Eating Disorders and Emotions: How Emotion Regulation Impacts Eating Behaviors

Emotional dysregulation, or difficulties in managing and regulating emotions, is often a key factor in the development or sustainment of an eating disorder.

Research shows that individuals with eating disorders frequently struggle with overwhelming emotions such as anxiety, depression, and low self-esteem. [1]

These emotions, in turn, may lead to maladaptive coping strategies, such as frequent binge eating, purging, and other eating disorder behaviors. And this cycle of disordered eating can further exacerbate emotional dysregulation, creating a vicious cycle that is difficult to break.

Indeed, the link between emotion regulation difficulties and eating disorders is complex and multifaceted. But understanding this connection is essential for effective treatment and recovery.

What is Emotion Dysregulation?

Emotion dysregulation is a common aspect of many mood disorders, eating disorders, and other mental health conditions. Broadly, the term refers to poorly managed emotional responses, which fall outside the typically accepted range of emotional reactions.

These reactions can manifest in a number of ways, including:

• Intense emotions: Anger, anxiety, sadness, or irritability are common emotional reactions, which may come on quickly and powerfully and feel difficult to manage.
• Impulsivity: Difficulties in emotion regulation often lead to impulse control difficulties, which can take the form of abrupt or even involuntary decisions or behaviors. [3]
• Rapid mood swings: Emotion dysregulation can cause rapid and unpredictable shifts in mood, making it difficult for someone to maintain stable emotional states.
• Emotion regulation difficulties: Individuals experiencing emotional dysregulation tend to struggle with controlling their emotional responses in social situations, or may lack emotional awareness of their own reactions.

Over time, this condition can significantly impact someone’s quality of life, interfering with their social interactions, relationships with others, and relationship with themself.

Signs and Symptoms of Emotional Dysregulation

While the outward signs of emotion dysregulation may be easier to spot, the condition can also lead to a number of more private signs, symptoms, and struggles, including:

• Low self-esteem: Struggling with emotion regulation may bring on a sense of shame or worthlessness, leading to negative self-talk and low self-esteem.
• Difficulty with interpersonal relationships: Emotional reactivity, mood swings, and other symptoms of emotional dysregulation can make it difficult to maintain social relationships.
• Avoidance behaviors: Avoiding situations that trigger intense emotions is common, and can lead to social isolation and further difficulty maintaining relationships.
• Chronic feelings of emptiness: Some people experience a persistent sense of inner emptiness or numbness, which may result in feelings of despair and hopelessness.

People who struggle with these intense emotions on a regular basis also frequently turn to coping mechanisms to help. Unfortunately, this can include maladaptive coping mechanisms, such as binge eating episodes, purging, diet limitation, or self-harm. [2]

Emotion Dysregulation and Eating Disorders

Emotional dysregulation is closely connected to many eating disorders, including anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED), among others.

It can serve as a primary condition, which contributes to the development of disordered eating behaviors, or develop along with the disorder, and eventually help drive the condition.

Emotion Dysregulation and Emotional Eating

Mood disorders involving depression and anxiety and low self-esteem are frequently co-occurring conditions with eating disorders. [4] And dealing with these intensive emotions on a regular basis can be difficult and exhausting on a mental, emotional, and spiritual level.

To help them cope with these intense emotions, many people turn to food. An array of eating disorder symptoms, including binge eating, purging episodes, or extreme diet limitations, may be utilized to help someone either release these unpleasant emotions or feel some sense of control over them. [4]

However, forging this mental, emotional, and physical connection can lead to significant and lasting problems with eating and body image. What starts out as a coping mechanism can easily develop into a full-blown eating disorder.

Disordered Eating and Mood Fluctuation

It’s also possible for someone to develop greater issues with emotion regulation as their eating disorder progresses.

Whether it involves the restriction of food intake or the fluctuations between binging and purging, an eating disorder will nearly always have a significant impact on someone’s overall nutrition and energy levels, among other aspects of their physical health.

When these essential factors are out of balance, it can send off a cascade of hormonal reactions, which can result in mood swings, irritability, trouble sleeping, fatigue, and other issues commonly associated with emotion dysregulation.

Emotion Regulation Strategies and Treatment

Emotion dysregulation is a major driver of many mental health conditions. As such, there have been a number of therapies and strategies developed to help people regulate emotions or achieve more regular emotional functioning.

While these techniques vary in approach and philosophy, the common factor among them is helping someone learn to recognize their negative emotions, and finding healthier ways to manage these intense feelings.

Dialectical Behavior Therapy

Dialectical behavior therapy (DBT) was expressly developed to help people better regulate their emotions.

