Childhood Trouble with Emotion Regulation Leads to Anorexia Nervosa Later in Adolescence

Mariella Henderson, MSc

A difficulty in developing appropriate emotion regulation behaviors in childhood could increase the likelihood of developing anorexia nervosa during the teenage years.

A team, led by Mariella Henderson, MSc, Division of Psychiatry, University College London, identified the association between emotional regulation trajectories from 3-7 years of age and symptoms of anorexia nervosa and atypical anorexia nervosa in adolescence.

While patients with anorexia nervosa can have difficulties regulating their emotions, there is a lack of longitudinal evidence on whether the differences are already present in childhood or when they begin to emerge.

The Study

In the cohort study, the researchers examined data from 15,896 children with complete exposure data in the Millennium Cohort Study, a UK general population birth cohort, between June 2001 and March 2016.

Using the Children’s Social Behavior Questionnaire, mothers reported on their child’s emotion regulation skills at age 3, 5, and 7. The researchers then used multilevel models to derive early childhood emotion regulation scores and within-child changes in emotion regulation scores from 3-7 years old.

Outcomes

The investigators sought main outcomes of symptoms consistent with a DSM-5 diagnosis of anorexia or atypical anorexia nervosa at 14 years of age. This was defined using a range of questions relative to body image, weight perception, and dieting behaviors.

The researchers tested the association between exposures and outcome using univariable and multivariable logistic regression models, which were adjusted for child and family sociodemographic and socioeconomic characteristics and mental health difficulties, prenatal and perinatal factors, child’s cognitive development, and maternal attachment.

Results

Of the patients with complete exposure and outcome data (n = 9912) of the analytical sample had symptoms consistent with a diagnosis of broad anorexia nervosa at 14 years old.

However, there was no evidence found suggesting children with lower emotion regulation ability at years old had greater probability of later reporting symptoms of broad anorexia nervosa (OR, 1.21; 95% CI, 0.91-1.63).

On the other hand, individuals whose emotion regulation skills did not improve over the course of their childhood and had greater problems regulating emotions at age 7 had higher odds of having broad anorexia nervosa at 14 years old (OR, 1.45; 95% CI, 1.16-1.83).

“These findings suggest that difficulties in developing age-appropriate emotion regulation skills in childhood are associated with experiencing broad anorexia nervosa in adolescence,” the authors wrote. “Interventions to support the development of emotion regulation skills across childhood may help reduce the incidence of anorexia nervosa.”

Anorexia nervosa generally begins in adolescence and is characterized by restrictions in food intake and severe anxiety regarding eating, body shape, and weight gain. The disorder, including in its subthreshold presentations, affects approximately 1% of young people and can be associated with mental and physical health comorbidities and high mortality.

The study, “Association of Emotion Regulation Trajectories in Childhood With Anorexia Nervosa and Atypical Anorexia Nervosa in Early Adolescence,” was published online in Jama Psychiatry.