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Haynos AF, Crosby RD, Engel SG, Lavender JM, Wonderlich SA, Mitchell JE, Peterson CB, Crow SJ, Le Grange D. Initial test of an emotional avoidance model of restriction in anorexia nervosa using ecological momentary assessment. J Psychiatr Res 2015; 68:134-9. [PMID: 26228412 PMCID: PMC4522040 DOI: 10.1016/j.jpsychires.2015.06.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 05/31/2015] [Accepted: 06/19/2015] [Indexed: 10/23/2022]
Abstract
It has been hypothesized that restrictive eating allows individuals with anorexia nervosa (AN) to avoid contact with negative emotions; however, this presumption has not been directly tested. In this study, we conducted an initial investigation examining whether restrictive eating serves an emotional avoidance function among individuals with AN. Females with AN (n = 118) reported on negative and positive affect, anxiety/tension, and eating behaviors at multiple time points daily over a 2-week period using ecological momentary assessment methodology. Affective patterns were compared using generalized estimating equation models between days in which participants reported either: (1) relatively high restriction (without binge eating); (2) relatively low restriction (without binge eating); (3) binge eating; or (4) no restriction or binge eating. We hypothesized that, if restriction were functioning to avoid negative affect, average negative affect and anxiety/tension, as well as average negative and positive affect lability, would be lower and average positive affect would be higher on days characterized by high levels of restriction compared to other eating patterns. Contrary to hypotheses: (1) average negative affect, anxiety/tension, and positive affect were not significantly different between days characterized by high restriction and those characterized by low or no restriction; (2) Negative affect and anxiety/tension lability were higher on days characterized by high restriction compared to no restriction or binge eating days; (3) Anxiety/tension lability was higher on days characterized by high versus low levels of restriction. This patterns of findings does not support an avoidance model of restrictive eating for individuals with AN.
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Affiliation(s)
- Ann F. Haynos
- Department of Psychology, University of Nevada, Reno, Reno, NV
| | - Ross D. Crosby
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences and Neuropsychiatric Research Institute, Fargo, ND
| | - Scott G. Engel
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences and Neuropsychiatric Research Institute, Fargo, ND
| | - Jason M. Lavender
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences and Neuropsychiatric Research Institute, Fargo, ND
| | - Stephen A. Wonderlich
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences and Neuropsychiatric Research Institute, Fargo, ND
| | - James E. Mitchell
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences and Neuropsychiatric Research Institute, Fargo, ND
| | - Carol B. Peterson
- Department of Psychiatry, University of Minnesota School of Medicine and the Emily Program, Minneapolis, MN
| | - Scott J. Crow
- Department of Psychiatry, University of Minnesota School of Medicine and the Emily Program, Minneapolis, MN
| | - Daniel Le Grange
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA
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Haynos AF, Roberto CA, Attia E. Examining the associations between emotion regulation difficulties, anxiety, and eating disorder severity among inpatients with anorexia nervosa. Compr Psychiatry 2015; 60:93-8. [PMID: 25842195 PMCID: PMC4459906 DOI: 10.1016/j.comppsych.2015.03.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 02/26/2015] [Accepted: 03/17/2015] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE There is growing interest in the role of emotion regulation in anorexia nervosa (AN). Although anxiety is also hypothesized to impact symptoms of AN, little is known about how emotion regulation, anxiety, and eating disorder symptoms interact in AN. In this study, we examined the associations between emotion regulation, anxiety, and eating disorder symptom severity in AN. METHODS Questionnaires and interviews assessing emotion regulation difficulties, anxiety, eating disorder symptoms, and eating disorder-related clinical impairment were collected from group of underweight individuals with AN (n=59) at admission to inpatient treatment. Hierarchical linear regressions were used to examine the associations of emotion regulation difficulties, anxiety, and the interaction of these constructs with eating disorder symptoms and eating disorder-related clinical impairment. RESULTS Emotion regulation difficulties were significantly positively associated with eating disorder symptoms and related clinical impairment only when anxiety levels were low and anxiety was significantly positively associated with eating disorder symptoms and related clinical impairment only when emotion regulation problems were not elevated. CONCLUSIONS This study adds to a growing literature suggesting that emotion regulation deficits are associated with eating disorder symptoms in AN. Certain individuals with AN may especially benefit from a focus on developing emotion regulation skills in the acute stages of illness.
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Affiliation(s)
- Ann F. Haynos
- Department of Psychology, University of Nevada, Reno, Reno, NV
| | - Christina A. Roberto
- Department of Social & Behavioral Sciences, Department of Nutrition, Harvard School of Public Health, Boston, MA
| | - Evelyn Attia
- Division of Clinical Therapeutics, New York State Psychiatric Institute and the Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY
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Lavender JM, Wonderlich SA, Engel SG, Gordon KH, Kaye WH, Mitchell JE. Dimensions of emotion dysregulation in anorexia nervosa and bulimia nervosa: A conceptual review of the empirical literature. Clin Psychol Rev 2015; 40:111-22. [PMID: 26112760 DOI: 10.1016/j.cpr.2015.05.010] [Citation(s) in RCA: 308] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 04/10/2015] [Accepted: 05/31/2015] [Indexed: 12/14/2022]
Abstract
Several existing conceptual models and psychological interventions address or emphasize the role of emotion dysregulation in eating disorders. The current article uses Gratz and Roemer's (2004) multidimensional model of emotion regulation and dysregulation as a clinically relevant framework to review the extant literature on emotion dysregulation in anorexia nervosa (AN) and bulimia nervosa (BN). Specifically, the dimensions reviewed include: (1) the flexible use of adaptive and situationally appropriate strategies to modulate the duration and/or intensity of emotional responses, (2) the ability to successfully inhibit impulsive behavior and maintain goal-directed behavior in the context of emotional distress, (3) awareness, clarity, and acceptance of emotional states, and (4) the willingness to experience emotional distress in the pursuit of meaningful activities. The current review suggests that both AN and BN are characterized by broad emotion regulation deficits, with difficulties in emotion regulation across the four dimensions found to characterize both AN and BN, although a small number of more specific difficulties may distinguish the two disorders. The review concludes with a discussion of the clinical implications of the findings, as well as a summary of limitations of the existing empirical literature and suggestions for future research.
