Psychiatr. Pol.

2021; 55(6): 1433–1448

PL ISSN 0033-2674 (PRINT), ISSN 2391-5854 (ONLINE)
[Link]
DOI: [Link]

Emotion regulation in binge eating disorder

Anna Walenda 1, Krzysztof Bogus z 2, Maciej K o p er a 3, Andrzej J ak u b czy k 3,

Marcin Wojnar 3,4, Katarzyna K u ch ar s k a 1
1
Institute of Psychology, Cardinal Stefan Wyszyński University in Warsaw, Poland
2
Nowowiejski Hospital in Warsaw, Poland
3
Department of Psychiatry, Medical University of Warsaw, Poland
4
Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, USA

Summary
A review of the literature on emotion regulation in binge eating disorder (BED) published
both in English and Polish between 1990 and 2020. BED might be considered as an impulsive
and compulsive disorder associated with altered reward sensitivity and food-related attentional
bias. The growing body of research indicated that there were corticostriatal circuitry altera-
tions in BED, comparable to those observed in substance abuse, including altered function of
orbitofrontal, prefrontal and insular cortices with the striatum included. Negative emotions
and deficits in their regulation play a significant role in BED. Processing of anger, anxiety
and sadness appear to be particularly important in this disorder. Research results identified
an increase in negative emotions preceding episodes of binge eating. However, there is still
inconsistency when it comes to whether these episodes alleviate negative affect. Individuals
with BED more often use non-adaptive emotion regulation strategies, such as rumination and
suppression of negative sensations. Whereas adaptive ones, for instance, cognitive reappraisal,
are used less often. Clinical implications, besides pharmacology, highlight the high effective-
ness of enhanced cognitive behavioral therapy (CBT–E), dialectic-behavioral therapy (DBT)
and psychodynamic therapy in the treatment of emotional dysregulation in BED. Further stud-
ies, including ecological momentary assessment (EMA), should focus on emotional changes
related to the binge cycle and the identification of reinforcing factors of BED.
Key words: binge eating disorder, emotion regulation, neuroimaging techniques

Introduction
Binge eating disorder (BED) is the most common among eating disorders [1]. Its
prevalence in the general population ranges between 2 and 5%, and it is considerably
higher in overweight or obese individuals – 30% [2]. The majority of patients with BED
1434 Anna Walenda et al.

fulfill the criteria of at least one lifetime comorbid psychiatric disorder (67–79%) [3].
Among the most common are affective disorders and anxiety disorders [4]. The dis-
order in question affects women three times more often than men [2]. According to
the European classification ICD-10 (International Statistical Classification of Diseases
and Related Health Problems), BED falls into overeating associated with other psy-
chological disturbances (F50.4), and hence, it is not a separate nosological entity [5].
Then, the American mental classification DSM-5 (Diagnostic and Statistical Manual of
Mental Disorders, 5th Edition) isolated BED as a separate entity – 307.51 (F50.8) [4].
Binge eating disorder manifests itself by recurrent uncontrolled episodes of overeat-
ing defined as consuming increased amounts of food in a definite period of time (e.g.,
within two hours) that the majority of people would not eat in similar circumstances
and within similar time period. A characteristic feature is the loss of control over the
amount and quality of the consumed food, and the difficulty in ceasing to eat despite the
sensation of discomfort caused by being overstuffed. Furthermore, a physical feeling
of being hungry does not precede episodes of binge eating. Fierce food consumption
often takes place in secrecy (due to shame), in private, and the pace is fast. Individuals
with BED are aware of losing control over the consumed food, what leads to feeling
guilt as well as disgust, and abhorring oneself. Therefore, one of the key parts of BED
is the sense of subjective suffering of the ill individual. However, this disorder is not
accompanied by compensatory behaviors (such as inducing emesis or abusing laxa-
tives) that are common for bulimia nervosa (BN), and thus, the two disease entities
should be differentiated correctly [4].
According to DSM-5, BED can be diagnosed if overeating episodes occur at least
once a week for 3 months. The disorder severity is determined by a number of binge
eating episodes within a week: mild (1–2 episodes), moderate (4 –7 episodes), severe
(8–13 episodes), and very severe (14 or more episodes) [4]. BED increases the risk for
obesity and somatic consequences associated with it such as heart diseases, hyperten-
sion, or type 2 diabetes [6]. Moreover, recurrent episodes of compulsive overeating
are the reasons behind self-harm or suicidal attempts [2].

