Emotion Fluctuations in Anorexia and Bulimia Nervosa: A Rollercoaster or Not So Much?

Restricting, bingeing, and purging are powerful ways to regulate emotional states. However, these behaviours probably play different roles in emotional regulation. Whereas restriction is hypothesized to pre-empt the onset of highly emotional states, bingeing and purging is thought to act as a coping mechanism to deal with overwhelming emotional states once they’ve already been activated. 

In BN there is abundant evidence that the binge–purge cycle functions as a means of emotion regulation. Binging [and I would arguing purging too! ] facilitates a temporary suppression of painful self-awareness and helps the self to dissociate from painful emotions or to block negative affect as demonstrated in both laboratory studies and diary studies in daily life.

In AN, restrictive eating patterns have been linked with a narrowing of emotional functioning, flattening of affect and lack of outward display of emotion. As such, Waller, Kennerley, and Ohanian (2007) argue that both binge– vomit-cycle and

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Comorbid PTSD and Eating Disorders: Can Treating One Improve The Other?

Women with bulimia nervosa are three times more likely to struggle with PTSD than women without eating disorders, according to a study by Dansky and colleagues (1997). In that study, 37% of individuals with bulimia nervosa had lifetime PTSD, compared to 12% of women without eating disorders. That’s almost two in five.

Treating eating disorders is hard, but treating eating disorders with comorbid conditions is way harder. There is no consensus, it seems, as to what disorder(s) to treat first, or whether they should be treated simultaneously:

Brewerton (2004) suggests that eating problems should be addressed prior to treating PTSD because bingeing and purging contribute to a state of physical and emotional dysregulation. Fairburn (2008), however, suggests that significant comorbid disorders be treated prior to beginning CBT for eating disorders.

The issue is quite complex,

For example, the presence of severe depression, of which hopelessness and difficulty

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Posttraumatic Stress Disorder in Women with Bulimia Nervosa

Posttraumatic stress disorder (PTSD) is 3-5 times more prevalent in individuals with bulimia nervosa (BN) than those without (Dansky et al., 1997). However, the relationship between PTSD and BN–in particular, how PTSD might affect or moderate bulimic symptoms–remains largely unexplored. In a recent study, Trisha Karr and colleagues followed 119 women (20 with PTSD and BN, and 99 with BN only) for a 2 week period to investigate whether participants with comorbid PTSD + BN differed from those with BN only on the:

  1. Levels of negative affect (negative emotional state/mood) and affect variability (fluctuation between negative and positive states)
  2. Frequency of bulimic behaviours
  3. Relationship between emotional states (negative or positive affect) and bulimic behaviours

They used the ecological momentary assessment (EMA) tool to track behaviours and emotional states close to when they occurI’ve blogged about a study using EMA before (‘What’s The Point of Bingeing/Purging? And Why Continue reading →

Emotion Recognition and Regulation in Anorexia Nervosa

Should anorexia nervosa (AN) – or subtypes of AN – be classified as part of the autism spectrum disorders (ASD)? That’s a question that has been receiving some attention in the literature in the last few years, although there are only a handful of studies, most of which are small and limited in scope (thus limiting interpretation of the results).

In the Time Magazine article  “A Genetic Link Between Anorexia and Autism?” the author mentions a study – which I decided to cover today – on emotion regulation and recognition in patients with AN. It is not directly evaluating the link between AN and ASD, but it is related and a good starting point. I was originally going to write about two papers, but I will save the other one  (Is anorexia nervosa a version of autism spectrum disorders?) for another time.

The study design in this paper … Continue reading →