Cited by 512Eating Disorders and BehaviorsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPersonality Disorders and Psychopathology

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Dimensions of emotion dysregulation in anorexia nervosa and bulimia nervosa: A conceptual review of the empirical literature

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Lavender, Jason M., Wonderlich, Stephen A., Engel, Scott G., Gordon, Kathryn H., Kaye, Walter H., Mitchell, James E.·2015·Clinical Psychology Review

DOI 10.1016/j.cpr.2015.05.010PMC PMC4537813

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Abstract

Several existing conceptual models and psychological interventions address or emphasize the role of emotion dysregulation in eating disorders. The current article uses Gratz and Roemer's (2004) multidimensional model of emotion regulation and dysregulation as a clinically relevant framework to review the extant literature on emotion dysregulation in anorexia nervosa (AN) and bulimia nervosa (BN). Specifically, the dimensions reviewed include: (1) the flexible use of adaptive and situationally appropriate strategies to modulate the duration and/or intensity of emotional responses, (2) the ability to successfully inhibit impulsive behavior and maintain goal-directed behavior in the context of emotional distress, (3) awareness, clarity, and acceptance of emotional states, and (4) the willingness to experience emotional distress in the pursuit of meaningful activities. The current review suggests that both AN and BN are characterized by broad emotion regulation deficits, with difficulties in emotion regulation across the four dimensions found to characterize both AN and BN, although a small number of more specific difficulties may distinguish the two disorders. The review concludes with a discussion of the clinical implications of the findings, as well as a summary of limitations of the existing empirical literature and suggestions for future research.