Functional mechanisms of BED – neuroimaging studies

Usage of neuroimaging, especially functional magnetic resonance imaging (fMRI),
allowed for evaluation of functional brain changes occurring in individuals with eating
disorders [7]. BED may be defined as an impulsive and compulsive disorder associ-
ated with altered sensitivity to rewards and attentional bias directed towards food [1].
Studies indicate [1] an occurrence of lesions in corticostriatal loops in individuals with
BED, similar to the ones observed in addictions to psychoactive substances, including
altered function of the prefrontal cortex (PFC), orbitofrontal cortex (OFC) function,
insular (IN) function, and ventral striatum (VS) function.
Results of neuroimaging studies and systemic reviews regarding the altered sensi-
tivity to rewards in BED are inconsistent; most of them suggest hypersensitivity [8–11],
while others hyposensitivity [12, 13] of the reward system. For instance, in an fMRI
study by Schienle et al. [9], the exposure to pictures of highly caloric food triggered
 Emotion regulation in binge eating disorder 1435

an increased activation in medial orbitofrontal cortex (mOFC) in women with BED

compared to other groups (i.e., healthy individuals, BN). However, there was no differ-
ence between the groups with regard to neuronal reactions to images triggering disgust
[9]. In another pilot study [10], individuals with BED presented a stronger activation
of the ventral striatum (VS) in response to food pictures than the control group. Then,
a study conducted by Simon et al. [14] did not show significant differences between
patients with bulimic eating disorders (i.e., BED and BN) and the healthy individuals
with regard to responses to general reward processing (i.e., monetary rewards). Thus,
a question arises whether changes in reward regions are specific for food or reflect
general disturbances in reward processing.
Balodis et al. [12, 13] obtained results different from the above and showed a de-
creased sensitivity to rewards in BED. A diminished response in the reward anticipation
phase appears to be consistent with the concept of reward deficit syndrome, which
assumes that individuals with an initially lower level of neuronal activity of reward
regions may engage in addictive behaviors or overeat in order to stimulate activity
in these regions [13]. However, there is likelihood that exposure to food signals (i.e.,
stimuli specific to this disorder) instead of monetary ones as described in the above two
studies could increase the activity in reward regions [12, 13]. Seemingly contradictory
study results regarding the sensitivity of the reward system may result from changes
associated with specific stages of the disorder [13]. Namely, initial hypersensitivity
of the reward system may be diminished due to episodes of overeating with food that
contain large amounts of sugar or fat [13].
A study of Balodis et al. [15], in which participants underwent fMRI during the
Stroop test, suggests that obese individuals with BED are characterized by a decreased
activity of cortical regions engaged in impulse control and self-regulation (i.e., ventro-
medial prefrontal cortex, inferior frontal gyrus, insular cortex) as compared to obese
individuals without BED. Then, Karhunen et al. [16] used single-photon emission
computed tomography (SPECT) and showed that exposure to a real portion of food in
obese women with BED was associated with an increase in regional brain blood flow
in the left hemisphere, especially in its prefrontal and frontal regions, as compared to
obese women and the ones with normal body weight without BED.
The results of the studies indicate that individuals with BED show changes in
corticostriatal loops, similar to the ones observed in impulsive, compulsive disorders
[1]. The idea of compulsiveness refers to performing repetitive persistent activities
that are not associated with the general aim and are maintained despite negative con-
sequences [1]. Available literature proves that individuals with BED are characterized
by attentional bias directed towards food [1, 17, 18] and impaired set-shifting char-
acteristic for compulsiveness [1]. The researchers [19] suggest that individuals with
an increased sensitivity to reward may perceive food as more satisfying; and then, an
increased impulsiveness may make it difficult to resist the temptation to receive this
reward. In the environment in which we are surrounded by high-calorie food, altered
attentional bias directed towards food may be an important factor for maintaining the
disorder [18].
1436 Anna Walenda et al.

