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Atwood ME. Emotion dysregulation and obesity: A conceptual review of the literature. Clin Obes 2024:e12699. [PMID: 39119935 DOI: 10.1111/cob.12699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 06/18/2024] [Accepted: 07/20/2024] [Indexed: 08/10/2024]
Abstract
Problematic eating behaviours are prevalent in individuals living with obesity and have been linked to weight gain over time. Furthermore, there is evidence that heightened negative emotionality is common in a subset of individuals living with obesity and that negative emotions often precede problematic eating behaviours. Consequently, several theories have highlighted emotion dysregulation as a potential explanatory mechanism of this relationship. However, to date, no comprehensive review has compiled the specific ways in which individuals living with obesity exhibit emotion dysregulation. The present review utilizes Gratz and Roemer's (2004) multidimensional conceptualization of emotion regulation and dysregulation as a framework to summarize the extant literature on emotion dysregulation in obesity. Specifically, this review examines research related to: (1) awareness and clarity of emotions; (2) acceptance of, and willingness to experience, emotion; (3) the ability to remain goal directed and inhibit impulsive behaviour when distressed; and (4) access to emotion regulation strategies. Overall, findings from the present review demonstrate that individuals living with obesity exhibit deficits in emotion clarity, and experience difficulty inhibiting impulsive behaviour and remaining goal directed when experiencing emotion. Strengths and limitations of the literature are reviewed, and future research directions and clinical implications are discussed in light of these findings.
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Affiliation(s)
- Molly E Atwood
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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2
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Romero-Rebollar C, García-Gómez L, Báez-Yáñez MG, Gutiérrez-Aguilar R, Pacheco-López G. Adiposity affects emotional information processing. Front Psychol 2022; 13:879065. [PMID: 36225672 PMCID: PMC9549075 DOI: 10.3389/fpsyg.2022.879065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
Obesity is a worldwide epidemic associated with severe health and psychological wellbeing impairments expressed by an increased prevalence of affective disorders. Emotional dysfunction is important due to its effect on social performance. The aim of the present narrative review is to provide a general overview of human research exploring emotional information processing in overweight and obese people. Evidence suggests that obesity is associated with an attenuation of emotional experience, contradictory findings about emotion recognition, and scarce research about automatic emotional information processing. Finally, we made some concluding considerations for future research on emotional information processing in overweight and obese people.
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Affiliation(s)
| | - Leonor García-Gómez
- School of Psychology, Intercontinental University (UIC), Mexico City, Mexico
- Department of Research on Smoking and COPD, National Institute of Respiratory Diseases (INER) Ismael Cosío Villegas, Mexico City, Mexico
| | - Mario G. Báez-Yáñez
- Radiology Department, University Medical Center Utrecht, Utrecht, Netherlands
| | - Ruth Gutiérrez-Aguilar
- Division of Research, School of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
- Laboratory of Metabolic Diseases: Obesity and Diabetes, Hospital Infantil de México “Federico Gómez”, Mexico City, Mexico
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Schlensog-Schuster F, Klein AM, Biringen Z, von Klitzing K, Bergmann S. Maternal sensitivity and intrusiveness in early childhood as predictors of children's weight at school age. Pediatr Obes 2022; 17:e12842. [PMID: 34553841 DOI: 10.1111/ijpo.12842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/12/2021] [Accepted: 07/26/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND While previous research indicates that low maternal sensitivity in mother-child interactions puts children at risk of overweight and obesity, maternal intrusiveness has rarely been investigated in association with children's weight. We investigated whether maternal sensitivity and intrusiveness in early childhood predict children's increased body mass index standard deviation scores (BMI-SDS) at school age. BMI-SDS are standardized for age and gender with respect to a reference standard. METHODS At baseline (t1), we assessed maternal sensitivity and (non-)intrusiveness of 116 mothers with their children (48.3% female) aged 5-47 months (M = 24.00, SD = 11.36) using the emotional availability scales. We obtained anthropometric data for mothers at t1 by measuring height and weight in the laboratory and for children at birth assessed by medical staff. Six years later (t2) we obtained anthropometric data for children in the laboratory or based on parental report. Linear regression analyses were run with child BMI-SDS at t2 as outcome and sensitivity and (non-)intrusiveness as predictors, adjusting for confounders and exploring child age and gender as moderators. RESULTS Maternal sensitivity only negatively predicted children's BMI-SDS in girls, while maternal intrusiveness predicted higher child BMI-SDS at school age regardless of child gender. The effect of maternal non-intrusiveness remained significant when controlling for confounders. CONCLUSION Maternal intrusiveness in early childhood seems to represent a risk factor for increased BMI-SDS in children, while lower maternal sensitivity tends to be a risk factor for increased BMI-SDS in girls. This may have implications for prevention or intervention programmes.
