Abstract
Background
Emotion dysregulation has frequently been theorised as a core component of internalising disorders, including eating disorders. However, it remains unclear at which points in the developmental and aetiological chain emotion dysregulation contributes to eating pathology. The current review synthesises the existing literature and theoretical models of eating disorders to illustrate the role of emotion dysregulation in eating pathology, and the corresponding implications for both theory and treatment. Specifically, the review discusses the implications of including emotional dysregulation in the transdiagnostic model of eating disorders (CBT-E model). Taking a lifespan approach, the review places particular importance on examining adolescence as a key developmental period of emotional turmoil and eating disorder onset.
Findings
The reviewed literature suggests that emotion dysregulation is an important factor in eating pathology broadly, as well as having associations with multiple specific eating disorder behaviours. Additionally, this review suggests that it is the interplay between emotion dysregulation – a transdiagnostic factor – and weight/shape concerns – an eating disorder-specific factor – that may contribute to the maintenance and potential development of eating disorders.
Conclusion
This review proposes that emotion dysregulation is a key maintenance factor of eating pathology, and adaptations to reflect this should be considered for the CBT-E model. Furthermore, treatments targeting emotion dysregulation for adolescents and adults represent a promising avenue for further development. Further research should explore the potential of emotion dysregulation as a risk factor proceeding eating disorder development.
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References
Abravanel, B. T., & Sinha, R. (2015). Emotion dysregulation mediates the relationship between lifetime cumulative adversity and depressive symptomatology. Journal of Psychiatric Research, 61, 89–96. https://doi.org/10.1016/j.jpsychires.2014.11.012
Aldao, A., Gee, D. G., De Los Reyes, A., & Seager, I. (2016). Emotion regulation as a transdiagnostic factor in the development of internalizing and externalizing psychopathology: Current and future directions. Development and Psychopathology, 28(4), 927–946. https://doi.org/10.1017/S0954579416000638
Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review. https://doi.org/10.1016/j.cpr.2009.11.004
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
Anderson, L. K., Claudat, K., Cusack, A., Brown, T. A., Trim, J., Rockwell, R., Nakamura, T., Gomez, L., & Kaye, W. H. (2018). Differences in emotion regulation difficulties among adults and adolescents across eating disorder diagnoses. Journal of Clinical Psychology, 74(10), 1867–1873. https://doi.org/10.1002/jclp.22638
Bailen, N. H., Green, L. M., & Thompson, R. J. (2018). Understanding emotion in adolescents: A review of emotional frequency, intensity, instability, and clarity. Emotion Review, 11(1), 63–73. https://doi.org/10.1177/1754073918768878
Bartholdy, S., Allen, K. L., Hodsoll, J., O’Daly, O. G., Campbell, I. C., Banaschewski, T., Bokde, A. L. W., Bromberg, U., Büchel, C., Quinlan, E. B., Conrod, P. J., Desrivières, S., Flor, H., Frouin, V., Gallinat, J., Garavan, H., Heinz, A., Ittermann, B., Martinot, J. L., & Schmidt, U. (2017). Identifying disordered eating behaviours in adolescents: how do parent and adolescent reports differ by sex and age? European Child and Adolescent Psychiatry, 26(6), 691–701. https://doi.org/10.1007/s00787-016-0935-1
Berg, K. C., Crosby, R. D., Cao, L., Peterson, C. B., Engel, S. G., Mitchell, J. E., & Wonderlich, S. A. (2013). Facets of negative affect prior to and following binge-only, purge-only, and binge/purge events in women with bulimia nervosa. Journal of Abnormal Psychology, 122(1), 111–118. https://doi.org/10.1037/a0029703
Bohrer, B. K., Carroll, I. A., Forbush, K. T., & Chen, P. Y. (2017). Treatment seeking for eating disorders: Results from a nationally representative study. International Journal of Eating Disorders, 50(12), 1341–1349. https://doi.org/10.1002/eat.22785
Boldt, L. J., Goffin, K. C., & Kochanska, G. (2020). The significance of early parent-child attachment for emerging regulation: A longitudinal investigation of processes and mechanisms from toddler age to preadolescence. Developmental Psychology, 56(3), 431–443. https://doi.org/10.1037/dev0000862
Breaux, R. P., McQuade, J. D., Harvey, E. A., & Zakarian, R. J. (2018). Longitudinal associations of parental emotion socialization and children’s emotion regulation: The moderating role of ADHD symptomatology. Journal of Abnormal Child Psychology, 46(4), 671–683. https://doi.org/10.1007/s10802-017-0327-0
Brockmeyer, T., Skunde, M., Wu, M., Bresslein, E., Rudofsky, G., Herzog, W., & Friederich, H. C. (2014). Difficulties in emotion regulation across the spectrum of eating disorders. Comprehensive Psychiatry, 55(3), 565–571. https://doi.org/10.1016/j.comppsych.2013.12.001
