Emotion regulation deficits in eating disorders: a marker of eating pathology or general psychopathology?
TL;DR: The findings suggest that ER difficulties appear to be a transdiagnostic risk and/or maintenance factor rather than being disorder-specific, and all clinical groups performed very similar on most ER variables and reported more difficulties regulating their emotions than HC.
Abstract: Preliminary evidence indicates that individuals with eating disorders (ED) show emotion regulation (ER) difficulties. However, it is yet unclear whether different types of ED differ in their ER profile and whether certain ER difficulties are specific for ED or rather a transdiagnostic factor. Twenty women with anorexia nervosa (AN), 18 with bulimia nervosa (BN), 25 with binge eating disorder (BED), 15 with borderline personality disorder (BPD), 16 with major depressive disorder (MDD) and 42 female healthy controls (HC) were administered the Emotion Regulation Questionnaire, the Inventory of Cognitive Affect Regulation Strategies, the Difficulties in Emotion Regulation Scale and the Affect Intensity Measure. The ED groups reported significantly higher levels of emotion intensity, lower acceptance of emotions, less emotional awareness and clarity, more self-reported ER problems as well as decreased use of functional and increased use of dysfunctional emotion regulation strategies when compared to HC. No significant differences between the ED groups emerged for most ER variables. However, there were indications that the BED group may show a slightly more adaptive pattern of ER than the two other ED groups. As a whole, all clinical groups performed very similar on most ER variables and reported more difficulties regulating their emotions than HC. The findings suggest that ER difficulties are not linked to a particular diagnostic category. Instead, ER difficulties appear to be a transdiagnostic risk and/or maintenance factor rather than being disorder-specific.
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TL;DR: Both anorexia nervosa and bulimia nervosa are characterized by broad emotion regulation deficits, with difficulties in emotion regulation across the four dimensions found to characterize both AN and BN, although a small number of more specific difficulties may distinguish the two disorders.
355 citations
Cites background or methods or result from "Emotion regulation deficits in eati..."
...Nonetheless, available evidence is consistent with greater behavioral control deficits during times of distress in BN/subthreshold BN versus controls (Brockmeyer et al., 2014; Fischer, Settles, Collins, Gunn, & Smith, 2012; Fischer, Smith, Annus, & Hendricks, 2007; Harrison, Sullivan, et al., 2010; Svaldi et al., 2012)....
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...A uthor M anuscript A uthor M anuscript A uthor M anuscript A uthor M anuscript al., 2005 [mixed ED sample]; Harrison et al., 2010; Legenbauer, Vocks, & Ruddel, 2008; Sim & Zeman, 2004; Svaldi et al., 2012)....
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...…deficits in the perceived effectiveness of emotion regulation strategies in BN versus control samples (Brockmeyer et al., 2014; Harrison, Tchanturia, et al., 2010; Svaldi et al., 2012), as well as a reduced tendency to utilize cognitive reappraisal (Danner et al., 2014; Svaldi et al., 2012)....
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...However, other studies have found no differences between BN and control groups in terms several adaptive strategies, including reframing and growth, mindful observation, positive thoughts, and cognitive reappraisal (Davies et al., 2011; Svaldi et al., 2012)....
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...In contrast, studies using self-report measures have more consistently found greater emotional clarity and awareness deficits in AN versus controls (Brockmeyer et al., 2014; Harrison et al., 2009; Harrison et al., 2010; Svaldi et al., 2012), but AN diagnostic subtypes have not been found to differ (Brockmeyer et al....
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TL;DR: A series of recommendations for facilitating cross-study comparisons and leveraging multifaceted approaches to studying emotion regulation processes within a developmental psychopathology framework are provided.
