Emotion dysregulation and symptoms of anorexia nervosa: the unique roles of lack of emotional awareness and impulse control difficulties when upset

Psychometric Properties of the Iranian Version of the Invalidating Childhood Environment Scale

Objective: To understand the consequences of an invalidating environment, it is essential to have a measurement tool with appropriate statistical properties. Thus, the primary aim of this study was to render the ICES (Invalidating Childhood Environment Scale) into Persian and subsequently evaluate the psychometric attributes of this translated version. Method : Data were collected from 1221 nonclinical participants, including 1053 females and 168 males, who were students at medical universities in Tehran, Iran. Several questionnaires, such as the ICES, CTQ (Childhood Trauma Questionnaire), DTS (Distress Tolerance Scale), BIS-11 (Barratt Impulsiveness Scale), Self-Compassion Questionnaire, Dutch Eating Behavior Questionnaire, and EAT-26 (Eating AttitudesTest) were used in the study. The data sets were investigated through SPSS and R language to evaluate the ICES' reliability and construct validity. Additionally, Item Response Theory (IRT) was employed with the Graded Response Model (GRM) to measure the psychometric properties of each item in terms of difficulty and discrimination parameters. Results: Confirmatory factor analysis indicated that both single-factor and two-factor models fit well for both maternal and paternal versions of the ICES. The internal consistency, as assessed by Cronbach's alpha, was high and satisfactory for both maternal (0.87) and paternal (0.87) versions. Notably, the IRT analysis revealed that item 9 performed poorly in both maternal and paternal versions. Compared to the one-factor model, the two-factor model demonstrated a superior fit. Additionally, the test-retest reliability of the ICES over two months demonstrated good reliability for both maternal and paternal versions (0.98). Divergent and convergent validity analysis revealed a significant negative relationship between childhood invalidation environment and distress tolerance (r = 0.175, P < 0.01) as well as self-compassion (r = 0.142, P < 0.01), which were inversely related to the ICES. Furthermore, there was a considerably positive correlation between the invalidating environment experienced during childhood and impulsivity, as evidenced by r = 0.196 and P < 0.01. Conclusion: This study established the favorable psychometric properties of the Persian version of the ICES, indicating that this version is reliable and valid to assess the Invalidating Childhood Environment in the Iranian population. However, further investigations are warranted to reevaluate its validity and reliability.

"Good food equals good health": a focus group study of adolescent boys' perceptions of eating and weight

BACKGROUND

Disordered eating refers to unhealthy, sometimes excessive eating including so-called compensatory behaviours such as extreme dieting or voluntary vomiting. Between 24% and 30% of adolescent boys are suggested to engage in disordered eating, making it a significant public health issue. However, current instruments for assessing disordered eating among adolescents have been primarily developed and validated for girls and women, which may make for flawed assessment of boys. The aim of this study is to shed light on adolescent boys' perceptions of eating, weight, and food intake to better understand their perspectives in service of disordered eating research.

METHODS

This exploratory study was conducted from May to November 2022 using focus groups with a total of 39 adolescent boys (aged 12-19 years) who attended 7th to 12th grade in one of four schools in Southern Sweden. In addition, participants completed a form with questions on background demographics and eating habits. The transcripts of the focus group discussions were analysed using thematic analysis.

RESULTS

The quantitative data showed that around one third of the adolescent boys were overweight or obese. They ate at least one meal per day with the family and ate healthy food about five days per week and unhealthy food about three. Analysis of the qualitative data yielded six themes: The intertwined relationship between food and one's health, "Don't worry, food makes you happy," "To be hungry or not. That is the question," Boys DO care about appearances, Dieting and weight gain, and Disordered eating is a tricky matter.

CONCLUSION

Adolescent boys appeared to have a good understanding of food and healthy eating. They also experienced body positivity and seemed to have only minor issues regarding their weight. The primarily pathological perspective used to measure disordered eating among girls seems in need of revision to adhere to boys' thoughts and ideas regarding eating and weight.

Premature termination of inpatient eating disorder treatment: Does timing matter?

BACKGROUND

Premature termination of treatment is a serious problem in the treatment of eating disorders. Prior research attempting to differentiate patients who are able to complete treatment from those who terminate early has yielded mixed results. One proposed explanation for this is a failure to examine the time course of treatment termination. This study was designed to explore associations between baseline patient characteristics and timing of treatment termination.

METHODS

Participants were 124 eating disorder patients admitted voluntarily to the inpatient program at Toronto General Hospital between 2009 and 2015. At admission, all patients completed measures of eating disorder symptoms, eating disorder cognitions, depressive symptoms and emotional dysregulation. Body weight was measured weekly. Data analyses were completed using one-way ANOVAs and Chi Square tests.

RESULTS

Results showed significant associations between timing of treatment termination and eating disorder diagnosis, severity of eating disorder cognitions and severity of depressive symptoms. Post-hoc analyses revealed that patients who left treatment early had more severe depressive symptoms, eating disorder cognitions related to eating and difficulties engaging in goal directed behaviors when emotionally dysregulated.

CONCLUSIONS

Patients who terminated inpatient treatment early in their admissions differ from patients who terminated later and those who completed treatment. These differences have potential clinical implications for the clinical management of patients with severe eating disorders requiring inpatient admission. Trial registration This paper is not associated with a clinical trial.

Positive communication workshops: are they useful for treatment programmes for anorexia nervosa?

Background

Social isolation, loneliness and difficulties in relationships are often described as a core feature of eating disorders. Based on the experimental research, we have designed one-off workshops for patients in inpatients and day care services and evaluated its acceptability and effectiveness using feedback questionnaires.

Methods

This naturalistic project is an evaluation of multiple positive communication workshops. Forty-one participants completed workshop questionnaires, which were provided immediately at the beginning and end of the workshop, including feedback on these one-off groups. The workshops consisted of educational and experiential components. The questionnaire outcomes were evaluated by independent researchers.

Results

All participants were female adults with a mean age of 33 (12.2) and a diagnosis of Anorexia Nervosa (AN; either restrictive or binge-purge subtype). Post-workshop questionnaires showed large effect sizes in the improvement of understanding the importance and confidence in using positive communication strategies.

Discussion

Addressing social communication difficulties in eating disorder treatment programmes adds valuable dimensions to these symptom-based treatments in both inpatient settings and day services, and may provide broader benefits in overall social functioning in patients with AN.

Conclusion

Brief one-off workshops targeting social functioning for patients with eating disorders might be useful complementary input for treatment programmes.

Assessing severity in anorexia nervosa: Do the DSM-5 and an alternative severity rating based on overvaluation of weight and shape severity differ in psychological and biological correlates?

OBJECTIVE

This study evaluated the severity ratings for anorexia nervosa (AN) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and an alternative severity rating based on overvaluation of weight/shape, on a range of psychological and biological variables.

METHOD

A sample of 312 treatment-seeking patients with AN (mean age = 25.3, SD = 7.6; mean BMI = 16.8 kg/m² , SD = 2.4) were categorised using both DSM-5 severity levels (mild/moderate/severe/extreme) and weight/shape (low/high) overvaluation. The severity categories were compared on a range of psychological (e.g., eating psychopathology) and biological (e.g., sodium) variables.