Brown, T. A., Cusack, A., Anderson, L., Reilly, E. E., Berner, L. A., Wierenga, C. E., Lavender, J. M., & Kaye, W. H. (2019a). Early versus later improvements in dialectical behavior therapy skills use and treatment outcome in eating disorders. Cognitive Therapy and Research, 43(4), 759–768. https://doi.org/10.1007/s10608-019-10006-1
Brown, T. A., Cusack, A., Berner, L. A., Anderson, L. K., Nakamura, T., Gomez, L., Trim, J., Chen, J. Y., & Kaye, W. H. (2019b). Emotion regulation difficulties during and after partial hospitalization treatment across eating disorders. Behavior Therapy. https://doi.org/10.1016/j.beth.2019.07.002
Brumariu, L. E., & Kerns, K. A. (2013). Pathways to anxiety: contributions of attachment history, temperament, peer competence, and ability to manage intense emotions. Child Psychiatry & Human Development, 44(4), 504–515. https://doi.org/10.1007/s10578-012-0345-7
Bucchianeri, M. M., Arikian, A. J., Hannan, P. J., Eisenberg, M. E., & Neumark-Sztainer, D. (2013). Body dissatisfaction from adolescence to young adulthood: Findings from a 10-year longitudinal study. Body Image, 10(1), 1–7. https://doi.org/10.1016/j.bodyim.2012.09.001
Burns, E. E., Fischer, S., Jackson, J. L., & Harding, H. G. (2012). Deficits in emotion regulation mediate the relationship between childhood abuse and later eating disorder symptoms. Child Abuse and Neglect. https://doi.org/10.1016/j.chiabu.2011.08.005
Burton, A. L., & Abbott, M. J. (2019). Processes and pathways to binge eating: development of an integrated cognitive and behavioural model of binge eating. Journal of Eating Disorders, 7(1), 18. https://doi.org/10.1186/s40337-019-0248-0
Byrne, S. M., Fursland, A., Allen, K. L., & Watson, H. (2011). The effectiveness of enhanced cognitive behavioural therapy for eating disorders: An open trial. Behaviour Research and Therapy, 49(4), 219–226. https://doi.org/10.1016/j.brat.2011.01.006
Cafri, G., van den Berg, P., & Thompson, J. K. (2006). Pursuit of muscularity in adolescent boys: relations among biopsychosocial variables and clinical outcomes. Journal of Clinical Child & Adolescent Psychology, 35(2), 283–291. https://doi.org/10.1207/s15374424jccp3502_12
Cavanagh, M., Quinn, D., Duncan, D., Graham, T., & Balbuena, L. (2014). Oppositional Defiant Disorder Is Better Conceptualized as a Disorder of Emotional Regulation. Journal of Attention Disorders, 21(5), 381–389. https://doi.org/10.1177/1087054713520221
Christian, C., Perko, V. L., Vanzhula, I. A., Tregarthen, J. P., Forbush, K. T., & Levinson, C. A. (2019). Eating Disorder Core Symptoms and Symptom Pathways Across Developmental Stages: A Network Analysis. Journal of Abnormal Psychology. https://doi.org/10.1037/abn0000477
Coffino, J. A., Udo, T., & Grilo, C. M. (2019). Rates of help-seeking in US adults with lifetime DSM-5 eating disorders: Prevalence across diagnoses and differences by sex and ethnicity/race. Mayo Clinic Proceedings, 94(8), 1415–1426
Colle, L., & Del Giudice, M. (2011). Patterns of Attachment and Emotional Competence in Middle Childhood. Social Development, 20(1), 51–72. https://doi.org/10.1111/j.1467-9507.2010.00576.x
Cortés-García, L., Takkouche, B., Seoane, G., & Senra, C. (2019). Mediators linking insecure attachment to eating symptoms: A systematic review and meta-analysis. In K. Hashimoto (Ed.), PLoS ONE (Vol. 14, Issue 3, p. e0213099). Public Library of Science. https://doi.org/https://doi.org/10.1371/journal.pone.0213099
Cunningham, M. L., Griffiths, S., Baillie, A., & Murray, S. B. (2018). Emotion dysregulation moderates the link between perfectionism and dysmorphic appearance concern. Psychology of Men and Masculinity, 19(1), 59–68. https://doi.org/10.1037/men0000082
Cunningham, M. L., Rodgers, R. F., Lavender, J. M., Nagata, J. M., Frederick, D. A., Szabo, M., & Murray, S. B. (2020). ‘Big boys don’t cry’: Examining the indirect pathway of masculinity discrepancy stress and muscle dysmorphia symptomatology through dimensions of emotion dysregulation. Body Image, 34, 209–214. https://doi.org/10.1016/j.bodyim.2020.05.014
Dakanalis, A., Favagrossa, L., Clerici, M., Prunas, A., Colmegna, F., Zanetti, M. A., & Riva, G. (2015). Body dissatisfaction and eating disorder symptomatology: A latent structural equation modeling analysis of moderating variables in 18-to-28-year-old males. Journal of Psychology: Interdisciplinary and Applied, 149(1), 85–112. https://doi.org/10.1080/00223980.2013.842141
Dakanalis, A., Timko, C. A., Clerici, M., Zanetti, M. A., & Riva, G. (2014). Comprehensive examination of the trans-diagnostic cognitive behavioral model of eating disorders in males. Eating Behaviors, 15(1), 63–67. https://doi.org/10.1016/j.eatbeh.2013.10.003
Dennis, T. A., & Kelemen, D. A. (2009). Preschool children’s views on emotion regulation: Functional associations and implications for social-emotional adjustment. International Journal of Behavioral Development, 33(3), 243–252. https://doi.org/10.1177/0165025408098024
Eichen, D. M., Chen, E., Boutelle, K. N., & McCloskey, M. S. (2017). Behavioral evidence of emotion dysregulation in binge eaters. Appetite, 111, 1–6. https://doi.org/10.1016/j.appet.2016.12.021
