Difficulties in developing emotion regulation skills in childhood are associated with developing anorexia nervosa in adolescence, according to a cohort study published in JAMA Psychiatry.

Emotion regulation — “the ability to both intrinsically and extrinsically monitor, appraise, and modify one’s emotional state” — has been proposed as a target for identifying young people at risk of developing anorexia. In clinical samples, adolescents with anorexia show poor emotion regulation and lower tolerance for distress compared with adolescents without an eating disorder.

The study used data from the Millennium Cohort Study, a UK-based longitudinal population-based birth cohort study of children born from September 1, 2000, to January 11, 2002. A total of 15,896 participants provided data for at least one emotion regulation assessment. The participants were nearly equally split between boys (51.0%) and girls (49.0%).


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Of the 9912 participants who completed all exposure and outcome data, 1.0%, mostly girls, showed symptoms of anorexia nervosa in adolescence. Prevalence was lower in boys (0.2%). The researchers found no evidence of poor emotion regulation at 3 and 5 years of age and broad anorexia at age 14. There was a stronger association at 7 years of age.

The study has limitations. For example, the cohort study did not gather information on binge eating and purging, which means some participants classified under broad anorexia nervosa could have had bulimia or a binge eating disorder. Some adolescents could have also transitioned to a different type of eating disorder after age 14. The questionnaires did not ask whether participants were happy with their current weight. To assess teens who were dissatisfied with their weight, the study looked at teens who overestimated their weight.

If the associations the researchers found were causal, they concluded, “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.”

Reference

Henderson M, Bould H, Flouri E, et al. Association of emotion regulation trajectories in childhood with anorexia nervosa and atypical anorexia nervosa in early adolescence. JAMA Psychiatry. Published online July 7, 2021. doi:10.1001/jamapsychiatry.2021.1599