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D iagnosis‐specific self‐image predicts longitudinal suicidal ideation in adult eating disorders
Andersén, M., & Birgegård, A. (2017) · International Journal of Eating Disorders · doi:10.1002/eat.22730 · Cited by 14
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Background
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Kirkpatrick, R. H., Booij, L., Vance, A., Marshall, B., Kanellos‐Sutton, M., Marchand, P., & Khalid‐Khan, S. (2019) · International Journal of Eating Disorders · doi:10.1002/eat.23017 · Cited by 11
Relationships Between Childhood Abuse and Eating Pathology Among Individuals with Binge-Eating Disorder: examining the Moderating Roles of Self-Discrepancy and Self-Directed Style
Borg, S. L., Schaefer, L. M., Hazzard, V. M., Herting, N. A., Peterson, C. B., Crosby, R. D., Crow, S. J., Engel, S. G., & Wonderlich, S. A. (2021) · Eating Disorders · doi:10.1080/10640266.2020.1864588 · Cited by 11
An examination of emotion regulation as a mechanism underlying eating disorder pathology in lesbian, gay, and bisexual individuals.
Gillikin, L., Manasse, S., & van Dyk, I. S. (2021) · Eating Behaviors · doi:10.1016/j.eatbeh.2021.101508 · Cited by 13
Alexithymia, body image and disordered eating in fashion models and student athletes
Zancu, S. A., Dafinoiu, I., & Enea, V. (2021) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-021-01207-3 · Cited by 10
“ED patients display higher alexithymia compared to healthy controls and exhibit broad and increased deficits in multiple emotion-regulation abilities [7, 12].”
Background
Exploring latent profiles of disordered eating using an indicator of dietary restriction in an undergraduate sample of men and women
Trolio, V., & Racine, S. E. (2023) · International Journal of Eating Disorders · doi:10.1002/eat.23985 · Cited by 10
Difficulties in Emotion Regulation in Avoidant/Restrictive Food Intake Disorder
Stern, C. M., Graver, H., McPherson, I. K., Gydus, J. E., Kambanis, P. E., Breithaupt, L. E., Murray, H. B., Zayas, L. V., Eddy, K. T., Thomas, J. J., et al. (2024) · International Journal of Eating Disorders · doi:10.1002/eat.24281 · Cited by 10
A Longitudinal Network Analysis of Emotion Regulation, Interpersonal Problems, and Eating Disorder Psychopathology in Chinese Adolescents
Zhang, J., Cui, S., Zickgraf, H. F., Barnhart, W. R., Xu, Y., Wang, Z., Ji, F., Chen, G., & He, J. (2024) · International Journal of Eating Disorders · doi:10.1002/eat.24292 · Cited by 10
When you avoid your feelings, you may feel even worse: how depersonalization puts you at risk of depression
Fortuna, D., & Golonka, K. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1481439 · Cited by 12
Emotion dysregulation and eating disorder symptoms: a network analysis in college students with subclinical eating disorders
Lian, Y., Liu, S., Zhang, D., Qiao, D., Zhang, Z., Mi, G., Liu, Z., & Wu, X. (2025) · Journal of Eating Disorders · doi:10.1186/s40337-025-01325-8 · Cited by 14
“This conceptual definition is widely used in ED research to explain maladaptive behaviors and psychopathology [15].”
Daily Diary Study of Emotion, Motivation, and Eating Expectancies in Loss of Control Eating
Burr, E. K., Dvorak, R. D., Leon, A. N. D., Leary, A. V., Peterson, R. S., Schaefer, L. M., & Wonderlich, S. A. (2021) · Appetite · doi:10.1016/j.appet.2022.106322 · Cited by 12
Fronto-temporal dysfunction in appetitive regulation of bulimia nervosa with affective disorders: A regional homogeneity and remote connectivity pattern analysis
Wang, J., Tang, L., Wang, M., Wu, G., Li, W., Wang, Y., Wang, X., Wang, H., Yang, Z., Li, Z., et al. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.08.036 · Cited by 10
Psychoneuroimmunology of oral diseases - a review
Par, M., & Tarle, Z. (2019) · STOMATOLOGY EDU JOURNAL · doi:10.25241/stomaeduj.2019.6(1).art.7 · Cited by 10
A naturalistic investigation of cognitive‐affective dysfunction in anorexia nervosa: The role of inefficiency
Fürtjes, S., Seidel, M., King, J. A., Boehm, I., Jaite, C., Roessner, V., & Ehrlich, S. (2019) · International Journal of Eating Disorders · doi:10.1002/eat.23189 · Cited by 10
“As emotion regulation models of eating disorders suggest, patients try to escape the resulting negative affect using typical illness-related behaviors such as exercising, bodychecking, or purging (Engel et al., 2013; Goldschmidt et al., 2014; Lavender et al., 2015).”
Background
Mindful self-regulation of attention is a key protective factor for emotional dysregulation and addictive behaviors among individuals with alcohol use disorder
Cavicchioli, M., Ramella, P., Vassena, G., Simone, G., Prudenziati, F., Sirtori, F., Movalli, M., & Maffei, C. (2020) · Addictive Behaviors · doi:10.1016/j.addbeh.2020.106317 · Cited by 11
Motivation-Enhancing Psychotherapy for Inpatients With Anorexia Nervosa (MANNA): A Randomized Controlled Pilot Study