Engel, S. G., Wonderlich, S. A., Crosby, R. D., Mitchell, J. E., Crow, S. J., Peterson, C. B., Grange, D. L., Simonich, H. K., Cao, L., Lavender, J. M., & Gordon, K. H. (2013). The role of affect in the maintenance of anorexia nervosa: Evidence from a naturalistic assessment of momentary behaviors and emotion. Journal of Abnormal Psychology, 122(3), 709–719. https://doi.org/10.1037/a0034010
Espeset, E. M. S., Gulliksen, K. S., Nordbø, R. H. S., Skårderud, F., & Holte, A. (2012). The Link Between Negative Emotions and Eating Disorder Behaviour in Patients with Anorexia Nervosa. European Eating Disorders Review, 20(6), 451–460. https://doi.org/10.1002/erv.2183
Fairburn, C. G., Bailey-Straebler, S., Basden, S., Doll, H. A., Jones, R., Murphy, R., O’Connor, M. E., & Cooper, Z. (2015). A transdiagnostic comparison of enhanced cognitive behaviour therapy (CBT-E) and interpersonal psychotherapy in the treatment of eating disorders. Behaviour Research and Therapy, 70, 64–71. https://doi.org/10.1016/j.brat.2015.04.010
Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: A “transdiagnostic” theory and treatment. In Behaviour Research and Therapy (Vol. 41, Issue 5, pp. 509–528). Elsevier Ltd. https://doi.org/https://doi.org/10.1016/S0005-7967(02)00088-8
Fallon, E. A., Harris, B. S., & Johnson, P. (2014). Prevalence of body dissatisfaction among a United States adult sample. Eating Behaviors, 15(1), 151–158. https://doi.org/10.1016/j.eatbeh.2013.11.007
Fatt, S. J., Mond, J., Bussey, K., Griffiths, S., Murray, S. B., Lonergan, A., Hay, P., Trompeter, N., & Mitchison, D. (2019). Help-seeking for body image problems among adolescents with eating disorders: findings from the EveryBODY study. Eating and Weight Disorders : EWD. https://doi.org/https://doi.org/10.1007/s40519-019-00759-9
Fichter, M. M., & Quadflieg, N. (2016). Mortality in eating disorders - Results of a large prospective clinical longitudinal study. International Journal of Eating Disorders, 49(4), 391–401. https://doi.org/10.1002/eat.22501
Fisher, M., Golden, N. H., Katzman, D. K., Kreipe, R. E., Rees, J., Schebendach, J., Sigman, G., Ammerman, S., & Hoberman, H. M. (1995). Eating disorders in adolescents: a background paper. Journal of Adolescent Health, 16, 420–437
Fitzpatrick, S., MacDonald, D. E., McFarlane, T., & Trottier, K. (2019). An experimental comparison of emotion regulation strategies for reducing acute distress in individuals with eating disorders. Canadian Journal of Behavioural Science, 51(2), 90–99. https://doi.org/10.1037/cbs0000119
Folk, J. B., Zeman, J., Poon, J. A., & Dallaire, D. H. (2014). A longitudinal examination of emotion regulation: Pathways to anxiety and depressive symptoms in Urban minority youth. Child and Adolescent Mental Health, 19(4), 243–250. https://doi.org/10.1111/camh.12058
Forbes, M. K., Rapee, R. M., & Krueger, R. F. (2019). Opportunities for the prevention of mental disorders by reducing general psychopathology in early childhood. Behaviour Research and Therapy. https://doi.org/10.1016/j.brat.2019.103411
Forbes, M. K., Tackett, J. L., Markon, K. E., & Krueger, R. F. (2016). Beyond comorbidity: Toward a dimensional and hierarchical approach to understanding psychopathology across the life span. Development and Psychopathology. https://doi.org/10.1017/S0954579416000651
Forrest, L. N., Smith, A. R., & Swanson, S. A. (2017). Characteristics of seeking treatment among US adolescents with eating disorders. International Journal of Eating Disorders, 50(7), 826–833. https://doi.org/10.1002/eat.22702
Foye, U., Hazlett, D. E., & Irving, P. (2019). ‘The body is a battleground for unwanted and unexpressed emotions’: exploring eating disorders and the role of emotional intelligence. Eating Disorders, 27(3), 321–342. https://doi.org/10.1080/10640266.2018.1517520
Galmiche, M., Déchelotte, P., Lambert, G., & Tavolacci, M. P. (2019). Prevalence of eating disorders over the 2000–2018 period: A systematic literature review. American Journal of Clinical Nutrition. https://doi.org/10.1093/ajcn/nqy342
Goldschmidt, A. B., Lavender, J. M., Hipwell, A. E., Stepp, S. D., & Keenan, K. (2017). Emotion regulation and loss of control eating in community-based adolescents. Journal of Abnormal Child Psychology, 45(1), 183–191. https://doi.org/10.1007/s10802-016-0152-x
Goodwin, H., Haycraft, E., & Meyer, C. (2014). Emotion regulation styles as longitudinal predictors of compulsive exercise: A twelve month prospective study. Journal of Adolescence, 37(8), 1399–1404. https://doi.org/10.1016/j.adolescence.2014.10.001
Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment. https://doi.org/10.1007/s10862-008-9102-4
Gratz, K. L., & Tull, M. T. (2010). The relationship between emotion dysregulation and deliberate self-harm among inpatients with substance use disorders. Cognitive Therapy and Research, 34(6), 544–553. https://doi.org/10.1007/s10608-009-9268-4
Gross, J. J. (1998). The emerging field of emotion regulation: an integrative review. Review of General Psychology, 2(3), 271–299. https://doi.org/10.1037/1089-2680.2.3.271
Gross, J. J., & Muñoz, R. F. (1995). Emotion Regulation and Mental Health. Clinical Psychology: Science and Practice, 2(2), 151–164. https://doi.org/10.1111/j.1468-2850.1995.tb00036.x