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Affiliation(s)
- Franziska Schlensog-Schuster
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Leipzig, Leipzig, Germany
| | | | - Zeynep Biringen
- Department of Human Development & Family Studies, Colorado State University, Fort Collins, Colorado, USA
| | - Kai von Klitzing
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Leipzig, Leipzig, Germany
| | - Sarah Bergmann
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Leipzig, Leipzig, Germany.,International Psychoanalytic University, Berlin, Germany
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Abstract
Facial emotion recognition (FER) is extensively investigated in psychological sciences in healthy individuals and clinical conditions. In this paper, we analyzed those studies in which FER was assessed in the case of obesity or fibromyalgia, in relation to the levels of alexithymia. Crucially, these two conditions frequently co-occur; however, no study has explored FER considering both fibromyalgia and obesity. Studies were identified using the electronic search engine of PubMed. The last research was run on 23 July 2021. Two independent lists were generated for the two clinical conditions. Six records were reviewed about obesity, while three records about fibromyalgia. The evidence relative to FER in obesity was not conclusive, whereas the evidence about an altered FER in fibromyalgia seemed more straightforward. Moreover, the role of alexithymia on FER in these clinical conditions was not extensively investigated. In our discussion, we highlighted those factors that should be carefully addressed in investigating FER in these clinical conditions. Moreover, we underlined methodological criticisms that should be overcome in future research.
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Scarpina F, Varallo G, Castelnuovo G, Capodaglio P, Molinari E, Mauro A. Implicit facial emotion recognition of fear and anger in obesity. Eat Weight Disord 2021; 26:1243-1251. [PMID: 32948997 DOI: 10.1007/s40519-020-01010-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 09/04/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Previous evidence about facial emotion recognition capability in obesity is few and not conclusive. OBJECTIVE We investigated the capability of female individuals affected by obesity to recognize the emotions of fear and anger through a facial emotion recognition task grounded on the implicit redundant target effect. METHODS 20 women affected by obesity and 20 healthy-weight women were enrolled. We administered an implicit facial emotion recognition task. Both reaction time and level of accuracy were computed. Moreover, the level of alexithymia was measured through the standard questionnaire. RESULTS Selective difficulties in recognizing the emotion of fear were observed in participants with obesity, when their performance was contrasted with healthy-weight controls. Instead, they showed the implicit redundant target effect when anger was the target. However, the two groups reported globally similar scores at the standard questionnaire relative to the level of alexithymia. CONCLUSIONS Our result might agree with the hypothesis about affected individuals' difficulties in being attentive to negative facial emotions, and specifically in the case of fearful expression. This study might encourage future research in which emotional processing will be investigated through subjective judgments and implicit/objective measurements. LEVEL I Experimental study.
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Affiliation(s)
- Federica Scarpina
- Istituto Auxologico Italiano, IRCCS, U.O. di Neurologia e Neuroriabilitazione, Ospedale San Giuseppe, 28824, Piancavallo, VCO, Italy.
