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Dimensions of emotion dysregulation in anorexia nervosa and bulimia nervosa: A conceptual review of the empirical literature
Open accessAbstract
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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“One recent review concluded that both AN and BN had demonstrated consistent associations with particular emotion regulation difficulties, including lack of awareness of emotions, lack of acceptance of emotions, negative beliefs about emotions or coping, and avoidance/suppression of emotions.”
From The Renfrew Unified Treatment for Eating Disorders and Comorbidity: Long-Term Effects of an Evidence-Based Practice Implementation in Residential Treatment (2021) · cites this paper as [15]
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“Dimensions of the Gratz and Roemer (2004) Multidimensional Model Dimension 1: To what extent is one able to flexibly use adaptive and situationally appropriate strategies to modulate emotional duration/intensity?”
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“…(e.g., affect intensity, negative urgency), interpersonal (e.g., social support availability), and environmental (e.g., context-specific social norms) factors (Gratz and Roemer 2004; Gross 1998a; Gross 1998b; Lavender et al. 2015, 2014) that cannot be fully captured by between-person meth-ods.”
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“I’m Not Hungry:” Bodily Representations and Bodily Experiences in Anorexia Nervosa
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Heart Rate Variability and Laboratory-Based Loss-of-Control Eating in Children and Adolescents
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Emotion Dysregulation and Alexithymia within Marital Burnout through an Emotion-Focused Therapy Lens
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Splitting, impulsivity, and intimate partnerships in young obese women seeking bariatric treatment
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“On the other hand, bariatric patients have lower levels of impulsivity and splitting in comparison to the patients with bulimia nervosa, who in agreement with recent findings have significant difficulties with impulsive behavior and other mental health problems.(30,31) The results also show specific differences in pat…”
ResultNegative affect and eating psychopathology: the moderator effect of gender
Marques, C., Santos, T., Martins, M. J., Rodrigues, I. P., Pereira, A. T., & Macedo, A. (2018) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-018-0598-7 · Cited by 5
RELIABILITY AND VALIDITY OF THE LATVIAN VERSION OF THE EMOTION REGULATION SKILLS QUESTIONNAIRE
Kristiņa-Everte, I., Paiča, I., & Mārtinsone, K. (2021) · SOCIETY INTEGRATION EDUCATION Proceedings of the International Scientific Conference · doi:10.17770/sie2021vol7.6227 · Cited by 5
An introduction to the special issue on emotion regulation and eating disorders
Claudat, K., & Lavender, J. M. (2018) · Eating Disorders · doi:10.1080/10640266.2018.1418281 · Cited by 5
“Difficulties with managing emotions and expressing them to others, as well as struggles with experiencing unwanted emotions in certain contexts and situations, are also common among those with eating disorders (e.g., Kittel, Brauhardt, & Hilbert, 2015; Lavender et al., 2015; Oldershaw et al., 2015).”
BackgroundRibeyron, J., Shankland, R., Leys, C., & Duriez, N. (2025) · Canadian Journal of Behavioural Science/Revue canadienne des sciences du comportement · doi:10.1037/cbs0000430 · Cited by 4
Countertransference in the treatment of patients with eating disorders
Zeeck, A., Gruteser, V., Lau, I., Egenolf, M., Klose, C., Lienhart, S., & Hartmann, A. (2025) · Journal of Eating Disorders · doi:10.1186/s40337-025-01439-z · Cited by 4
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Validation of the intolerance of uncertainty scale-12 in a sample of pregnant people
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“The DERS-36 was included here based on prior work suggesting that greater difficulties in emotion regulation are indicative of elevated levels of depression [42], anxiety [15], and eating disorders [47].”
Emotion Regulation as a Predictor of Disordered Eating Symptoms in Young Female University Students
Rojas-Valverde, M., & Castaño, E. F. (2025) · European Journal of Investigation in Health Psychology and Education · doi:10.3390/ejihpe15090171 · Cited by 4
“Emotion dysregulation appears more strongly tied to body dissatisfaction, body image overvaluation, and eating-related impulsivity (Lavender et al., 2015).”
Genç Yetişkinler ve Bakım Verenlerinin Duygu Düzenleme Strateji Kullanımları: Nitel Bir İnceleme
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The Connection Between Eating Disorders and Substance Use Disorders
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“…de estos pacientes, en cuanto a las problemáticas que presentan en términos de regulación emocional (Douglas y Varnado-Sullivan, 2016; Racine y Wildes, 2013), autocontrol e imagen corporal (Lavender et al., 2015), esta técnica puede ser beneficiosa para su tratamiento (Klein y CookCottone, 2013).”
