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Eating Disorders

(PS14-16) The Mediating Role of Emotion Dysregulation Between Behavior Inhibition and Restrictive Eating

Sunday, November 17, 2024
10:30 AM – 11:30 AM EST
Location: Franklin Hall, Level 4, Marriott Downtown
Abstract Text: Eating disorders like anorexia nervosa (AN) are dangerous conditions with high risk of death, in part due to malnutrition related to restrictive eating. Because AN is a notoriously difficult condition to treat, understanding the mechanisms associated with restrictive eating behaviors may be helpful in guiding treatment efforts. Previous research has documented the relationship between impairments in emotion regulation (ER) and AN (e.g., Haynos & Fruzzetti, 2011), proposing that restrictive eating may help regulate emotions. Similarly, a link has been noted between sensitivity in behavioral inhibition and activation systems (BIS/BAS)— reflecting heightened sensitivity to punishment and reward, respectively— and emotion regulation (e.g., Tull et al., 2010). Higher sensitivity to punishment is theorized to lead to high emotional reactivity and negative affect, and thus greater difficulties in ER. Given this link, some research has suggested that the relationship between BIS/BAS sensitivity and other psychological concerns (e.g., anxiety, depression) is mediated by ER difficulties (e.g., Sun et al., 2020). Therefore, in this study, we investigated whether ER impairments (measured by the Difficulties in Emotion Regulation Scale; Gratz & Roemer, 2004) would mediate the relationship between punishment sensitivity (BIS scores; Carver & White, 1994) and drive towards restrictive eating (measured by the Self-Starvation Scale or SSS; Godier & Park, 2014) in a sample (N = 94) consisting of acute AN (n = 18), weight-restored AN (n = 41), and healthy control participants (n = 35). Results confirmed pre-established relationships between BIS sensitivity and the desire to engage in restrictive eating on the SSS (R2 =.22, F(1,92) = 25.59, p</em> < 0.001). Results of mediation analysis confirmed that the BIS was associated with SSS scores indirectly as mediated by ER impairments (significant total effect, β = 3.21, p < 0.001). Once ER difficulties entered the model, there was no longer a direct relationship between BIS and SSS (β = 0.83, p = 0.211). As anticipated, BAS reward sensitivity was not significant associated with drive towards restriction. Further exploratory analyses revealed that the specific ER impairments that best accounted for SSS variance were a lack of access to ER strategies (β = 1.97, p = 0.007) and lack of emotional clarity (β = .82, p = 0.038). These results confirm that a likely pathway for symptom severity in AN may be due to heightened sensitivity to punishment leading to impaired ER difficulties. As a result, people with these impairments may develop a drive towards restrictive eating as a means of regulating emotions. These pathways suggest that strengthening the regulatory capacity of patients, particularly in response to punishment, may be a key component in reducing the perceived necessity to engage in restrictive eating.