Emotion generation and regulation in anorexia nervosa: a systematic review and meta-analysis of self-report data

Anna Oldershaw; Tony Lavender; Hannah Sallis; Daniel Stahl; Ulrike Schmidt

doi:10.1016/j.cpr.2015.04.005

Emotion generation and regulation in anorexia nervosa: a systematic review and meta-analysis of self-report data

Clin Psychol Rev. 2015 Jul:39:83-95. doi: 10.1016/j.cpr.2015.04.005. Epub 2015 May 2.

Authors

Anna Oldershaw¹, Tony Lavender², Hannah Sallis³, Daniel Stahl³, Ulrike Schmidt⁴

Affiliations

¹ Centre for Applied Psychology, Canterbury Christ Church University, Salomons Centre at Tunbridge Wells, Broomhill Road Southborough, Tunbridge Wells, Kent TN3 0TG, UK; Section of Eating Disorders, Division of Psychological Medicine, King's College London, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. Electronic address: annaoldershaw@hotmail.com.
² Centre for Applied Psychology, Canterbury Christ Church University, Salomons Centre at Tunbridge Wells, Broomhill Road Southborough, Tunbridge Wells, Kent TN3 0TG, UK.
³ Department of Biostatistics, King's College London, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK.
⁴ Section of Eating Disorders, Division of Psychological Medicine, King's College London, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK.

PMID: 26043394
DOI: 10.1016/j.cpr.2015.04.005

Abstract

This systematic review sought to examine the generation and regulation of emotion in people with Anorexia Nervosa (AN). Key databases (Medline, Embase, PsychINFO and Web of Science) were searched for peer-reviewed articles published by March 2015 yielding 131 studies relevant to emotion generation and emotion regulation (ER) processes as defined by Gross (1998). Meta-analyses determined pooled group differences between AN and healthy control (HC) groups. More maladaptive schemata were reported by people with AN than HCs, with largest pooled effects for defectiveness/shame (d=2.81), subjugation (d=1.59) and social isolation (d=1.66). Poorer awareness of and clarity over emotion generated and some elevated emotionality (disgust and shame) were reported. A greater use of 'maladaptive' ER strategies was reported by people with AN than HCs, alongside less use of 'adaptive' strategies. Pooled differences of particularly large effect were observed for: experiential avoidance (d=1.00), negative problem-solving style (d=1.06), external/social comparison (d=1.25), submissiveness (d=1.16), attention concentration (worry/rumination; d=1.44) and emotion suppression (d=1.15), particularly to avoid conflict (d=1.54). These data support the notion that emotion regulation difficulties are a factor in AN and support use of associated cognitive-affective models. The implications of these findings for further understanding AN, and developing models and related psychological interventions are discussed.

Keywords: Affect; Anorexia nervosa; Eating disorders; Emotion; Regulation; Review.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Adaptation, Psychological*
Anorexia Nervosa / psychology*
Awareness
Emotions*
Humans
Self Report
Surveys and Questionnaires