Self-directed behaviors differentially explain associations between emotion dysregulation and eating disorder psychopathology in patients with or without objective binge-eating

Elin Monell,Andreas Birgegård,David Clinton

doi:10.1186/s40337-020-00294-4

Abstract

BackgroundEmotion dysregulation and negative self-directed behaviors are key characteristics of eating disorders (EDs), but their interaction in relation to ED psychopathology is insufficiently explored, and empirically robust and clinically relevant models are needed.MethodsThis study examined whether the association between emotion dysregulation and ED psychopathology was mediated by different negative self-directed behaviors in 999 ED patients divided into two sub-samples based on absence or presence of objective binge-eating episodes (OBE). Several simple and extended mediation models were examined using the Difficulties in Emotion Regulation Scale (DERS) as independent variable, the Structural Analysis of Social Behavior (SASB) as mediator, and the Eating Disorder Examination Questionnaire (EDE-Q) as dependent variable.ResultsAn associational pathway was found where higher emotion dysregulation was associated with more negative self-directed behaviors, which in turn was associated with higher ED psychopathology. Self-directed behaviors of importance differed between patient groups. In participants without OBE, lower self-love and higher self-attack were influential, whereas in participants with OBE, lower self-affirmation and higher self-blame were influential.ConclusionsSelf-directed behaviors may help to explain the association between emotion dysregulation and ED psychopathology. Our findings have both theoretical and clinical implications that are pathology-specific. Addressing specific self-directed behaviors could be an important way of helping patients deal with their emotions in relation to ED psychopathology.

Highlights

Eating disorders (EDs) are complex psychiatric conditions associated with high rates of psychiatric and medical comorbidity, life-disruptions, and significant suffering [1], but the etiology of eating disorders (EDs) is unclear [2] and treatment outcomes are mixed [3]
We found that higher emotion dysregulation, such as difficulties focusing on and understanding emotions, was associated with negatively attuned selfdirected behaviors, for instance with harsh self-criticism, which in turn was associated with greater body, shape and weight concerns
We found that in participants who did not have objective binge-eating episodes, higher emotion dysregulation seemed to be associated with less self-love and more self-attack in relation to eating disorder symptoms

Summary

Introduction

Eating disorders (EDs) are complex psychiatric conditions associated with high rates of psychiatric and medical comorbidity, life-disruptions, and significant suffering [1], but the etiology of EDs is unclear [2] and treatment outcomes are mixed [3]. In order to improve our understanding and treatment of EDs we need to identify empirically robust and clinically relevant models of etiology and maintenance. Emotion dysregulation refers to difficulties understanding and managing emotions [6], while self-directed behaviors refers to dimensions of self-control vs spontaneity and selfaffiliation vs self-attack [7]. These factors impact symptoms, but their interaction in relation to ED psychopathology remains insufficiently explored. Emotion dysregulation and negative self-directed behaviors are key characteristics of eating disorders (EDs), but their interaction in relation to ED psychopathology is insufficiently explored, and empirically robust and clinically relevant models are needed

Methods

Results

Discussion

Conclusion