Haedt-Matt, A. A., & Keel, P. K. (2011). Revisiting the affect regulation model of binge eating: A meta-analysis of studies using ecological momentary assessment. Psychological Bulletin. https://doi.org/10.1037/a0023660
Halligan, S. L., Cooper, P. J., Fearon, P., Wheeler, S. L., Crosby, M., & Murray, L. (2013). The longitudinal development of emotion regulation capacities in children at risk for externalizing disorders. Development and Psychopathology, 25(2), 391–406. https://doi.org/10.1017/S0954579412001137
Hansson, E., Daukantaité, D., & Johnsson, P. (2017). Disordered eating and emotion dysregulation among adolescents and their parents. BMC Psychology. https://doi.org/10.1186/s40359-017-0180-5
Hay, P., Chinn, D., Forbes, D., Madden, S., Newton, R., Sugenor, L., Touyz, S., & Ward, W. (2014). Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders. Australian & New Zealand Journal of Psychiatry, 48(11), 977–1008. https://doi.org/10.1177/0004867414555814
Haynos, A. F., & Fruzzetti, A. E. (2011). Anorexia Nervosa as a Disorder of Emotion Dysregulation: Evidence and Treatment Implications. In Clinical Psychology: Science and Practice (Vol. 18, Issue 3, pp. 183–202). https://doi.org/https://doi.org/10.1111/j.1468-2850.2011.01250.x
Haynos, A. F., Roberto, C. A., Martinez, M. A., Attia, E., & Fruzzetti, A. E. (2014). Emotion regulation difficulties in anorexia nervosa before and after inpatient weight restoration. International Journal of Eating Disorders, 47(8), 888–891. https://doi.org/10.1002/eat.22265
Henderson, Z. B., Fox, J. R. E., Trayner, P., & Wittkowski, A. (2019). Emotional development in eating disorders: A qualitative metasynthesis. In Clinical Psychology and Psychotherapy (Vol. 26, Issue 4, pp. 440–457). https://doi.org/https://doi.org/10.1002/cpp.2365
Hilbert, A., Vögele, C., Tuschen-Caffier, B., & Hartmann, A. S. (2011). Psychophysiological responses to idiosyncratic stress in bulimia nervosa and binge eating disorder. Physiology and Behavior, 104(5), 770–777. https://doi.org/10.1016/j.physbeh.2011.07.013
Hofmann, S. G. (2014). Interpersonal Emotion Regulation Model of Mood and Anxiety Disorders. Cognitive Therapy and Research, 38(5), 483–492. https://doi.org/10.1007/s10608-014-9620-1
Hofmann, S. G., Sawyer, A. T., Fang, A., & Asnaani, A. (2012). Emotion dysregulation model of mood and anxiety disorders. In Depression and Anxiety (Vol. 29, Issue 5, pp. 409–416). https://doi.org/https://doi.org/10.1002/da.21888
Hoiles, K. J., Egan, S. J., & Kane, R. T. (2012). The validity of the transdiagnostic cognitive behavioural model of eating disorders in predicting dietary restraint. Eating Behaviors, 13(2), 123–126. https://doi.org/10.1016/j.eatbeh.2011.11.007
Holmqvist Larsson, K., Andersson, G., Stern, H., & Zetterqvist, M. (2020). Emotion regulation group skills training for adolescents and parents: A pilot study of an add-on treatment in a clinical setting. Clinical Child Psychology and Psychiatry, 25(1), 141–155. https://doi.org/10.1177/1359104519869782
Hudson, J. I., Hiripi, E., Pope, H. G., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biological Psychiatry, 61(3), 348–358. https://doi.org/10.1016/j.biopsych.2006.03.040
Johnston, J. A. Y., O’Gara, J. S. X., Koman, S. L., Baker, C. W., & Anderson, D. A. (2015). A pilot study of maudsley family therapy with group dialectical behavior therapy skills training in an intensive outpatient program for adolescent eating disorders. Journal of Clinical Psychology, 71(6), 527–543. https://doi.org/10.1002/jclp.22176
Jones, E. J., Egan, S. J., Howell, J. A., Hoiles, K. J., & Mazzucchelli, T. G. (2020). An examination of the transdiagnostic cognitive-behavioural model of eating disorders in adolescents. Eating Behaviors, 39, 101445
Juarascio, A. S., Manasse, S. M., Clark, K. E., Schaumberg, K., Kerrigan, S., Goldstein, S. P., Evans, B. C., Wyckoff, E., Murray, H. B., Felonis, C. R., & Forman, E. (2020). Understanding the overlap and differences in terms describing patterns of maladaptive avoidance and intolerance of negative emotional states. Personality and Individual Differences. https://doi.org/10.1016/j.paid.2020.109859
Keenan, K. (2000). Emotion Dysregulation as a Risk Factor for Child Psychopathology. Clinical Psychology: Science and Practice, 7(4), 418–434. https://doi.org/10.1093/clipsy.7.4.418
Kenardy, J., Arnow, B., & Agras, W. S. (1996). The aversiveness of specific emotional states associated with binge-eating in obese subjects. Australian and New Zealand Journal of Psychiatry, 30(6), 839–844. https://doi.org/10.3109/00048679609065053
Kenny, T. E., Singleton, C., & Carter, J. C. (2017). Testing predictions of the emotion regulation model of binge-eating disorder. International Journal of Eating Disorders, 50(11), 1297–1305. https://doi.org/10.1002/eat.22787
Kim, J., & Cicchetti, D. (2010). Longitudinal pathways linking child maltreatment, emotion regulation, peer relations, and psychopathology. Journal of Child Psychology and Psychiatry, 51(6), 706–716. https://doi.org/10.1111/j.1469-7610.2009.02202.x