Abstract: In response to rapidly growing rates of comorbidity among psychiatric disorders, clinical scientists have become interested in identifying transdiagnostic processes that can help explain dysfunction across diagnostic categories (e.g., Kring & Sloan, 2009). One factor that has received a great deal of attention is that of emotion regulation, namely, the ability to modulate the intensity and/or duration of emotional states (e.g., Cicchetti, Ackerman, & Izard, 1995; Gross, 1998). Recent theoretical and empirical work has begun to emphasize the role that emotion regulation plays in the temporal comorbidity between internalizing and externalizing conditions (e.g., Aldao & De Los Reyes, 2015; De Los Reyes & Aldao, 2015; Drabick & Kendall, 2010; Jarrett & Ollendick, 2008; Patrick & Hajcak, 2016). However, close inspection of this work reveals two very pertinent areas of growth: (a) this literature is characterized by mixed findings that are likely explained, in part, by methodological heterogeneity; and (b) emotion regulation tends to be studied in relatively narrow terms. To address these issues, we provide a series of recommendations for facilitating cross-study comparisons and leveraging multifaceted approaches to studying emotion regulation processes within a developmental psychopathology framework. We hope that our perspective can enhance the organization and growth of this very important area of inquiry, and ultimately result in more effective prevention and treatment programs.
282 citations
TL;DR: The present study investigated specific ER difficulties in 120 patients with different ED subtypes, including AN-R, AN-BP, bulimia nervosa (BN), and binge-eating disorder (BED) to support the trans-diagnostic view of ER difficulties being present across the whole spectrum of ED.
229 citations
TL;DR: Findings are consistent with the idea that that negative affect is potentially a critical maintenance mechanism of some AN symptoms, but that the analytic approach used to examine affect and behavior may have significant implications on the interpretation of findings.
Abstract: The current study examines the relationship of affect and eating disorder behavior in anorexia nervosa (AN) using ecological momentary assessment. Participants were 118 adult females recruited at three sites from eating disorder treatment centers and community advertisements. All participants met full Diagnostic and statistical manual of mental disorders (4th ed.) criteria or subthreshold criteria for AN. Participants were provided handheld computers and asked to report positive affect, negative affect, loss of control (LOC) eating, purging, exercise, drinking fluids to curb appetite, and weighing one's self multiple times per day as well as dietary restriction once daily over a 2-week interval. Mixed-effects models were used to examine the extent to which affective states predict dietary restriction. In addition, we used two analytic approaches to compare affect before and after other eating disorder behaviors. We found that higher daily ratings of negative affect were associated with a greater likelihood of dietary restriction on subsequent days. When examining the single rating immediately before and after behaviors, we found that negative affect increased significantly after LOC eating, purging, the combination of LOC and eating/purging, and weighing of one's self. Using this same analytic approach, we also found negative affect to decrease significantly after the consumption of fluids to curb appetite and exercise. When examining the covariation of AN behaviors and negative affect assessed multiple times in the hours and minutes before the behaviors, we found negative affect significantly increased before LOC eating, purging, the combination of LOC eating/and purging, and weighing behavior. Negative affect also significantly decreased after the occurrence of these behaviors. These findings are consistent with the idea that that negative affect is potentially a critical maintenance mechanism of some AN symptoms, but that the analytic approach used to examine affect and behavior may have significant implications on the interpretation of findings.
202 citations
TL;DR: There seems to be less support for the possibility that binge eating serves as a means to alleviate negative affect and other forms of maladaptive emotion regulation strategies, such as substance abuse and self-harm, while experimental studies in a laboratory setting lack ecological validity.
Abstract: The purpose of the present review is to provide a summary of the research findings on emotion regulation in Binge Eating Disorder (BED). Negative emotions and maladaptive emotion regulation strategies play a role in the onset and maintenance of binge eating in BED. Anger and sadness, along with negative emotions related to interpersonal experiences (i.e., disappointment, being hurt or loneliness), seem to be particularly relevant. Individuals with BED have a tendency to suppress and ruminate on their unwanted emotions, which leads to increased psychopathological thoughts and symptoms. Compared to healthy controls, they use adaptive strategies, such as reappraisal, less frequently. Evidence concerning the causal relation between negative affect and binge eating is inconclusive and still very limited. While experimental studies in a laboratory setting lack ecological validity, ecological momentary assessment studies offer more promise at unraveling the causal relationship between emotions and binge eating. Increases in negative affect are found to be antecedents of binge eating in BED. However, there seems to be less support for the possibility that binge eating serves as a means to alleviate negative affect. Finally, BED seems to be related to other forms of maladaptive emotion regulation strategies, such as substance abuse and self-harm.
188 citations
References
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Book•
01 Dec 1969TL;DR: The concepts of power analysis are discussed in this paper, where Chi-square Tests for Goodness of Fit and Contingency Tables, t-Test for Means, and Sign Test are used.
