Unpacking cognitive emotion regulation in eating disorder psychopathology: The differential relationships between rumination, thought suppression, and eating disorder symptoms among men and women

Highlights

• Thought suppression (TS) and rumination have been linked to eating disorders (EDs).

• Previous research also suggests gender differences in emotion regulation strategies.

• We examined influences of TS and ruminative brooding (RB) on ED symptoms by gender.

• Relationships between cognitive emotion regulation and ED symptoms differed by gender.

• RB was related to bingeing in women; TS was related to fasting in men.

Abstract

While previous literature suggests that emotion dysregulation is a salient factor contributing to the onset and maintenance of eating disorders (EDs), less is known about how maladaptive, cognitively oriented regulation strategies such as rumination and thought suppression may be uniquely related to ED symptoms in men and women. The present study sought to examine the independent associations of ruminative brooding and thought suppression with ED symptoms, after controlling for negative affect intensity, and assess whether these associations differ by gender. Participants were 263 undergraduates who completed a series of questionnaires, including measures of ED symptoms (Eating Disorder Diagnostic Scale), ruminative brooding (Ruminative Response Scale), and thought suppression (White Bear Suppression Inventory). Generalized linear models examined main effects of ruminative brooding and thought suppression and their interactions with gender on ED symptoms, controlling for negative affect intensity. Higher ruminative brooding was associated with higher binge eating among women. Thought suppression was associated with higher vomiting and fasting frequency in both genders, with a stronger association between suppression and fasting in men compared to women. Together results demonstrate the unique contributions of cognitive perseveration and avoidance in ED symptomatology; specifically, ruminative brooding may be a salient factor contributing to binge eating in women, while high levels of thought suppression among males may contribute to fasting. Findings highlight the potential importance of examining and differentially targeting specific facets of cognitive emotion regulation in men and women engaging in ED behaviors.

Introduction

Prior theoretical and empirical work has demonstrated that negative affectivity and emotion regulation difficulties are centrally important in the etiology and maintenance of eating disorder (ED) psychopathology (Hawkins & Clement, 1984; Lavender et al., 2015; Leehr et al., 2015; Stice, 2002). However, less is known about how specific maladaptive emotion regulation strategies may be differentially related to ED behaviors in men and women, as previous research indicates men and women evidence differences in both emotion regulation strategies and ED psychopathology (Murray et al., 2017; Nolen-Hoeksema & Aldao, 2011). Therefore, identifying the emotion regulation facets and skill sets that are most relevant to different types of ED behaviors in men and women may help to refine intervention approaches.

Recent work examining the underlying structure of emotion regulation strategies identified disengagement and aversive cognitive perseveration as two distinct factors (Naragon-Gainey, McMahon, & Chacko, 2017), each of which have been implicated across psychopathology (Aldao, Nolen-Hoeksema, & Schweizer, 2010). Whereas disengagement includes strategies such as distraction and experiential avoidance (i.e., refusal to accept contact with aversive internal experiences; Hayes, Wilson, Gifford, Follette, & Strosahl, 1996), aversive cognitive perseveration refers to preoccupation with or difficulty disengaging from negative thoughts (Naragon-Gainey et al., 2017). Importantly, thought suppression (i.e., a facet of disengagement reflecting the tendency to suppress unwanted or negative thoughts) and rumination (i.e., a facet of aversive cognitive perseveration referring to repetitive and passive focus on the meaning, causes, and consequences of negative emotions) have paradoxical effects on negative affect and therefore may be particularly relevant in the onset and maintenance of ED symptoms. That is, when individuals attempt to suppress unwanted thoughts, the frequency of such thoughts and related negative affect tends to increase (e.g., Borton, Markowitz, & Dieterich, 2005; Wenzlaff & Wegner, 2000), and while individuals often engage in cognitive rumination with the expectation that doing so will lead to increased insight and generate solutions to problems, rumination serves to increase negative emotions and cognitions (e.g., Lyubomirsky & Tkach, 2004; Selby, Kranzler, Panza, & Fehling, 2016).

Extant research has demonstrated relationships between each of these cognitive strategies and ED symptoms. For example, a recent meta-analysis found rumination was related to a range of ED symptoms, though relationships were stronger among studies with larger proportions of women (Smith, Mason, & Lavender, 2018). In addition, thought suppression and the broader construct of experiential avoidance have been implicated in ED psychopathology; in particular, thought suppression was associated with bulimic symptoms in male and female undergraduates (Lavender, Jardin, & Anderson, 2009), and cognitive ED symptoms among males (Lavender, Anderson, & Gratz, 2012).

Taken together, rumination and thought suppression are cognitive emotion regulation strategies that appear to be relevant to ED psychopathology, which are subsumed under the broader dimensions of disengagement and aversive cognitive perseveration. However, these domains have not been examined in conjunction with one another, which would help to demonstrate how cognitive avoidance and perseveration may uniquely contribute to differing ED symptom presentations. Given that research also suggests that rumination, avoidance and negative affect are strongly related (e.g., Cribb, Moulds, & Carter, 2006; Moulds, Kandris, Starr, & Wong, 2007), it is important for ED research going forward to consider the independent contribution of perseveration and avoidance while controlling for negative affect intensity. In addition, there is a dearth of research examining potential gender differences in the relationships between cognitive emotion regulation strategies and ED symptoms, although preliminary findings suggest that rumination may be more salient among women and thought suppression may be particularly relevant among men (Lavender et al., 2012; Smith et al., 2018). Therefore, the present study sought to (1) examine the extent to which two particular facets of cognitive emotion regulation, thought suppression (i.e., a facet of disengagement) and ruminative brooding (i.e., a facet of aversive cognitive perseveration), are independently associated with various ED symptoms, and (2) explore whether these associations are moderated by gender.