Emotion regulation difficulties, such as rumination, deficits in acceptance and problem solving, are observed in eating disorders. However, few studies have explored whether emotion regulation improves after treatment of the eating disorders, and whether difficulties in emotion regulation are different for various eating disorder types.
Eating disorder is a broad term that includes binge eating disorder, anorexia nervosa and bulimia nervosa. Recently we explored emotion regulation difficulties across eating disorder types and a healthy control group without eating disorders (Study 1) and we assessed pre-treatment and post-treatment changes among the different eating disorder types (Study 2).
In Study 1, 438 adult women with eating disorders and 126 healthy women without eating disorders completed an assessment including Eating Disorders Inventory-2 and Difficulties in Emotion Regulation Scale and Symptom Checklist-90-Revised (which assesses psychological problems and psychopathology).
In study 2, we included 69 women with eating disorders who were also reassessed after treatment. This psychological treatment was different according to the eating disorder type. On the one hand, patients with anorexia nervosa completed a day hospital treatment programme, which included daily group cognitive behavioral therapy sessions during 3 months. On the other hand, patients with bulimia nervosa, binge eating disorder and other specified feeding or eating disorders had completed group cognitive behavioral therapy over 16-week sessions.
All eating disorder types reported worse emotion regulation compared with the control women, and differences in emotion regulation were also found between the different types of eating disorders. Especially, patients with binge-related behaviours (e.g. binge eating disorder and bulimia nervosa) presented higher emotion regulation difficulties compared with patients with restrictive behaviours (i.e. anorexia nervosa restrictive subtype).
Prospective analyses (Study 2) show emotion regulation improvements after treatment, particularly in patients with bulimia nervosa, with greater improvement in those with a better treatment outcome. We also observed that changes in emotion regulation are closely linked to psychopathology and symptom severity improvement.
To sum up, emotion dysregulation is a part of all forms of eating disorders, which means that this is a transdiagnostic risk factor for the occurrence of any disorder of the eating disorder spectrum. Furthermore, emotional dysregulation can be modified. Treatments for anorexia nervosa and binge eating disorder might be enhanced by targeting emotion regulation skills.