Emotions & Eating Disorders

Woman sitting in desert struggling with Bulimia Nervosa

What does the word emotions mean to you? For many people, the word brings up images of sadness, grief, and crying. Or perhaps when you hear the word emotions, you think of joy, excitement, or laughter. What emotions are invoked when you think about eating disorders?

While emotions do, indeed, regulate whether we feel like crying or laughing, they do so much more than that. The truth is, emotions play important roles in every aspect of our lives, guiding our decision-making, actions, motivations, goals, learning, and so much more.

As one study on emotions attests, to behave beneficially, “it is necessary and functional to be able to both act upon and inhibit emotions” [1]. In other words, our ability (or lack thereof) to recognize and properly regulate our emotions determines how we act and respond to the world around us and decides whether or not we behave in healthy, beneficial ways.

The Connection Between Emotions & Eating Disorders

Given that emotional regulation plays such a critical role in our lives–from guiding healthy behaviors to determining goals and decision making–researchers have begun to explore the connection between emotions and eating disorders. Interestingly, recent studies show that people with eating disorders report more emotional suppression and avoidance, lower emotional awareness, problems with emotional management, and less ability to use adaptive strategies to regulate emotions than compared to people in healthy control groups [2].

One recent study conducted on female ED patients at the AnorexiBulimiCenter (ABC) in southern Sweden found that all patients described some degree of problematic and unhealthy experiences with their emotions [3]. More specifically, the study results uncovered four main categories of emotional dysregulation among ED patients:

  1. Not knowing what one feels
  2. Switch off, run away, or hide behind a mask
  3. Emotions in a lifelong perspective
  4. Using eating disorder behaviors to regulate emotions

For example, all patients, except one, described difficulties distinguishing emotions. This inability to identify their various emotions led to feelings of chaos, confusion, and anxiety. One patient described it this way: “At times, everything’s just chaos in my head, and I don’t really know what I feel. “I usually try to describe it as (…), as I usually say like fireworks in my brain” [4].

Similar to other findings, the participants in the Sweden study also reported high levels of emotional suppression. Some described how they tried to “switch off” their emotions or run away from them, while others attempted to suppress their emotions by “hiding behind a mask.”

One respondent described it this way, “You don’t want to feel (anything), you try to run from it and push everything away (…)” [5]. Another opened up about how she used emotions such as joy to mask what she was really feeling inside: “It gets easy to put on that mask and pretend to be happy all the time, I guess (…) I walked around like a robot and just did everything while I helped out around the house and carried on” [6].

Another participant said it this way: “I’m so switched off and so used to going around and pretending to be happy all the time, that even joy becomes so charged since I get so I don’t really know when I’m really happy” [7].

Emotion Dysregulation and Eating Disorder Behaviors

Woman feeling joy in recovery from Eating DisordersPerhaps most importantly, the researchers discovered that emotional dysregulation (defined as the inability to respond to and manage emotions in a healthy and socially acceptable way) among ED patients was directly linked to eating disorder behaviors [8]. In other words, participants turned to ED behaviors (e.g., excessive exercise, caloric restriction, binge eating, and purging) as a way to cope with/escape unpleasant or confusing emotional experiences.

The connection between emotion dysregulation and ED behaviors is exemplified in the following three participant responses [9]:

  • “The eating disorder has been a kind of control, a (way) to withhold feelings, I suppose.”
  • “The eating disorder is a way to handle anxiety and depression.”
  • “It’s easier when you can flee to and be ‘within’ the eating disorder; it’s easier when I can reduce my world to this.”

Treating Emotions & Eating Disorders

In light of these and other findings, several studies now conclude that emotion dysregulation is a transdiagnostic feature of eating disorders [10], [11]. In fact, one study attests that higher degrees of emotion dysregulation among ED patients are directly correlated to more severe ED symptomatology [12]. Meaning ED patients who report higher levels of emotional dysregulation tend to display worse ED symptoms and behaviors than patients who have fewer difficulties with emotional regulation.

While researchers are not yet certain if emotion dysregulation precedes the eating disorder diagnosis or if it develops later as a result of the eating disorder, some studies suggest that problems with emotional regulation may be a risk factor for the development of EDs. However, regardless of whether emotional difficulties come first or if they are a result of ED, it is clear that problems with emotional regulation play a critical role in the maintenance of eating disorder behaviors.

As such, it is critical for ED specialists and treatment programs to address emotional regulation in their treatment approach. Therapies such as cognitive-behavioral therapy (CBT) and dialectical behavior therapy (DBT) help patients uncover emotional dysregulation and teach effective, healthy ways to cope with emotions.

If you or a loved one are struggling with emotional difficulties and have a history of ED, consider reaching out to a therapist or a treatment program that addresses both ED symptoms and underlying emotional dysregulation.


References:

[1] Petersson, S., Gullbing, L. & Perseius, KI. Just like fireworks in my brain – a Swedish interview study on experiences of emotions in female patients with eating disorders. J Eat Disord 9, 24 (2021). https://doi.org/10.1186/s40337-021-00371-2
[2] ibid.
[3] ibid.
[4] ibid.
[5] ibid.
[6] ibid.
[7] ibid.
[8] ibid.
[9] ibid.
[10] Monell E, Clinton D, Birgegård A. Emotion dysregulation and eating disorders—associations with diagnostic presentation and key symptoms. Int J Eat Disord. 2018;51:921–30. https://doi.org/10.1002/eat.22925.
[11] Prefit AB, Cândea DM, & Szentagatai-Tătar A. Emotion regulation across eating pathology: a meta-analysis. Appetite, 2019;143;104438. https://doi.org/10.1016/j.appet.2019.104438.
[12] Racine SE, Wildes JE. Emotion dysregulation and symptoms of anorexia nervosa: the unique roles of lack of emotional awareness and impulse control difficulties when upset. Int J Eat Disord. 2013;46(7):713–20. https://doi.org/10.1002/eat.22145.


About the Author:

Sarah Musick PhotoSarah Musick is a freelance writer who specializes in eating disorder awareness and education. After battling with a 4-years long eating disorder, she made it her mission to help others find hope and healing in recovery.

Her work has been featured on numerous eating disorder blogs and websites. When she’s not writing, Sarah is off traveling the world with her husband.


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.

Published April 16, 2021, on EatingDisorderHope.com
Reviewed & Approved on April 16, 2021, by Jacquelyn Ekern MS, LPC

About Baxter Ekern

Baxter is the Vice President of Ekern Enterprises, Inc. He is responsible for the operations of Eating Disorder Hope and ensuring that the website is functioning smoothly.