While first conceived to help people struggling with borderline personality disorder, a mental health condition defined by extreme emotion dysregulation, the therapy has since been adapted to help people with eating disorder diagnoses.

The therapeutic approach teaches a number of emotion regulation strategies, including:

• Mindfulness: An emphasis on the present moment, which can help people create space between themselves, their emotions, and their reactions to the world around them.
• Distress tolerance: A skill set that is designed to help someone better accept or cope with their current situation, even if it’s unpleasant.
• Interpersonal effectiveness: Strategies that help someone express their needs better and more assertively, while simultaneously maintaining positive and healthy relationships.

While DBT aims to help individuals develop a more balanced relationship with their emotions, it can also help address the complex psychological issues that are often at the heart of eating disorders. [5]

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a goal-oriented, problem-solving therapy, which identifies and challenges negative thought patterns and beliefs.

This approach operates on the idea that unhelpful behaviors stem from unhelpful thoughts. It helps individuals learn to first identify, then redirect, and, eventually, change these unhelpful thoughts, which hopefully leads to a positive change in behavior.

When used to treat emotional dysregulation, this approach can help individuals identify and change the thoughts and behaviors contributing to their emotional distress. The hope is that learning to identify these patterns can help someone more clearly understand their reactions and more effectively manage their emotions.

In particular, CBT is commonly used for treating emotional dysregulation associated with an array of eating disorders, anxiety disorders, and other mood disorders. [6]

Acceptance and Commitment Therapy

Acceptance and commitment therapy (ACT) is another therapeutic approach designed to help people more positively and proactively deal with negative thoughts and feelings.

Rather than attempting to stop or change certain thoughts or thought patterns, the method instead encourages patients to understand and accept their less-pleasant thoughts as part of a normal spectrum of emotions. The energy that would be used to redirect these thoughts is then instead directed toward building healthier and more positive hobbies, habits, and interests.

ACT deploys a number of psychological strategies to help patients disassociate their “self” from their thoughts. This newfound psychological space is then used to help them have more measured, healthy, and positive reactions to situations.

The strategy has also been found to increase psychological flexibility, which is an underlying factor of many eating disorders and mental disorders in general.

Finding Help for Emotional Issues and Eating Disorders

If you or a loved one are struggling with emotion dysregulation or eating disorder behaviors, it’s pivotal to find help. These conditions are dangerous, and can be deadly if left untreated.

If you’re unsure where to start, you may want to first speak with a healthcare professional. This can include your primary care physician, therapist, psychiatrist, or another trusted medical professional.

These experts are often educated in a number of disordered eating and mental health conditions, and they can help assess symptoms, make an official diagnosis, or recommend the best next steps for finding treatment.

If you’d rather not broach the topic with someone face-to-face, there are a number of eating disorder hotlines and mental health hotlines that can offer additional help. These services are generally free and almost always anonymous, providing additional information and resources on certain eating disorder behaviors, emotion regulation strategies, and ideas on where to find help.

Regardless, finding support for emotional dysregulation and eating disorders is essential for recovery. It’s important to know that help is available, and taking the first step towards seeking assistance can be a pivotal moment in the healing journey.

Resources

1. Ruscitti C, Rufino K, Goodwin N, & Wagner R. (2016). Difficulties in emotion regulation in patients with eating disorders. Borderline Personality Disorder and Emotion Dysregulation; 3:3.
2. Henderson ZB, Fox JRE, Trayner P, & Wittkowski A. (2019). Emotional development in eating disorders: A qualitative metasynthesis. Clinical Psychology & Psychotherapy; 26(4):440–457.
3. Waxman SE. (2009). A systematic review of impulsivity in eating disorders. European Eating Disorders Review: The Journal of the Eating Disorders Association; 17(6): 408–425.
4. Sander J, Moessner M, & Bauer S. (2021). Depression, Anxiety and Eating Disorder-Related Impairment: Moderators in Female Adolescents and Young Adults. International Journal of Environmental Research and Public Health; 18(5):2779.
5. Pennell A, Webb C, Agar P, Federici A, & Couturier J. (2019). Implementation of Dialectical Behavior Therapy in a Day Hospital Setting for Adolescents with Eating Disorders. Journal of the Canadian Academy of Child and Adolescent Psychiatry; 28(1):21–29.
6. Grosse Holtforth M, Krieger T, Zimmermann J, Altenstein-Yamanaka D, Dörig N, Meisch L, & Hayes AM. (2019). A randomized-controlled trial of cognitive-behavioral therapy for depression with integrated techniques from emotion-focused and exposure therapies. Journal of the Society for Psychotherapy Research; 29(1):30–44.

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The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Updated on September 19, 2023, on EatingDisorderHope.com