BackgroundComponents of emotion dysregulation in borderline personality disorder: A review of recent research
Grzegorzewski, P., & Kucharska, K. (2018) · Postępy Psychiatrii i Neurologii · doi:10.5114/ppn.2018.77033 · Cited by 4
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“Theoretical background and empirical evidence have supported the idea that deficits in the processing and managing of emotions play a key role in the development and maintenance of ED (Polivy and Herman, 1993) and that difficulties with the regulation of emotions are related with ED psychopathology (Corstorphine, 2006…”
BackgroundModified Dual Pathway Model for Binge Eating: The Role of Emotion Dysregulation
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Suicidal Behavior in Eating Disorders
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“…plausible that the obsessive-compulsive behaviors initially employed to maintain rigid control over emotions and body-related concerns may, over time, become less effective or destabilized, leading to episodes of emotional dysregulation characterized by impulsive or dysregulated behaviors [48, 59].”
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“This pattern aligns with a body of literature suggesting that emotional unawareness and dysregulation are central features of EDs, particularly anorexia nervosa and bulimia nervosa [8, 32, 33].”
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“…while specific objectives are; 1), To evaluate the different dimensions of quality of service, 2), To know approach makes it possible to check the dimensions of service quality, and to propose an instrument of the dimensions of service quality (Lavender et al., 2015; Horlings & Marsden, 2011).”
BackgroundAzzi, R., Samaha, S., Malaeb, D. N., Akel, M., Azzi, V., Hallit, S. R., & Obeïd, S. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-04847-0 · Cited by 6
“BN patients are unable to use healthy coping methods when facing distress, because of deficits in emotion regulation, which leads them to maladaptive coping behaviors [83].”
BackgroundPsychometric evaluation of a novel measure of trauma-related eating to cope
Hawn, S. E., Kliebhan, T., Richardson, N., Deoliveira, M., Heron, K. E., & Mitchell, K. S. (2024) · Journal of Mood and Anxiety Disorders · doi:10.1016/j.xjmad.2024.100102 · Cited by 4
“For instance, research has shown that some people increase their food intake (e.g., emotional eating, binge eating [36-39]), whereas others intentionally decrease their food intake (i.e., dietary restriction [40-42]) to regulate negative affect.”
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“…regulation abilities are still maturing during adolescence, and difficulties in affect regulation and emotion expression have been consistently associated with an increased risk of mood and anxiety disorders, as well as binge eating and other disordered eating patterns (Lavender et al., 2015).”
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Emotion Regulation in Bulimia Nervosa and Purging Disorder
MacDonald, D. E., Solomon‐Krakus, S., Jewett, R., Liebman, R. E., & Trottier, K. (2023) · Springer eBooks · doi:10.1007/978-3-031-16691-4_44 · Cited by 3
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“These findings are consistent with past research demonstrating emotion dysregulation as a key mechanism in EDs and a key target for ED interventions (Racine and Wildes 2015; Safer, Telch, and Chen 2009; Lavender et al. 2015).”
Tobar-Santamaria, A. L., Kiefer, R., Godin, J., Contractor, A. A., & Weiss, N. H. (2021) · Eating Behaviors · doi:10.1016/j.eatbeh.2021.101567 · Cited by 4
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“These problems often result in other consequences include aggression towards oneself [18] serious eating disorders, non-suicidal self-injury [19].”
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Affective Trajectories of Binge Eating, Purging, and Exercise Among Sexual Minority Men
Harris, E., Moeck, E., & Griffiths, S. (2025) · International Journal of Eating Disorders · doi:10.1002/eat.24406 · Cited by 3
“Second, eating disorder models of affect regulation suggest that, when experiencing stress or negative affect more generally, individuals engage in disordered eating behaviors to reduce negative affect (Lavender et al. 2015).”
Durpoix, A., Weiner, L., Porche, C., Walter, M., Séverac, F., Weibel, S., D’USSEL, L.-M., & Lalanne, L. (2026) · Substance Abuse Treatment Prevention and Policy · doi:10.1186/s13011-025-00698-y · Cited by 2
“Two central processes of addictive and eating disorders are emotional dysregulation [14, 19, 48, 53, 76], classically defined as a pattern of emotional experience and/or expression that interferes with appropriate goal-directed behaviour [9], and impulsivity, classically defined as a predisposition…”
Fantozzi, P., Chiara, C., Ditaranto, F., Apicella, F., Belmonti, V., Tancredi, R., Levantini, V., & Calderoni, S. (2026) · Children · doi:10.3390/children13030402 · Cited by 2
“Recent reviews emphasize the presence of global difficulties with regulating affective states in subjects with AN [10,11], and more broadly in adolescents with the spectrum of eating psychopathology [12].”
Racine, S., Riddle, D. R., Durcan, J., Iordache, N., & Paterson, J. (2026) · Clinical Psychology Review · doi:10.1016/j.cpr.2026.102730 · Cited by 4
Iida, N., Ono, J., Mizuhara, Y., & Narumoto, J. (2023) · Psychiatry and Clinical Neurosciences Reports · doi:10.1002/pcn5.151 · Cited by 2
“33 Emotion regulation has recently become a topic of discussion in ED treatment.”