RESULTS

Results showed that the overvaluation of weight/shape appeared better at indexing the level of severity in psychological variables among patients with AN compared to the DSM-5 severity rating with moderate to large effect sizes. Moreover, the DSM-5 mild and moderate severity groups experienced significantly higher eating and general psychopathology than the severe and extreme groups. Finally, neither the DSM-5 nor the weight/shape severity groups differed on any of the biological variables.

CONCLUSIONS

This study provided no support for the DSM-5 severity rating for AN, while initial support was found for the weight/shape overvaluation approach in indexing psychological but not biological correlates.

State of Mind Assessment in Relation to Adult Attachment and Text Analysis of Adult Attachment Interviews in a Sample of Patients with Anorexia Nervosa

BACKGROUND

Attachment theory represents one of the most important references for the study of the development of an individual throughout their life cycle and provides the clinician with a profound key for the purposes of understanding the suffering that underlies severe psychopathologies such as eating disorders. As such, we conducted a cross-sectional study with a mixed-methods analysis on a sample of 32 young women with anorexia nervosa (AN); this study was embedded in the utilized theoretical framework with the following aims: 1. to evaluate the state of mind (SoM) in relation to adult attachment, assuming a prevalence of the dismissing (DS) SoM and 2. to analyze the linguistic attachment profile emerging from the transcripts of the AAIs.

METHODS

Interviews were transcribed verbatim, coded, and analyzed using the linguistic inquiry and word count (LIWC) method.

RESULTS

The results were observed to be consistent with the referenced literature. The prevalence of a DS SoM (68.75%) is observed in the study sample, whereas the results of the lexical analysis of the stories deviate from expectations. Notably, the lexical results indicate the coexistence of the dismissing and entangled aspects at the representational level.

CONCLUSIONS

The study results suggest a high level of specificity in the emotional functioning of patients with AN, with a focusing on a pervasive control of emotions that is well illustrated by the avoidant/ambivalent (A/C) strategy described in Crittenden's dynamic-maturational model. These findings and considerations have important implications for clinical work and treatment, which we believe must be structured on the basis of starting from a reappraisal of emotional content.

Emotion regulation, perfectionism, and eating disorder symptoms in adolescents: the mediating role of cognitive eating patterns

Poor emotion regulation, along with elevated perfectionism, is recognised as a risk factor for the development of eating disorder (ED) symptoms. Therefore, the aim of our study was to examine the relationship between emotion regulation difficulties and perfectionism with ED symptoms, while controlling for emotional eating, uncontrolled eating, and cognitive restraint as mediators. In total, 482 adolescents (246 girls and 236 boys; M = 15.00, SD = 0.31) participated in this study. Based on the participants' body height and weight measured by the medical team during their regular preventive health examinations, the body mass index (BMI) was calculated. Participants also answered the Difficulties in Emotion Regulation Scale, Multidimensional Perfectionism Scale, Three-Factor Eating Questionnaire, and Eating Disorder Examination Questionnaire. According to the results obtained, adolescent girls in our sample reported more difficulties in emotion regulation, more uncontrolled and emotional eating, and more ED symptoms. A significant direct effect was found for difficulties in emotion regulation and ED symptoms but not for perfectionism. In addition, only emotional eating and cognitive restraint (not uncontrolled eating) mediated the relationship between difficulties in emotion regulation and perfectionism and ED symptoms. The results suggest that difficulties in emotion regulation may be more important than perfectionism in explaining ED symptoms in a sample of healthy adolescents. When adolescents experience problems in emotion regulation in combination with emotional or uncontrolled eating, they might be at a higher risk of experiencing concerns about weight and a variety of other ED symptoms, and this should be considered when planning preventive interventions for adolescents.

Momentary fluctuations in emotional intelligence and stress predict changes in disordered eating

Objective: Low emotional intelligence and symptoms of disordered eating are connected, however, whether daily fluctuations in emotional intelligence predict daily changes in disordered eating symptoms has not been examined, nor has stress been explored as a potential moderator of this relationship. Participants: Participants were undergraduate students (n = 100). Methods: Participants completed baseline questionnaires, then responded to random ecological momentary assessment prompts 3 times daily for 2 weeks. Results: Results indicated that when individuals had higher momentary emotional intelligence, they had lower disordered eating at the same time point (within subjects estimate = -0.30, p < .001) and following time point (within subjects estimate = -0.08, p = 0.03). Momentary stress moderated the relationship between baseline emotional intelligence and momentary disordered eating (b = -0.02, p < .01). Conclusions: Changes in emotional intelligence predict day-to-day changes in disordered eating, and stress moderates the connection between emotional intelligence and disordered eating.

A piece of a puzzle—Patient and psychologist experiences of the Affect School as additional treatment in a Swedish eating disorder unit

Background

Emotion dysregulation has been shown to be a transdiagnostic characteristic of eating disorders. The Affect School aims to enhance emotional awareness and the ability to perceive and express emotions. This study was conducted as part of an RCT where patients with various eating disorders were randomised to participation in the Affect School as a supplement to treatment.

Aim

To explore Affect School participants’ and leaders’ experiences of the Affect school at an Eating Disorder outpatient unit in Sweden.

Method

Nine patients with eating disorder diagnoses and three Affect School leaders at an eating disorder outpatient clinic in Sweden were interviewed for their experiences of the intervention. The interviews were analysed with Thematic Analysis.

Result

Eight themes were revealed at the analysis, five from the participants: “Worries about group participation”, “Not alone anymore and gaining new insights about oneself”, “Shared stories can also be painful”, “Relationships outside the Affect School as a foundation for affective work”, and “A change is coming”, and three from the leaders:”Affect awareness is important in eating disorders”, “Group meetings create opportunities and challenges”, and “The Affect School setup needs more customisation”.

Conclusion

The results suggested that the Affect School provided an acceptance for experiencing all sorts of affects. Both leaders and participants considered working with affects necessary, although participants reported no changes in their life situation or condition after the intervention but considered the intervention as part of a process with gradual results. Being part of a group and sharing experiences was experienced as positive by participants and leaders, but the model could be further developed to better adapt to patients with an eating disorder.

Interactions between emotion regulation and everyday flexibility in anorexia nervosa: Preliminary evidence of associations with clinical outcomes

The current study explored interactions between emotion regulation (ER) and cognitive-behavioral flexibility in everyday life in individuals with anorexia nervosa (AN). Participants were 97 female adults with current (57%) or past (43%) full or partial AN syndrome diagnosis. Participants completed the Difficulties with Emotion Regulation Scale, Emotion Regulation Questionnaire, Eating Disorder Flexibility Index, Eating Disorder Examination Questionnaire and Depression Anxiety Stress Scale short form. Lower flexibility was a strong independent predictor of more severe ED-related cognitions and higher frequency of compensatory behaviors beyond individual differences in emotion regulation and mood. ER measures did not predict clinical characteristics. However, two interactions between flexibility and ER measures were observed which suggested there was a stronger association between greater flexibility and higher BMI for individuals with either higher levels of cognitive reappraisal use, or higher levels of global ER difficulties. Interactions between flexibility and emotion regulation provide evidence that co-occurring difficulties may impact clinical outcomes in AN.

