Emotion Regulation in Eating Disorders

BY: Hunna Watson, PhD

DATE: 20 February 2018

According to theories of emotion regulation in eating disorders, unpleasant emotions, like sadness, anger, and anxiety, can precipitate eating disorder symptoms. Eating disorder symptoms, in turn, can distract from or even temporarily alleviate unpleasant emotions. Coping with unpleasant emotions by binge eating, purging, restricting, or compulsively exercising, may make these symptoms become more entrenched.

Researchers have used scientific strategies to study emotion regulation within the context of eating disorders. Many questions have been investigated: Do people with an eating disorder feel negative emotions more intensely than those without an eating disorder? Do their coping methods differ from people without an eating disorder? Can teaching skills to cope with strong emotions reduce eating disorder symptoms? Here, we look at the research findings on emotion regulation in the past year and present a snapshot of up-to-the-minute research.

Recent Research Findings on Emotion Regulation

The data suggest that people with eating disorders report greater difficulties with emotion regulation than people without eating disorders, and tend to engage in less healthy emotion regulation strategies, such as worry, rumination, and self-punishment, than cognitive reappraisal (i.e., re-interpretation of the situation) or acceptance of uninvited emotion1,2,3,4. People with anorexia nervosa (AN) and bulimia nervosa (BN) were found to have a bias where they rated neutral facial expressions as expressing more anger than controls did and were less likely than controls to express positive emotion in their own facial expressions5,6.

People with eating disorders engage in eating disorder behaviors to regulate their moods. In one study, individuals with BN carried digital devices and were asked periodically during the day, over 2 weeks, to record their emotion and binge-eating, purging, or combined binge-purge episodes. Acute increases in unpleasant emotions preceded eating disorder behaviors, and after these behaviors odes mood was boosted, although there was also greater instability in unpleasant emotions7. Likewise, for individuals with AN, guilt peaked before restrictive eating periods and decreased afterward8.

According to emotion regulation theory, enabling individuals to better regulate their moods and emotional reactions to stressors could reduce eating disorder symptoms. In one study, improvement in one’s ability to regulate emotions during psychotherapy for BN was linked to greater improvement in eating disorder-related cognitive symptoms and binge eating frequency, but not purging frequency9. Other studies found that improvements in emotion regulation during treatment were correlated with treatment gains10,3. Sloan and colleagues tested the idea that emotion regulation difficulties underlie a range of mental health problems11. Results supported emotion regulation as a “transdiagnostic” construct. They suggested that when targeted for improvement in treatment, emotion regulation may help with a range of symptoms associated with anxiety, depression, eating disorders, and substance use.


People with acute eating disorders may have an internal world where positive emotions (e.g., joy) seem harder to tap, while negative emotions (e.g., distress, anxiety, disappointment, sadness) are closer to the surface and more frequently experienced. Their strategies for dealing with these emotions may be ineffective and may be compounded by problems with social communication, such as misreading others’ emotional states (in a negatively biased way). Enhancing the ability to manage emotions is incorporated into several psychotherapies (e.g., cognitive-behavior therapy) and is one way in which disordered eating behaviors can be addressed therapeutically. A deeper understanding of the role of emotion regulation in eating disorders and how best to enhance emotion regulation strategies are important topics in both basic research and in treatment development and refinement.



  1. Crino, N., Touyz, S. & Rieger, E. (2017) How eating disordered and non-eating disordered women differ in their use (and effectiveness) of cognitive self-regulation strategies for managing negative experiences. Eat Weight Disord. 1-8.
  2. Kenny T.E., Singleton C., & Carter J.C. (2017) Testing predictions of the emotion regulation model of binge eating disorder. Int J Eat Disord. 50, 1297-1305.
  3. Mallorquí-Bagué, N., Vintró-Alcaraz, C., Sánchez, I., Riesco, N., Agüera, Z., et al.(2018) Emotion Regulation as a Transdiagnostic Feature Among Eating Disorders: Cross-sectional and Longitudinal Approach.  Eat. Disorders Rev., 26: 53–61.
  4. Westwood, H., Kerr-Gaffney, J., Stahl, D., & Tchanturia, K. (20**) Alexithymia in eating disorders: Systematic review and meta-analyses of studies using the Toronto Alexithymia Scale. Journal of Psychosomatic Research, 99, 66-81.
  5. Dapelo, M. M., Surguladze, S., Morris, R., & Tchanturia, K.(2017) Emotion recognition in face and body motion in bulimia nervosa.  Eat. Disorders Rev., 25, 595–600.
  6. Leppanen, J., Dapelo, M.M., Davies, H., Lang, K., et al. (2017) Computerised analysis of facial emotion expression in eating disorders. PLOS ONE 12(6): e0178972.
  7. Berner, L., ***et? (20**) Temporal associations between affective instability and dysregulated eating behavior in bulimia nervosa. Journal of Psychiatric Research, 92, 183-190.
  8. Haynos, A. F., Berg, K. C., Cao, L., Crosby, R. D., et al. (2017). Trajectories of higher- and lower-order dimensions of negative and positive affect relative to restrictive eating in anorexia nervosa. Journal of Abnormal Psychology, 126(5), 495-505.
  9. Peterson, C.B., Berg, K.C., Crosby, R.D., Lavender, J.M., et al. (2017). The effects of psychotherapy treatment on outcome in bulimia nervosa: Examining indirect effects through emotion regulation, self-directed behavior, and self-discrepancy within the mediation model. Int J Eat Disord. 50, 636-647.
  10. MacDonald, D.E., Trottier, K., Olmsted, M.P. (2017) Rapid improvements in emotion regulation predict intensive treatment outcome for patients with bulimia nervosa and purging disorder. Int J Eat Disord.50, 1152-1161.
  11. Sloan, E., Hall, K., Moulding, R., Bryce, S., et al. (2017) Emotion regulation as a transdiagnostic treatment construct across anxiety, depression, substance, eating and borderline personality disorders: A systematic review. Clinical Psychology Review. 57, 141-163.