Kukk, K., & Akkermann, K. (2019). Emotion regulation difficulties and dietary restraint independently predict binge eating among men. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity. https://doi.org/10.1007/s40519-019-00791-9
Laessle, R. G., & Schulz, S. (2013). No evidence for effects of negative emotions on eating behaviour in overweight children. Eating and Weight Disorders, 18(1), 91–93. https://doi.org/10.1007/s40519-013-0012-4
Laghi, F., Bianchi, D., Pompili, S., Lonigro, A., & Baiocco, R. (2018). Metacognition, emotional functioning and binge eating in adolescence: the moderation role of need to control thoughts. Eating and Weight Disorders, 23(6), 861–869. https://doi.org/10.1007/s40519-018-0603-1
Lampard, A. M., Tasca, G. A., Balfour, L., & Bissada, H. (2013). An evaluation of the transdiagnostic cognitive-behavioural model of eating disorders. European Eating Disorders Review, 21(2), 99–107. https://doi.org/10.1002/erv.2214
Lavender, J. M., & Anderson, D. A. (2010). Contribution of emotion regulation difficulties to disordered eating and body dissatisfaction in college men. International Journal of Eating Disorders, 43(4), 352–357. https://doi.org/10.1002/eat.20705
Lavender, J. M., Wonderlich, S. A., Engel, S. G., Gordon, K. H., Kaye, W. H., & Mitchell, J. E. (2015). Dimensions of emotion dysregulation in anorexia nervosa and bulimia nervosa: A conceptual review of the empirical literature. In Clinical Psychology Review (Vol. 40, pp. 111–122). Elsevier Inc. https://doi.org/https://doi.org/10.1016/j.cpr.2015.05.010
Lavender, J. M., Wonderlich, S. A., Peterson, C. B., Crosby, R. D., Engel, S. G., Mitchell, J. E., Crow, S. J., Smith, T. L., Klein, M. H., Goldschmidt, A. B., & Berg, K. C. (2014). Dimensions of emotion dysregulation in bulimia Nervosa. European Eating Disorders Review, 22(3), 212–216. https://doi.org/10.1002/erv.2288
Lee, A. Y., Reynolds, K. D., Stacy, A., Niu, Z., & Xie, B. (2019). Family functioning, moods, and binge eating among urban adolescents. Journal of Behavioral Medicine, 42(3), 511–521. https://doi.org/10.1007/s10865-018-9994-8
Leehr, E. J., Krohmer, K., Schag, K., Dresler, T., Zipfel, S., & Giel, K. E. (2015). Emotion regulation model in binge eating disorder and obesity - a systematic review. In Neuroscience and Biobehavioral Reviews (Vol. 49, pp. 125–134). Elsevier Ltd. https://doi.org/https://doi.org/10.1016/j.neubiorev.2014.12.008
Liebman, R. E., Coniglio, K. A., Becker, K. R., Tabri, N., Keshishian, A. C., Wons, O., Keel, P. K., Eddy, K. T., & Thomas, J. J. (2020). Behavioral inhibition moderates the association between overvaluation of shape and weight and noncompensatory purging in eating disorders. International Journal of Eating Disorders. https://doi.org/10.1002/eat.23195
Linardon, J., Fairburn, C. G., Fitzsimmons-Craft, E. E., Wilfley, D. E., & Brennan, L. (2017). The empirical status of the third-wave behaviour therapies for the treatment of eating disorders: A systematic review. In Clinical Psychology Review (Vol. 58, pp. 125–140). Elsevier Inc. https://doi.org/https://doi.org/10.1016/j.cpr.2017.10.005
Lock, J., & Le Grange, D. (2019). Family-based treatment: Where are we and where should we be going to improve recovery in child and adolescent eating disorders. International Journal of Eating Disorders. https://doi.org/10.1002/eat.22980
Macht, M. (2008). How emotions affect eating: A five-way model. In Appetite (Vol. 50, Issue 1, pp. 1–11). Academic Press. https://doi.org/https://doi.org/10.1016/j.appet.2007.07.002
McLaughlin, K. A., Hatzenbuehler, M. L., Mennin, D. S., & Nolen-Hoeksema, S. (2011). Emotion dysregulation and adolescent psychopathology: A prospective study. Behaviour Research and Therapy, 49(9), 544–554. https://doi.org/10.1016/j.brat.2011.06.003
Mennin, D. S., Heimberg, R. G., Turk, C. L., & Fresco, D. M. (2002). Applying an emotion regulation framework to integrative approaches to generalized anxiety disorder. Clinical Psychology: Science and Practice, 9(1), 85–90. https://doi.org/10.1093/clipsy.9.1.85
Meule, A., Richard, A., Schnepper, R., Reichenberger, J., Georgii, C., Naab, S., Voderholzer, U., & Blechert, J. (2019). Emotion regulation and emotional eating in anorexia nervosa and bulimia nervosa. Eating Disorders. https://doi.org/10.1080/10640266.2019.1642036
Mitchison, D., Mond, J., Bussey, K., Griffiths, S., Trompeter, N., Lonergan, A., Pike, K. M., Murray, S. B., & Hay, P. (2019). DSM-5 full syndrome, other specified, and unspecified eating disorders in Australian adolescents: Prevalence and clinical significance [Article]. Psychological Medicine, 50(6), 1–10. https://doi.org/10.1017/S0033291719000898
Mitchison, D., Morin, A., Mond, J., Slewa-Younan, S., & Hay, P. (2015). The bidirectional relationship between quality of life and eating disorder symptoms: A 9-year community-based study of Australian women. PLoS ONE, 10(3), 1–19. https://doi.org/10.1371/journal.pone.0120591
Mitchison, G. M., Liber, J. M., Hannesdottir, D. K., & Njardvik, U. (2019). Emotion Dysregulation, ODD and Conduct Problems in a Sample of Five and Six-Year-Old Children. Child Psychiatry & Human Development. https://doi.org/https://doi.org/10.1007/s10578-019-00911-7
