Advertisement

Journal of Abnormal Child Psychology

, Volume 46, Issue 6, pp 1351–1358 | Cite as

Differences in Emotion Regulation Difficulties Across Types of Eating Disorders During Adolescence

  • Noam Weinbach
  • Helene Sher
  • Cara Bohon
Article

Abstract

Emotion regulation appears to play a key role in eating disorders. However, prior attempts to associate specific emotion regulation abilities with specific types of eating disorders resulted in inconsistent findings. Moreover, far less is known about emotion regulation in eating disorders during adolescence, a critical period of emotional development. The current study addresses this gap, comparing emotion regulation characteristics between adolescents with restrictive types of eating disorders and those with binge eating or purging types of eating disorders. Ninety-eight adolescents with eating disorders (49 with restrictive and 49 with binge eating/purging eating disorders) completed a set of questionnaires including the Difficulties in Emotion Regulation Scale (DERS). The results revealed that binge eating/purging types of eating disorders were associated with greater difficulties in a variety of emotion regulation dimensions including impulse control, goal-directed behavior and access to effective emotion regulation strategies. Awareness and clarity of emotions were also worse in the binge eating/purging types of eating disorders, but this difference did not remain when comorbid psychopathology measures were controlled for. Moreover, the emotion regulation profile of adolescents with anorexia nervosa-binging/purging type was more similar to that of adolescents with bulimia nervosa than to that of adolescents with anorexia nervosa-restrictive type. While both restrictive and binge eating/purging eating disorders have been associated with emotion regulation difficulties, the current study shows that the presence of binge eating or purging episodes is linked with greater severity of emotion regulation deficits among adolescents with eating disorders.

Keywords

Emotion regulation Eating disorders Adolescence DERS 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

