Examining emotion regulation in binge-eating disorder

Abstract

Background Inefficient mechanisms of emotional regulation appear essential in understanding the development and maintenance of binge-eating disorder (BED). Previous research focused mainly on a very limited emotion regulation strategies in BED, such as rumination, suppression, and positive reappraisal. Therefore, the aim of the study was to assess a wider range of emotional regulation strategies (i.e. acceptance, refocusing on planning, positive refocusing, positive reappraisal, putting into perspective, self-blame, other-blame, rumination, and catastrophizing), as well as associations between those strategies and binge-eating-related beliefs (negative, positive, and permissive), and clinical variables (eating disorders symptoms, both anxiety, depressive symptoms, and alexithymia). Methods Women diagnosed with BED (n = 35) according to the DSM-5 criteria and healthy women (n = 41) aged 22–60 years were assessed using: the Eating Attitudes Test-26, the Eating Beliefs Questionnaire-18, the Hospital Anxiety and Depression Scale, the Toronto Alexithymia Scale-20, the Cognitive Emotion Regulation Questionnaire, and the Difficulties in Emotion Regulation Scale. Statistical analyses included: Student t - tests or Mann–Whitney U tests for testing group differences between BED and HC group, and Pearson’s r coefficient or Spearman’s rho for exploring associations between the emotion regulation difficulties and strategies, and clinical variables and binge-eating-related beliefs in both groups. Results The BED group presented with a significantly higher level of emotion regulation difficulties such as: nonacceptance of emotional responses, lack of emotional clarity, difficulties engaging in goal-directed behavior, impulse control difficulties, and limited access to emotion regulation strategies compared to the healthy controls. Moreover, patients with BED were significantly more likely to use maladaptive strategies (rumination and self-blame) and less likely to use adaptive strategies (positive refocusing and putting into perspective). In the clinical group, various difficulties in emotion regulation difficulties occurred to be positively correlated with the level of alexithymia, and anxiety and depressive symptoms. Regarding emotion regulation strategies, self-blame and catastrophizing were positively related to anxiety symptoms, but solely catastrophizing was related to the severity of eating disorder psychopathology. Conclusions Our results indicate an essential and still insufficiently understood role of emotional dysregulation in BED. An especially important construct in this context seems to be alexithymia, which was strongly related to the majority of emotion regulation difficulties. Therefore, it might be beneficial to pay special attention to this construct when planning therapeutic interventions, as well as to the maladaptive emotion regulation strategies self-blame and catastrophizing, which were significantly related to BED psychopathology.

An Examination of the Relationships between Eating-Disorder Symptoms, Difficulties with Emotion Regulation, and Mental Health in People with Binge Eating Disorder

“…It is noteworthy that people with eating disorders report overall poorer emotion regulation in comparison to people without eating disorders [ 10 ], and that poor emotional awareness and clarity has been found in people with eating disorders [ 11 ]. Studies with samples of people with BED found similar results [ 12 , 13 ]. For instance, limited access to emotion-regulation strategies were associated with BED in people with obesity who were candidates for bariatric surgery [ 12 ].…”

“…For instance, limited access to emotion-regulation strategies were associated with BED in people with obesity who were candidates for bariatric surgery [ 12 ]. Moreover, women with BED can experience greater emotion-regulation difficulties, namely nonacceptance of emotional responses, lack of emotional clarity, difficulties engaging in goal-directed behavior, impulse-control difficulties, and limited access to emotion-regulation strategies in comparison to women without BED [ 13 ]. Women with BED may also use more maladaptive emotion-regulation strategies (i.e., rumination, self-blame), and use less adaptive emotion-regulation strategies (i.e., positive refocusing, putting into perspective), in comparison to women without BED [ 13 ].…”

Novel approaches to tackling emotional loss of control of eating across the weight spectrum

“…Before it was tested in binge-eating disorder, LDX was in use for the treatment of children and adults with ADHD. We have mentioned earlier that people with binge-eating disorder have a genetic profile similar to that of people with ADHD and emotional dysregulation is a feature of both (97,98) . The approval of LDX in binge-eating disorder was based on three randomised controlled trials which found LDX superior to placebo for reducing binge-eating days, obsessive-compulsive binge-eating symptoms and body weight (99) .…”

What about males? Exploring sex differences in the relationship between emotion difficulties and eating disorders

“…The ability to anticipate, recognise and differentiate between emotions may also be a prerequisite for identifying and flexibly utilising adaptive regulation strategies [11][12][13]. As such, a relationship has indeed been demonstrated between alexithymia and emotion regulation deficits in anorexia nervosa (AN) [14], binge eating disorder (BED) [15] and bulimia nervosa (BN) [16]. People with EDs also struggle to flexibly employ emotion regulation strategies in a context-dependent manner [17], both under-utilising adaptive strategies (like reappraisal and problem-solving) and over-relying on maladaptive ones [4,18].…”