The Role of Emotion Regulation in Eating Disorders: A Network Meta-Analysis Approach

Jenni Leppanen; Dalia Brown; Hannah McLinden; Steven Williams; Kate Tchanturia

doi:10.3389/fpsyt.2022.793094

The Role of Emotion Regulation in Eating Disorders: A Network Meta-Analysis Approach

Front Psychiatry. 2022 Feb 23:13:793094. doi: 10.3389/fpsyt.2022.793094. eCollection 2022.

Authors

Jenni Leppanen¹, Dalia Brown^{1

2}, Hannah McLinden^{1

2}, Steven Williams¹, Kate Tchanturia^{3

4

5}

Affiliations

¹ Department of Neuroimaging, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, United Kingdom.
² School of Education, University of Bristol, Bristol, United Kingdom.
³ Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, United Kingdom.
⁴ South London and Maudsley National Health Service (NHS) Foundation Trust National Eating Disorder Service, London, United Kingdom.
⁵ Psychology Department, Illia State University, Tbilisi, Georgia.

Abstract

Background: Previous theoretical models and reviews have documented a strong connection between emotion dysregulation eating disorder (ED) psychopathology among the general and clinical populations. The aim of this review was to build on this previous work by conducting a network meta-analysis to explore associations between adaptive and maladaptive emotion regulation strategies and ED psychopathology trans-diagnostically across the ED spectrum to identify areas of emotion dysregulation that have the strongest association with symptomatology.

Methodology: A total of 104 studies were included in the meta-analysis and correlation coefficient representing the associations between specific emotion regulation strategies and ED symptomatology were extracted. We ran a Bayesian random effects network meta-analysis and the initial network was well-connected with each emotion regulation strategy being linked to at least one other strategy. We also conducted a network meta-regression to explore whether between-study differences in body mass index (BMI), age, and whether the sample consisted of solely female participants explained any possible network inconsistency.

Results: The network meta-analysis revealed that ruminations and non-acceptance of emotions were most closely associated with ED psychopathology. There was no significant network inconsistency but two comparisons approached significance and thus meta-regressions were conducted. The meta-regressions revealed a significant effect of BMI such that the associations between different emotion regulation strategies and ED symptomatology were weaker among those with low BMI.

Discussion: The present findings build on previous work and highlight the role of rumination and difficulties with accepting emotions as key emotion regulation difficulties in EDs. Additionally, the finding that the associations were weaker among ED patients with low BMI may point toward a complex relationship between ED behaviors and emotion regulation. Taken together, our findings call for interventions that target emotion regulation, specifically rumination and difficulties accepting emotions, in the treatment of EDs.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021249996, PROSPERO, identifier: CRD42021249996.

Keywords: acceptance of emotions; eating disorders; emotion regulation; meta-analysis; rumination.

Publication types

Systematic Review

Abstract

Publication types

Grants and funding