Jennifer Svaldi

Emotion regulation deficits in eating disorders: a marker of eating pathology or general psychopathology?

Preliminary evidence indicates that individuals with eating disorders (ED) show emotion regulation (ER) difficulties. However, it is yet unclear whether different types of ED differ in their ER profile and whether certain ER difficulties are specific for ED or rather a transdiagnostic factor. Twenty women with anorexia nervosa (AN), 18 with bulimia nervosa (BN), 25 with binge eating disorder (BED), 15 with borderline personality disorder (BPD), 16 with major depressive disorder (MDD) and 42 female healthy controls (HC) were administered the Emotion Regulation Questionnaire, the Inventory of Cognitive Affect Regulation Strategies, the Difficulties in Emotion Regulation Scale and the Affect Intensity Measure. The ED groups reported significantly higher levels of emotion intensity, lower acceptance of emotions, less emotional awareness and clarity, more self-reported ER problems as well as decreased use of functional and increased use of dysfunctional emotion regulation strategies when compared to HC. No significant differences between the ED groups emerged for most ER variables. However, there were indications that the BED group may show a slightly more adaptive pattern of ER than the two other ED groups. As a whole, all clinical groups performed very similar on most ER variables and reported more difficulties regulating their emotions than HC. The findings suggest that ER difficulties are not linked to a particular diagnostic category. Instead, ER difficulties appear to be a transdiagnostic risk and/or maintenance factor rather than being disorder-specific.

Decision-making impairments in women with binge eating disorder.

Even though eating is frequently driven by overindulgence and reward rather than by energy balance, few studies so far have analyzed decision-making processes and disturbances in feedback processing in women with binge eating disorder (BED). In an experimental study, 17 women with BED (DSM-IV) and 18 overweight healthy controls (HC) were compared in the game of dice task (GDT). This task assesses decision-making under risk with explicit rules for gains and losses. Additionally, differences in dispositional activation of the behavior inhibition and behavior approach system as well as cognitive flexibility were measured. Main results revealed that women with BED make risky decisions significantly more often than HC. Moreover, they show impaired capacities to advantageously utilize feedback processing. Even though these deficits were not related to disease-specific variables, they may be important for the daily decision-making behavior of women with BED, thus being relevant as a maintenance factor for the disorder.

General and food-specific inhibitory deficits in binge eating disorder

OBJECTIVE To investigate behavioral inhibition in individuals with binge eating disorder (BED) compared with overweight and obese individuals without BED (No-BED). METHOD Participants with BED (n = 31) and the weight-matched No-BED group (n = 29) completed an inhibitory control task (stop-signal task, SST) with food and neutral stimuli. RESULTS The BED group needed more time to stop an ongoing response, as indicated by increased stop signal reaction time (SSRT) relative to the No-BED group. Additionally, compared with the No-BED group, the BED group displayed more difficulty inhibiting responses elicited by food stimuli. The deficits in behavioral response inhibition were also found to be related to the severity of reported symptoms. DISCUSSION There is a general deficit in late stage behavioral inhibition in BED, and this may be particularly pronounced in the context of food stimuli.

Emotion regulation predicts symptoms of depression over five years.

Deficits in emotion regulation have been identified as an important risk and maintaining factor for depression. The aim of this study was to examine the long-term effects of emotion regulation on symptoms of depression. Moreover, we investigated which specific emotion regulation skills were associated with subsequent symptoms of depression. Participants were 116 individuals (78% women, average age 35.2 years) who registered for an online-based assessment of depression and its risk-factors and reported at least some symptoms of depression. Successful application of emotion regulation skills and depressive symptom severity were assessed twice over a 5-year period. We utilized cross-lagged panel analyses to assess whether successful skills application would be negatively associated with subsequent depressive symptom severity. Cross-lagged panel analyses identified successful skills application as a significant predictor for depressive symptom severity even when controlling for the effects of initial symptoms of depression. A comparison of the effect sizes for different emotion regulation skills on subsequent depressive symptoms suggests that most of the skills included have similar predictive value. These findings provide preliminary evidence for the hypotheses that deficits in emotion regulation may contribute to the development of depression and that interventions systematically enhancing adaptive emotion regulation skills may help prevent and treat depressive symptoms.

Information processing of food pictures in binge eating disorder

Previous research has yielded evidence of attentional biases for food-related cues in binge eating disorder (BED) using behavioural measures such as the Stroop and dot probe paradigm. Being a more direct measure of attentional processing, the present study used event related potentials (ERPs) to test reactivity to high caloric and low caloric food pictures in women with BED compared to overweight healthy female controls (HC). In order to detect a possible motivational ambivalence, self-report and psychophysiological measures of the sympathetic and parasympathetic response system were assessed additionally. The main results yielded evidence that in women with BED high caloric food pictures elicit larger long latency ERPs compared to HC. By contrast, no such group difference was found for low caloric food pictures. Peripheral measures did not yield any group differences with respect to the processing of the caloric value of food. The results suggest that for women with BED, high caloric food may have high motivational properties and consume large parts of attentional resources. In the context of an environment in which high caloric food is omnipresent, such an abnormal processing may be relevant for the maintenance of the disorder.

