Children who struggle to regulate their emotions as they grow older may be at greater risk of exhibiting symptoms consistent with a diagnosis of anorexia nervosa at age 14, according to a study published in JAMA Psychiatry.
Though interventions in childhood could prevent anorexia nervosa, “targets for such interventions are elusive,” wrote Mariella Henderson, M.Sc., of the University College London, Helen Bould, Ph.D., of Bristol Medical School, and colleagues. Emotion regulation, however, “defined as the ability to both intrinsically and extrinsically monitor, appraise, and modify one’s emotional state, has been increasingly proposed as a potential target,” the authors continued.
Henderson, Bould, and colleagues used data from the Millennium Cohort Study, a longitudinal study in the United Kingdom of children born from 2000 to 2002. When the children were 3, 5, and 7 years of age, their mothers reported on their emotion regulation abilities over the previous six months using five questions from the Child Social Behavior Questionnaire (a modified version of the Adaptive Social Behavior Inventory). Scores ranged from zero to 10, with higher scores indicating greater difficulties regulating emotions.
When the children were age 14, the researchers used a set of questions broadly covering DSM-5 criteria for anorexia nervosa and atypical anorexia nervosa to identify participants who had behaviors and thoughts consistent with these two diagnoses (which the authors termed “broad anorexia nervosa”). Adolescents who were defined as having broad anorexia nervosa were those who met all of the following criteria: reported lifetime dieting and exercising for weight loss; were trying to lose weight; skipped breakfast every day; described themselves as overweight despite a body mass index in the underweight or normal weight range; and scored below the median sample score on a question about body image.
In the sample of 15,896 participants, emotion regulation largely improved between ages 3 and 5. Among the 9,912 participants with complete data during childhood and adolescence, 97 (89% of whom were girls) had symptoms consistent with a broad anorexia nervosa diagnosis at age 14.
There was no association between lower emotion regulation ability at age 3 and greater risk of later reporting symptoms of broad anorexia nervosa. However, children whose emotion regulation did not improve over childhood had higher odds of broad anorexia nervosa at 14 years. Those children exhibited the same emotion regulation scores at ages 3 and 7 (about 4.4), while most children in the study had improved scores, falling from 4.4 at 3 years to about 3.6 at age 7.
“If the associations we observed were causal, universal interventions fostering skills for emotion regulation in this age group, such as building tolerance for uncomfortable feelings and learning how to overcome frustration, could have a preventative role in the emergence of eating disorders and other mental health problems with an onset in adolescence,” the authors concluded.
For related information, see the Psychiatric News article “Eating Disorders: Current Knowledge and Treatment Update.”
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