Dynamic longitudinal relations between emotion regulation difficulties and anorexia nervosa symptoms over the year following intensive treatment

Abstract

Objective: Emotion regulation difficulties have been implicated in theoretical models of anorexia nervosa (AN) development/maintenance, and several treatments for AN have been designed to target emotion dysregulation. However, no research has used longitudinal methodology to examine whether emotion regulation difficulties predict the maintenance of AN symptoms, or vice versa. The current study evaluated dynamic longitudinal relations between emotion dysregulation and AN symptom severity over the year following discharge from intensive treatment in order to enhance theoretical models and treatments for AN.

Method: Participants were 191 patients with AN recruited during intensive treatment. Assessments including the Eating Disorders Examination and the Difficulties in Emotion Regulation Scale were completed at discharge from treatment and at 3-, 6-, and 12-month follow-ups. Bivariate latent change score models were used to examine the direction of associations between emotion dysregulation and AN symptom severity across time.

Results: Emotion dysregulation predicted change in AN symptom severity, but the reverse relationship did not occur. Individuals with high levels of emotion dysregulation experienced an increase and subsequent maintenance of AN psychopathology, whereas low emotion dysregulation predicted a decreasing AN symptom trajectory. Importantly, these dynamic temporal relationships could not be accounted for by body mass index or depressive symptoms and were present for patients with the restricting and binge-eating/purging subtypes of AN.

Conclusions: Emotion regulation difficulties appear to be involved in the maintenance of AN symptom severity over time. Findings provide support for an increasing emphasis on emotion regulation in the development of novel treatments for AN.

Figure 1. Path diagram of the best-fitting bivariate latent change score (LCS) model in which latent Difficulties in Emotion Regulation Scale (DERS) scores predict rate of change in Eating Disorder Examination (EDE) scores

D and E represent observed DERS and EDE scores; respectively; d and e represent latent scores; e_D and e_E represent error variances; Δd and Δe represent LCSs; ρ_Id,Ie represents the DERS and EDE intercept covariance; ρ_Ie,Se represents the EDE intercept and slope covariance; β_e represents the EDE time-invariant proportional coefficient; γ_d represents the DERS to EDE coupling coefficient. Unlabeled paths were set to 1. Error variances for DERS and EDE observed scores were equated across time, respectively, and DERS and EDE error variances within each time point were correlated and set equal over time.

Figure 2. Expected change trajectory in AN symptom severity over time

Trajectories are plotted for individuals with average Eating Disorder Examination (EDE) Global Scores at discharge. High DERS is defined as a Difficulties in Emotion Regulation Scale (DERS) Total score 1 SD above the mean, and low DERS is defined as a DERS Total score 1 SD below the mean.