Modified Dual Pathway Model for Binge Eating: The Role of Emotion Dysregulation

We tested a modification of the dual pathway model using two sequential mediators between body dissatisfaction and binge eating: restricted eating and difficulties in emotion regulation replacing negative affect. A total of 435 college students completed an online survey. Results from path analyses indicated that the relationship between body dissatisfaction and binge eating was not mediated by restricted eating for neither women nor men. However, this relationship was mediated first by restricted eating and then by difficulties in emotion regulation for women only. Moreover, this relationship was mediated by difficulties in emotion regulation for both women and men. A post hoc analysis indicated that the above mediation results were still significant after adding negative affect into the model. No mediations through negative affect were significant. Clinical implications include the conceptualization and intervention of eating concerns within an emotion dysregulation framework.

Treating PTSD with Imagery Rescripting in underweight eating disorder patients: a multiple baseline case series study

BACKGROUND

Eating disorder patients with posttraumatic stress disorder have worse treatment results regarding their eating disorder than patients without posttraumatic stress disorder. Many eating disorder patients with co-morbid posttraumatic stress disorder symptoms are not treated for posttraumatic stress disorder symptoms during an underweight state. We propose that treatment of posttraumatic stress disorder is possible for underweight patients and that their trauma symptoms decrease with the use of Imagery Rescripting. We also investigated whether treatment of trauma influences eating disorder pathology in general and the process of weight gain specifically.

METHOD

Ten patients in clinical treatment (BMI 14-16.5) participated. A multiple baseline design was used, with baseline varying from 6 to 10 weeks, a 6-week treatment phase, a 3-week follow-up period and a 3-month follow-up measurement. Data were analysed with mixed regression.

RESULTS

Evidence was found that Imagery Rescripting had strong positive effects on posttraumatic stress disorder symptoms without interfering with eating disorder treatment. Positive effects were also found on a range of secondary emotional and cognitive measures.

CONCLUSION

Imagery Rescripting of traumatic memories is a possible and safe intervention for underweight eating disorder patients. It also had positive clinical effects. Trial registration Netherlands trial register (NTR) Trial NL5906 (NTR6094). Date of registration 09/23/2016. https://www.trialregister.nl/trial/5906 .

The Role of Emotion Regulation in Eating Disorders: A Network Meta-Analysis Approach

Background

Previous theoretical models and reviews have documented a strong connection between emotion dysregulation eating disorder (ED) psychopathology among the general and clinical populations. The aim of this review was to build on this previous work by conducting a network meta-analysis to explore associations between adaptive and maladaptive emotion regulation strategies and ED psychopathology trans-diagnostically across the ED spectrum to identify areas of emotion dysregulation that have the strongest association with symptomatology.

Methodology

A total of 104 studies were included in the meta-analysis and correlation coefficient representing the associations between specific emotion regulation strategies and ED symptomatology were extracted. We ran a Bayesian random effects network meta-analysis and the initial network was well-connected with each emotion regulation strategy being linked to at least one other strategy. We also conducted a network meta-regression to explore whether between-study differences in body mass index (BMI), age, and whether the sample consisted of solely female participants explained any possible network inconsistency.

Results

The network meta-analysis revealed that ruminations and non-acceptance of emotions were most closely associated with ED psychopathology. There was no significant network inconsistency but two comparisons approached significance and thus meta-regressions were conducted. The meta-regressions revealed a significant effect of BMI such that the associations between different emotion regulation strategies and ED symptomatology were weaker among those with low BMI.

Discussion

The present findings build on previous work and highlight the role of rumination and difficulties with accepting emotions as key emotion regulation difficulties in EDs. Additionally, the finding that the associations were weaker among ED patients with low BMI may point toward a complex relationship between ED behaviors and emotion regulation. Taken together, our findings call for interventions that target emotion regulation, specifically rumination and difficulties accepting emotions, in the treatment of EDs.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021249996, PROSPERO, identifier: CRD42021249996.

Meta-Analysis of the Associations Among Constructs of Intrapersonal Emotion Knowledge

To better define the boundaries of conceptually overlapping constructs of intrapersonal emotion knowledge (EK), we examined meta-analytic correlations among five intrapersonal EK-related constructs (affect labelling, alexithymia, emotional awareness, emotional clarity, emotion differentiation) and attention to emotion. Affect labelling, alexithymia, and emotional clarity were strongly associated, and they were moderately associated with attention to emotion. Alexithymia and emotional awareness were weakly associated, and emotion differentiation was unrelated with emotional clarity. Sample characteristics and measures moderated some of the associations. Publication bias was not found, except for the alexithymia-emotional awareness association. This study helped to clarify the extent to which similarly defined constructs overlap or are distinct, which can inform our decision to adequately label important constructs and employ corresponding measures.

Mediating Mechanisms of Perfectionism: Clinical Comorbidity of OCD and ED

Obsessive-compulsive disorder (OCD) and eating disorders (ED) share common causal factors and often represent similar entities. Studies on obsessive-compulsive disorders and eating disorders reveal a significant correlation between maladaptive perfectionism. The objective of this study is to evaluate the predictive variables of perfectionism in patients diagnosed with Anorexia Nervosa (AN), Bulimia Nervosa (BN) and OCD using a structural equation model (SEM). The sample consisted of 187 participants (60.9% women, 39.1% men) with a mean age of 26.68 (SD = 10.97). The findings reveal that the model is the same in all the disorders evaluated, achieving an adequate fit: χ2 = 7.95 (p = 0.000), RMSEA = 0.087 (95% confidence interval: 0.00 to 0.02), CFI = 0.991, TLI = 0.951 and with an overall predictive capacity of around 30% (CD = 0.318). It is recommended that future studies address the subtypes of disorders evaluated using longitudinal designs.

Factor structure and clinical correlates of the original and 16-item version of the Difficulties In Emotion Regulation Scale in adolescent girls with eating disorders

OBJECTIVES

The Difficulties in Emotion Regulation Scale (DERS) is increasingly used in adolescents. This study is the first to examine the factor structure, measurement, and structural invariance across age, reliability, and validity of the original 36-item and 16-item version of the DERS in adolescents with eating disorders.

METHODS

Several models were examined using confirmatory factor analysis. Measurement and structural invariance were studied across age groups, and Omega, Omega Hierarchical, and criterion validity were examined.

RESULTS

A bifactor model, with five subscales, showed acceptable fit in both DERS versions. Measurement and structural invariance held across age. The general factor had high reliability and accounted for a large proportion of variance in eating pathology and emotional symptoms.

CONCLUSION

The Awareness subscale had a negative effect on fit in DERS, but both DERS versions were reliable and valid measures in both younger and older adolescents with eating disorders when using only five subscales.