Emotion regulation in BED

Results of numerous studies prove that deficits in the processes involving regula-
tion of emotions (emotional dysregulation) play a significant role in the occurrence
and persistence of eating disorders, including BED [20–23]. According to Gross’
definition [24], most often described in psychological literature, emotion regulation
involves processes by means of which an individual can influence their own emotional
states, and more precisely, emotions that they feel, how they experience them, and
how they express them. Then, Linehan [25], an author of a biosocial theory, postulates
that emotion dysregulation is one of the most serious problems in psychopathology,
and more specifically in borderline personality disorder. She conceptualizes emotion
regulation as an ability to: (1) inhibit dysfunctional and impulsive reactions to strong
negative and positive emotions; (2) perform coordinated activities in order to maintain
an external aim (regardless of the mood, if necessary); (3) self-control of physiological
stimuli triggered by strong emotions; (4) regain focused attention while experiencing
intense emotions.
It appears that a negative affect plays a key role in the discussed disorder [26].
Numerous empirical studies, applying various methodologies, prove that it directly
precedes overeating episodes [27–31]. Having conducted a meta-analysis, Haedt-
Matt and Keel [6] noticed that 69–100% of patients with BN and BED reported in
retrospection that negative mood caused the episodes of overeating. Moreover, it was
observed that BED patients experienced intensified negative affects during the days
when the overeating episodes occurred [27, 31, 32]. A negative affect is a broad term
that includes various components such as: depressive mood/sadness, anxiety, anger.
It could be believed that emotions other than sadness are also significant in this
disorder [3]. Study results regarding anxiety in BED are inconsistent. Some research-
ers [3, 33] claim that it is less important than other emotions in this disorder, whereas
others suggest that it is a stronger predictor for binge eating than depression [26, 32,
34]. While examining the mood that precedes overeating, Arnow et al. [34] obtained
the following results with regard to particular variables: anger/frustration (42%), anxi-
ety/excitement (37%), sadness/depression (16%), and grief (5%). Other researchers
[e.g., 33] also emphasize the role of anger in BED.
Individuals with BED are less able to tolerate negative mood, when compared to
healthy controls [3]. Moreover, a study of Crowther et al. (2001) [as cited in 3] reported
that overeating women assessed their daily difficulties as more stressful than the control
group that experienced a similar amount of odds. Then, Hilbert and Tuschen-Caffier
[35] compared emotion dynamics in patients with BED and patients with bulimia (BN),
showing that BED patients experience less negative mood as compared to bulimic
patients, and overeat in response to a moderately negative condition.
So far, very few studies have explored the relationship between positive emotions
and overeating in BED. Therefore, further research is needed to elaborate on it.
 Emotion regulation in binge eating disorder 1437