Emotion suppression but not reappraisal increases desire to binge in women with binge eating disorder.

For each dependent variable, a 2 (group) ! 3 (instruction) ! 2 (time) repeated-measures ANCOVA with BMI as a covariate was computed. When statistically justified, additional 2 (group) ! 2 (time) ANCOVAs for each instruction were computed. All clips significantly increased sadness ratings (all F 1 62.2 and p ! 0.01). DTB increased from baseline to post-film in the EG after watch and suppress instructions, but not after the reappraise instruction. For HC, no changes occurred. Even when controlling for BDI, the 3-way interaction remained significant (F 2, 88 = 3.96, p = 0.023). Regarding parasympathetic activation, HF-HRV decreased in the EG in response to the watch and the suppress instruction, while under these conditions there was an increase in the HC. Under the reappraise instruction, no changes in HF-HRV occurred, but LF-HRV decreased in HC and slightly increased in the EG. No substantial results were found on the sympathetic branch (cardiac interbeat interval, skin conductance level, finger pulse transit time; table 1 ). Compared to HC, the EG scored significantly lower on ERQ reappraisal (F 1, 48 = 5.63, p = 0.022; EG: 3.89 8 0.27, HC: 4.88 8 0.27) and significantly higher on ERQ suppression (F 1, 48 = 13.1, p = 0.001; EG: 3.57 8 0.27, HC: 2.09 8 0.27), TAS global , (F 1, 48 = 18.3, p ! 0.000; EG: 49.3 8 10.1, HC: 39.3 8 5.95), TAS identification (F 1, 48 = 15.6, p ! 0.000; EG: 18.1 8 1.17, HC: 11.1 8 1.19) and TAS describing (F 1, 48 = 12.2, p = 0.001; EG: 15.2 8 0.66, HC: 11.7 8 0.67). There were no significant differences on the TAS thinking (F 1, 48 = 0.992, p = 0.324; EG: 16.7 8 0.70, HC: 15.7 8 0.72) and no significant correlations of self-report questionnaires with DTB. The results of the ERQ revealed that women with BED dispositionally suppress more and reappraise their emotions less than HC. As experimental data shows, contrary to reappraisal, suppression leads to increased food craving and a decrease in parasympathetic activation in women with BED. When instructed to watch or suppress, the HC reacted with an increase in parasympathetic activation, which may function as an adaptive reaction to the sadness-evoking film [16] . Such adaptation does not seem to be necessary during execution of reappraisal, which already aims at a shift of attention. By contrast, reappraisal makes some cognitive demands upon women with BED, as shown in the sympathetic increase (LF-HRV) from baseline to post-film. This could be due to the fact that it may be difficult to reappraise emotions without recognizing the link with sadness itself, as indicated by BED women’s higher alexithymia scores. A possible criticism is the lack of randomization of the film clips and instructions. Randomization of clips would have produced loss of statistical power due to the production of very heterogeneous physiological data. However, empirical data showed that these film clips were able to induce sadness on a comparable level [17] . Instructions were presented in a fixed order because we reasoned that participants would not indulge in suppression once they had experienced the alleviating effect of reappraisal. A further limitation concerns the assessment of control emotions. While results remained unaffected when controlling for BDI Several studies have suggested that negative emotions may have a causal impact on the occurrence of binge eating [1–5] in binge eating disorder (BED). Furthermore, emotion regulation (ER) is known to influence the course of emotional experience [6, 7] , and there is some evidence of ER deficits in BED patients [8, 9] . We therefore tested the causal role of ER as a mediator in the link between negative emotions and desire to binge (DTB). The experimental group (EG) consisted of 27 women with a DSM-IV [10] diagnosis of BED, and the control group (HC) consisted of 25 healthy overweight women [for exclusion and inclusion criteria, see 11 ]. Groups did not differ significantly on age (means 8 SD; EG: 42.7 8 11.6 years, HC: 38.3 8 13.8 years; F 1, 51 = 1.57, n.s.), but the EG had a significantly higher BMI (EG: 36.7 8 3.89, HC: 33.8 8 6.53; F 1, 51 = 14.5, p ! 0.000) and Beck Depression Inventory (BDI) score (EG: 14.7 8 7.80, HC: 3.0 8 2.70; F 1,51 = 50.6, p ! 0.000). Women in the EG had 4.00 8 2.61 binges per week over the past 6 months. Participants watched 3 sadness-inducing film clips [12] , each preceded by a different instruction: (1) watch the clip; (2) watch the clip and suppress; (3) watch the clip reappraise upcoming emotions [13] . DTB was computed by the sum of the items: ‘At the moment, I would really like to eat something; I could not resist a savory meal; I am hungry; I would eat more than I usually do’ (Cronbach’s 6 0.84). Sadness and DTB were rated on a Likert scale ranging from 1 (not at all) to 8 (extremely). Cardiac interbeat interval (ms), skin conductance level, finger pulse transit time, high-frequency heart rate variability (HF-HRV), and low-frequency HRV (LF-HRV) were assessed continuously. After each instruction (60 s), participants rated levels of sadness and DTB. After watching the clip, they re-rated sadness and then watched a still image of the last scene of the clip for 2 min. Then they rated DTB again. After a 2-min interval in front of a black screen, participants received the next instruction followed by the next clip. Corresponding to the assessments of DTB, the physiological baseline was computed by averaging measurement taken over the time before the instructions (in minutes), and postfilm physiology by the averaged first and second half of the still film images. Habitual ER strategies were assessed by the Emotion Regulation Questionnaire (ERQ) [14] and the Toronto Alexithymia Scale [TAS; 15 ]. Received: May 29, 2009 Accepted: August 12, 2009 Published online: March 17, 2010