Monell, E., Clinton, D., & Birgegård, A. (2018). Emotion dysregulation and eating disorders—Associations with diagnostic presentation and key symptoms. International Journal of Eating Disorders, 51(8), 921–930. https://doi.org/10.1002/eat.22925
Monteleone, A. M., Ruzzi, V., Patriciello, G., Cascino, G., Pellegrino, F., Vece, A., Monteleone, P., & Maj, M. (2020). Emotional reactivity and eating disorder related attitudes in response to the trier social stress test: An experimental study in people with anorexia nervosa and with bulimia nervosa. Journal of Affective Disorders, 274, 23–30
Morris, A. S., Criss, M. M., Silk, J. S., & Houltberg, B. J. (2017). The impact of parenting on emotion regulation during childhood and adolescence. Child Development Perspectives, 11(4), 233–238. https://doi.org/10.1111/cdep.12238
Morris, A. S., Silk, J. S., Steinberg, L., Myers, S. S., & Robinson, L. R. (2007). The role of the family context in the development of emotion regulation. Social Development, 16(2), 361–388. https://doi.org/10.1111/j.1467-9507.2007.00389.x
Murray, S. B. (2019). Updates in the treatment of eating disorders in 2018: A year in review in eating disorders: The Journal of Treatment & Prevention. Eating Disorders. https://doi.org/10.1080/10640266.2019.1567155
Murray, S. B., Anderson, L. K., Cusack, A., Nakamura, T., Rockwell, R., Griffiths, S., & Kaye, W. H. (2015). Integrating family-based treatment and dialectical behavior therapy for adolescent bulimia nervosa: preliminary outcomes of an open pilot trial. Eating Disorders, 23(4), 336–344. https://doi.org/10.1080/10640266.2015.1044345
Nagl, M., Jacobi, C., Paul, M., Beesdo-Baum, K., Höfler, M., Lieb, R., & Wittchen, H. U. (2016). Prevalence, incidence, and natural course of anorexia and bulimia nervosa among adolescents and young adults [Article]. European Child and Adolescent Psychiatry, 25(8), 903–918. https://doi.org/10.1007/s00787-015-0808-z
Naumann, E., Tuschen-Caffier, B., Voderholzer, U., & Svaldi, J. (2016). Spontaneous emotion regulation in anorexia and bulimia nervosa. Cognitive Therapy and Research, 40(3), 304–313. https://doi.org/10.1007/s10608-015-9723-3
Nolen-Hoeksema, S., Stice, E., Wade, E., & Bohon, C. (2007). Reciprocal relations between rumination and bulimic, substance abuse, and depressive symptoms in female adolescents. Journal of Abnormal Psychology, 116(1), 198–207. https://doi.org/10.1037/0021-843X.116.1.198
Nolen-Hoeksema, S., & Watkins, E. R. (2011). A heuristic for developing transdiagnostic models of psychopathology: explaining multifinality and divergent trajectories. Perspectives on Psychological Science, 6(6), 589–609. https://doi.org/10.1177/1745691611419672
O’shaughnessy, R., & Dallos, R. . (2009). Attachment Research and Eating Disorders: A Review of the Literature. JournalsPermissions Nav, 14(4), 559–574. https://doi.org/10.1177/1359104509339082
Oldershaw, A., Lavender, T., Sallis, H., Stahl, D., & Schmidt, U. (2015). Emotion generation and regulation in anorexia nervosa: A systematic review and meta-analysis of self-report data. In Clinical Psychology Review (Vol. 39, pp. 83–95). Elsevier Inc. https://doi.org/https://doi.org/10.1016/j.cpr.2015.04.005
Pennesi, J. L., & Wade, T. D. (2016). A systematic review of the existing models of disordered eating: Do they inform the development of effective interventions? In Clinical Psychology Review (Vol. 43, pp. 175–192). Elsevier Inc. https://doi.org/https://doi.org/10.1016/j.cpr.2015.12.004
Peterson, C. B., Berg, K. C., Crosby, R. D., Lavender, J. M., Accurso, E. C., Ciao, A. C., Smith, T. L., Klein, M. H., Mitchell, J. E., Crow, S. J., & Wonderlich, S. A. (2017). The effects of psychotherapy treatment on outcome in bulimia nervosa: Examining indirect effects through emotion regulation, self-directed behavior, and self-discrepancy within the mediation model. International Journal of Eating Disorders, 50(6), 636–647. https://doi.org/10.1002/eat.22669
Peterson, C. M., Van Diest, A. M. K., Mara, C. A., & Matthews, A. (2020). Dialectical behavioral therapy skills group as an adjunct to family-based therapy in adolescents with restrictive eating disorders. Eating Disorders, 28(1), 67–79. https://doi.org/10.1080/10640266.2019.1568101
Pila, E., Murray, S. B., Le Grange, D., Sawyer, S. M., & Hughes, E. K. (2019). Reciprocal relations between dietary restraint and negative affect in adolescents receiving treatment for anorexia nervosa. Journal of Abnormal Psychology. https://doi.org/10.1037/abn0000402
Pisetsky, E. M., Haynos, A. F., Lavender, J. M., Crow, S. J., & Peterson, C. B. (2017). Associations between emotion regulation difficulties, eating disorder symptoms, non-suicidal self-injury, and suicide attempts in a heterogeneous eating disorder sample. Comprehensive Psychiatry, 73, 143–150. https://doi.org/10.1016/j.comppsych.2016.11.012
Polivy, J., & Herman, C. P. (1993). Etiology of binge eating: Psychological mechanisms. In C. G. Fairburn & G. T. Wilson (Eds.), Binge eating: Nature, assessment, and treatment (pp. 173–205). Guilford Press.
