Impaired psychosocial functioning and emotion regulation difficulties in eating disorders: a cross-sectional study

Abstract

Eating disorders (EDs) are severe mental disorders marked by disturbed eating and body-related concerns, leading to significant distress and impairment. However, psychosocial functioning in ED diagnoses remains understudied. Emotion dysregulation is a central feature of EDs, linked to their development and severity, and is known to predict functional impairment in other mental disorders. However, its role in psychosocial functioning in EDs remains unclear. This cross-sectional study aimed to compare psychosocial functioning across ED diagnoses, identify subgroups based on emotion dysregulation, and examine the association between emotion regulation and psychosocial functioning while controlling for key clinical and demographic factors. In total, n = 193 women were recruited from a specialised ED clinic. All were assessed with diagnostic interview and self-report questionnaires. The questionnaires measured psychosocial functioning, emotion dysregulation, depression, anxiety and non-suicidal self-injury (NSSI). Psychosocial functioning was compared across five ED groups: anorexia nervosa restrictive type (ANr) (n = 30), anorexia nervosa binge eating/purging type (ANbp) (n = 32), bulimia nervosa (BN) (n = 74), other specified feeding or eating disorders atypical anorexia nervosa (OSFED AN) (n = 25), and OSFED bulimia nervosa/purging disorder (OSFED BN) (n = 32). Emotion regulation sub-groups were extracted through latent class analysis (LCA). A hierarchical linear regression examined the impact of emotion regulation on psychosocial functioning, controlling for age, depression, and anxiety. Patients with ANr and OSFED BN showed the lowest levels of psychosocial impairment, whereas those with BN and OSFED AN had the most impaired functioning. A latent class analysis revealed three distinct emotion dysregulation profiles; low, intermediate and high emotion dysregulation. These were significantly associated with eating pathology, depression, anxiety, NSSI, and compensatory behaviours. Emotion dysregulation was not a significant predictor of psychosocial functioning when controlling for age and symptoms of depression and anxiety; instead, depression and ED diagnosis accounted for significant variance. Psychosocial functioning differed across EDs but was not explained by emotion dysregulation. Three emotion dysregulation profiles were found that were associated with symptom severity. In this study, we examined how women with different eating disorders function in daily life and whether they differ in how they manage their emotions. We also examined whether difficulties with managing emotions were related to everyday functioning. We collected data from 193 women seeking care for an eating disorder at Uppsala University Hospital. Participants completed questionnaires measuring daily functioning, difficulties with managing emotions, depression, anxiety, and self-harm. We found that women with bulimia nervosa and atypical anorexia nervosa reported greater difficulties in daily functioning than women with other eating disorders. We also identified three groups based on difficulties managing emotions: one with few difficulties, one with moderate difficulties, and one with severe difficulties, such as difficulty accepting negative emotions or controlling impulsive behaviour. Women with greater difficulties managing their emotions had more severe eating disorder symptoms, higher levels of depression and anxiety, and more frequent self-harm. However, they reported less use of laxatives and diuretics than women with fewer difficulties managing their emotions. In addition, after taking depression and anxiety into account, difficulties managing emotions were no longer linked to daily functioning.