BackgroundThe Role of Emotion Dysregulation in Problematic Exercise in those with Eating Disorders
Perry, T. R., Denning, D. M., Kaye, W. H., Wierenga, C. E., & Brown, T. A. (2023) · Journal of Emotion and Psychopathology · doi:10.55913/joep.v1i1.24 · Cited by 2
“Previous research has documented that individuals with EDs have difficulties with emotion regulation (Anderson et al., 2018; Haynos & Fruzzetti, 2011; Lavender et al., 2015).”
BackgroundPreconception weight suppression predicts eating disorder symptoms in pregnancy
Hormes, J. M. (2024) · European Eating Disorders Review · doi:10.1002/erv.3076 · Cited by 2
Rodrigues, T. F., Silva, R., Fernández‐Aranda, F., & Machado, P. P. P. (2024) · Nutrients · doi:10.3390/nu16203452 · Cited by 2
Shi, Q., Thornton, L. M., Kilshaw, R. E., Flatt, R. E., Butner, J., Adamo, C., Deboeck, P. R., Baucom, B., Tregarthen, J., Argue, S., et al. (2024) · Clinical Psychological Science · doi:10.1177/21677026241280728 · Cited by 4
“Numerous studies have found that various manifestations of dysregulated eating compensate for escaping from or regulating aversive emotional states (N. R. Fisher et al., 2017; Lavender et al., 2015; Smyth et al., 2007; Stice, 2001).”
What the Eye Sees, the Mind Rejects: Implicit Visual Processing of Food Images in Anorexia Nervosa
Dimakopoulou, M., Ciorli, T., Pyasik, M. M., Andriulli, C., Bevione, F., Martini, M., Daga, G. A., & Pia, L. (2025) · European Eating Disorders Review · doi:10.1002/erv.3210 · Cited by 3
“The Noticing scale reflects an individual's heightened awareness of bodily sensations, which can amplify distress and reinforce food avoidance due to fear of weight gain (Lavender et al. 2015).”
Intuitive eating may underlie the link between food insecurity and binge eating in college students
Rezeppa, T. L., & Forney, K. J. (2025) · Appetite · doi:10.1016/j.appet.2025.108147 · Cited by 2
Toward a synthesis of cognitive behaviour therapy via component analysis of self‐regulation
Arco, L. (2023) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2918 · Cited by 4
Recognition of others’ interoceptive states in those with and without eating disorders
Gajperia, C., McBride, J., Treasure, J. L., Cardi, V., & Brewer, R. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-05615-4 · Cited by 3
“It is therefore likely that impaired interoceptive accuracy or attention gives rise to some of the emotional difficulties (e.g. difficulties identifying and regulating one’s own emotions and difficulties recognising others’ emotions) commonly experienced by those with EDs [27, 61, 62].”
BackgroundSubstance-Related Disorders in Eating Disorders
Fernández‐Aranda, F., Steward, T., & Jiménez‐Múrcia, S. (2017) · Springer eBooks · doi:10.1007/978-981-287-104-6_19 · Cited by 2
Bronstein, M. V., Everaert, J., Kummerfeld, E., Haynos, A. F., & Vinogradov, S. (2021) · SSRN Electronic Journal · doi:10.2139/ssrn.3936928 · Cited by 1
Hairston, I. S. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.1053988 · Cited by 2
Emotion Regulation in Bulimia Nervosa and Purging Disorder
MacDonald, D. E., Solomon‐Krakus, S., Jewett, R., Liebman, R. E., & Trottier, K. (2022) · Springer eBooks · doi:10.1007/978-3-030-67929-3_44-1 · Cited by 1
Khalil, R. B., Kassab, A., Richa, S., Sénèque, M., Lefebvre, P., Sultan, A., Avignon, A., Maı̈moun, L., Renard, É., Courtet, P., et al. (2024) · Eating Behaviors · doi:10.1016/j.eatbeh.2024.101853 · Cited by 1
Tilstra-Ferrell, E. L., Braden, A. L., & Russin, S. E. (2024) · Military Psychology · doi:10.1080/08995605.2024.2336639 · Cited by 1
“Emotion regulation challenges, or difficulty managing and responding to strong emotions, are core symptoms of traumatic stress and eating disorders (Lavender et al., 2015; Seligowski & Orcutt, 2016).”
Expressive Suppression of Emotions in Bulimia Nervosa: An Electroencephalography Study
Desdentado, L., & Pollatos, O. (2024) · Journal of Clinical Psychology · doi:10.1002/jclp.23761 · Cited by 1
“The scarcity of laboratory ‐ based experimental studies in this field underscores a significant gap in our understanding of the mechanisms underlying emotion regulation processes in BN, as noted by Lavender et al. (2015).”