Ziser, K., Rheindorf, N., Keifenheim, K. E., Becker, S., Resmark, G., Giel, K. E., Skoda, E., Teufel, M., Zipfel, S., & Junne, F. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.632660 · Cited by 10
Emotional Response Inhibition: A Shared Neurocognitive Deficit in Eating Disorder Symptoms and Nonsuicidal Self-Injury
Allen, J. D., Sammon, M. M., Fox, K. R., & Stewart, J. G. (2020) · Brain Sciences · doi:10.3390/brainsci10020104 · Cited by 11
Emotion Regulation Difficulties
Lavender, J. M. (2015) · Springer eBooks · doi:10.1007/978-981-287-087-2_90-1 · Cited by 51
Affective processes underlying restrictive eating in atypical anorexia nervosa: Comparisons to anorexia nervosa and bulimia nervosa using ecological momentary assessment.
Biçaker, E., Trolio, V., Miller, A. E., Zhu, L. Y., White, C., & Racine, S. (2024) · International Journal of Eating Disorders · doi:10.1002/eat.24134 · Cited by 10
Emotion dysregulation and obesity: A conceptual review of the literature
Atwood, M. E. (2024) · Clinical Obesity · doi:10.1111/cob.12699 · Cited by 10
“As Lavender et al. 21 note, it is considered theoretically consistent for individuals who are emotion avoidant to display a tendency to avoid emotion-eliciting situations.”
Alliance processes in eating disorders with childhood maltreatment sequelae: Preliminary implications
Olofsson, M. E., Vrabel, K. R., Kopland, M. C. G., Eielsen, H. P., Oddli, H. W., & Brewerton, T. D. (2024) · European Eating Disorders Review · doi:10.1002/erv.3137 · Cited by 9
Ability to tolerate distress moderates the indirect relationship between emotion regulation difficulties and loss-of-control over eating via affective lability
Burr, E. K., Dvorak, R. D., Stevenson, B. L., Schaefer, L. M., & Wonderlich, S. A. (2021) · Eating Behaviors · doi:10.1016/j.eatbeh.2021.101561 · Cited by 9
Specificity and wealth of autobiographical memories in restrictive and mixed anorexic patients
Gandolphe, M., Nandrino, J., Hendrickx, M., Willem, C., Cottencin, O., Gérardin, P., Guardia, D., Buttitta, M., Zanini, V., & Dodin, V. (2021) · PLoS ONE · doi:10.1371/journal.pone.0256959 · Cited by 9
Affect-based profiles of Bulimia Nervosa: The utility and validity of indicators assessed in the natural environment
Leraas, B. C., Smith, K. E., Utzinger, L. M., Cao, L., Engel, S., Crosby, R., Mitchell, J., & Wonderlich, S. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.09.080 · Cited by 10
Effect of intrapersonal emotional competences on the relationship between attachment insecurity and severity of eating disorder symptoms in patients with restrictive anorexia
Nandrino, J., Dodin, V., Cottencin, O., & Doba, K. (2019) · Journal of Clinical Psychology · doi:10.1002/jclp.22877 · Cited by 9
Outpatient treatment for adults with complex eating disorders and co-morbid conditions: a decision making model and case example
Marino, J. M., Hardin, R., Gasbarro, A., Dansereau, V. A., & Fischer, S. F. (2020) · Eating Disorders · doi:10.1080/10640266.2020.1723372 · Cited by 9
“Thus, a thorough discussion of referral decision making for patients withMulti-diagnostic EDs (Federici & Wisniewski, 2013) is lacking.”
BackgroundMethodInfluential
Aberrant modular segregation of brain networks in female patients with bulimia nervosa
Lan, Z., Zhu, L.-L., Wu, Y., Yang, J., Li, J., Zeng, Y., Li, K., Kong, Q., Su, Y., & Si, T. (2023) · International Journal of Eating Disorders · doi:10.1002/eat.23939 · Cited by 9
Therapeutic interventions in the treatment of eating disorders: A naturalistic study.
Colli, A., Gentile, D., Tanzilli, A., Speranza, A. M., & Lingiardi, V. (2016) · Psychotherapy · doi:10.1037/pst0000063 · Cited by 10
A systematic review of blood-based serotonergic biomarkers in Bulimia Nervosa
Sjögren, M., Nielsen, A. S. M., Hasselbalch, K. C., Wøllo, M., & Hansen, J. S. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2018.12.167 · Cited by 9
Differences in alexithymia, emotional awareness, and facial emotion recognition under conditions of self-focused attention among women with high and low eating disorder symptoms: a 2 x 2 experimental study
Wal, J. S. V., Kauffman, A. A., & Soulliard, Z. A. (2020) · Journal of Eating Disorders · doi:10.1186/s40337-020-00304-5 · Cited by 9
Risk and resilience in eating disorders: differentiating pathways among psychosocial predictors
Perez, M. B., & Frazier, L. D. (2024) · Journal of Eating Disorders · doi:10.1186/s40337-024-01023-x · Cited by 10
“Lavender et al. [50] found evidence that deficits in adaptive emotion regulation skills, emotional awareness, emotional avoidance, impulse control, and distress tolerance difficulties were associated with anorexia nervosa.”
Background
Micro-level de-coupling of negative affect and binge eating in relationship to macro-level outcomes in binge eating disorder treatment