Theoretical BED models

It is assumed that patients with the discussed disorder, who have difficulties with
regulating negative emotions, use overeating as means of coping with these emotions
and finding a relief [36]. Given that, several theoretical models that explain basic
mechanism behind BED were offered. Below there are assumptions for two of the
most common models found in literature.
An Affect Regulation Model, authored by Polivy and Herman, assumes that an
increase in negative emotions triggers a binge eating episode, which is supposed to
alleviate these emotions by using food as a specific ‛comforter’ and distractor [3].
According to this theory, an overeating episode results in an immediate affect improve-
ment [37]. Overeating as a response to ‛unwanted emotions’ becomes a learnt reaction
maintained by negative reinforcement [30].
Then, an Escape from Self-awareness Theory [38] propounds that overeating is
motivated by a desire to escape from a negative self-perception (i.e., focus on personal
failures; failing to meet high standards) [38]. According to this theory, overeating
episodes are attempts to alleviate negative emotions by shifting attention from averse
self-awareness to direct surroundings (e.g., food) [38]. The model assumes allevia-
tion of negative affect during overeating, and then, its subsequent decrease after the
overeating episode, when self-awareness is re-established [6].
The above models have two common features: (1) negative emotions cause
overeating; (2) overeating aims at alleviating these negative emotions within a short-
term perspective (during the overeating episode) or a long-term perspective (after the
episode) [3]. Experimental studies verified the assumptions of the above theories and
brought only a partial confirmation.
According to our knowledge, there have only been a few experimental studies that
would assess the connections between affect and eating behaviors in BED. Moreover,
their results are inconsistent. For instance, Agras and Telch [39] and Chua et al. [29]
conducted separate experiments in which female participants with BED were randomly
ascribed to one of the groups: (1) negative or (2) neutral mood inductions, and then the
amount of food consumed by them was assessed. The authors discovered that women
from the group in which a negative affect was induced ate more during a taste test
and experienced more frequent overeating episodes than the second group. The results
of these studies were confirmed by a meta-analysis conducted by Cardi et al. [40],
and a systemic review by Leehr [36] that came to a conclusion that a negative affect
is a trigger for overeating in the group of individuals with BED as opposed to obese
individuals who do not suffer from this disease. However, other studies did not report
such a relation [e.g., 41].

Application of an ecological momentary assessment (EMA) in emotion

regulation in individuals with BED
A promising research method, adapted to verify the assumptions of the Affect
Regulation Model in BED, is ecological momentary assessment (EMA) [6]. This study
1438 Anna Walenda et al.

method is based on repeated evaluation of emotions, behaviors or experiences made

by a studied person on a portable electronic device (e.g., a smartphone) during the day
(at random or at specific moments) and in the person’s natural habitat [6]. Evaluations
repeated in time allow for identifying both emotional states and contextual events
preceding overeating episodes and occurring right after them [42]. EMA reduces recall
bias because participants evaluate their current state (i.e., mood, behavior), not the state
that occurred a few days or weeks ago [6]. In addition, this study method presents with
high ecological validity, thereby overcomes the limitations of experimental studies [3].
Prevailing number of EMA studies identified the negative affect as a factor pre-
ceding binge eating episodes [20, 27, 28, 30, 31, 35]. The results of a meta-analysis
conducted by Haedtt-Matt and Keel [6] showed a greater negative affect preceding
overeating episodes as compared with an average affect and the affect before normal
eating, i.e., without episodes. Munsch et al. [31] obtained some interesting results;
according to them, binge eating episodes occurring in BED do not result from an ac-
cumulation of aversive affect but from a sudden increase in negative emotions and
tension that lead to immediate collapse of emotion and impulse regulation processes.
These discoveries indicate a role played by impulsivness, which is characterized by
experiencing fast changing affect states, and is an important factor in BED [31].
According to Dawe and Loxton [19], impulsiveness may be conceptualized as
a multidimensional construct including (1) sensitivity to reward and (2) tendencies
towards rash-spontaneous impulsiveness. The researchers [8, 19] suggest that BED is
a separate phenotype in the obesity spectrum that is characterized by an increased im-
pulsiveness. Results of many studies prove that individuals with BED and non-clinical
groups show an increased impulsiveness as compared with healthy individuals [8, 19,
43] that may be the basis for decreased control during the overeating episodes [1].
However, insufficient support was obtained for the second thesis of the Affect
Regulation Theory, which says that an overeating episode eliminates the negative af-
fect, what in turn maintains the stodging. Both Stein et al. [27] and Hilbert et al. [35]
observed a considerable increase in aversive affect after the episodes of overeating in
individuals with BED, and it was supported by a meta-analysis authored by Haedt-
Matt and Keel [6]. Hence, these results did not confirm the Affect Regulation Model in
BED and did not exclude the assumptions of the Escape from Self-awareness Theory
(improvements in negative affect only while eating). Then, other researchers [30, 31]
obtained results contradictory to the above. The study of Munsch et al. [31] showed
a gradual and permanent mood improvement within several hours after the overeating
episode. Similarly, Berg et al. [30] noticed a significant decrease in negative affect
while they were examining emotions four hours after the uncontrolled eating.
It should be highlighted that some of the mentioned studies assessed the affect im-
mediately after an overeating episode, whereas others – after a period of time. Thus, it is
possible that discrepancies in the above results are associated with this fact. Moreover,
it seems possible that overeating does not aim at regulating general negative affect but
specific emotions [6]. Kenardy et al. [44] suggest that compulsive eating may decrease
some of the components of negative affect (e.g., anger), while simultaneously increas-
ing others (e.g., the feeling of guilt). This idea lines with a trade-off theory by Kenardy
 Emotion regulation in binge eating disorder 1439