The ethereal bodies of pro-Ana blogs: emotional communities and spaces of sociability on the web

The study presented in this paper aimed at understanding how anorexic young women use virtual environments as spaces of sociability in order to construct a narrative about anorexia, anchor their experiences through emotional mutuality and validate discourses. To do so, an analysis of the content found in the commenting and posting sections of pro-anorexia blogs was carried out. Three thematic categories were identified: body, personal identity and sociability on the web. It was observed that blogs are virtual spaces of sociability and construction of identity groups. The representations and the experiences lived by the corporal materiality feed cyberspace and are the starting point for understanding a phenomenon particular to the contemporaneity, that is the virtual exchanges. In blogs, one can find body narratives that seek to give coherence to an individual and to his or her existence as well as narratives that aim at anchoring and legitimizing personal experiences and validating pro-anorexia attitudes. Social ties are strengthened within the group, which becomes an emotional community. The meanings of the spreading discourses allow us to infer that in these groups, the materiality of anorexic bodies emancipates itself from the social stigmas of a disease.

Inflammatory dysregulation in women with an eating disorder: Relationships with altered emotional reactivity

BACKGROUND

Some studies suggest that inflammatory signaling dysregulation may contribute to eating disorder (ED) pathophysiology. However, little is known about the influence of inflammatory response on altered processes seen among patients with ED, such as emotional processing and reactivity.

OBJECTIVES

The objectives were: (a) to investigate the systemic inflammatory response in ED women; and (b) to analyze the role of inflammatory markers in emotional reactivity.

METHOD

Concentrations of several intercellular and intracellular inflammatory mediators (cytokines, prostaglandin by-products and enzymes, TBARS, and MAPK proteins) were quantified in plasma and PBMCs from 68 women with an ED (m = 22.01 years, SD = 9.15) and 35 healthy controls (m = 18.54 years, SD = 4.21). Moreover, emotional reactivity to affective pictures (those without either food or thinness content) was studied using the adult (>18 years old) sample (n = 41).

RESULTS

Between-group differences were revealed for most markers (TNF-α, PGE₂ , COX2, and ratio of activated MAPK proteins), pointing to increased inflammatory response in patients (p < .01). Women with ED showed heightened emotional reactivity, regardless of picture valence. Principal components derived from inflammatory markers showed an explanatory loading on patient's emotional reaction, in terms of valence and arousal.

CONCLUSION

This study corroborates the altered systemic inflammatory response in patients with ED. The inflammatory dysregulation may contribute to ED phenotype, as seen by its relationship with heightened emotional reactivity, even though the inflammatory markers were not evaluated throughout the emotional reactivity protocol.

Emotion dysregulation moderates the relationship between alcohol use and eating pathology among heavy-drinking college men

OBJECTIVES

There is limited research examining the relationship between alcohol use and eating pathology in men or factors that may moderate this association. The current study investigated the relationship between alcohol use and eating pathology, and examined emotion dysregulation as a moderator of this association, among heavy-drinking college men.

METHOD

Men mandated to receive an alcohol intervention (N = 88; average age = 19 years) completed questionnaires related to alcohol use, emotion dysregulation, and eating pathology.

RESULTS

Results demonstrated positive relationships between alcohol use and some eating pathology, and a significant interaction between alcohol use and emotion dysregulation. However, results were contrary to hypotheses, such that there was a positive relationship between alcohol use and eating pathology at low levels of emotion dysregulation.

CONCLUSION

Future studies should continue to examine the overall presentation of eating pathology in men and investigate factors that may impact the relationship between alcohol use and eating pathology.

Just like fireworks in my brain - a Swedish interview study on experiences of emotions in female patients with eating disorders

BACKGROUND

Patients with eating disorders have reported poorer emotional awareness, more emotional suppression, less use of adaptive emotional regulation strategies, and more use of maladaptive emotional regulation strategies compared to people in healthy control groups.

AIM

To explore experiences of emotions by a transdiagnostic sample of patients with eating disorders.

METHOD

Nine patients with different eating disorder diagnoses at an eating disorder outpatient clinic in Sweden were interviewed for their thoughts on emotions. The interviews were analyzed with Thematic Analysis.

RESULT

Four themes were constructed: "Not knowing what one feels", "Switch off, run away, or hide behind a mask", "Emotions in a lifelong perspective", and "Using eating behaviours to regulate emotions". The patients described uncertainty regarding whether they experienced emotions correctly. They described how they tried to avoid difficult emotions through suppressive strategies and eating disorder behaviour. All described strategies were inefficient and all emotions were experienced as problematic, even joy. Since joy was used as a mask, the real experience of happiness was lost and mourned.

CONCLUSION

All kinds of emotions were considered problematic to experience, but shame, fear, and sadness were considered worst. It is difficult to know if the emotional difficulties preceded an eating disorder, however such difficulties may have increased as a result of the eating disorder.

Emotional eating during COVID-19 in the United Kingdom: Exploring the roles of alexithymia and emotion dysregulation

Emotional eating, generally defined as (over)-eating in response to negative emotions, has been associated with poor physical and psychological outcomes. During a time of heightened negative affect, it is important to understand the impact of the COVID-19 pandemic and associated lockdown measures on eating behaviours, and further elucidate the ways in which emotional eating is related to emotion dysregulation and impaired abilities to identify emotions (i.e. alexithymia). The aims of this study were to explore perceived changes in eating behaviours in relation to self-reported negative affect during the pandemic and to examine direct and indirect effects of alexithymia on emotional eating. An online questionnaire measured these constructs in the general population of the United Kingdom (n = 136). Findings demonstrated that those who reported changes to their eating behaviours during the pandemic also reported greater levels of depression during the same time frame. Mediation analyses revealed that difficulties identifying and describing feelings both predicted emotional eating indirectly via emotion dysregulation. Findings contribute to the understanding of the mechanisms underpinning the relationship between alexithymia and emotional eating and describe changes to eating behaviours during COVID-19. We discuss how these findings should be applied, and recommendations for future research.

•

One quarter of participants reported eating more than usual during COVID-19.

•

One third of participants reported eating less healthfully than usual.

•

Difficulty identifying feelings influences emotional eating via emotion dysregulation.

•

Difficulty describing feelings influences emotional eating via emotion dysregulation.

Are emotions better left unknown? Sex-specific effects of emotional awareness and daily hassles on internalizing symptoms among college students

Amid growing concern about internalizing disorders on college campuses, few researchers have examined the ways emotional awareness deficits may contribute to risk. We examined the effect of the interaction between daily hassles, emotional awareness, and sex on depression and anxiety symptoms. Participants: Data were collected from 196 college students (M_age = 19.6, SD_age = 2.26) at a large university in June 2016. Methods: Participants completed online surveys to assess daily hassles, emotional awareness, and internalizing symptoms. Results: Daily hassles were significantly associated with internalizing symptoms, p < .01. For women, daily hassles were significantly associated with internalizing symptoms at all levels of emotional awareness, ps < .05. For men, daily hassles were significantly associated with internalizing symptoms only at high levels of emotional awareness, ps < .05. Conclusion: Future researchers could examine the context in which emotional awareness may be most beneficial to college students.

