Eating pathology, emotion regulation, and emotional overeating in obese adults with binge eating disorder

Highlights

• We examine the relationship between emotion regulation and emotional eating.

• Emotional eating and emotion regulation difficulties are positively correlated.

• Emotional eating is partially accounted for by emotion regulation difficulties.

Abstract

Objective

The purpose of the current study was to examine the relationship among emotional regulation, emotional overeating, and general eating pathology in a treatment seeking sample of adults with Binge Eating Disorder (BED).

Method

The sample was composed of 326 adults (248 women, 78 men) who were obese and met DSM-IV-TR criteria for BED. Prior to treatment, participants completed the Difficulties in Emotion Regulation Scale (DERS), Emotional Overeating Questionnaire (EOQ), Beck Depression Inventory (BDI), and Eating Disorder Examination-Questionnaire (EDE-Q) as part of a larger assessment battery.

Results

A series of hierarchical regression analyses indicated that difficulties with emotion regulation accounted for unique variance in both emotional overeating and general eating pathology above and beyond sex and negative affect.

Discussion

Emotion regulation may play a significant role in the maintenance of emotional overeating and eating pathology in obese adults with BED.

Introduction

A predominant theoretical model for explaining disordered eating behaviors suggests that these behaviors are undertaken as an attempt to regulate or escape from negative affect (Heatherton and Baumeister, 1991, Stice et al., 2001). Past research suggests that many individuals who struggle with excess weight or have an eating disorder also engage in a maladaptive behavior termed emotionally-driven eating, which is eating in response to emotions (Goossens et al., 2009, Masheb and Grilo, 2006, Ricca et al., 2009). Negative affect is one of the most commonly reported precipitants of binge eating episodes (Polivy & Herman, 1993) and a meta-analytic review examining studies implementing ecological momentary assessment (EMA) demonstrates that increases in negative affect often precede binge episodes in individuals with binge eating disorder (BED) and bulimia nervosa (Haedt-Matt & Keel, 2011). Experimentally-induced negative affect is also associated with binge eating and loss-of-control eating in laboratory settings in obese women with BED (Agras and Telch, 1998, Chua et al., 2004).

It has been hypothesized that individuals with eating disorders are vulnerable to engaging in emotional overeating because they lack adaptive emotion regulation strategies and skills, including being able to clearly identify and adaptively cope with emotional states (Sim and Zeman, 2006, Wiser and Telch, 1999). Compared to healthy controls, individuals with anorexia nervosa and bulimia nervosa report more difficulties with emotion regulation, although there is not yet evidence demonstrating a causal relationship between emotion regulation difficulties and disordered eating behaviors in these groups (Harrison, Sullivan, Tchanturia, & Treasure, 2010). Initial studies suggest that emotion regulation difficulties explain a significant portion of the variance of binge eating behaviors in a non-clinical college sample and a non-clinical sample of children (Czaja et al., 2009, Whiteside et al., 2007).

Binge eating disorder is found in between 1 and 3% of the population, with the prevalence increasing to approximately 8% in overweight and obese samples (Bruce and Agras, 1992, Spitzer et al., 1992). Among overweight and obese samples seeking weight loss treatment, the prevalence of BED is between 20% and 30% (Striegel-Moore & Franko, 2003). A substantial body of literature suggests that individuals with BED report overeating in response to emotions (Eldredge and Agras, 1996, Masheb and Grilo, 2006, Stein et al., 2007). There have been a number of trials examining the efficacy of treatments for BED which focus on developing adaptive emotion regulation skills, with the intent of reducing emotional overeating (Robinson, 2012, Telch et al., 2001). It is important to better characterize the relationship between emotion regulation difficulties and disordered eating behaviors within a sample of adults with BED, as this may provide us with valuable information regarding appropriate points of intervention for these individuals.

The purpose of the current study was to determine whether emotion regulation difficulties significantly contributed to emotional overeating and general eating disorder pathology in a clinical sample of obese, treatment-seeking adults with BED after accounting for sex and negative affect. We hypothesized that emotion regulation difficulties would explain unique variance in both emotional overeating and general eating disorder pathology. Furthermore, we sought to examine what specific types of emotion regulation difficulties would significantly account for variance in these two outcome variables.