- "Rita Levi Montalcini", Department of Neurosciences, University of Turin, 10124, Turin, Italy.
| | - Giorgia Varallo
- Istituto Auxologico Italiano, IRCCS, Laboratorio di Psicologia, Ospedale San Giuseppe, 28824, Piancavallo, Italy
- Psychology Department, Università Cattolica del Sacro Cuore, 20123, Milan, Italy
| | - Gianluca Castelnuovo
- Istituto Auxologico Italiano, IRCCS, Laboratorio di Psicologia, Ospedale San Giuseppe, 28824, Piancavallo, Italy
- Psychology Department, Università Cattolica del Sacro Cuore, 20123, Milan, Italy
| | - Paolo Capodaglio
- Istituto Auxologico Italiano, IRCCS, U.O. di. Riabilitazione Osteoarticolare, Ospedale S. Giuseppe, 28824, Piancavallo, Italy
| | - Enrico Molinari
- Istituto Auxologico Italiano, IRCCS, Laboratorio di Psicologia, Ospedale San Giuseppe, 28824, Piancavallo, Italy
- Psychology Department, Università Cattolica del Sacro Cuore, 20123, Milan, Italy
| | - Alessandro Mauro
- Istituto Auxologico Italiano, IRCCS, U.O. di Neurologia e Neuroriabilitazione, Ospedale San Giuseppe, 28824, Piancavallo, VCO, Italy
- "Rita Levi Montalcini", Department of Neurosciences, University of Turin, 10124, Turin, Italy
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Balter LJ, Raymond JE, Aldred S, Higgs S, Bosch JA. Age, BMI, and inflammation: Associations with emotion recognition. Physiol Behav 2021; 232:113324. [PMID: 33482194 DOI: 10.1016/j.physbeh.2021.113324] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 01/08/2021] [Accepted: 01/18/2021] [Indexed: 11/18/2022]
Abstract
Experimental studies show that inflammation impairs the ability to interpret the mental state of another person, denoted theory of mind (ToM). The current study attempted a conceptual replication in states associated with elevated low-grade inflammation, i.e., high body weight and advanced age. Ninety young (M = 26.3 years, SD = 4.1) or older (M = 70.7 years, SD = 4.0) participants with either a normal body mass index (BMI) (M = 22.4, SD = 2.2) or high BMI (M = 33.1, SD = 3.8) completed the Reading the Mind in the Eyes Test (RMET) to assess emotion recognition. Plasma interleukin-6 (IL-6) level was measured to index low-grade inflammation. As anticipated, elevated IL-6 levels were found with higher BMI, although not with increased age. IL-6 was associated with poorer task performance, independent of potential demographic and health confounders (e.g., sex, education, smoking status, alcohol intake, presence of medical conditions, and medication intake). Analyses also revealed an interaction whereby young individuals with a high BMI showed worse RMET performance compared to their normal BMI counterparts, whereas the opposite pattern was found in older individuals. The present observational study replicated experimental results showing that elevated low-grade inflammation is correlated with a lower ability to infer the mental states of others. These findings suggest that also naturalistic conditions of (protracted) low-grade inflammation may alter emotion recognition.
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Affiliation(s)
- Leonie Jt Balter
- Stress Research Institute, Stockholm University, Stockholm, SE-10691.
| | - Jane E Raymond
- School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK
| | - Sarah Aldred
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Suzanne Higgs
- School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK
| | - Jos A Bosch
- Psychology Department, Clinical Psychology, University of Amsterdam, Amsterdam, 1018 WT, NL
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Emotion perception and theory of mind in obesity: a systematic review on the impact of social cognitive deficits on dysfunctional eating behaviors. Surg Obes Relat Dis 2020; 17:618-629. [PMID: 33249085 DOI: 10.1016/j.soard.2020.10.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 02/05/2023]
Abstract
The aim of this paper was to summarize our current understanding of emotion perception and Theory of Mind (ToM) in obesity and how they relate to dysfunctional eating behaviors (DEB), frequently found in candidates for bariatric surgery. The literature was searched using the electronic databases PsychInfo, Medline, and Web of Science databases, and by additional hand searches through reference lists and specialist eating disorders journals. Relevant studies were included if they were written in English, included participants suffering from obesity and evaluation with tasks assessing social cognition, such as emotion recognition and perception, as well as ToM. Twelve studies analyzed for this systematic review suggest that deficits in such social cognitive domains may lie behind many emotional and social difficulties present in people with obesity, be they bariatric or not, which usually favor DEB. Our review suggests that people with obesity of all ages score significantly less than controls on instruments assessing emotion recognition and ToM, justifying a possible relationship between social cognitive impairments and dysfunctional eating behaviors, such as binges, emotional eating, and addition to food, frequently seen in people with obesity. These findings have important implications for our understanding of the social cognitive foundations of eating behavior in individuals with obesity. They can help not only the presurgical behavioral assessment, but also guide postoperative follow-up of this population.