et al. [44], which assumes that a specific negative emotional state is substituted with
another one – less aversive. Therefore, it is necessary to conduct further research that
would focus on affect changes associated with an overeating cycle, and identification
of factors enhancing uncontrolled eating.

Strategies for emotion regulation in BED

Every person, most often unconsciously, uses emotion regulation strategies in order
to cope with everyday experiences [3]. Many models assume that individuals with
BED use overeating as a way to decrease negative emotions due to the lack of more
adaptive strategies of regulating them [45]. It means that patients with this disorder
resort to stodging since they do not know another way of coping with their emotions.
Researchers list various strategies for emotion regulation, however, for the purpose
of this paper, we are going to discuss the most commonly used ones by individuals
with BED.
An example of an adaptive strategy for emotion regulation is cognitive reappraisal
defined by Gross as “changing a meaning of a situation in order to change emotional
reaction to this situation,” or as a re-evaluation of the situation in order to modify its
emotional significance [24, p. 195]. It is counted among antecedent-focused strategies
since it is ‛triggered’ before an emotional reaction takes its final shape [24]. Learning
the skill of cognitive reappraisal is an important part of behavioral therapies [45].
Then, suppression is counted among non-adaptive strategies for emotion regulation
[46]. It is an example of a response-focused strategy since it appears when an emotion
is fully formed [24]. This strategy may be a good short-term solution, however, it fails
in the long-term perspective [3]. Suppression of unwanted thoughts leads to their inten-
sification [47] and causes an increase in physiological stimulation (due to activation of
sympathetic nervous system) [24]. Thus, the strategy has an opposite result. Chronic
suppression prevents getting used to emotional stimuli, and simultaneously increases
susceptibility to various types of psychopathological symptoms [45]. This strategy is
listed as a common one among individuals with eating disorders, including BED [45].
Another non-adaptive strategy, strongly associated with psychopathology, is
rumination [48]. It is based on constant passive focusing on thoughts on oneself and
one’s situation in a self-critical and pessimistic way [49]. It consists of two dimensions:
(1) reflexive rumination, and (2) brooding rumination [49]. Rumination is an attempt
to understand and solve one’s own problems, however, it fails to generate results in
the end [47]. The discussed strategy is commonly used by individuals suffering from
depression, anxiety disorders and eating disorders [48].
Svaldi et al. [46] induced sadness in a group of women with BED and the control
group by screening three films. Every film came with a different instruction: (1) watch
the clip, (2) watch the clip and try to suppress emotions, (3) watch the clip and evalu-
ate your emotional state again. Then, a tendency towards overeating was assessed by
using a questionnaire. The results of the study showed that, as opposed to cognitive
reappraisal, suppression leads to an increased desire to overeat and a decrease in the
parasympathetic activation in women with BED, as compared to the healthy group.
1440 Anna Walenda et al.

