Wong, V. Z., Koithan, E. M., Santos, B. M., Johnson, A., & Haynos, A. F. (2025). Does evidence support an emotion regulation model of anorexia nervosa? A systematic review of over a decade of research. Clinical Psychology: Science and Practice, 32(1), 1–17. https://doi.org/10.1037/cps0000244
Key Takeaways
- Focus: The study explored the role of emotion regulation in Anorexia Nervosa (AN).
- Objectives: To systematically review research on emotion regulation in AN since the proposal of the Haynos and Fruzzetti model in 2011.
- Key Findings: Individuals with AN show difficulties in emotion regulation, including heightened sensitivity to negative emotions, less adaptive strategies, and a tendency to use eating disorder behaviors to manage emotions.
- Implications: The findings highlight the need for treatments targeting emotion regulation in AN.
Rationale
Anorexia Nervosa (AN) is a severe eating disorder with high mortality rates and limited treatment success.
Traditional models have focused on cognitive and behavioral factors, but recent research suggests that emotion regulation difficulties may play a crucial role in AN.
Haynos and Fruzzetti (2011) proposed a transactional model suggesting that emotion dysregulation in AN stems from an interaction of individual vulnerabilities and invalidating environmental experiences.
This systematic review aimed to evaluate the evidence for this model and identify clinical implications.
Method
- Followed PRISMA guidelines.
- Databases searched: PubMed, PsycINFO, Web of Science (2011-2023).
- Search terms: “emotion regulation” OR “affective regulation” AND “anorexia nervosa.”
- Inclusion criteria: Empirical, quantitative articles in English; human participants; diagnosis of AN; focused on emotion regulation.
- 134 studies included.
- Data extraction: Sample characteristics, primary findings.
Results
- Emotional Vulnerabilities: Individuals with AN showed heightened sensitivity to negative stimuli, difficulties with emotional awareness, and prolonged emotional activation. Findings on emotional reactivity were mixed.
- Invalidating Environments: Individuals with AN reported exposure to invalidating social and family environments, which were linked to emotion regulation difficulties.
- Emotion Dysregulation: Individuals with AN demonstrated deficits in adaptive emotion regulation strategies and a greater use of maladaptive strategies, including eating disorder behaviors.
Insight:
This review confirms that emotion regulation is a crucial factor in AN.
Individuals with AN struggle to manage their emotions effectively, relying on maladaptive strategies that maintain the disorder.
These findings highlight the need to shift the focus of AN treatment towards addressing emotional difficulties.
Future research should examine the specific mechanisms linking emotion dysregulation and AN, and develop targeted interventions.
Clinical Implications
- Practitioners should assess and target emotion regulation skills in AN treatment.
- Develop and test interventions specifically addressing emotional vulnerabilities and promoting adaptive coping mechanisms.
- Training for families and caregivers to provide validating responses and support healthy emotion regulation.
Strengths
- Comprehensive review following PRISMA guidelines.
- Large number of studies included.
- Provides a strong foundation for future research and clinical practice.
Limitations
- Heterogeneity of study designs and measures.
- Limited research on specific aspects of the transactional model.
- Primarily focused on self-reported data.
References
Wong, V. Z., Koithan, E. M., Santos, B. M., Johnson, A., & Haynos, A. F. (2025). Does evidence support an emotion regulation model of anorexia nervosa? A systematic review of over a decade of research. Clinical Psychology: Science and Practice, 32(1), 1–17. https://doi.org/10.1037/cps0000244
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
- Haynos, A. F., & Fruzzetti, A. E. (2011). Anorexia nervosa as a disorder of emotion dysregulation: Evidence and treatment implications. Clinical Psychology: Science and Practice, 18(3), 183–202.
- Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & PRISMA Group. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Medicine, 6(7), e1000097.
Socratic Questions
- How might the findings of this review change the way we assess and treat AN?
- What are the potential challenges of implementing emotion-focused interventions in AN treatment?
- How can we further investigate the specific emotional events and judgments that contribute to emotion dysregulation in AN?
- What are the ethical considerations in researching and treating emotion regulation difficulties in vulnerable individuals with AN?
