Emotion regulation difficulties interact with negative, not positive, emotional eating to strengthen relationships with disordered eating: An exploratory study
Introduction
Disordered eating (DE) includes a spectrum of maladaptive attitudes, cognitions, and behaviors associated with negative psychological and physiological health outcomes. DE is present in clinical and non-clinical populations, varies in level of severity, and spans throughout adolescence and adulthood (Cooley & Toray, 2001; Krahn et al., 2005; Loth et al., 2014). Hallmark DE behaviors include dietary restraint and binge eating (American Psychiatric Association [APA], 2013; Fairburn & Beglin, 1994), and DE attitudes, and cognitions include shape and weight overvaluation (e.g., body dissatisfaction; APA, 2013; Fairburn & Beglin, 1994), as well as eating concerns (e.g., fear of loss of control of eating; Fairburn & Beglin, 1994). Current research has moved to understanding the relationship between DE and other maladaptive eating phenotypes such as emotional eating.
Emotional eating, or more specifically, the urge to eat in response to negative emotions in the absence of physiological hunger (Arnow et al., 1995), may be positively associated with DE. However, the relationship between emotional eating and DE may vary depending on valence of emotional eating (i.e., eating in response to negative or positive emotions). In the eating and weight disorders literature, emotional eating has emerged as a unique, maladaptive eating phenotype associated with poor health outcomes such as weight gain and obesity (Arnow et al., 1995; Koenders & van Strien, 2011). While valence-specific emotional eating research is in its infancy, some research hypothesizes that negative emotional eating may be driven by internal processes (e.g., negative affect regulation; Arnow et al., 1995). Furthermore, positive emotional eating is hypothesized to be driven by external processes (e.g., food reward; van Strien et al., 2016), but for positive emotional eating specifically, mechanisms remain largely unknown. Building on these ideas, previous research has identified negative relationships between negative and positive emotional eating across different emotional eating instruments (Geliebter & Aversa, 2003; Nolan et al., 2010). Yet, research continues to focus on negative emotional eating to the exclusion of positive emotional eating (Reichenberger et al., 2020). The evidence base for associations between emotional eating and DE is no exception.
Negative emotional eating is positively associated with DE. For example, a wealth of research has identified a positive association between binge eating and negative emotional eating (Agras & Telch, 1998; Fischer et al., 2007; Tanofsky et al., 1997). Furthermore the dietary restraint literature suggests a positive relationship between anorexia nervosa-restricting subtype and negative emotional eating (Ricca et al., 2012); but, these effects were lost when controlling for fear of loss of control. Other research has documented that anorexia nervosa binge-purge subtype, but not restricting subtype, was positively related to negative emotional eating outcomes in a treatment sample receiving cognitive behavioral therapy (Fioravanti et al., 2014). Finally, in the weight and body shape literature, negative emotional eating has again been identified as a positive correlate such that increased negative emotional eating was associated with increased weight and body shape overvaluation (Masheb & Grilo, 2006; Stice, 2002). More recently, significant negative relationships have been observed between body image flexibility and negative emotional eating in a community sample (Duarte & Pinto-Gouveia, 2015). Furthermore, intervention-based research around this same time targeted negative emotional eating through cognitive-behavior weight loss strategies, identifying that reductions in negative emotional eating were associated with improved body image in obese women (Annesi & Mareno, 2015). Taken together, negative emotional eating appears to be positively related to the full spectrum of DE attitudes, cognitions, and behaviors and may prove a useful target for researchers and clinicians alike. However, considerably less research has examined relationships between positive emotional eating and DE.
Despite a limited research base, positive emotional eating may be positively related to DE. Previous research has shown relationships between positive emotional eating and binge eating (Sultson et al., 2017) but these effects may depend on moderators such as emotional reactivity (i.e., increased ease of activation and intensity of the experience of positive emotions; Barnhart et al., 2020). Of note, both of these studies examined relationships between positive emotional eating and binge eating in non-clinical university (Sultson et al., 2017) and online community (Barnhart et al., 2020) samples, and thus the evidence base for this relationship in clinical binge eating presentations (e.g., bulimia nervosa or binge eating disorder populations) is limited. Related work has demonstrated significant positive relationships between positive emotional eating and maladaptive eating behaviors such as a tendency to eat palatable foods for social and reward enhancement reasons (Bilici et al., 2020). Research that has examined the association between positive emotional eating and DE in clinical populations identified that restriction-based eating disorder phenotypes (e.g., anorexia nervosa) were related to increased positive emotional eating whereas binge eating-based eating disorder phenotypes (e.g., bulimia nervosa) were related to increased negative emotional eating (Meule et al., 2019). Despite identifying differences in positive emotional eating when comparing diagnostic groups, a review of the literature base revealed no studies examining relationships between positive emotional eating and more specific, core DE symptoms, including weight and body shape overvaluation. Because positive emotional eating is speculated to occur at similar rates to that observed with negative emotional eating (Macht et al., 2004), it is important for research to examine associations between positive emotional eating and the full spectrum of DE attitudes, cognitions, and behaviors. The present study builds on this body of research by examining potential moderators of the relationship between emotional eating and DE such as emotion regulation.
