CEED and CEDI Science Corner: Ghrelin and Emotion Dysregulation

In this new Exchanges feature, we will provide capsule summaries of emerging research from both the UNC Center of Excellence for Eating Disorders (CEED) and the Karolinska Institutet Centre for Eating Disorders Innovation (CEDI). Much of our work bridges our sister programs and optimizes the unique resources of the two institutions. Tune in to the CEED and CEDI Science Corner for regular updates on our eating disorders research!

A systematic review and meta-analysis finds increased blood levels of all forms of ghrelin in both restricting and binge-eating/purging subtypes of anorexia nervosa

Maria Seidel, Signe Markmann Jensen, Darren Healy, Aakriti Dureja, Hunna J. Watson,

Birgitte Holst, Cynthia M. Bulik, and Jan Magnus Sjögren

Nutrients. DOI: https://doi.org/10.3390/nu13030784

Anorexia nervosa is a severe mental illness associated with high mortality and chronicity. The search for biological markers is ongoing as they could be useful in improving diagnosis and measuring state of illness, recovery, and treatment outcome. One biomarker candidate is the so called “hunger hormone” ghrelin that has been often reported to be elevated in individuals with anorexia nervosa. We conducted a meta-analysis by pooling data from all published studies on ghrelin in anorexia nervosa to determine how reliable ghrelin might be as a biomarker.  A meta-analysis is important because many of the studies on ghrelin have been conducted on very small samples. Our approach is a combined analysis that brings all of the smaller studies together in a single analysis. The results of our meta-analysis (comparing data from over 1000 patients with current or past anorexia nervosa to healthy individuals) point towards strong evidence of elevated ghrelin during the underweight state. Findings about whether ghrelin levels decrease during recovery are mixed and may reflect differences in methods across studies. Our results confirm the potential of ghrelin as indicator of acute anorexia nervosa, but underscore the need for more consistent and standardized research to determine the value of ghrelin as an index of treatment success or recovery status.

Emotion dysregulation and suicidality in eating disorders

Marianna Rania, Elin Monell, Arvid Sjölander, and Cynthia M Bulik

Int J Eat Disord. DOI: https://onlinelibrary.wiley.com/doi/10.1002/eat.23410

Suicidality in eating disorders is tragically common, yet our ability to predict who is at risk for thoughts of suicide (suicidal ideation) and suicide attempts is very limited. We used Swedish registry data from 2,406 individuals with diagnosed eating disorders who completed the Difficulties in Emotion Regulation Scale (DERS) when they were first registered in the Swedish eating disorders quality register (Riksät). Emotion dysregulation refers to difficulties in emotional awareness, clarity and acceptance, as well as difficulties managing emotions and refraining from impulsive behaviors when in distress.

When we combined individuals with all eating disorders diagnoses, high emotion dysregulation (total DERS scores) were associated with a lifetime history of suicide attempts, even when accounting for the effects of eating disorder symptoms and depression. The same held true for thoughts about suicide. The strongest predictor of future suicidal ideation, however, was past suicidal ideation.

Targeting emotion dysregulation may be beneficial in eating disorder treatment for patients with and without past suicidality. Treatments that target emotion dysregulation for other psychiatric disorders (e.g., depression, anxiety, borderline personality disorder) confirm that improving emotion regulation skills is associated with clinical improvement. Using such approaches to address eating disorder symptoms may also serve to reduce suicidality. Emotion regulation-focused therapies such as Dialectical Behavior Therapy, Emotion Acceptance Behavior Therapy, and Integrative Cognitive-Affective Therapy have been developed or adapted for eating disorders. This work encourages assessing and addressing emotion regulation in the treatment of all eating disorders.