Mental Capacity, Decision-Making and Emotion Dysregulation in Severe Enduring Anorexia Nervosa

Severe and Enduring Anorexia Nervosa (SE-AN) is a chronic eating disorder characterized by long-term starvation and its physical and psychological sequelae, and severe loss of quality of life. Interactions between neurobiological changes caused by starvation, vulnerability (personality) traits, and eating behaviors play a role. Several other factors, such as increased fear and decreased social cognition, have also been found in relation to SE-AN. With this in mind, we aim to add to the understanding of SE-AN by introducing the concept of mental capacity (MC), which refers to the ability to understand and process information-both on a cognitive and an emotional level-and then make a well-informed choice. MC may be an important construct within the context of SE-AN. Furthermore, we will argue how impaired decision-making processes may underlie, fuel, or contribute to limited MC in SE-AN. We will speculate on the importance of dysfunctional emotion processing and anxiety-related processes (e.g., a high intolerance of uncertainty) and their potential interaction with decision-making. Lastly, we will propose how these aspects, which to our knowledge have previously received little attention, may advise research and treatment or help in dealing with the "want but cannot" situation of life-threatening AN.

Emotional Dysregulation in Children and Adolescents With Psychiatric Disorders. A Narrative Review

Background: Emotional dysregulation (ED) is a transdiagnostic construct defined as the inability to regulate the intensity and quality of emotions (such as, fear, anger, sadness), in order to generate an appropriate emotional response, to handle excitability, mood instability, and emotional overreactivity, and to come down to an emotional baseline. Because ED has not been defined as a clinical entity, and because ED plays a major role in child and adolescent psychopathology, we decided to summarize current knowledge on this topic based on a narrative review of the current literature. Methods: This narrative review is based on a literature search of peer-reviewed journals. We searched the databases ERIC, PsycARTICLES, PsycINFO and PSYNDEX on June 2, 2020 for peer reviewed articles published between 2000 and 2020 in English language for the preschool, school, and adolescent age (2-17 years) using the following search terms: "emotional dysregulation" OR "affect dysregulation," retrieving 943 articles. Results: The results of the literature search are presented in the following sections: the relationship between ED and psychiatric disorders (ADHD, Mood Disorders, Psychological Trauma, Posttraumatic Stress Disorder, Non-suicidal Self-Injury, Eating Disorders, Oppositional Defiant Disorder, Conduct Disorder, Disruptive Disruptive Mood Dysregulation Disorder, Personality Disorders, Substance Use Disorder, Developmental Disorders, Autism Spectrum Disorder, Psychosis and Schizophrenia, and Gaming Disorder), prevention, and treatment of ED. Conclusion: Basic conditions of ED are genetic disposition, the experience of trauma, especially sexual or physical abuse, emotional neglect in childhood or adolescence, and personal stress. ED is a complex construct and a comprehensive concept, aggravating a number of various mental disorders. Differential treatment is mandatory for individual and social functioning.

Why would I want to be more self-compassionate? A qualitative study of the pros and cons to cultivating self-compassion in individuals with anorexia nervosa

OBJECTIVE

Although self-compassion facilitates eating disorder symptom remission, individuals with eating disorders are fearful of developing it and higher fears of self-compassion are associated with poorer treatment outcomes. In-depth exploration of individuals' pros and cons of behaviour change is generally helpful at resolving ambivalence; however, no research has examined the pros and cons individuals with eating disorders perceive to be associated with developing self-compassion, limiting our understanding of their personal experiences when confronted with self-compassion. Given the research suggesting higher resistance to self-compassion development in individuals with anorexia nervosa (AN), the present study used qualitative methods to gain a deeper understanding of their perceived pros and cons to self-compassion.

METHODS

Thirty-seven women with typical (64%) and atypical (36%) AN signed up for a study on self-help strategies for daily distress. Upon learning that the intervention would entail cultivating self-compassion, they identified their perceived pros and cons of developing self-compassion by typing them out.

RESULTS

Thematic analysis was used to extract themes. Three superordinate cons and four superordinate pros of self-compassion emerged. Perceived cons were as follows: self-compassion leading to personal shortcomings; apprehension and doubt about the efficacy of self-compassion; and emotional challenges associated with developing self-compassion. Perceived pros were as follows: improved health; personal development (e.g., growth, coping); improved outlook; and enhanced social relationships.

CONCLUSIONS

These findings reveal the various advantages and disadvantages that women with AN perceive to be associated with developing self-compassion. Results may help clinicians work more sensitively and effectively when trying to cultivate self-compassion in patients who have AN.

PRACTITIONER POINTS

This research suggests that patients with anorexia nervosa (AN) perceive various disadvantages to cultivating self-compassion, but also certain advantages. By familiarizing themselves with the pros and cons to self-compassion identified by individuals with AN, clinicians may be able to more effectively listen to and communicate with their patients about ambivalence about self-compassion development. Clinicians may want to listen for and explore concerns in their AN patients that self-compassion will lead to personal shortcomings, fail to be beneficial, and be emotionally challenging. Clinicians may want to listen for and help patients elaborate upon their beliefs about how self-compassion might benefit their outlook, health, personal development, and relationships.

Nonsuicidal self-injury, difficulties in emotion regulation, negative urgency, and childhood invalidation: A study with outpatients with eating disorders

OBJECTIVES

Among outpatients with eating disorders (ED), we compared participants without nonsuicidal self-injury (non-NSSI group), with NSSI over a year ago (past NSSI group) and with NSSI in the previous year (current NSSI group) regarding different variables, and examined whether difficulties in emotion regulation and negative urgency moderated the relationship between maternal/paternal invalidation and NSSI.

METHOD

The sample included 171 outpatients (94.2% female; M_age  = 28.78, SD_age  = 11.19).

RESULTS

Fifty-four participants (31.6%) had NSSI in the previous year. This group showed higher eating pathology, difficulties in emotion regulation, negative urgency, and maternal/paternal invalidation than the non-NSSI group. Analyses revealed an adequate fit to the data for the model that included moderating effects of emotional awareness and negative urgency in the relationship between maternal/paternal invalidation and increased likelihood of NSSI in the previous year.

CONCLUSIONS

Interventions for NSSI and ED should include emotion regulation, impulse control, and validation strategies.