The authors showed that individuals with BED less often use cognitive reappraisal and
more often suppress their emotions as compared to the healthy group. Then, in another
study [41], in which participants were asked to watch the film freely or suppress their
emotions when watching it, no differences between the groups were observed with
regard to a later calorie intake during the taste test. Therefore, the studies did not con-
firm the hypothesis that suppression of negative emotions leads to overeating in BED.
Then, results obtained by Dondzilo et al. [48], Wang et al. [49] and then by Smith
et al. [47] indicated that rumination (i.e., passive comparison of current situation with
desired standards) was an important process engaged in occurrence and persistence
of BED psychopathology. The researchers suggest [48] that preoccupation with food
and body shape/weight may be perceived as a type of rumination specific for eating
disorders. Moreover, rumination seems to upkeep focus of an individual on failing to
meet the desired standards associated with the body, while simultaneously enforcing
the negative affect, which in turn leads to binge eating episodes [48].
Results of studies that compare eating disorders (anorexia – AN with BN and BED)
with regard to the used strategies for emotion regulation are inconsistent. Both Aldao
et al. [45] and Monell et al. [21] did not find significant differences between particular
eating disorders in strategies used for emotion regulation. Similarly, the study of Svaldi
et al. [23] did not present such differences, although the authors assume that the group
with BED may be characterized by a more adaptive pattern of emotional regulation
than the two other groups. On the other hand, some study results suggest [e.g., 22]
that individuals with BED experience less difficulties with emotion regulation than
people with other eating disorders. Nevertheless, there is likelihood that the differences
between the groups result from the character of studies, and not the diagnosis [21].

Clinical implications of emotion dysregulation in BED

BED treatment requires interdisciplinary approach and cooperation of many
specialists, including a psychiatrist, a psychotherapist, a dietician, and a physician
[2]. A psychotherapy is the standard form of treatment for emotion dysregulation in
BED, with widely proven effectiveness for enhanced cognitive behavioral therapy
(CBT-E) [50] as well as dialectical behavior therapy (DBT), so-called ‛third-wave’
[51]. Another effective form of psychotherapeutic intervention in BED is psycho-
dynamic therapy [2]. According to this approach, the cause of eating disorders may
be regarded as displaced traumatic experiences of a person or abnormal course of
individuation-separation process [2]. Psychodynamic therapy aims to help the patient
to process the ‛unwanted’ emotions and their cause, and to learn how to function in
harmony with them [2].
The prognosis for patients with BED is more favorable than for other eating dis-
orders, [4] whilst 50–80% of individuals who have undergone treatment reach clinical
remission. The combination of pharmacological and psychotherapeutic interventions
brings the most successful results [2]. Nevertheless, there is still a significant proportion
of patients who are not helped by the above-mentioned treatments, which indicates
the need for further clinical research with therapeutic implications.
 Emotion regulation in binge eating disorder 1441

Conclusions
To conclude, negative emotions and deficits in their regulation play a significant
role in BED. Individuals with BED apply non-adaptive strategies for emotion regulation
more often than healthy individuals. They also present statistically significantly higher
levels of emotion intensity, greater emotional lability with a tendency to depressive
states. Interestingly, BED do not differ much in emotion regulation from other groups
of eating disorders. Some authors [21, 23, 45] are in favor of the hypothesis that dif-
ficulties in emotion regulation are not associated with a specific diagnostic category.
There seems to be a trans-diagnostic risk/maintenance factor that underlies various
forms of psychopathology.
Table 1. Review of research on emotion regulation in BED
Authors, year
Subjects (n) Method Results
of publication
EMA
overeating 14 days; the assessment Before binge eating episodes:
Keating et al. (2019) of depressive symptoms,
women = 55 depressive symptoms
emotion dysregulation,
binge eating

individuals
with ED = 999 Emotion dysregulation
Monell et al. (2018) DERS, EDE-Q
ED > HC
HC = 252

women with Emotion dysregulation

ED > HC;
ED = 120, including
Brockmeyer et al. DERS, SCID, PHQ, AN-R = AN-BP = BN;
AN-R, AN-BP, BN,
(2014) BDI-II BED less severe ER
BED
difficulties in some domains
HC = 89 than other ED