Risky decision making in adults with ADHD

BACKGROUND AND OBJECTIVES Risky decision making and disadvantageous choices constitute core characteristics of patients with attention-deficit/hyperactivity disorder (ADHD). Consequences include negative psychosocial and health-related outcomes. However, risky decision making and its interrelations with emotional states in ADHD are poorly understood. Therefore, the authors investigated risky decision making without and after boredom induction in adults with and without ADHD. METHODS In study 1, ADHD patients (n = 15) and age/education matched controls (CG; n = 16) were compared on the Game of Dice Task (GDT), an established task measuring decision making in unambiguous situations. In study 2, ADHD patients (n = 14) and CG (n = 13) underwent boredom induction prior to the GDT. RESULTS In study 1, ADHD patients selected the disadvantageous alternatives significantly more often than CG. In study 2, no significant group differences were found due to an increase in risky decision making in CG following the boredom induction. LIMITATIONS Even if severity of depression did not affect our results, it may be necessary to compare GDT responses in ADHD patients with and without current depression. CONCLUSIONS Risk as a motor of disadvantageous decision making needs to be taken into account in therapeutic contexts as a maintenance factor of dysfunctional behaviour. The findings of study 2 are in line with postulated alterations of emotional state adjustment in ADHD. The link between decisions making and emotional regulation in ADHD needs further attention in research.

Attentional bias for food cues in binge eating disorder

The aim of the present study was to investigate an attentional bias toward food stimuli in binge eating disorder (BED). To this end, a BED and a weight-matched control group (CG) completed a clarification task and a spatial cueing paradigm. The clarification task revealed that food stimuli were faster detected than neutral stimuli, and that this difference was more pronounced in BED than in the CG. The spatial cueing paradigm indicated a stimulus engagement effect in the BED group but not in the CG, suggesting that an early locus in stimulus processing contributes to differences between BED patients and obese controls. Both groups experienced difficulty disengaging attention from food stimuli, and this effect was only descriptively larger in the BED group. The effects obtained in both paradigms were found to be correlated with reported severity of BED symptoms. Of note, this relationship was partially mediated by the arousal associated with food stimuli relative to neutral stimuli, as predicted by an account on incentive sensitization.

Risky decision-making in borderline personality disorder

Impulsivity is a core feature of borderline personality disorder (BPD). Thereby, individuals with BPD are most often explicitly aware of the deleterious long-term consequences of their impulsive behaviors, but still engage in them. Therefore, the aim of the present study was to test decision-making in BPD. Female individuals with BPD (n=21) and female controls without BPD (CG; n=29) were compared on the Game of Dice Task (GDT) with regard to disadvantageous decision-making and feedback processing. In the GDT rules for reinforcement and punishment are explicitly clear and the outcome is defined by probabilities. By providing feedback about the outcome of previous decisions, the GDT is a valid measure to simulate decision-making in real life situations. Main results revealed that women with BPD make risky decisions significantly more often than the CG. Moreover, they show reduced capacities to advantageously utilize feedback. As deficits in decision-making were correlated with BPD symptom severity and impulsivity, risky decision-making may be a relevant maintenance factor for the disorder.

Body-related film clip triggers desire to binge in women with binge eating disorder

Previous research suggests that excessive influence of shape or weight concern on self-evaluation is strongly associated with psychological functioning in women with binge eating disorder (BED). However, little is known so far about its direct influence on binge episodes. In an experimental study, 27 women with BED (DSM-IV) and 25 overweight healthy controls watched a body-related film clip. Ratings of the desire to binge and mood were assessed prior to and at the end of the film clip. Additionally, measures of heart rate, finger pulse and electrodermal activity were obtained. Main results revealed a significant increase in the desire to binge, sadness and anxiety, as well as a significant increase in non-specific skin conductance fluctuation on the body-related clip in the group of BED only. The results underline the importance of shape and weight concerns in BED.