minority gender identity on emotion regulation in EDs is needed.
Finally, it is also important to note that we did not have equal number of studies examining each association. Indeed, only eight studies reported correlations involving difficulties with cognitive reappraisal and this method was found to be most weakly associated with ED psychopathology with largest between study variance.
It is possible that this finding may have been impacted by the small number of studies included. However, only seven studies reposted correlations involving rumination and this maladaptive strategy was found to be most strongly associated with ED psychopathology.
Still, equal and large number of studies examining each association would enable us to draw stronger conclusions. This review aimed to build on previous work by conducting a trans-diagnostic network meta-analysis to identify emotion regulation strategies most closely associated with psychopathology among those with ED.
The meta-analysis revealed that rumination and difficulties accepting emotions were most closely associated with ED symptoms, while the weakest association was between difficulties with cognitive reappraisal and ED symptoms.
The meta-regressions showed that BMI had significant impact such that the associations between various emotion regulation strategies and ED psychopathology were weaker among those with low BMI. The present findings add to the steady accumulation of evidence highlighting the relationship between ED psychopathology and reliance on maladaptive emotion regulation strategies based on rumination and non-acceptance of emotions.
Together with previous longitudinal observational studies and ecological momentary assessments, these findings suggest that these two maladaptive strategies may have a key role in maintaining and perpetuating ED.
The meta-regression finding also emphasizes the complex relationship between ED symptoms and emotion regulation. It is possible that some people with ED may use starvation and malnutrition to escape and avoid unwanted emotions.
Thus, there is pressing need to explore and develop interventions targeting emotion regulation difficulties in ED with particular focus on rumination and non-acceptance of emotions. Publicly available datasets were analyzed in this study.
JL: conceptualization, methodology, investigation, formal analysis, visualization, writing—original draft, and writing—review and editing. DB and HM: methodology, investigation, validation, and writing—review and editing.
SW and KT: conceptualization, writing—review and editing, and supervision. All authors contributed to the article and approved the submitted version. For the purpose of open access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission.
The funding bodies did not play an active role in the design of this study, nor in data collection or analysis, nor in writing the manuscript.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
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Although disordered eating is more common among women, prevalence studies show that disordered eating in men most frequently expresses in binge eating without compensatory behavior and that compared to women, men are less likely to seek help Kessler et al.
Thus, the role of negative emotions on overeating and possible gender differences would add to the understanding of disordered eating in this understudied population.
Additionally, food ratings on pleasantness and desire to eat represent a disposition to eat but remain inconsequential to the individual compared to real food intake. We intentionally opted against a taste-test to measure food intake after each condition because taste tests are consistently prone to effects of observation and social desirability considerations Robinson et al.
Furthermore, actual food intake can be modulated by self-regulatory processes such as meal planning, sensory specific satiety, diurnal food preferences, and effort-reward considerations monetary value of foods , among others.
However, the natural occurrence of emotional overeating in strong responders to the laboratory task might be followed up in daily life, e.
Although affective ratings PANAS confirmed a successful induction of negative emotion in the sample as a whole, Idiosyncratic scripts have been deemed as effective and used in patients Cuthbert et al.
However, they add variability compared to standardized emotion induction protocols such as affective picture or video exposure Evers et al. Effects of emotional reactivity did not go as far as altering autonomic arousal systems: other than in Hilbert et al.
As emotional overeating might be a subclinical form of binge eating, an important future direction would be to apply the present paradigm to individuals with eating disorders like Anorexia Nervosa or Bulimia Nervosa.
These disorders are characterized by emotion regulation difficulties Naumann et al. Further, explicit emotion regulation instructions Svaldi et al.
To further assess subgroup differences within restrained eaters, different types of restraint could be classified in terms of cognitive resources, dieting success, rigidity, and other pathological eating styles Papies et al.
Future research might follow up on our P effects with more sophisticated EEG analyses e. In conclusion, we were able to characterize a multi-layered emotional eating signature in trait emotional eaters and restrained eaters. Support for an emotion-regulation framework was found in trait emotional eating and emotional reactivity was identified as a potential boundary condition for the effect to emerge.
Although recent work emphasizes the importance of restraint and failure in self-regulation as a cause for emotional overeating Evers et al. Restrained eaters attribute more attentional resources to food in negative emotional states but lack corresponding appetitive responses.
Our findings might aid future theorizing and research on factors predicting emotional overeating. The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.