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Willem C, Nandrino JL, Doba K, Roussel M, Triquet C, Verkindt H, Pattou F, Gandolphe MC. Interoceptive reliance as a major determinant of emotional eating in adult obesity. J Health Psychol 2020; 26:2118-2130. [DOI: 10.1177/1359105320903093] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This study examined the association between emotional eating, emotion dysregulations, and interoceptive sensibility in 116 patients with obesity by distinguishing an “awareness” and a “reliance” component of interoceptive sensibility. Deficits in interoceptive awareness were only associated with more emotional eating in obesity through less interoceptive reliance and more emotion dysregulations. The results suggest that good interoceptive awareness can increase the risk of emotional eating if not supported by good interoceptive reliance. Interoceptive reliance, like the ability to trust, positively consider, and positively use inner sensations, should be a privileged target of psychotherapeutic interventions in obesity.
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Affiliation(s)
- Clémence Willem
- University of Lille, CNRS, CHU Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, Lille, France
| | - Jean-Louis Nandrino
- University of Lille, CNRS, CHU Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, Lille, France
| | - Karyn Doba
- University of Lille, CNRS, CHU Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, Lille, France
| | - Méline Roussel
- CETRADIMN Diabetology Center, Roubaix Hospital, Roubaix, France
| | - Claire Triquet
- Departmental Hospital of Felleries-Liessies, Sorle le chateau, France
| | - Hélène Verkindt
- General and Endocrine Surgery, Faculty of Medicine, University of Lille, CHU Lille, Inserm, Lille, France
| | - François Pattou
- General and Endocrine Surgery, Faculty of Medicine, University of Lille, CHU Lille, Inserm, Lille, France
| | - Marie-Charlotte Gandolphe
- University of Lille, CNRS, CHU Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, Lille, France
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[The Emotional Competence of Mothers and the Clinical Quality of Mother-Child Relationship in a Preschool Psychiatric Population]. Prax Kinderpsychol Kinderpsychiatr 2020; 69:22-39. [PMID: 31918644 DOI: 10.13109/prkk.2020.69.1.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The Emotional Competence of Mothers and the Clinical Quality of Mother-Child Relationship in a Preschool Psychiatric Population The quality of mother-child interaction and relationship is an essential risk factor for the development of mental disorders at preschool age. We examine maternal emotional competence and maternal level of psychopathology as predictors for the quality of mother-child relationship. At the beginning of their treatment a clinical sample of mother-child-dyads at the Child Psychiatric Family Day Hospital in Münster was assessed concerning the emotional competence of mothers (EKF), the maternal psychopathology (SCL) and the mother-child relationship quality, the latter with three different instruments reflecting the mother's, the child's and the therapist's perspective (PIR-GAS, SKEI, M-PCR). The mothers showed decreased results in the EKF scales emotional regulation, recognition of emotions and in the EKF-overall-score and presented a higher level of maternal psychopathology compared to the normal population. There is a direct relation between emotional regulation and the M-PCR scales affective bond and functional-conflict. Besides the direct influence of the maternal psychopathology, the expected moderator effect of emotional expressiveness and the M-PCR scale functional-conflict, reported by mothers, was apparent. Certain aspects of the emotional competence of mothers and their psychopathology show an influence on mother-child relationship quality. The method and the perspective of assessment are crucial to the results.