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Affiliation(s)
- Jason M Lavender
- Neuropsychiatric Research Institute, Fargo, ND, USA; University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA.
| | - Stephen A Wonderlich
- Neuropsychiatric Research Institute, Fargo, ND, USA; University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - Scott G Engel
- Neuropsychiatric Research Institute, Fargo, ND, USA; University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - Kathryn H Gordon
- North Dakota State University, Department of Psychology, Fargo, ND, USA
| | - Walter H Kaye
- University of California, San Diego School of Medicine, San Diego, CA, USA
| | - James E Mitchell
- Neuropsychiatric Research Institute, Fargo, ND, USA; University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
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Monell E, Högdahl L, Mantilla EF, Birgegård A. Emotion dysregulation, self-image and eating disorder symptoms in University Women. J Eat Disord 2015; 3:44. [PMID: 26629343 PMCID: PMC4666164 DOI: 10.1186/s40337-015-0083-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 11/24/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND We studied associations between emotion dysregulation, self-image and eating disorder (ED) symptoms in university women, and contrasted two indirect effect models to examine possible intervening mechanisms to produce ED symptoms. METHODS 252 female Swedish university students completed the Difficulties in Emotion Regulation Scale (DERS), the Structural Analysis of Social Behavior (SASB) self-image measure, and the Eating Disorder Examination Questionnaire (EDE-Q). Correlations between scales were followed by five simple mediation analysis pairs with two possible pathways using five ED symptom variables as outcome. The models posited either self-image or emotion dysregulation as mediator or independent variable, respectively. ED symptoms were EDE-Q Global score, objective binge eating episodes (OBE), subjective binge eating episodes (SBE), and two variants of EDE-Q excessive exercise. RESULTS Emotion dysregulation and self-image were strongly correlated, and both correlated moderately with EDE-Q Global score. There were distinct indirect effects through self-image on the relationship between emotion dysregulation and ED symptoms, but not vice versa. These indirect effects were evident in relation to cognitive ED symptoms and both OBE and SBE, but not in relation to excessive exercise. CONCLUSIONS Results suggest that even if closely related, emotion dysregulation and self-image both contribute unique knowledge in relation to ED symptoms. Self-image as an intervening mechanism between emotion dysregulation and ED symptoms is relevant for models of the development, maintenance and treatment of ED, as well as treatment focus.
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Affiliation(s)
- Elin Monell
- Department of Clinical Neuroscience, Karolinska Institute, Norra Stationsgatan 69 7th floor, 113 64 Stockholm, Sweden ; Centre for Research & Development, Uppsala University/Region Gävleborg, Uppsala, Sweden
| | - Louise Högdahl
- Department of Clinical Neuroscience, Karolinska Institute, Norra Stationsgatan 69 7th floor, 113 64 Stockholm, Sweden
| | - Emma Forsén Mantilla
- Department of Clinical Neuroscience, Karolinska Institute, Norra Stationsgatan 69 7th floor, 113 64 Stockholm, Sweden
| | - Andreas Birgegård
- Department of Clinical Neuroscience, Karolinska Institute, Norra Stationsgatan 69 7th floor, 113 64 Stockholm, Sweden
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Racine SE, Wildes JE. Emotion dysregulation and anorexia nervosa: an exploration of the role of childhood abuse. Int J Eat Disord 2015; 48:55-8. [PMID: 25358997 PMCID: PMC4404145 DOI: 10.1002/eat.22364] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 10/08/2014] [Accepted: 10/10/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Theoretical models of emotion regulation difficulties in anorexia nervosa (AN) specify a role for factors that predispose to or precipitate emotion dysregulation. The current study considered whether childhood abuse (i.e., emotional, sexual, physical) might be related to emotion regulation difficulties and eating disorder symptom severity in patients with AN. Childhood abuse was hypothesized to relate to AN symptoms indirectly via emotion dysregulation. METHOD Participants were 188 patients with AN presenting to an intensive treatment facility. The Childhood Trauma Questionnaire, Difficulties in Emotion Regulation Scale, and Eating Disorder Examination were used to assess childhood abuse, emotion dysregulation, and AN symptom severity, respectively. RESULTS Of the three forms of childhood abuse, reports of emotional abuse were most strongly related to emotion regulation difficulties and AN symptom severity. Mediation analyses revealed that emotion dysregulation significantly explained the relationship between childhood emotional abuse and AN symptomatology, and mediation effects did not differ by AN subtype (i.e., restricting vs. binge-eating/purging). DISCUSSION Findings provide initial support for a model in which childhood emotional abuse precipitates emotion dysregulation and the development of AN. Future studies with longitudinal designs and control groups are necessary to examine the direction and specificity of these cross-sectional associations
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Affiliation(s)
- Sarah E. Racine
- Department of Psychology, Ohio University, Athens, OH, USA,Department of Psychiatry, University of Pittsburgh School of Medicine. Pittsburgh, PA, USA
| | - Jennifer E. Wildes
- Department of Psychiatry, University of Pittsburgh School of Medicine. Pittsburgh, PA, USA,Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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