Associations between emotion regulation difficulties, eating disorder symptoms, non-suicidal self-injury, and suicide attempts in a heterogeneous eating disorder sample

doi:10.1016/j.comppsych.2016.11.012

Comprehensive Psychiatry

Volume 73, February 2017, Pages 143-150

https://doi.org/10.1016/j.comppsych.2016.11.012 Get rights and content

Abstract

Background

This study examined the associations between specific dimensions of emotion dysregulation and eating disorder (ED) symptoms and behaviors, non-suicidal self-injury (NSSI), and suicide attempts in a heterogeneous ED sample.

Methods

Participants (N = 110) completed the Difficulties in Emotion Regulation Scale (DERS), the Eating Disorder Examination Questionnaire (EDE-Q), and self-reported the presence of lifetime NSSI and a lifetime suicide attempt.

Results

The EDE-Q global score, a primarily cognitive measure of ED symptoms, was significantly positively correlated with DERS strategies, clarity, and awareness subscale scores and DERS total score (ps < 0.01). Only the strategies subscale was uniquely positively associated with EDE-Q global score in a multivariate regression analysis. There was no association between the frequency of binge eating or frequency of driven exercise and any of the DERS subscale scores or total score (ps > 0.01). Frequency of purging was significantly, positively associated with DERS impulse subscale score and total score (p < 0.01). None of the DERS subscale scores were significantly different between those with and without NSSI or between those with and without a lifetime suicide attempt (ps > 0.01).

Conclusions

Findings indicate that in a heterogeneous ED sample, emotion regulation deficits are more strongly associated with cognitively-oriented symptoms of EDs than behavioral symptoms such as a binge eating, purging, driven exercise, NSSI, or suicide attempts.

Section snippets

Participants and procedures

Participants (N = 110; 93.6% female; mean age = 33.5, SD = 12.2) were recruited from a national ED treatment facility through advertisements in clinic waiting rooms and on social media. The advertisements stated that the study was about “understanding the emotional experiences of individuals with eating disorders.” Inclusion criteria included age 18 years or older, currently in ED treatment, and ability to read and write English.

Potential participants were able to go to the study's website where they

Results

Preliminary analyses revealed that there were no differences in the DERS subscale scores, prevalence of NSSI, or prevalence of suicide attempt by the probable ED diagnoses derived from the EDE-Q (ps > 0.05). Thus, as planned, we conducted all analyses for the present study transdiagnostically.

Descriptive statistics and intercorrelations between DERS subscale scores, total score, ED symptoms, and BMI are presented in Table 1. EDE-Q global score was significantly, positively correlated with DERS

Discussion

This study examined the associations between specific dimensions of emotion regulation concerns and global ED severity, ED behaviors, NSSI, and suicide attempts in a transdiagnostic clinical ED sample. The overall pattern of findings suggests that deficits in emotion regulation are most strongly associated with the EDE-Q global score, a more cognitively-oriented measure, as opposed to frequency of behavioral symptoms such as binge eating, purging, and driven exercise, or lifetime prevalence of

Funding

Research reported in this publication was supported by grant T32 MH 082761, P30 DK 50456 and UL1 TR 000114. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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The study's secondary objective was to examine whether mindfulness and emotion dysregulation differentiate individuals who have attempted suicide and those with only ENSSI. Previous research yielded mixed findings (Heffer and Willoughby, 2018; Pisetsky et al., 2017). The objectives of this study are of great clinical relevance.
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Effect sizes were small (see Table 3). In light of prior research reporting differential associations between emotion dysregulation dimensions and different forms of compensatory behaviours (Lavender et al., 2014; Pisetsky et al., 2017), we re-ran analyses with driven exercise as the outcome for symptom onset and persistence. Results from these analyses are presented in Supplementary Tables 1 and 2.
Theoretical models highlight the importance of emotion dysregulation as a key risk and maintaining factor for eating disorders. However, most studies testing these theories are cross-sectional. It remains unclear which dimensions of emotion dysregulation account for the onset and persistence of eating disorder behaviours over time.
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View full text

Emotion dysregulationAssociations between emotion regulation difficulties, eating disorder symptoms, non-suicidal self-injury, and suicide attempts in a heterogeneous eating disorder sample

Abstract

Background

Methods

Results

Conclusions

Section snippets

Participants and procedures

Results

Discussion

Funding

Clin Psychol Rev

Neurosci Biobehav Rev

Compr Psychiatry

Psychiatry Res

Compr Psychiatry

Behav Res Ther

Clin Psychol Rev

Clin Psychol Rev

J Psychosom Res

J Affect Disord

J Psychiatr Res

Anorexia nervosa as a disorder of emotion dysregulation: evidence and treatment implications

Clin Psychol Sci Pract

Emotional functioning in eating disorders: attentional bias, emotion recognition and emotion regulation

Psychol Med

Difficulties in emotion regulation in patients with eating disorders

Borderline Personal Disord Emot Dysregul

Revisiting the affect regulation model of binge eating: a meta-analysis of studies using ecological momentary assessment

Psychol Bull

The role of affect in the maintenance of anorexia nervosa: evidence from a naturalistic assessment of momentary behaviors and emotion

J Abnorm Psychol

Ecological momentary assessment of affect, stress, and binge-purge behaviors: day of week and time of day effects in the natural environment

Int J Eat Disord

Self-injurious behavior and eating disorders: the extent and nature of the association

Suicide Life Threat Behav

Lifetime prevalence of non-suicidal self-injury in patients with eating disorders: a systematic review and meta-analysis

Psychol Med

The relationship between non-suicidal self-injury and the UPPS-P impulsivity facets in eating disorders and healthy controls

PLoS One

The moderating role of purging behaviour in the relationship between sexual/physical abuse and nonsuicidal self-injury in eating disorder patients

Eur Eat Disord Rev

Risk factors for and functions of deliberate self harm: an empirical and conceptual review

Clin Psychol Sci Pract

Suicide attempts in anorexia nervosa

Psychosom Med

Suicide attempts in women with eating disorders

J Abnorm Psychol

Increased mortality in bulimia nervosa and other eating disorders

Am J Psychiatry

Emotion dysregulation
Associations between emotion regulation difficulties, eating disorder symptoms, non-suicidal self-injury, and suicide attempts in a heterogeneous eating disorder sample