Emotion Regulation Difficulties During and After Partial Hospitalization Treatment Across Eating Disorders

Emotion regulation deficits are associated with eating disorder (ED) symptoms, regardless of eating disorder diagnosis. Thus, recent treatment approaches for EDs, such as dialectical behavior therapy (DBT), have focused on teaching patients skills to better regulate emotions. The present study examined changes in emotion regulation among adult patients with EDs during DBT-oriented partial hospital treatment, and at follow-up (M[SD] = 309.58[144.59] days from discharge). Exploratory analyses examined associations between changes in emotion regulation and ED symptoms. Patients with anorexia nervosa, restricting (AN-R, n = 77), and binge-eating/purging subtype (AN-BP, n = 46), or bulimia nervosa (BN, n = 118) completed the Difficulties in Emotion Regulation Scale (DERS) at admission, discharge, and follow-up. Patients with BN demonstrated significant improvements across all facets of emotion dysregulation from admission to discharge and maintained improvements at follow-up. Although patients with AN-BP demonstrated statistically significant improvements on overall emotion regulation, impulsivity, and acceptance, awareness, and clarity of emotions, from admission to discharge, these improvements were not significant at follow-up. Patients with AN-R demonstrated statistically significant improvements on overall emotion dysregulation from treatment admission to discharge. Changes in emotion regulation were moderately correlated with changes in ED symptoms over time. Results support different trajectories of emotion regulation symptom change in DBT-oriented partial hospital treatment across ED diagnoses, with patients with BN demonstrating the most consistent significant improvements.

Validation of the greek version of the body image-acceptance and action questionnaire

The present study aimed to examine the psychometric properties and factorial structure of the Greek version of the Body Image-Acceptance and Action Questionnaire (BI-AAQ). The BI-AAQ assesses cognitive flexibility and acceptance relative to body image. Two samples: an all female middle and high school sample (N = 85; Age M = 17.97, SD = 2.74) and a college student sample (N = 240; Age M = 21.50; SD = 2.98) in Cyprus completed a set of self-reported eating-related questionnaires. Reliability analysis showed that the Greek BI-AAQ has high internal consistency and good item-total correlations. Principal Component Analysis (Sample 1) and Confirmatory Factor Analysis (Sample 2) supported a one-factor solution, as in the case of the original BI-AAQ. Hierarchical multiple regression predicting eating disorder behaviors (as assessed by the EDE-Q) from Weight Concerns (WCS) and BI-AAQ scores after controlling for BMI, produced a significant model, which accounted for 67% of variance. The BI-AAQ remained a significant predictor of eating disorder behaviors after controlling for BMI and weight concerns scores. The Greek version of the BI-AAQ questionnaire is thus a robust and reliable instrument. It adds to previous knowledge and research on the role of psychological flexibility and acceptance of body image in eating disorder behaviours and psychological difficulties.

Understanding and Taking Stock of Positive Emotion Disturbance

The prevailing view on positive emotions is that they correlate with and confer psychological health benefits for the individual, including improved social, physical and cognitive functioning. Yet an emerging wave of scientific work suggests that positive emotions are also related to a range of suboptimal psychological health outcomes, especially when the intensity, duration, or context do not optimize the individual's goals or meet current environmental demands. This paper provides an overview of the 'other side' of positive emotion, by describing and reviewing evidence supporting the emerging field of Positive Emotion Disturbance (PED). We review relevant emotion processes and key themes of PED and apply this framework to example emotional disorders, and discuss implications for psychological change and future research agendas.

Lack of Emotional Awareness is Associated with Thwarted Belongingness and Acquired Capability for Suicide in a Military Psychiatric Inpatient Sample

OBJECTIVE

To examine potential links between facets of impulsivity and emotion dysregulation to components of the Interpersonal-Psychological Theory of Suicide (thwarted belongingness, perceived burdensomeness, and acquired capability) among U.S. military personnel.

METHOD

The current study performed secondary data analysis from a randomized control trial testing the efficacy of a cognitive therapy for 134 service members (71.64% male, 68.66% Caucasian; mean age: 30.14) admitted to a psychiatric inpatient unit for a suicide-related crisis. We utilized the Difficulties in Emotion Regulation Scale, the Barratt Impulsivity Scale, the Acquired Capability for Suicide Scale, and the Interpersonal Needs Questionnaire.

RESULTS

All emotion dysregulation dimensions and one impulsivity facet (attentional) were positively correlated with perceived burdensomeness and thwarted belongingness. Lack of emotional awareness was positively associated with acquired capability. After controlling for depression, hopelessness, and demographic covariates, lack of emotional awareness was significantly associated with both thwarted belongingness and acquired capability, but not perceived burdensomeness, and impulsivity dimensions did not link to any variable of interest.

CONCLUSIONS

Findings imply that individuals with reduced emotional awareness may have difficulty cultivating interpersonal bonds and be more vulnerable to elevated acquired capability. Lack of emotional awareness may be a potential contributor to both suicidal desire and capability.

Relationships Between Self-Esteem, Interoceptive Awareness, Impulse Regulation, and Binge Eating. Path Analysis in Bariatric Surgery Candidates

OBJECTIVE

The current study investigates the hypothesis that the effect of low self-esteem on binge eating in bariatric candidates was mediated by both difficulties in the perception of bodily signals and impulse regulation after accounting for gender, age, and body mass index.

METHOD

59 preoperative patients (both male and female) were screened by means of self-report measures of self-esteem, interoceptive deficits, impulse dysregulation, and severity of binge eating. Results: Results indicated that all direct effects were significant, except for the self-esteem on impulse dysregulation and the interoceptive deficits on binge eating. Self-esteem had a significant indirect effect on impulse dysregulation mediated by interoceptive deficits. Impulse dysregulation, in turn, mediates the effect of interoceptive deficits on binge eating. Moreover, the path starting from self-esteem, going first to interoceptive deficits, then going via impulse regulation difficulties to binge eating was significant.

RESULTS AND CONCLUSIONS

A potential underlying mechanism through which self-esteem is linked to binge eating has been suggested. Obese individuals who perceived themselves as inadequate may carry a stronger burden by the confusion and mistrust related to bodily functioning and, consequently, may act more impulsively, through binge eating.

An investigation of the affective experience of females at high risk for eating disorders in general and pathology-specific contexts

OBJECTIVE

Difficulties with emotional experiences have long been implicated in the development or maintenance of eating disorders (EDs). However, the vast majority of this work is theoretical or self-report, with few studies examining the somatic-affective experience of individuals with EDs under experimental conditions. The aim of the current study was to: i) examine physiological reactivity and subjective report of emotional experiences in response to ED pathology-specific and general affective film clips, and ii) examine the impact of film on body size estimation in females at risk for EDs.

METHOD

Females aged 14-24 years old of either high (N = 42) or low (N = 43) risk for EDs viewed pathology-specific and general affective film clips and provided their affective ratings and body-size estimations post film clips. Heart Rate and Skin Conductance Levels were recorded during each clip.

RESULTS

High risk participants evidenced greater physiological arousal across conditions and in both general and pathology-specific affective contexts. Negative affect induced via the ED-pathology specific film clip had a greater impact on the high risk group's body-size estimations.

CONCLUSIONS

Individuals at risk for EDs seem to experience greater physiological arousal and this may influence the experience of their bodies, or direct attention to their body as a way to attenuate unwanted emotion or due to somatic feedback.

