Emotion dysregulation in childhood promotes anorexia nervosa in teenage, JAMA study

People with anorexia nervosa often experience difficulties regulating their emotions. To assess whether emotion dysregulation in childhood is associated with an increased risk of broad anorexia nervosa in adolescents, Henderson et al conducted a cohort study, the results of which are now published in JAMA Psychiatry. The study shows that difficulties in developing age-appropriate emotion regulation skills in childhood are associated with experiencing broad anorexia nervosa in adolescence.

Anorexia nervosa is a psychiatric disorder typically beginning in adolescence and characterized by restriction of food intake and severe anxiety regarding eating, body shape, and weight gain. Childhood interventions could help to prevent a number of anorexia nervosa cases, yet longitudinal etiological research remains scant, and targets for such interventions are elusive.

Emotion regulation, defined as the ability to both intrinsically and extrinsically monitor, appraise, and modify one's emotional state, has been increasingly proposed as a potential target. It has been hypothesized that emotional avoidance might increase negative affect and the use of maladaptive coping strategies, such as disordered eating behaviors.

Henderson et al used data from the Millennium Cohort Study (MCS) to investigate the association between trajectories of emotion dysregulation across childhood and broadly defined anorexia nervosa at 14 years of age.

Mothers reported on their children's emotion regulation skills at 3, 5, and 7 years of age using the Children's Social Behavior Questionnaire. Multilevel models were used to derive early childhood emotion regulation scores (ie, predicted intercept) and within-child changes in emotion regulation scores from 3 to 7 years of age (ie, predicted slope).

Symptoms consistent with a DSM-5 diagnosis of anorexia nervosa or atypical anorexia nervosa at 14 years of age, defined using a range of questions relative to body image, weight perception, and dieting behaviors (broad anorexia nervosa).

The authors found that children whose emotion regulation skills improved less during the course of childhood and who had greater problems regulating emotions by 7 years of age had increased odds of broadly defined anorexia nervosa at 14 years of age.(Figure)

This association was independent of baseline levels of internalizing and externalizing symptoms, emotion, cognitive self-regulation skills, cognitive development, maternal attachment, BMI, and family characteristics and was consistent across main and sensitivity analyses.

"We observed that although most children experienced improvement in their ability to regulate their emotions between 3 and 7 years of age, this was not the case for those who later developed symptoms consistent with a diagnosis of anorexia nervosa or atypical anorexia nervosa", noted the authors.

Emotion dysregulation might represent an early manifestation of genetic and neurobiological risk. Cognitive rigidity, reward insensitivity, and perfectionism typical of anorexia nervosa could emerge in response to or accompany difficulties regulating negative emotions.

The findings promote universal interventions fostering skills for emotion regulation in this age group, such as building tolerance for uncomfortable feelings and learning how to overcome frustration, could have a preventative role in the emergence of eating disorders and other mental health problems with an onset in adolescence.

Source: JAMA Psychiatry: doi:10.1001/jamapsychiatry.2021.1599