Muscle Dysmorphia and Emotion Regulation: Findings From the Study of Boys and Men
Ganson, K. T., Testa, A. M., Rodgers, R. F., Murray, S. B., & Nagata, J. M. (2025) · The Journal of Men s Studies · doi:10.1177/10608265251334322 · Cited by 2
Diaz, M. A. V. –., Martínez, J. L. –., & Toro, R. (2025) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2025.100895 · Cited by 1
Visco, M. A., Juli, M. R., Covelli, V., & Camisasca, E. (2025) · MALTRATTAMENTO E ABUSO ALL INFANZIA · doi:10.3280/mal2025-001002 · Cited by 1
Eibl, M., & Turliuc, M. N. (2025) · Eating Disorders · doi:10.1080/10640266.2025.2558015 · Cited by 1
Alexithymia and Eating Disorders
Enea, V. (2025) · Springer eBooks · doi:10.1007/978-3-031-73363-5_75 · Cited by 1
Meneguzzo, P., Bonello, E., & Todisco, P. (2025) · Journal of Eating Disorders · doi:10.1186/s40337-025-01423-7 · Cited by 2
“Recent critiques have underscored the limitations of such metrics, highlighting their insufficiency in reflecting internal processes such as motivation, self-reflection, or changes in embodiment [19, 30, 36].”
Musial, A., Foye, U., Kakar, S. A., Jewell, T., Treasure, J. L., Kalsi, G., Smith, I., Meldrum, L., Bristow, S., Marsh, I., et al. (2025) · The British Journal of Psychiatry · doi:10.1192/bjp.2025.10468 · Cited by 3
Ganson, K. T., Lavender, J. M., Rodgers, R. F., Testa, A. M., & Nagata, J. M. (2025) · Eating Disorders · doi:10.1080/10640266.2025.2602456 · Cited by 1
Lim, K. O., Kummerfeld, E., Anderson, L. M., Wonderlich, S. A., Engel, S. G., Crosby, R. D., & Peterson, C. B. (2026) · Journal of Eating Disorders · doi:10.1186/s40337-026-01524-x · Cited by 1
“Negative affect (NA) and emotion dysregulation have been identified as putative maintenance mechanisms of BN [18].”
Wezenberg, E., Peters, S., Elburg, A. A. V., & Mares, S. H. W. (2026) · European Eating Disorders Review · doi:10.1002/erv.70125 · Cited by 1
“…often becomes chronic (Eddy et al. 2017) and underlying deficits in emotion processing related to alexithymia and emotion regulation are thought to play a role, next to state related features like starvation (Gramaglia et al. 2020; Lavender et al. 2015; Oldershaw et al. 2015; Zeiler et al. 2025).”
From Mental Fatigue to Binge Eating: Emotion Dysregulation as a Transdiagnostic Bridge
Aktürk, B. E., Kaya, A. E., & Tamam, L. (2026) · Cognitive Therapy and Research · doi:10.1007/s10608-026-10753-y · Cited by 1
On Targeting Emotion Regulation Deficits in Eating Disorders through Defense Analysis
Rice, T. (2016) · Journal of Infant Child and Adolescent Psychotherapy · doi:10.1080/15289168.2016.1231539 · Cited by 1
“A recent review of the anorexia nervosa and bulimia nervosa (Lavender et al., 2015) demonstrates that emotion regulation deficits are important in both disorders, and that it may in fact be differences in emotion regulation that distinguish these two eating disorders from one another.”
BackgroundNitkowski, D., Wünsch‐Leiteritz, W., Braks, K., Hristova, S., & Petermann, F. (2019) · Kindheit und Entwicklung · doi:10.1026/0942-5403/a000293 · Cited by 1
Rodrigues, T. F., Vieira, A. I., Vaz, A., Brandão, I., Timóteo, S., Nunes, P., Fernández‐Aranda, F., & Machado, P. P. P. (2021) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2621 · Cited by 1
An International Collection of Multidisciplinary Approaches to Violence and Aggression
Lewis, C. (2022) · IntechOpen eBooks · doi:10.5772/intechopen.100654 · Cited by 2
The Connection Between Eating Disorders and Substance Use Disorders
Claudat, K., Simpson, C. C., Bohrer, B. K., & Bongiornio, G. M. (2022) · Springer eBooks · doi:10.1007/978-3-030-67929-3_16-1 · Cited by 1
Metadata
- 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.
- Venue
- Clinical Psychology Review
- Publisher
- Elsevier BV
- Published
- 2015-08
- Volume
- 40
- Pages
- 111-122
- ISSN
- 0272-7358 (ISSN-L)
- 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
- 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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