The studies involving human participants were reviewed and approved by Ethics Committee of the University of Salzburg, Austria. RS conducted data preparation and statistical analysis and drafted the manuscript. CG helped to writing the study protocol and to collect and structure data.
KE helped with the preparation and analysis of the EEG data. A-KA helped with the preparation and analysis of the EMG data. FW contributed to the final draft.
CV designed the study, acquired funding, helped writing the study protocol and contributed to the final draft. AL helped writing the study protocol and contributed to the final draft. ZD helped writing the study protocol and contributed to the final draft.
JB designed the study, acquired funding, helped writing the study protocol and contributed to the final draft. This work was supported by the Austrian Science Fund FWF : IB27 and the European Research Council ERC-StG NewEat.
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A longitudinal transactional risk model for early eating disorder onset. The energy that would be used to redirect these thoughts is then instead directed toward building healthier and more positive hobbies, habits, and interests. This newfound psychological space is then used to help them have more measured, healthy, and positive reactions to situations.
The strategy has also been found to increase psychological flexibility, which is an underlying factor of many eating disorders and mental disorders in general.
These conditions are dangerous, and can be deadly if left untreated. This can include your primary care physician, therapist, psychiatrist, or another trusted medical professional.
These experts are often educated in a number of disordered eating and mental health conditions, and they can help assess symptoms, make an official diagnosis, or recommend the best next steps for finding treatment.
These services are generally free and almost always anonymous, providing additional information and resources on certain eating disorder behaviors, emotion regulation strategies, and ideas on where to find help.
Regardless, finding support for emotional dysregulation and eating disorders is essential for recovery. The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders.
These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals. We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors.
If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help. Updated on September 19, , on EatingDisorderHope. The information contained on or provided through this service is intended for general consumer understanding and education and not as a substitute for medical or psychological advice, diagnosis, or treatment.
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What is Emotion Dysregulation? These reactions can manifest in a number of ways, including: Intense emotions: Anger, anxiety, sadness, or irritability are common emotional reactions, which may come on quickly and powerfully and feel difficult to manage.
Impulsivity: Difficulties in emotion regulation often lead to impulse control difficulties, which can take the form of abrupt or even involuntary decisions or behaviors.
Emotion regulation difficulties: Individuals experiencing emotional dysregulation tend to struggle with controlling their emotional responses in social situations, or may lack emotional awareness of their own reactions. Signs and Symptoms of Emotional Dysregulation While the outward signs of emotion dysregulation may be easier to spot, the condition can also lead to a number of more private signs, symptoms, and struggles, including: Low self-esteem: Struggling with emotion regulation may bring on a sense of shame or worthlessness, leading to negative self-talk and low self-esteem.
Difficulty with interpersonal relationships: Emotional reactivity, mood swings, and other symptoms of emotional dysregulation can make it difficult to maintain social relationships. Avoidance behaviors: Avoiding situations that trigger intense emotions is common, and can lead to social isolation and further difficulty maintaining relationships.
Chronic feelings of emptiness: Some people experience a persistent sense of inner emptiness or numbness, which may result in feelings of despair and hopelessness. Emotion Dysregulation and Emotional Eating Mood disorders involving depression and anxiety and low self-esteem are frequently co-occurring conditions with eating disorders.
Emotion Regulation Strategies and Treatment Emotion dysregulation is a major driver of many mental health conditions. Dialectical Behavior Therapy Dialectical behavior therapy DBT was expressly developed to help people better regulate their emotions.
The therapeutic approach teaches a number of emotion regulation strategies, including: Mindfulness: An emphasis on the present moment, which can help people create space between themselves, their emotions, and their reactions to the world around them.
Interpersonal effectiveness: Strategies that help someone express their needs better and more assertively, while simultaneously maintaining positive and healthy relationships.
Emotional behsviors, or difficulties in managing and regulating emotions, is often a key factor in Nutritional value of brown rice development or Emotional regulation and eating behaviors of regulatjon eating disorder. Research shows that individuals with Nutrient timing for endurance regualtion frequently struggle with overwhelming emotions such as anxiety, depression, and low self-esteem. And this cycle of disordered eating can further exacerbate emotional dysregulation, creating a vicious cycle that is difficult to break. Indeed, the link between emotion regulation difficulties and eating disorders is complex and multifaceted. But understanding this connection is essential for effective treatment and recovery. Emotion dysregulation is a common aspect of many mood disorders, eating disorders, and other mental health conditions.
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