Distress, emotional clarity, and disordered eating in young people with complex emotional and behavioural difficulties

Abstract

Background Disordered eating frequently co‐occurs in young people seeking treatment for mental health and substance use difficulties. High levels of psychological distress and a lack of emotional clarity (LEC) are two constructs that have received recent attention as important constructs underlying this harmful behaviour; however how they interact to precipitate and maintain disordered eating still remains unclear. This study sought to address this gap by examining whether psychological distress moderates the relationship between LEC and disordered eating in a sample of young people with complex emotional and behavioural difficulties. Methods Participants were young people (N = 306, M = 20.8 years) accessing youth specific alcohol and other drugs and/or primary mental health services in Australia who completed an online questionnaire which examined their level of emotional clarity, degree of distress, and engagement in disordered eating behaviours. Results Moderation analysis was employed to examine if psychological distress (i.e., anxiety and depression) significantly moderates the relationship between LEC and disordered eating. A small, significant interactive effect of high levels of depressive symptoms on the relationship between LEC and disordered eating was found. Whereas, anxious affect did not significantly interact with LEC to predict disordered eating. Conclusions Young people who struggle to identify and articulate their emotions are more likely to engage in disordered eating in the presence of high distress relating to depressive symptomatology. Addressing LEC through increasing emotional literacy, while treating depressive symptomatology, are key intervention strategies that may assist young people with complex emotional and behavioural difficulties manage disordered eating.

Broad and Narrow Transdiagnostic Risk Factors in Eating Disorders: A Preliminary Study on an Italian Clinical Sample

“…To our knowledge, research has mainly investigated emotion dysregulation and psychological distress separately in patients with EDs, while the relationship between these two variables is still unexplored in such a population. However, the following independent lines of evidence could provide support to our preliminary result and lead to a step-by-step understanding of it: (1) the presence of ER difficulties is a well-established mechanism involved in eating pathology (e.g., [ 35 , 38 ]); (2) emotion dysregulation is a transdiagnostic factor found to be associated with anxiety and depressive disorders in different populations (e.g., [ 37 , 99 ]); (3) anxiety and depressive symptoms have been recognized as precipitating and maintenance factors for EDs [ 85 , 86 ]; (4) ED behaviors—such as vomiting, bingeing, and restriction—may represent cognitive avoidance strategies performed to block/escape from negative affect (i.e., anxiety and depression) [ 100 ] and/or means to cope with difficult emotional states (e.g., [ 35 , 43 , 44 ]). In light of our findings and the aforementioned arguments, it is possible to surmise that patients with EDs may be characterized by deficits in ER that may heighten the risk of experiencing general psychological distress—expressed in terms of anxiety, depression, and stress symptoms—in response to emotions perceived as overwhelming and difficult to regulate; general distress, in turn and together with other factors, may contribute to increasing the likelihood of habitual usage of ED behaviors to deal with negative affect and emotions, in the face of an inability to find more adaptive coping strategies.…”

A qualitative examination of the relationship between rumination, distress, and dysregulated behaviours in vulnerable young people

“…These young people found it difficult to identify any thoughts or emotions that preceded behavioural dysregulation, and instead focused solely on a situational trigger as a precipitant (i.e., relationship break up). This may reflect a lack of insight or clarity into their cognitive and/or emotional experience which supports existing research that: (1) Young people experience developmentally appropriate deficits in emotional clarity (Mankus, Boden, & Thompson, 2016); and (2) deficits in emotional clarity are a key risk factor of behavioural dysregulation (Sloan, O'Donnell, et al ., 2018; Vine & Aldao, 2014).…”

“…Of particular concern are the high rates and co‐occurrence of multiple harmful dysregulated behaviours (Howe, Batchelor, & Coates, 2017; Rickwood, Telford, Parker, Tanti, & McGorry, 2014; Shingleton et al ., 2013). Dysregulated behaviours observed in this cohort include deliberate self‐harm (DSH), defined as the intentional, direct injuring of body tissue without suicidal intent (Klonsky, 2007); disordered eating, which includes a range of maladaptive or atypical eating behaviours (e.g., binge eating, purging) that may not meet diagnostic threshold for an eating disorder yet are still associated with distress or impairment (Buckholdt et al ., 2014; Sloan, O'Donnell, et al ., 2018); and substance misuse, encompassing harmful use of illicit drugs, prescribed medications or binge use of alcohol. While the presence of dysregulated behaviours poses significant harms in their own right, they are also associated with high levels of psychological distress, result in significant psychological morbidity, and can be a precursor to more severe mental health difficulties and/or suicide (Borges et al ., 2017; Fliege, Lee, Grimm, & Klapp, 2009; Franko & Keel, 2006).…”

Examining the role of brooding, distress, and negative urgency in dysregulated behaviors: A cross‐sectional study in treatment‐seeking young people

“…Dysregulated behaviors, such as nonsuicidal self‐injury (NSSI; e.g., deliberately injuring body tissue without suicidal ideation [Klonsky, 2007 ]); disordered eating (e.g., binge eating or purging resulting in distress and impairment [Buckholdt et al, 2014 ; Sloan et al, 2018 ]); and the binge use of drugs or alcohol, are a complex group of behaviors that are often comorbid (Blinder et al, 2006 ; Cucchi et al, 2016 ; Zlotnick et al, 1999 ), although what unifies this specific set of behaviors to often co‐occur requires further investigation. These behaviors are associated with a significantly heightened risk for suicide (Borges et al, 2017 ; Fliege et al, 2009 ; Franko & Keel, 2006 ), are difficult to control, result in functional impairment (Selby & Joiner, 2009 ), and have significant health and social implications, such as prolonged psychopathology, poorer physical health, and impaired occupational and interpersonal functioning (Mckellar et al, 2006 ; Perez & Warren, 2012 ; Turner et al, 2012 ).…”