How Does Emotion Regulation Affect Food Addiction in PTSD?

Avoidance Coping Strategies Linked to Depression, Anxiety in Student Veterans
Avoidance Coping Strategies Linked to Depression, Anxiety in Student Veterans
Veterans remain understudied in the field of eating disorders, possibly due to the misperception that men are not affected by them.

Researchers from Boston have found that in veterans, expression suppression was significantly associated with eating disorder (ED) symptoms and mediated the connection between PTSD and food addiction. The findings were published in Psychiatry Research.

“Findings from clinical and community samples of veterans suggest that rates of EDs are comparable to, and possibly higher than, rates of EDs among women and men in the general population, underscoring the need for further investigation of ED-related constructs among veterans,” wrote Karen S. Mitchell, PhD, from the National Center for PTSD in the VA Boston Healthcare System, and Erika J. Wolf, PhD, from the Department of Psychiatry at Boston University School of Medicine. “However, [veterans] remain understudied in the field of EDs, possibly due to the misperception that members of this traditionally male population are not affected by [them].”

The researchers investigated associations among PTSD, emotion regulation, ED symptoms, and food addiction in a population-based sample of 860 veterans (787 men and 73 women) who were recruited from a larger study of 3156 veterans who participated in a GfK Knowledge Networks, Inc. study in 2011.

The aims of the current study were: 1) to report rates of PTSD, EDs, and food addiction in the population of veterans; 2) to assess direct associations between PTSD and food addiction and ED symptoms, with a focus on men; and 3) to examine emotion regulation’s mediating role in linking PTSD to ED and food addiction symptoms.

The researchers used the Eating Disorder Diagnostic Scale (EDDS) to determine symptoms of anorexia nervosa, bulimia nervosa, and binge eating disorder; the Yale Food Addiction Scale (YFAS) to assess food addiction symptoms; and the National Stressful Events Survey (NSES) to assess trauma exposure as well as lifetime and current symptoms of DSM-5 PTSD symptoms.

They found that the maladaptive coping mechanism of expressive suppression was associated with ED symptoms, but not the adaptive coping mechanism of cognitive reappraisal. This points to the maladaptive suppression of emotion as a potential pathway from PTSD to EDs.

“We found that PTSD was significantly associated with ED symptoms as well as food addiction symptoms in this primarily male sample of older veterans… To date, only one previous study has examined the association between PTSD and food addiction2 and was focused on women only; our results support this finding in a sample of men as well,” the authors wrote.

However, contrary to the researchers’ expectations, neither cognitive reappraisal nor expressive suppression was significantly associated with food addiction scores in the final model.

“Emotion dysregulation, which has been associated with both PTSD and disordered eating, is a multifaceted trait. Future research should explore whether additional emotion regulation constructs, such as acceptance of emotions, emotional avoidance, and impulsivity, mediate the PTSD—food addiction/disordered eating association,” the authors concluded.


1. Mitchell KS, Wolf EJ. PTSD, food addiction, and disordered eating in a sample of primarily older veterans: The mediating role of emotion regulation. Psychiatry Res. 2016;243:23-29. doi:10.1016/j.psychres.2016.06.013. [Epub ahead of print]

2. Mason SM, Flint AJ, Roberts AL, Agnew-Blais J, Koenen KC, Rich-Edwards JW. Posttraumatic stress disorder symptoms and food addiction in women by timing and type of trauma exposure. JAMA Psychiatry. 2014;71:1271-1278. doi:10.1001/jamapsychiatry.2014.1208.