Prefit, A. B., Cândea, D. M., & Szentagotai-Tătar, A. (2019). Emotion regulation across eating pathology: A meta-analysis. Appetite, 143, 104438
Racine, S. E., & Martin, S. J. (2017). Integrating eating disorder-specific risk factors into the acquired preparedness model of dysregulated eating: A moderated mediation analysis. Eating Behaviors. https://doi.org/10.1016/j.eatbeh.2016.12.007
Racine, S. E., VanHuysse, J. L., Keel, P. K., Burt, S. A., Neale, M. C., Boker, S., & Klump, K. L. (2017). Eating disorder-specific risk factors moderate the relationship between negative urgency and binge eating: A behavioral genetic investigation. Journal of Abnormal Psychology, 126(5), 481–494. https://doi.org/10.1037/abn0000204
Racine, S. E., & Wildes, J. E. (2013). Emotion dysregulation and symptoms of anorexia nervosa: The unique roles of lack of emotional awareness and impulse control difficulties when upset. International Journal of Eating Disorders. https://doi.org/10.1002/eat.22145
Racine, S. E., & Wildes, J. E. (2015). Dynamic longitudinal relations between emotion regulation difficulties and anorexia nervosa symptoms over the year following intensive treatment. Journal of Consulting and Clinical Psychology, 83(4), 785–795. https://doi.org/10.1037/ccp0000011
Rapee, R. M., Oar, E. L., Johnco, C. J., Forbes, M. K., Fardouly, J., Magson, N. R., & Richardson, C. E. (2019). Adolescent development and risk for the onset of social-emotional disorders: A review and conceptual model. In Behaviour Research and Therapy (Vol. 123, p. 103501). Pergamon. https://doi.org/https://doi.org/10.1016/j.brat.2019.103501
Reilly, E. E., Orloff, N. C., Luo, T., Berner, L. A., Brown, T. A., Claudat, K., Kaye, W. H., & Anderson, L. K. (2020). Dialectical behavioral therapy for the treatment of adolescent eating disorders: a review of existing work and proposed future directions. Eating Disorders, 28(2), 122–141. https://doi.org/10.1080/10640266.2020.1743098
Rosenberg, N., Bloch, M., Ben Avi, I., Rouach, V., Schreiber, S., Stern, N., & Greenman, Y. (2013). Cortisol response and desire to binge following psychological stress: Comparison between obese subjects with and without binge eating disorder. Psychiatry Research. https://doi.org/10.1016/j.psychres.2012.09.050
Rufino, K. A., Viswanath, H., Wagner, R., & Patriquin, M. A. (2018). Body dissatisfaction and suicidal ideation among psychiatric inpatients with eating disorders. Comprehensive Psychiatry, 84, 22–25. https://doi.org/10.1016/j.comppsych.2018.03.013
Schneider, R. L., Long, E. E., Arch, J. J., & Hankin, B. L. (2020). The relationship between stressful events, emotion dysregulation, and anxiety symptoms among youth: longitudinal support for stress causation but not stress generation. Anxiety, Stress, & Coping,. https://doi.org/10.1080/10615806.2020.1839730
Shihata, S., McEvoy, P. M., & Mullan, B. A. (2017). Pathways from uncertainty to anxiety: An evaluation of a hierarchical model of trait and disorder-specific intolerance of uncertainty on anxiety disorder symptoms. Journal of Anxiety Disorders, 45, 72–79
Shriver, L. H., Dollar, J. M., Lawless, M., Calkins, S. D., Keane, S. P., Shanahan, L., & Wideman, L. (2019). Longitudinal associations between emotion regulation and adiposity in late adolescence: indirect effects through eating behaviors. Nutrients. https://doi.org/10.3390/nu11030517
Sim, L., & Zeman, J. (2006). The contribution of emotion regulation to body dissatisfaction and disordered eating in early adolescent girls. Journal of Youth and Adolescence, 35(2), 219–228. https://doi.org/10.1007/s10964-005-9003-8
Sloan, E., Hall, K., Moulding, R., Bryce, S., Mildred, H., & Staiger, P. K. (2017). Emotion regulation as a transdiagnostic treatment construct across anxiety, depression, substance, eating and borderline personality disorders: A systematic review. In Clinical Psychology Review (Vol. 57, pp. 141–163). Pergamon. https://doi.org/https://doi.org/10.1016/j.cpr.2017.09.002
Stice, E., Marti, C. N., Shaw, H., & Jaconis, M. (2009). An 8-Year longitudinal study of the natural history of threshold, subthreshold, and partial eating disorders from a community sample of adolescents. Journal of Abnormal Psychology. https://doi.org/10.1037/a0016481
Svaldi, J., Griepenstroh, J., Tuschen-Caffier, B., & Ehring, T. (2012). Emotion regulation deficits in eating disorders: A marker of eating pathology or general psychopathology? Psychiatry Research, 197(1–2), 103–111. https://doi.org/10.1016/j.psychres.2011.11.009