Emotion regulation across eating pathology: A meta-analysis

The goal of this meta-analysis was to examine the associations between specific emotion regulation abilities (emotional awareness, emotional clarity) and strategies (acceptance of emotions, reappraisal, problem-solving, rumination, avoidance of emotions, and suppression), and eating pathology. A total of 96 studies and 239 effect sizes were included in the analysis. Relations between global and specific emotion regulation abilities and strategies and eating disorders and eating-related symptoms were examined. Results indicated medium-to-large effect sizes for the associations between adaptive emotion regulation and eating disorder and eating-related symptoms, and medium-to-large effect sizes for the associations between maladaptive emotion regulation and eating disorders and eating-related symptoms. In terms of specific emotion regulation strategies, large magnitude of associations were identified for the relations between lack of emotional awareness, clarity, acceptance, reappraisal, problem-solving, and eating disorders. Rumination, avoidance of emotions, and suppression also showed large associations with anorexia nervosa and bulimia nervosa. Overall, emotion regulation did not differ across eating disorders, a finding supporting the transdiagnostic character of emotion regulation problems in eating pathology. These findings have important theoretical and practical implications for prevention and intervention programs.

Neural Processing of Disorder-Related Stimuli in Patients with Anorexia Nervosa: A Narrative Review of Brain Imaging Studies

Abnormalities and alterations in brain function are commonly associated with the etiology and maintenance of anorexia nervosa (AN). Different symptom categories of AN have been correlated with distinct neurobiological patterns in previous studies. The aim of this literature review is to provide a narrative overview of the investigations into neural correlates of disorder-specific stimuli in patients with AN. Although findings vary across studies, a summary of neuroimaging results according to stimulus category allows us to account for methodological differences in experimental paradigms. Based on the available evidence, the following conclusions can be made: (a) the neural processing of visual food cues is characterized by increased top-down control, which enables restrictive eating, (b) increased emotional and reward processing during gustatory stimulation triggers disorder-specific thought patterns, (c) hunger ceases to motivate food foraging but instead reinforces disorder-related behaviors, (d) body image processing is related to increased emotional and hedonic reactions, (e) emotional stimuli provoke increased saliency associated with decreased top-down control and (f) neural hypersensitivity during interoceptive processing reinforces avoidance behavior. Taken together, studies that investigated symptom-specific neural processing have contributed to a better understanding of the underlying mechanisms of AN.

Binge Eating Disorder and Related Features in Bariatric Surgery Candidates

OBJECTIVE

The present study sought to: 1) assess the prevalence of Binge Eating Disorder (BED) and abnormal eating behaviors in bariatric surgery candidates; 2) compare patients with and without BED as regards to eating disturbances, psychological characteristics, and health status; 3) individuate which factors were significantly related to binge eating severity.

METHODS

Sixty-three preoperative patients (17 males and 46 females) were screened by means of an ad hoc socio-demographic schedule, the Rosenberg Self-Esteem Scale, the Eating Disorders Inventory-3, the Binge Eating Scale, and the General Health Questionnaire-28. BED diagnosis was performed through a clinical interview.

RESULTS

BED and disordered eating, such as episodes of binge eating, sense of lack of control over eating and inappropriate compensatory behaviors, appear common in patients undergoing weight loss surgery. Significant differences between BED and non-BED subjects in relation to eating disturbances and psychological characteristics emerged. Multiple regression analysis revealed that only emotional dys-regulation significantly predicted binge eating vulnerability.

CONCLUSION

The recognition of factors involved in the development and maintenance of disordered eating in bariatric patients may support the choice of particular therapeutic strategies and improve bariatric surgery outcome. Further studies on this issue would be useful.

Inducing negative affect using film clips with general and eating disorder-related content

The aim of the present study was to select appropriate film clips with a general vs. eating disorder (ED)-related content to induce negative affect. More specifically, the study examined the subjective emotional experience (valence, arousal, anxiety, induction of somatic symptoms, and ability to control reactions during film clips) of Greek-Cypriot university students (N = 79) in response to three types of film clips: general unpleasant, ED-specific unpleasant, and emotionally neutral. In addition, the study aimed to compare the emotional reactions to the aforementioned clips between two groups of participants differing on their risk for ED (high vs. low). Preliminary results indicate the clips with general content ("The Champ") and with ED-specific content ("Binge eating") that are most effective in inducing negative affect and differentiating between risk groups. These clips provide an effective method for emotion induction that can be used for assessing the emotional experience of individuals with ED symptoms, since their emotional experience is significantly implicated in the development and maintenance of their symptoms (Merwin, Clin Psychol Sci Pract 18(3):208-214, 2011).Level of evidence No level of evidence, Experimental Study.

Targeting habits in anorexia nervosa: a proof-of-concept randomized trial

BACKGROUND

Habits are behavioral routines that are automatic and frequent, relatively independent of any desired outcome, and have potent antecedent cues. Among individuals with anorexia nervosa (AN), behaviors that promote the starved state appear habitual, and this is the foundation of a recent neurobiological model of AN. In this proof-of-concept study, we tested the habit model of AN by examining the impact of an intervention focused on antecedent cues for eating disorder routines.

METHODS

The primary intervention target was habit strength; we also measured clinical impact via eating disorder psychopathology and actual eating. Twenty-two hospitalized patients with AN were randomly assigned to 12 sessions of either Supportive Psychotherapy or a behavioral intervention aimed at cues for maladaptive behavioral routines, Regulating Emotions and Changing Habits (REaCH).

RESULTS

Covarying for baseline, REaCH was associated with a significantly lower Self-Report Habit Index (SRHI) score and significantly lower Eating Disorder Examination-Questionnaire (EDE-Q) global score at the end-of-treatment. The end-of-treatment effect size for SRHI was d = 1.28, for EDE-Q was d = 0.81, and for caloric intake was d = 1.16.

CONCLUSIONS

REaCH changed habit strength of maladaptive routines more than an active control therapy, and targeting habit strength yielded improvement in clinically meaningful measures. These findings support a habit-based model of AN, and suggest habit strength as a mechanism-based target for intervention.

Factor Structure and Incremental Validity of the Original and Modified Versions of the Difficulties in Emotion Regulation Scale

The Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004) is a self-report measure that assesses six facets of emotion dysregulation. A modified version of the DERS (M-DERS) was developed to address psychometric limitations of the original measure (Bardeen, Fergus, Hannan, & Orcutt, 2016). Although the factor structure of the M-DERS (i.e., two models: correlated trait and second-order models) has been supported via confirmatory factor analysis (CFA), the tenability of a bifactor model of the M-DERS has yet to be examined. Preliminary research suggests that a bifactor model of the M-DERS is tenable. In this study (Ns of 993 and 578), results from a series of CFAs indicated adequate fit of the M-DERS and poor fit of the original DERS across several tested models (e.g., correlated trait, second-order, bifactor). Although a considerable amount of variance was accounted for by the general factor, statistical indexes from the bifactor model supported a multidimensional conceptualization of the M-DERS. The Nonacceptance and Goals subscales evidenced incremental utility, after accounting for the general factor, in predicting general distress (Nonacceptance only) and intolerance of uncertainty. Implications for future use of the DERS and M-DERS are discussed.

Predictors of outcome among young adult patients with anorexia nervosa in a randomised controlled trial

OBJECTIVE

The prognosis in cases of anorexia nervosa (AN) is unsatisfactory, and it is therefore important to examine pretreatment predictors of outcome.