Smith, K. E., Mason, T. B., Schaefer, L. M., Anderson, L., Hazzard, V. M., Crosby, R., Engel, S., Crow, S., Wonderlich, S., & Peterson, C. (2020) · Psychological Medicine · doi:10.1017/s0033291720001804 · Cited by 7
The coregulatory effects of emotionally focused therapy
Conroy, J., Perryman, K. L., Robinson, S., Rana, R., Blisard, P., & Gray, M. (2022) · Journal of Counseling & Development · doi:10.1002/jcad.12453 · Cited by 11
Broad and Narrow Transdiagnostic Risk Factors in Eating Disorders: A Preliminary Study on an Italian Clinical Sample
Iannattone, S., Cerea, S., Carraro, E., Ghisi, M., & Bottesi, G. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19116886 · Cited by 8
“Finally, recent meta-analyses and systematic reviews, which included studies conducted using different ER measures, concluded that global ER problems may be a transdiagnostic trait throughout the ED spectrum, but specific ER difficulties may distinguish between AN and BN [39,54,55]; hence the importance of further inv…”
Background
Interactional Effects of Multidimensional Perfectionism and Cognitive Emotion Regulation Strategies on Eating Disorder Symptoms in Female College Students
Tng, G. Y. Q., & Yang, H. (2021) · Brain Sciences · doi:10.3390/brainsci11111374 · Cited by 8
“Moreover, previous studies examining similar interactional relations have drawn on Gratz and Roemer’s (2004) model of difficulties with emotion management to demonstrate the moderating role of emotion dysregulation, particularly limited access to adaptive regulatory strategies, in the relation between perfectionism an…”
Background
How early can an upcoming critical transition be detected?Preprint
Southall, E., Tildesley, M. J., & Dyson, L. (2022) · medRxiv · doi:10.1101/2022.05.27.22275693 · Cited by 8
Mentalizing in psychotherapeutic processes of patients with eating disorders
Zeeck, A., Lau, I., Endorf, K., Schaefer, L. M., Euler, S., Lahmann, C., & Hartmann, A. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1367863 · Cited by 7
“At the core of psychopathology are dif ﬁ culties in regulating negative affect (21), along with weight and shape concerns (22).”
Background
Emotionsregulation bei psychischen Störungen und in der Psychotherapie
Holl, J., von Oepen, R., & Benecke, C. (2020) · Springer eBooks · doi:10.1007/978-3-662-60280-5_12 · Cited by 7
Regulatory parental feeding behaviors, emotion suppression, and emotional eating in the absence of hunger: Examining parent-adolescent dyadic associations
Romano, K. A., & Heron, K. E. (2021) · Appetite · doi:10.1016/j.appet.2021.105603 · Cited by 7
Distress Intolerance in Relation to Reliance on Cigarettes for Weight, Shape, and Appetite Control
Burr, E. K., O’Keeffe, B., Kibbey, M. M., Coniglio, K., Leyro, T. M., & Farris, S. G. (2020) · International Journal of Behavioral Medicine · doi:10.1007/s12529-020-09858-9 · Cited by 8
DAT1 and Its Psychological Correlates in Children with Avoidant/Restrictive Food Intake Disorder: A Cross-Sectional Pilot Study
Cimino, S., Marzilli, E., Babore, A., Trumello, C., & Cerniglia, L. (2021) · Behavioral Sciences · doi:10.3390/bs11010009 · Cited by 7
Emotion regulation difficulties and distress tolerance in predicting loss-of-control eating.
Burr, E. K., Dvorak, R., Peterson, R. S., & Leon, A. N. D. (2022) · British Journal of Health Psychology · doi:10.1111/bjhp.12611 · Cited by 7
Specialist psychotherapy with emotion for anorexia in Kent and Sussex: An intervention development and non‐randomised single arm feasibility trial
Oldershaw, A., Basra, R. S., Lavender, T., & Startup, H. M. (2023) · European Eating Disorders Review · doi:10.1002/erv.3034 · Cited by 8
Emotion Specific Effects on Attentional Bias Among Women with Shape and Weight Concerns
Allen, J. L., Mason, T. B., Stout, D. M., & Rokke, P. D. (2018) · Cognitive Therapy and Research · doi:10.1007/s10608-018-9916-7 · Cited by 7
When left-behind children become parents in rural china: does their emotional expressiveness influence children’s social–emotional competence?
Liu, H., & Li, L. (2025) · BMC Psychology · doi:10.1186/s40359-025-02772-3 · Cited by 7
“In measures related to behavioural impulsivity, individuals with high emotional expression often display a lack of inhibition [30].”
The relevance of cardiac and gastric interoception for disordered eating behavior
Tiemann, A., Ortmann, J., Rubo, M., Meyer, A. H., Munsch, S., Vögele, C., & Dyck, Z. V. (2025) · Journal of Eating Disorders · doi:10.1186/s40337-025-01284-0 · Cited by 13
“Since emotional processing issues and dysregulation appear to be key aspects in ED development and maintenance [28], cardioception may be linked to ED symptoms [28–30].”
Psychological predictors of eating Behavior: The role of maladaptive schemas and emotion regulation across BMI, gender, and age groups
Obara-Gołębiowska, M. (2025) · Appetite · doi:10.1016/j.appet.2025.108243 · Cited by 9