Svaldi, J., Werle, D., Naumann, E., Eichler, E., & Berking, M. (2019). Prospective associations of negative mood and emotion regulation in the occurrence of binge eating in binge eating disorder. Journal of Psychiatric Research, 115, 61–68. https://doi.org/10.1016/j.jpsychires.2019.05.005
Thompson, R. A., & Calkins, S. D. (1996). The double-edged sword: Emotional regulation for children at risk. Development and Psychopathology, 8(1), 163–182
Tozzi, F., Thornton, L. M., Klump, K. L., Fichter, M. M., Halmi, K. A., Kaplan, A. S., Strober, M., Woodside, D. B., Crow, S. J., Mitchell, J. E., Rotondo, A., Mauri, M., Cassano, G., Keel, P. K., Plotnicov, K. H., Pollice, C., Lilenfeld, L. R., Berrettini, W. H., Bulik, C. M., & Kaye, W. H. (2005). Symptom fluctuation in eating disorders: Correlates of diagnostic crossover. American Journal of Psychiatry. https://doi.org/10.1176/appi.ajp.162.4.732
Treasure, J., & Russell, G. (2011). The case for early intervention in anorexia nervosa: Theoretical exploration of maintaining factors. British Journal of Psychiatry, 199(1), 5–7. https://doi.org/10.1192/bjp.bp.110.087585
Trompeter, N., Bussey, K., Forbes, M. K., Mond, J., Hay, P., Basten, C., Goldstein, M., Thornton, C., Heruc, G., Byrne, S. M., Griffiths, S., Lonergan, A., Touyz, S., & Mitchison, D. (2020). Differences between Australian adolescents with eating disorder symptoms who are in treatment or not in treatment for an eating disorder. Early Intervention in Psychiatry. https://doi.org/10.1111/eip.13027
Turgon, R., Ruffault, A., Juneau, C., Blatier, C., & Shankland, R. (2019). Eating disorder treatment: a systematic review and meta-analysis of the efficacy of mindfulness-based programs. Mindfulness, 10(11), 2225–2244. https://doi.org/10.1007/s12671-019-01216-5
Ward, A., Ramsay, R., Turnbull, S., Benedettini, M., & Treasure, J. (2000). Attachment patterns in eating disorders: Past in the present. International Journal of Eating Disorders, 28(4), 370–376
Weinbach, N., Sher, H., & Bohon, C. (2018). Differences in emotion regulation difficulties across types of eating disorders during adolescence. Journal of Abnormal Child Psychology, 46(6), 1351–1358. https://doi.org/10.1007/s10802-017-0365-7
Weissman, D. G., Bitran, D., Miller, A. B., Schaefer, J. D., Sheridan, M. A., & McLaughlin, K. A. (2019). Difficulties with emotion regulation as a transdiagnostic mechanism linking child maltreatment with the emergence of psychopathology. Development and Psychopathology, 31(3), 899–915
Whiteside, U., Chen, E., Neighbors, C., Hunter, D., Lo, T., & Larimer, M. (2007). Difficulties regulating emotions: Do binge eaters have fewer strategies to modulate and tolerate negative affect? Eating Behaviors, 8(2), 162–169. https://doi.org/10.1016/j.eatbeh.2006.04.001
Wildes, J. E., Marcus, M. D., Bright, A. C., Dapelo, M. M., & Psychol, M. C. (2012). Emotion and eating disorder symptoms in patients with anorexia nervosa: An experimental study. International Journal of Eating Disorders, 45(7), 876–882. https://doi.org/10.1002/eat.22020
Wildes, J. E., Ringham, R. M., & Marcus, M. D. (2010). Emotion avoidance in patients with anorexia nervosa: Initial test of a functional model. International Journal of Eating Disorders, 43(5), 398–404. https://doi.org/10.1002/eat.20730
Winsper, C., Bilgin, A., & Wolke, D. (2020). Associations between infant and toddler regulatory problems, childhood co-developing internalising and externalising trajectories, and adolescent depression, psychotic and borderline personality disorder symptoms. Journal of Child Psychology and Psychiatry and Allied Disciplines. https://doi.org/10.1111/jcpp.13125
Wonderlich, S. A., Engel, S. G., Peterson, C. B., Robinson, M. D., Crosby, R. D., Mitchell, J. E., Smith, T. L., Klein, M. H., Lysne, C. M., Crow, S. J., Strauman, T. J., & Simonich, H. K. (2008). Examining the conceptual model of integrative cognitive-affective therapy for BN: Two assessment studies. International Journal of Eating Disorders, 41(8), 748–754. https://doi.org/10.1002/eat.20551
Zeman, J., Shipman, K., & Suveg, C. (2002). Anger and sadness regulation: Predictions to internalizing and externalizing symptoms in children. Journal of Clinical Child and Adolescent Psychology. https://doi.org/10.1207/S15374424JCCP3103_11
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Nora Trompeter is supported by the Research Training scholarship at Macquarie University.
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Trompeter, N., Bussey, K., Forbes, M.K. et al. Emotion Dysregulation within the CBT-E Model of Eating Disorders: A Narrative Review. Cogn Ther Res 45, 1021–1036 (2021). https://doi.org/10.1007/s10608-021-10225-5
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DOI: https://doi.org/10.1007/s10608-021-10225-5