Food stimulus in BED: ↑

OB women Exposure to a food activity in brain areas: insula,
Aviram-Friedman et with BED = 13 stimulus vs control anterior cingulate cortex,
al. (2018) OB women without stimulus Brodmann areas 19 & 32,
BED = 29 fMRI inferior parietal lobule,
posterior cingulate cortex
women with
Emotion dysregulation: ED,
AN = 20,
MDD, BPD > HC;
BN = 18, BED slightly more adaptive
ERQ, ICARUS, pattern of ER than AN, BN
Svaldi et al. (2012) BED = 25,
DERS, AIM
BPD = 15, Adaptive strategies of ER:
ED < HC;
MDD = 16
non-adaptive ED > HC
HC =42

table continued on the next page

1442 Anna Walenda et al.

Negative mood and hunger:

EMA
prebinge time > nonbinge
Stein et al. (2007) women with BED = 33 7 days; the assessment time
of emotions, hunger,
Postbinge time: ↑ negative
binge status
mood
EMA
women with BED = 41 6 days; the examination BED, before binge episodes:
Greeno et al. (2000) of mood, appetite, poor mood, feeling of poor
HC = 38 eating control, craving sweets
setting of eating
episodes
Experimental
OB women manipulation of mood Sad film: ↓mood;
Chua et al. (2004)
with BED = 40 (neutral vs. sad film) Negative mood: ↑ food intake
prior to a taste test
EMA Global negative affect
2 weeks; an examination and guilt:
of eating episodes, ↑ prior to binge eating
Berg et al. (2015) OB individuals = 50
global negative affect, episodes,
fear, guilt, hostility, ↓ following binge eating
sadness episodes
Before the binge eating
episode: strong, immediate ↑
EMA
negative mood and tension
women with 1 week; the assessment
Munsch et al. (2011) Following binge eating: ↓
BED = 22 of positive and negative
negative mood and tension
mood, tension
(measured up to 4h after the
episode)
Negative mood: binge days >
nonbinge days
SCID, BDI, STAI, DEBQ, Comorbidity (in particular
OB women with BED The assessment of mood and anxiety disorders,
Schulz and Laessle = 40 naturalistic food intake substance-related disorders)
(2010) OB women without and mood before and BED > HC
BED = 44 after the episode (food BED predictors: anxiety,
diaries) emotional eating
BED: ↑ Depressive
symptoms: ↑ food intake
mDES, EES, TAS-20,
Individuals ↑ Negative emotions,
SCL-27
alexithymia BED >HC
with BED = 20 The assessment of
Zeeck et al. (2011) The emotion most often
OB = 23 emotions, alexithymia,
reported preceding binge
NWC = 20 overall psychopathology
eating: anger
and binge eating

table continued on the next page

 Emotion regulation in binge eating disorder 1443

The interview Factors triggering binge eating:

The assessment of ↑ negative mood, diet
feelings before, during violations
OB women
Arnow et al. (1992) and following the Before the episode: ↑ anger,
with BED = 19
episode; occurrence ↑ anxiety,
of restrictive food rules ↑ depression
between binge episodes After: ↑ guilt
women with EMA Before the episode: ↑ negative
mood,
Hilbert and Tuschen- BED = 20 The examination of
mood, thoughts before, BN and BED BN > BED
Caffier (2007) BN = 20
during and after binge After the episode: ↑ negative
HC = 20 eating episodes mood
1) 14-hour period of
caloric deprivation vs. no Caloric deprivation and
Agras and Telch OB women deprivation negative mood:
(1998) with BED = 60 2) Induction of negative ↑ number of binge eating
vs. neutral mood before episodes
eating
↑ Depressive symptoms: ↑
Induction of negative food intake
mood; ↑ Negative mood: ↑ food
Dingemans et al. women with
g1) emotion suppression, intake
(2009) BED = 66
g2) no aditional insruction Food intake: g1 = g2
Taste task, BDI After the episode of binge
eating: ↑ mood
Experiment 1)
BED = OB = NWC
Visual saccade tracking
initial fixation time
Food stimuli vs. neutral
OB individuals BED: gazed longer at food
stimuli
with BED = 25 stimuli
Experiment 1)
Schag et al. (2013) OB without assessment of reward Experiment 2) BED > OB,
sensitivity NWC difficulties in inhibiting
BED = 26
first saccades regardless of
NWC = 25 Experiment 2) the type of stimuli
assessment of
disinhibition BED > OB, NWC difficulties
in inhibiting second saccades
toward food stimuli
BED: ↑ Attentional
OB individuals with impulsiveness:
BED = 37 Visual, food-related go/ ↓ response inhibition
Hege et al. (2015) no-go task; fMRI performance and hypoactivity
OB without in the prefrontal control
BIS-11
BED = 19 network
BED: ↓ food-specific inhibition