Authors: Lavender, J. M., Wonderlich, S. A., Engel, S. G., Gordon, K. H., Kaye, W. H., & Mitchell, J. E.
Affiliations: University of North Dakota (US)
North Dakota State University (US)
University of California San Diego (US)
Corresponding author: Lavender, Jason M.
ORCID: Lavender, Jason M.
Wonderlich, Stephen A.
Gordon, Kathryn H.
Kaye, Walter H.
Mitchell, James E.
Venue: Clinical Psychology Review
Publisher: Elsevier BV
Published: 2015-08
Volume: 40
Pages: 111-122
ISSN: 0272-7358 (ISSN-L)
DOI: 10.1016/j.cpr.2015.05.010
PMC: PMC4537813
OpenAlex: W585778545
Cited by: 512
References: 156
Citations by year: 2026: 45 · 2025: 45 · 2024: 45 · 2023: 38 · 2022: 58 · 2021: 69 · 2020: 52 · 2019: 50 · 2018: 40 · 2017: 38 · 2016: 26 · 2015: 5
FWCI: 5.22
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Clinical Psychology Review (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
eScholarship (California Digital Library) (submittedVersion)
Funders: U.S. Public Health Service (K23 101342)
National Institute of Mental Health (K23MH101342, T32MH082761)
Topics: Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
Keywords: emotional dysregulation, anorexia nervosa, bulimia nervosa, eating disorders, emotion regulation, emotional awareness, emotional acceptance, emotional distress, goal-directed behavior, psychological intervention
MeSH terms: Self-Control, Anorexia Nervosa, Emotions, Humans, Bulimia Nervosa

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Dimensions of emotion dysregulation in anorexia nervosa and bulimia nervosa: A conceptual review of the empirical literature

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