Emotion Regulation Challenges Among Teenage Girls Who Have Anorexia or Depression

Girl walking and struggling with Emotion Regulation

Contributor: Staff at Timberline Knolls Residential Treatment Center

Given the physical, psychological, and social transformations that are characteristic of adolescence, it is not uncommon for a teen to experience temporary challenges related to healthy or appropriate emotion regulation strategies.

For teenage girls who have developed anorexia nervosa or a depressive disorder, the likelihood that they may engage in unhealthy emotion regulation strategies may be more pronounced. In turn, these dysfunctional or self-defeating strategies may exacerbate their struggles with anorexia and depression.

Healthy vs. Unhealthy Emotion Regulation

As defined by Abigail Rolston, B.A., and Elizabeth Lloyd-Richardson, Ph.D., in a document created for the Cornell Research Program on Self-Injury and Recovery, emotion regulation refers to “a person’s ability to manage and respond to an emotional experience effectively.”

Rolston and Lloyd-Richardson cited meditating, talking with friends, seeking therapy, and maintaining appropriate self-care as examples of healthy emotion regulation. Unhealthy emotion regulation strategies, they noted, include substance use, self-harm, aggression, and withdrawal.

Rolston and Lloyd-Richardson also observed that adolescence can be a “particularly precarious” time, with adolescent girls at elevated risk for interpersonal stress, which can prompt them to employ unhealthy emotion regulation strategies.

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In a 2015 study that was published by the journal Frontiers in Psychology, lead author Ines Wolz of the University of Tübingen and her co-authors cite a relationship between emotion regulation, body image, and disordered eating. The authors also report that, in the absence of appropriate emotion regulation strategies, individuals may engage in unhealthy eating behaviors in an attempt to control or process their emotions, which can lead to the onset of an eating disorder.

Increased Risk Among Teenage Girls Who Have Anorexia or Depression

According to a 2019 study that was published by the Journal of Eating Disorders, both anorexia and depression can predispose adolescent girls to struggle with maladaptive emotion regulation strategies. The study was led by Anca Sfärlea and Sandra Dehning, both of whom are affiliated with the Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy at University Hospital, Ludwig Maximilian University of Munich.

Girl sad about Anorexia RecoverySfärlea and Dehning’s study involved 86 girls ages 12-18. Twenty-five of the study’s subjects were experiencing anorexia nervosa, 26 had been diagnosed with major depression, and 35 had neither condition. The girls who had either anorexia or depression had received either inpatient or outpatient care at University Hospital Munich. The girls in the “healthy” group had been recruited either from previous studies or via local advertisements.

Sfärlea and Dehning determined that the girls who had anorexia or major depression were much more likely than those in the “healthy” group to struggle with maladaptive emotion regulation. For purposes of this study, the researchers identified acceptance, problem-solving, and reappraisal as examples of appropriate or adaptive emotion regulation strategies. They listed rumination, avoidance, and suppression as examples of maladaptive emotion regulation strategies.

Potential Impact of Emotion Regulation on Treatment

In Sfärlea and Dehning’s study, the girls in the anorexia nervosa and major depression groups also demonstrated an increased prevalence of alexithymia, which is an impaired ability to recognize or discuss one’s emotions.

The authors of a 2017 study by researchers at the University of California San Diego and Dartmouth College reported that difficulties related to alexithymia appear to have a greater impact on emotion dysregulation among patients who were treated for anorexia nervosa.

A 2019 study from the United Kingdom suggests that alexithymia may complicate the treatment process. “It has been frequently observed that people experiencing alexithymia may find it difficult to engage with and benefit from psychological therapy,” the authors of the UK study wrote.

The Value of Comprehensive Care

As the multiple studies cited in previous sections indicate, the risks associated with anorexia nervosa and depression are not limited to the symptoms that are directly linked to these disorders. Unhealthy emotion regulation strategies and alexithymia are two of the many potential effects that can further complicate the lives of individuals who develop anorexia or a depressive disorder.

Woman outside with belief shes overweightAnorexia is more common among adolescents than among adults, and more prevalent among girls than among boys. In the abstract of a 2016 study in the journal European Child & Adolescent Psychiatry, the authors report that “symptomatic anorexia nervosa showed the earliest onset with a considerable proportion of cases emerging in childhood.” The authors also observed that “eating disorder symptomatology is common, particularly in female adolescents and young women.”

For teen girls who have developed anorexia, an elevated risk for concerns such as depression, emotion regulation difficulties, and alexithymia is among the many reasons why comprehensive treatment may be most valuable. Effective care that can identify and properly address the full scope of a teen girl’s physical, mental, and behavioral health needs can best prepare her to make sustained progress toward improved well-being.


Brown, T.A.; Avery, J.C.; Jones, M.D.; Anderson, L.K.; Wierenga, C.E.; and Kaye, W.H. The Impact of Alexithymia on Emotion Dysregulation in Anorexia Nervosa and Bulimia Nervosa over Time. Eur Eat Disord Rev. 2018 Mar;26(2):150-155. doi: 10.1002/erv.2574. Epub 2017 Dec 21. PubMed PMID: 29266572. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29266572

Hemming, L.; Haddock, G.; Shaw, J.; and Pratt, D. (2019) Alexithymia and Its Associations with Depression, Suicidality, and Aggression: An Overview of the Literature. Front. Psychiatry 10:203. doi: 10.3389/fpsyt.2019.00203

Nagl, M.; Jacobi, C.; Paul, M.; Beesdo-Baum, K.; Höfler, M.; Lieb, R.; Wittchen, H.U. Prevalence, incidence, and natural course of anorexia and bulimia nervosa among adolescents and young adults. Eur Child Adolesc Psychiatry. 2016 Aug;25(8):903-18. doi: 10.1007/s00787-015-0808-z. Epub 2016 Jan 11. PubMed PMID: 26754944. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26754944

Rolston, A. and Lloyd-Richardson, E. What is emotion regulation, and how do we do it? Cornell Research Program on Self-Injury and Recovery. Retrieved from http://selfinjury.bctr.cornell.edu/perch/resources/what-is-emotion-regulationsinfo-brief.pdf

Sfärlea, A.; Dehning, S.; Keller, L.K.; et al. Alexithymia predicts maladaptive but not adaptive emotion regulation strategies in adolescent girls with anorexia nervosa or depression. J Eat Disord 7, 41 (2019) doi:10.1186/s40337-019-0271-1

Wolz, I.; Agüera, Z.; Granero, R.; Jiménez-Murcia, S.; Gratz, K.L.; Menchón, J.M.; and Fernández-Aranda, F. (2015) Emotion regulation in disordered eating: Psychometric properties of the Difficulties in Emotion Regulation Scale among Spanish adults and its interrelations with personality and clinical severity. Front. Psychol. 6:907. doi: 10.3389/fpsyg.2015.00907

About Our Sponsor:

Timberline Knolls Residential Treatment Center, which is located in suburban Chicago, Illinois, provides comprehensive, personalized services in a supportive, gender-specific environment for adolescent girls and adult women who have developed eating disorders, substance use disorders, and certain co-occurring mental health concerns, including depressive disorders. Treatment options at Timberline Knolls include residential care and partial hospitalization. Additional features include specialized faith-based services, family support, and a robust alumnae program.

The opinions and views of our guest contributors are shared to provide a broad perspective of 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.

Reviewed & Approved on January 6, 2020, by Jacquelyn Ekern MS, LPC
Published January 6, 2020, on EatingDisorderHope.com