Abstract: Contents: Prefaces. The Concepts of Power Analysis. The t-Test for Means. The Significance of a Product Moment rs (subscript s). Differences Between Correlation Coefficients. The Test That a Proportion is .50 and the Sign Test. Differences Between Proportions. Chi-Square Tests for Goodness of Fit and Contingency Tables. The Analysis of Variance and Covariance. Multiple Regression and Correlation Analysis. Set Correlation and Multivariate Methods. Some Issues in Power Analysis. Computational Procedures.
115,069 citations
"Emotion regulation deficits in eati..." refers methods in this paper
...Between group differences are reported with Cohen's d, whereby values up to 0.2 refer to small, 0.5 to moderate, and 0.8 to large effect sizes (Cohen, 1988)....
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...Effect sizes of the group differences and interactions are reported by partial eta squared (η2), whereby values up to 0.01 refer to small, 0.06 to moderate, and 0.14 to large effect sizes (Cohen, 1988)....
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11 Jun 2013
113,134 citations
TL;DR: A meta-analysis of the BDI's internal consistency estimates yielded a mean coefficient alpha of 0.86 for psychiatric patients and 0.81 for non-psychiatric subjects as mentioned in this paper.
11,149 citations
TL;DR: Five studies tested two general hypotheses: Individuals differ in their use of emotion regulation strategies such as reappraisal and suppression, and these individual differences have implications for affect, well-being, and social relationships.
Abstract: Five studies tested two general hypotheses: Individuals differ in their use of emotion regulation strategies such as reappraisal and suppression, and these individual differences have implications for affect, well-being, and social relationships. Study 1 presents new measures of the habitual use of reappraisal and suppression. Study 2 examines convergent and discriminant validity. Study 3 shows that reappraisers experience and express greater positive emotion and lesser negative emotion, whereas suppressors experience and express lesser positive emotion, yet experience greater negative emotion. Study 4 indicates that using reappraisal is associated with better interpersonal functioning, whereas using suppression is associated with worse interpersonal functioning. Study 5 shows that using reappraisal is related positively to well-being, whereas using suppression is related negatively.
8,261 citations
"Emotion regulation deficits in eati..." refers background or methods in this paper
...Test–retest reliability across 3 months was 0.69 for both scales (Gross and John, 2003) with good discriminant and convergent validity....
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...Both subscales have satisfactory internal consistencies, stability and convergent validity (Gross and John, 2003; Abler and Kessler, 2009)....
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...The classification of strategies into functional versus dysfunctional was based on earlier empirical findings (see Gross and John, 2003; Wolfsdorf Kamholz et al., 2006)....
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...The Emotion Regulation Questionnaire (ERQ; Gross and John, 2003; German version: Abler and Kessler, 2009) is a 10 item self report measure that assesses chronic use of cognitive reappraisal (e.g., “I control my emotions by changing the way I think about the situation I'm in”) and expressive…...
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Book•
01 Jan 1993TL;DR: The treatment of Borderline personality disorder (BPD) has been studied extensively in the literature as discussed by the authors, with a focus on the treatment of the behavioral patterns of patients with BPD.
Abstract: Part I: Theory and Concepts Borderline Personality Disorder: Concepts, Controversies, and Definitions Dialectical and Biosocial Underpinnings of Treatment Behavioral Patterns: Dialectical Dilemmas in the Treatment of Borderline Patients Part II: Treatment Overview and Goals Overview of Treatment: Targets, Strategies, and Assumptions in a Nutshell Behavioral Targets in Treatment: Behaviors to Increase and Decrease Structuring Treatment around Target Behaviors: Who Treats What and When Part III: Basic Treatment Strategies Dialectical Treatment Strategies Core Strategies: Validation Core Strategies: Problem Solving Change Procedures: Contingency Procedures of Managing Contingencies and Observing Limits Change Procedures: Skills Training, Exposure, Cognitive Modification Stylistic Strategies: Balancing Communication Case Management Strategies: Interacting with the Community Part IV: Strategies for Specific Tasks Structural Strategies Special Treatment Strategies Appendix: Suggesting Reading References Index
6,378 citations