table continued on the next page

1444 Anna Walenda et al.

COPE, ERQ, RRS,

WBSI, MASQ-SF,
EDE-Q
The assessment of Psychopathology:
Aldao and Nolen-
Graduates = 252 relationship between maladaptive ER strategies >
Hoeksema (2010)
cognitive emotion adaptive
regulation strategies
and ED, anxiety, and
depression
Suppression BED > HC
Induction of negative
women with mood (sad film clip); g1) Cognitive reappraisal BED
no additional instruction; < HC
Svaldi et al. (2010) BED = 27
g2) suppression; BED: suppression: ↑ food
HC = 25
g3) cognitive reappraisal craving,
↓ parasymphatetic activation
EDDS, MASQ-SF, RRS,
WBSI
The examination of ↑ brooding rumination: ↑
Smith et al. (2019) graduates = 263 association of brooding binge eating among women
rumination and thought
suppression with ED
symptoms
RRS-ED
The examination of ↑ Brooding rumination: ↑ ED
Women association between
Dondzilo et al. (2016) symptoms, including binge
(age: 17–24) = 119 rumination, eating, eating and dieting
weight, and ED
symptoms
SCID-I/P, EDE, RRS,
WBIS
OB individuals with The assessment of Rumination: ↑ ED
Wang et al. (2017)
BED = 237 relationship between psychopathology
rumination and ED
psychopathology
EMA – ecological momentary assessment; ED – eating disorders; BED – binge eating disorder;
AN-R – anorexia nervosa, restrictive type; AN–BP – anorexia nervosa, binge/purge type;
BN – bulimia nervosa; HC(s) – healthy control(s);
ER – emotion regulation; OB – obese; MDD – major depressive disorder; BPD – borderline
personality disorder; NWC(s) – healthy normal weight control(s); DERS – Difficulties in Emotion
Regulation Scale; EDE-Q – Eating Disorder Examination Questionnaire; SCID – Structured
Clinical Interview for DSM-IV; PHQ – Patient Health Questionnaire; BDI-II – Beck Depression
Inventory II; ERQ – Emotion Regulation Questionnaire; ICARUS – Inventory of Cognitive Affect
Regulation Strategies; AIM – Affect Intensity Measure; PANAS – Positive and Negative Affect
Schedule; STAI – State-Trait Anxiety Inventory; DEBQ – Dutch Eating Behavior Questionnaire;

table continued on the next page

 Emotion regulation in binge eating disorder 1445

mDES – Modified Differential Emotions Scale; EES – Emotional Eating Scale; TAS-20 – Toronto
Alexithymia Scale; SCL-27 – Symptom-Check-List; BIS-11 – Barratt Impulsiveness Scale; RRS
– Ruminative Response Scale; WBSI – White Bear Suppression Inventory; MASQ-SF – Mood
and Anxiety Symptom Questionnaire – Short Form; EDDS – Eating Disorder Diagnostic Scale;
RRS–ED – Ruminative Response Scale for Eating Disorders; EDE – Eating Disorder Examination;
WBIS – Weight–Bias Internalization Scale.

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Address: Anna Walenda

Institute of Psychology
Cardinal Stefan Wyszyński University in Warsaw
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