(PS6-A6) Gut Feelings: Body Mistrust and Emotion Dysregulation in Bulimia Nervosa

Background:  Altered interoceptive awareness, and specifically mistrust of internal body signals, has been implicated in both disordered eating and emotion dysregulation, but the cognitions that could explain these common links have not yet been investigated. Individuals with bulimia nervosa (BN), a disorder characterized by loss-of-control eating, purging, and emotion dysregulation, tend to expect eating to relieve their negative affect; however, little is known about how these beliefs may relate to body mistrust and influence difficulties accessing other emotion regulation strategies in BN.

Method:  We examined body mistrust, emotion regulation difficulties, and eating expectancies in 30 women with BN and 31 age-, BMI-, and FSIQ-matched healthy controls who completed the Eating Disorder Examination, the Difficulties in Emotion Regulation Scale (DERS), the Eating Expectancies Inventory (EEI), and the Multidimensional Assessment of Interoceptive Awareness (MAIA)). 

Results:  Consistent with prior results, women with BN reported lower levels of body trust (t(55.65)=-10.91, p< 0.001), greater difficulties accessing emotion regulation strategies (t(36.04)=7.11, p< 0.001), and greater beliefs that eating helps manage negative affect (t(56.65)=10.05, p< 0.001) compared to their healthy counterparts. Within the BN group, robust regressions revealed that lower levels of body trust were associated with stronger beliefs that eating will help alleviate negative affect (B=-1.75, SE=0.88, p=0.046). Body mistrust (B=-3.16, SE=1.22, p< 0.01) and these beliefs about eating (B=.50, SE=.30, p=0.011) were both linked to greater difficulties accessing adaptive emotion regulation strategies. Difficulties accessing emotion regulation strategies were, in turn, related to more frequent loss-of-control eating episodes (B=.11, SE=.04, p< 0.01).

Conclusion:  Results highlight a potentially critical role for body mistrust in maladaptive expectations that eating will regulate emotions and in difficulties accessing other, more adaptive emotion regulation strategies in BN. These findings add to the growing literature suggesting that beliefs about body signals and what will regulate them may be useful targets in cognitive behavioral therapy. Future longitudinal and ecological momentary assessment studies are needed to test whether expectations that eating will reduce negative affect mediate the relationship between body mistrust and emotion regulation difficulties, ultimately leading to more frequent symptoms.