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Willem C, Gandolphe MC, Roussel M, Verkindt H, Pattou F, Nandrino JL. Difficulties in emotion regulation and deficits in interoceptive awareness in moderate and severe obesity. Eat Weight Disord 2019; 24:633-644. [PMID: 31243741 DOI: 10.1007/s40519-019-00738-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 06/15/2019] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Difficulties in emotion regulation and deficits in interoceptive awareness may be responsible for overeating and weight gain in obesity by increasing the risks of problematic eating behaviors. This study aimed to: (1) examine emotion regulation difficulties and interoceptive deficits in obesity; (2) compare the emotion regulation and interoceptive abilities of moderately and severely obese patients. METHODS Participants were recruited through the university, diabetology centers and bariatric surgery departments. A total of 165 participants were categorized in three groups, matched by age and gender, according to their Body Mass Index (BMI). The severely obese (SO), moderately obese (MO) and normal weight (NW) groups were constituted of 55 participants each. Self-report questionnaires were used to assess emotion regulation difficulties (CERQ-DERS) and interoceptive awareness (MAIA-FFMQ). RESULTS Overall, obese participants reported more emotion regulation difficulties and less interoceptive awareness than NW participants did. They also reported a lack of planning strategies and emotional awareness, as well as less ability to observe, notice and trust body sensations. No differences in emotion regulation and interoceptive abilities were found between MO and SO participants. CONCLUSIONS Emotion regulation and interoceptive awareness should be targeted in the psychotherapeutic care of obese people, regardless of their BMI. LEVEL OF EVIDENCE Level III, case-control analytic study.
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Affiliation(s)
- Clémence Willem
- SCALab Laboratory, Department of Psychology, UMR 9193, CNRS, University of Lille, Villeneuve d'ascq, France.
| | - Marie-Charlotte Gandolphe
- SCALab Laboratory, Department of Psychology, UMR 9193, CNRS, University of Lille, Villeneuve d'ascq, France
| | - Méline Roussel
- Diabetology Center, CETRADIMN, Hospital of Roubaix, Roubaix, France
| | - Hélène Verkindt
- General and Endocrine Surgery, University Hospital of Lille, INSERM U1190, University of Lille, Lille, France
| | - François Pattou
- General and Endocrine Surgery, University Hospital of Lille, INSERM U1190, University of Lille, Lille, France
| | - Jean-Louis Nandrino
- SCALab Laboratory, Department of Psychology, UMR 9193, CNRS, University of Lille, Villeneuve d'ascq, France
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Fernandes J, Ferreira-Santos F, Miller K, Torres S. Emotional processing in obesity: a systematic review and exploratory meta-analysis. Obes Rev 2018; 19:111-120. [PMID: 29024361 DOI: 10.1111/obr.12607] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 08/10/2017] [Accepted: 08/10/2017] [Indexed: 12/24/2022]
Abstract
The role of emotional functioning in the development and maintenance of obesity has been investigated, but the literature is poorly integrated. A systematic review and meta-analysis was performed to explore emotional processing impairments in obesity. PubMed, Web of Knowledge and PsycINFO databases were searched in March 2016, yielding 31 studies comparing emotional processing competencies in individuals with obesity, with or without binge eating disorder (BED), and control groups. Meta-analyses demonstrated that individuals with obesity had higher scores of alexithymia (d = 0.53), difficulty in identifying feelings (d = 0.34) and externally oriented thinking style (d = 0.31), when compared with control groups. On other competencies, patients with obesity, especially those with comorbid BED, reported lower levels of emotional awareness and difficulty in using emotion regulation strategies, namely, reduced cognitive reappraisal and acceptance, and greater suppression of expression. No evidence of impaired ability to recognize emotions in others or verbally express emotions was found. A general emotion-processing deficit in obesity was not supported. Instead, an emotional avoidance style may occur modulating later responses of emotion regulation. Additional research is needed to extend the comprehension of these conclusions and the role of BED in emotional functioning in obesity.
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Affiliation(s)
- J Fernandes
- Centre for Psychology at University of Porto (CPUP), Porto, Portugal
| | - F Ferreira-Santos
- Laboratory of Neuropsychophysiology, University of Porto, Porto, Portugal.,Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
| | - K Miller
- School Psychology, School of Education, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S Torres
- Centre for Psychology at University of Porto (CPUP), Porto, Portugal.,Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
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