METHODS

Female AN patients (N = 74) included in a randomised controlled trial receiving individual cognitive behavioural therapy (CBT) or family-based treatment (FBT) were included. Predictors of the outcome were explored using pretreatment eating disorder psychopathology.

RESULTS

In the CBT group, lower levels of emotional dysregulation and greater deficits in identifying and coping with inner states were predictors of weight increase, explaining 37.7% of the variance. In the FBT group, lower interoceptive deficits predicted an increase in weight (explaining 17.7% of the variance), whereas bulimic behaviour (32.4%) and problems with emotional regulation (23.3%) were predictors of increased diagnostic symptoms.

CONCLUSIONS

Bulimic symptoms and the ability to identify and cope with emotional states appear to be important aspects that should be addressed in the treatment of young adult patients with AN.

Emotion dysregulation and eating disorders-Associations with diagnostic presentation and key symptoms

OBJECTIVE

Emotion dysregulation seems involved in the development, maintenance, and outcome of eating disorders (EDs). The present study aimed to differentiate patients with EDs from a comparison group on emotion dysregulation, and to examine emotion dysregulation in relation to ED diagnostic presentation and ED symptoms.

METHOD

Participants, patients with EDs (N = 999) and a student comparison group (N = 252), completed the Difficulties in Emotion Regulation Scale and the Eating Disorder Examination Questionnaire. Patients were compared to the comparison group and compared by diagnosis regarding emotion dysregulation, and unique associations between emotion dysregulation aspects and ED symptoms were examined.

RESULTS

Patients reported greater general emotion dysregulation than the comparison group, especially poorer emotional awareness and clarity. There were very few diagnostic differences. In both patients and the comparison group, limited access to emotion regulation strategies was associated with cognitive ED symptoms, and presence of binge eating in the comparison group. In patients, poor emotional awareness and emotional non-acceptance were additionally associated with cognitive symptoms, and difficulties in impulse control and emotional non-acceptance were associated with binge eating.

DISCUSSION

Emotion dysregulation is an important transdiagnostic characteristic of ED. Results suggest interventions that enhance emotional awareness and acceptance, as well as emotion regulation skills training, in both ED treatment and prevention.

Development of a methodology to combine fMRI and EMG to measure emotional responses in patients with anorexia nervosa

OBJECTIVE

Individuals with eating disorders are theorized to have basic impairments in affective appraisal and social-emotional processing that contribute to pathogenesis of the disease. We aimed to determine if facial electromyography could be used to discriminate between happy and disgust emotions during simultaneous acquisition of an fMRI BOLD sequence in efforts to establish a novel tool for investigating emotion-driven hypotheses about eating pathology. In line with standards for rigor and reproducibility, we provide detailed protocols and code to support each step of this project.

METHOD

Sixteen adolescents with low-weight eating disorders viewed emotional faces (Happy or Disgust) and were asked to mimic their facial expression during simultaneous BOLD and EMG (Corrugator supercilli, Lavator lavii, Zygomaticus major) acquisition. Trials were repeated with the scanner off and again with scanner on (i.e., fatigue).

RESULTS

The Levator and Zygomaticus activation patterns discriminated disgust and happy faces successfully. The pattern held between scanner on and off conditions, but muscle activation attenuated in the Fatigue condition, especially for the Zygomaticus.

DISCUSSION

Simultaneous fMRI-EMG is a new tool capable of discriminating specific emotions based on muscle activation patterns and can be leveraged to answer emotion-driven hypotheses about clinical populations characterized by difficulty labeling or processing emotions.

Differences in emotion regulation difficulties among adults and adolescents across eating disorder diagnoses

OBJECTIVE

Although much empirical attention has been devoted to emotion regulation (ER) in individuals with eating disorders, little is known about ER across a wide age range and among different ED subtypes. The current study sought to examine ER in a sample of eating disorder patients.

METHOD

A total of 364 adults and adolescents with anorexia nervosa restricting subtype (AN-R), anorexia nervosa binge/purge subtype (AN-BP), or bulimia nervosa (BN) were assessed with the Difficulties in Emotion Regulation Scale (DERS).

RESULTS

Older ages were associated with higher DERS total, nonacceptance, goals, and impulsivity scores. When controlling for age, patients with BN and AN-BP had higher overall DERS scores than those with AN, and there were some differences among diagnostic subtypes on specific facets of ER.

CONCLUSIONS

These results indicate that treatments for emotion dysregulation may be applied across eating disorder diagnoses and ages, and inform how these strategies apply to different diagnostic groups.

Exploring emotion regulation and emotion recognition in people with presymptomatic Huntington's disease: The role of emotional awareness

Interest in the role of both emotion regulation and recognition in our understanding of mental health has been steadily increasing, especially in people with chronic illness who also have psychological difficulties. One illness which belongs to this category is Huntington's disease. Huntington's disease (HD) is a chronic neurodegenerative disorder that can cause a number of cognitive and psychological difficulties, including emotion recognition deficits, even before the onset of the symptoms required to make a formal diagnosis. Despite the lack of definite evidence, recent studies have suggested that deficits of emotion regulation and recognition may be expected to play a pivotal role in the early cognitive manifestations of HD. In this study, we hypothesised that the ability to regulate emotions can be impaired in people with presymptomatic HD, and that such impairment may be associated with a deficit of emotion recognition. To test this, an online survey was carried out with 117 English and Italian-speaking people with presymptomatic HD, compared to 217 controls matched for age and education. The results suggest that, in presymptomatic participants, emotion regulation and emotion recognition are generally not significantly impaired, and no significant relationships between performances on the two constructs were observed. However, a specific impairment in emotional awareness (a subscale on the Difficulties in Emotion Regulation Scale, DERS) was observed, which appears to be enhanced by the co-occurrence of depressive symptoms, even at a subclinical level. Consequently, it is suggested that difficulties in emotional awareness may represent a precursor of more general emotion recognition impairments, which only become apparent as the disease reaches a more symptomatic level. Clinical implications of the findings are discussed and directions for future research are proposed.

Reconsidering Emotion Dysregulation

This article aims to review the concept of emotion dysregulation, focusing on issues related to its definition, meanings and role in psychiatric disorders. Articles on emotion dysregulation published until May 2016 were identified through electronic database searches. Although there is no agreement about the definition of emotion dysregulation, the following five overlapping, not mutually exclusive dimensions of emotion dysregulation were identified: decreased emotional awareness, inadequate emotional reactivity, intense experience and expression of emotions, emotional rigidity and cognitive reappraisal difficulty. These dimensions characterise a number of psychiatric disorders in various proportions, with borderline personality disorder and eating disorders seemingly more affected than other conditions. The present review contributes to the literature by identifying the key components of emotion dysregulation and by showing how these permeate various forms of psychopathology. It also makes suggestions for improving research endeavours. Better understanding of the various dimensions of emotion dysregulation will have implications for clinical practice. Future research needs to address emotion dysregulation in all its multifaceted complexity so that it becomes clearer what the concept encompasses.