References

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.  https://doi.org/10.1176/appi.books.9780890425596.dsm10.CrossRefGoogle Scholar
  2. Beck, A., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893–897.  https://doi.org/10.1037/0022-006X.56.6.893.CrossRefPubMedGoogle Scholar
  3. Beck, A., Steer, R., & Brown, G. (1996). Beck depression inventory-II. San Antonio, TX: The Psychological Corporation.  https://doi.org/10.1037/t00742-000.Google Scholar
  4. 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, 565–571.  https://doi.org/10.1016/j.comppsych.2013.12.001.CrossRefPubMedGoogle Scholar
  5. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum.  https://doi.org/10.4324/9780203771587.Google Scholar
  6. Corcos, M., Guilbaud, O., Speranza, M., Paterniti, S., Loas, G., Stephan, P., & Jeammet, P. (2000). Alexithymia and depression in eating disorders. Psychiatry Research, 93, 263–266.  https://doi.org/10.1016/S0165-1781(00)00109-8.CrossRefPubMedGoogle Scholar
  7. Couturier, J. L., & Lock, J. (2006). Denial and minimization in adolescents with anorexia nervosa. International Journal of Eating Disorders, 39, 212–216.  https://doi.org/10.1002/eat.20241.CrossRefPubMedGoogle Scholar
  8. Danner, U. N., Evers, C., Stok, F. M., Van Elburg, A. A., & De Ridder, D. T. D. (2012). A double burden: Emotional eating and lack of cognitive reappraisal in eating disordered women. European Eating Disorders Review, 20, 490–495.  https://doi.org/10.1002/erv.2184.CrossRefPubMedGoogle Scholar
  9. Eddy, K. T., Dorer, D. J., Franko, D. L., Tahilani, K., Thompson-Brenner, H., & Herzog, D. B. (2008). Diagnostic crossover in anorexia nervosa and bulimia nervosa: Implications for DSM-V. American Journal of Psychiatry, 165, 245–250.  https://doi.org/10.1176/appi.ajp.2007.07060951.CrossRefPubMedGoogle Scholar
  10. Engel, S. G., Wonderlich, S. A., Crosby, R. D., Mitchell, J. E., Crow, S., Peterson, C. B., et al. (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, 709–719.  https://doi.org/10.1037/a0034010.CrossRefPubMedPubMedCentralGoogle Scholar
  11. Foa, E. B., Huppert, J. D., Leiberg, S., Langner, R., Kichic, R., Hajcak, G., & Salkovskis, P. M. (2002). The Obsessive-Compulsive Inventory: Development and validation of a short version. Psychological Assessment, 14, 485–496.  https://doi.org/10.1037/1040-3590.14.4.485.CrossRefPubMedGoogle Scholar
  12. Garner, D. M., Olmstead, M. P., Bohr, Y., & Garfinkel, P. (1982). The eating attitudes test: Psychometric features and clinical correlates. Psychological Medicine, 12(1980), 871–878.  https://doi.org/10.1017/S0033291700049163.CrossRefPubMedGoogle Scholar
  13. Gilboa-Schechtman, E., Avnon, L., Zubery, E., & Jeczmien, P. (2006). Emotional processing in eating disorders: Specific impairment or general distress related deficiency? Depression and Anxiety, 23, 331–339.  https://doi.org/10.1002/da.20163.CrossRefPubMedGoogle Scholar
  14. 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, 26, 41–54.  https://doi.org/10.1023/B:JOBA.0000007455.08539.94.CrossRefGoogle Scholar
  15. Harrison, A., Sullivan, S., Tchanturia, K., & Treasure, J. (2010). Emotional functioning in eating disorders: attentional bias, emotion recognition and emotion regulation. Psychological Medicine, 40, 1887–1897.  https://doi.org/10.1017/S0033291710000036.CrossRefPubMedGoogle Scholar
  16. Hatzenbuehler, M. L., McLaughlin, K. A., & Nolen-Hoeksema, S. (2008). Emotion regulation and internalizing symptoms in a longitudinal study of sexual minority and heterosexual adolescents. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 49, 1270–1278.  https://doi.org/10.1111/j.1469-7610.2008.01924.x.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 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. Clinical Psychology Review, 40, 111–122.  https://doi.org/10.1016/j.cpr.2015.05.010.CrossRefPubMedPubMedCentralGoogle Scholar
  18. Lock, J., Garrett, A., Beenhakker, J., & Reiss, A. L. (2011). Aberrant brain activation during a response inhibition task in adolescent eating disorder subtypes. American Journal of Psychiatry, 168, 55–64.  https://doi.org/10.1176/appi.ajp.2010.10010056.CrossRefPubMedGoogle Scholar
  19. Neumann, A., van Lier, P. A. C., Gratz, K. L., & Koot, H. M. (2010). Multidimensional assessment of emotion regulation difficulties in adolescents using the difficulties in emotion regulation scale. Assessment, 17, 138–149.  https://doi.org/10.1177/1073191109349579.CrossRefPubMedGoogle Scholar
  20. Nowakowski, M. E., McFarlane, T., & Cassin, S. (2013). Alexithymia and eating disorders: a critical review of the literature. International Journal of Eating Disorders, 1, 21.  https://doi.org/10.1186/2050-2974-1-21.CrossRefGoogle Scholar
  21. Rosval, L., Steiger, H., Bruce, K., Israël, M., Richardson, J., & Aubut, M. (2006). Impulsivity in women with eating disorders: Problem of response inhibition, planning, or attention? International Journal of Eating Disorders, 39, 590–593.  https://doi.org/10.1002/eat.20296.CrossRefPubMedGoogle Scholar
  22. Rowsell, M., & MacDonald, D. (2016). Emotion regulation difficulties in anorexia nervosa: associations with improvements in eating psychopathology. International Journal of Eating Disorders, 4, 17.  https://doi.org/10.1186/s40337-016-0108-0.CrossRefGoogle Scholar
  23. Ruscitti, C., Rufino, K., Goodwin, N., & Wagner, R. (2016). Difficulties in emotion regulation in patients with eating disorders. Borderline Personality Disorder and Emotion Dysregulation, 3, 1–7.  https://doi.org/10.1186/s40479-016-0037-1.CrossRefGoogle Scholar
  24. Schmidt, U., Jiwany, A., & Treasure, J. (1993). A controlled study of alexithymia in eating disorders. Comprehensive Psychiatry, 34, 54–58.  https://doi.org/10.1016/0010-440X(93)90036-4.CrossRefPubMedGoogle Scholar
  25. Silk, J. S., Steinberg, L., & Morris, A. S. (2003). Adolescents’ emotion regulation in daily life: Links to depressive symptoms and problem behavior. Child Development, 74, 1869–1880.  https://doi.org/10.1046/j.1467-8624.2003.00643.x.CrossRefPubMedGoogle Scholar
  26. Spear, L. P. (2000). The adolescent brain and age-related behavioral manifestations. Neuroscience and Biobehavioral Reviews, 24, 417–463.  https://doi.org/10.1016/S0149-7634(00)00014-2.CrossRefPubMedGoogle Scholar
  27. 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, 103–111.  https://doi.org/10.1016/j.psychres.2011.11.009.CrossRefPubMedGoogle Scholar
  28. Waller, G., Babbs, M., Milligan, R., Meyer, C., Ohanian, V., & Leung, N. (2003). Anger and core beliefs in the eating disorders. International Journal of Eating Disorders, 34, 118–124.  https://doi.org/10.1002/eat.10163.CrossRefPubMedGoogle Scholar
  29. Weinberg, A., & Klonsky, E. D. (2009). Measurement of emotion dysregulation in adolescents. Psychological Assessment, 21, 616–621.  https://doi.org/10.1037/a0016669.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Department of Psychiatry and Behavioral Sciences, Child and Adolescent PsychiatryStanford University School of MedicineStanfordUSA
  2. 2.Eating Disorder Unit, Child and Adolescent Psychiatry, Soroka Medical CenterBeer-ShevaIsrael

Personalised recommendations