The relationship between emotional eating and DE may depend on emotion regulation difficulties. Emotion regulation is operationalized as awareness and acceptance of emotions including the employment of effective behavioral responses to the full range of emotions (Gratz & Roemer, 2004). Emotion dysregulation has been identified as a potential transdiagnostic risk factor (Svaldi et al., 2012) and is positively related to DE such that emotion regulation difficulties are associated with increased binge eating (Dingemans et al., 2017, for a review), dietary restraint (Haynos, Wang, & Fruzzetti, 2018), shape and weight concerns (Lavender & Anderson, 2010), and overall eating pathology (Prefit et al., 2019, for a meta-analysis). In the context of emotional eating, emotion regulation has largely been evidenced to be related to negative emotional eating (Braden et al., 2018; Evers et al., 2010). Gianini and colleagues (2013) conducted a series of hierarchical regressions to assess associations between emotion regulation difficulties and emotional (negative) eating and DE in people with obesity and binge eating disorder. Emotion regulation difficulties predicted unique variance above and beyond sex and the experience of negative emotions in separate models of negative emotional eating and DE broadly, both models pointing to positive relationships between these constructs. Recently, Braden et al. (2018) examined associations between psychological (emotion regulation and DE) outcomes and emotional eating across negative and positive emotional eating dimensions, identifying that negative, not positive, emotional eating was related to increased emotion regulation difficulties and DE. These data are consistent with a body of research identifying a positive relationship between negative emotional eating and emotion regulation difficulties (Crockett et al., 2015), including research that has teased out specific facets of emotion regulation difficulties such as impaired acting with awareness (Höppener et al., 2019), poor access to emotion regulation strategies (Braden et al., 2018), and difficulty identifying emotions (Larsen et al., 2006). Research exploring emotional eating and emotional regulation together in relation to DE is limited, especially research exploring relationships with positive emotional eating.
Previous research that has explored these questions has identified that emotion dysregulation is a unique predictor of negative, not positive, emotional eating and DE. Recently, Muele and colleagues (2019) explored various diagnostic groups (i.e., anorexia nervosa, bulimia nervosa, and control) by emotion regulation (function and dysfunction) to assess relationships with negative and positive emotional eating. Results identified that higher functional emotion regulation was associated with higher positive emotional eating in the bulimia nervosa, not anorexia nervosa, diagnostic group. Results also showed that higher dysfunctional emotion regulation was associated with lower negative emotional eating (i.e., eating in response to sadness and anger) in the anorexia nervosa diagnostic group. However, in the control group, higher dysfunctional emotion regulation was associated with higher eating in response to anger (Meule et al., 2019). Thus, it is possible that negative and positive emotional eating may be uniquely related to emotion regulation across different eating disorder phenotypes. Because of the exploratory nature of these results, the present study builds on this research to test potential constraints on generality while also examining valence-specific effects of emotional eating and emotion regulation difficulties in relation to DE attitudes, cognitions (e.g., eating, weight, and shape concerns), and behaviors (e.g., dietary restraint) in a non-clinical, university student sample.
The present study builds on theories of emotional eating and emotion regulation (Arnow et al., 1995; Gratz & Roemer, 2004) to examine the association between these variables and DE. To date, research supports the positive relationship between negative emotional eating and DE (Braden et al., 2018; Ricca et al., 2012; Stice, 2002; Tanofsky et al., 1997), as well as the positive relationship between emotion regulation difficulties and DE (Dingemans et al., 2017; Haynos, Wang, & Fruzzetti, 2018; Lavender & Anderson, 2010; Prefit et al., 2019). Limited research, however, has explored these research questions with positive emotional eating (Braden et al., 2018), and because some research points to the positive relationship between positive emotional eating and DE (e.g., the DE behavior binge eating, Sultson et al., 2017), its exploration and associations with emotion regulation is needed across the full spectrum of DE attitudes, cognitions, and behaviors to help address an important gap in the literature. To this end, the present study was exploratory in nature, examining emotion regulation difficulties as a moderator of relationships between negative and positive emotional eating and DE. More specifically, the present study examined if emotion regulation difficulties strengthened relationships between negative and positive emotional eating and dietary restraint, eating, weight, and shape concerns, and global scores of DE.
Section snippets
Participants
University student participants (N = 77; 79% female; Mage = 20.3 (SD = 2.5); MBMI = 26.8 (SD = 6.8); on average, overweight) were analyzed as part of a secondary analysis from the parent study (Braden et al., 2020). Participants' race/ethnicity was mixed, with participants identifying as Caucasian (60%, n = 46), African American (29%, n = 22), Asian (5%, n = 4), Hispanic (3%, n = 2), and not specified (4%, n = 3). Participants’ education was also mixed, with participants identifying as having a
Preliminary results
Means and standard deviations were presented in Table 1. Variability was sufficient and normality of residuals was confirmed using visual inspection of Q-Q plots and histograms. Significant correlations were observed between primary study variables (Table 1). Collinearity diagnostics were calculated to dismiss concerns of multicollinearity between negative and positive emotional eating and emotion regulation. Each independent variable had a tolerance greater than 0.20 and variance inflation
Discussion
Disordered eating represents core eating disorder symptoms related to maladaptive eating phenotypes such as emotional eating (Agras & Telch, 1998; Fischer et al., 2007; Masheb & Grilo, 2006; Ricca et al., 2012; Stice, 2002; Tanofsky et al., 1997). Consistent with previous research (Agras & Telch, 1998; Fischer et al., 2007; Masheb & Grilo, 2006; Ricca et al., 2012; Stice, 2002; Tanofsky et al., 1997), bivariate associations revealed that negative emotional eating was positively associated with
Conclusions
Taken together, the present study further distinguishes negative and positive emotional eating as unique eating phenotypes. Exploratory findings reveal the importance of emotion regulation to uniquely interact with negative and positive emotional eating in relation to DE, namely that negative, not positive, emotional eating was associated with worsened DE outcomes. Researchers and clinicians interested in the full spectrum of emotional eating could leverage these findings when addressing people
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