Emotion regulation problems in childhood increase risk for broad anorexia nervosa

Failure to meet certain emotional developmental milestones between ages 3 to 7 years appeared to increase risk for broad anorexia nervosa, according to results of a cohort study published in JAMA Psychiatry.

“Existing studies of emotion regulation and anorexia nervosa have predominantly used case-control designs within clinical populations,” Mariella Henderson, MSc, of the division of psychiatry at the University College London, and colleagues wrote. “These studies have limitations. They are prone to reverse causality and cannot exclude the possibility that emotion regulation difficulties are a consequence rather than a cause of anorexia nervosa.”

According to the researchers, clinical studies also have limitations, including their susceptibility to selection bias due to their cases commonly being drawn from secondary care and controls from general population samples. No prior studies used a longitudinal design to assess whether emotion regulation difficulties among people with anorexia nervosa were present in their childhood, nor did they assess when they began to emerge. Henderson and colleagues aimed to address these research gaps by analyzing data of 15,896 children (51% boys; 84.5% white) with complete exposure data who participated in the Millennium Cohort study, a general population birth cohort in the U.K. with data collection between June 2001 and March 2016. Via the Children’s Social Behavior Questionnaire, mothers reported on their children’s emotion regulation skills at ages 3, 5 and 7 years.

The researchers used multilevel models to determine early childhood emotion regulation scores and within-child changes in emotion regulation scores between ages 3 and 7 years. Main outcomes and measures included symptoms that aligned with a DSM-5 diagnosis of anorexia nervosa or atypical nervosa at age 14 years according to numerous questions related to body image, weight perception and dieting behaviors. The researchers used univariable and multivariable logistic regression models to assess the relationship between exposures and outcome. They adjusted regression models for child and family sociodemographic characteristics and mental health difficulties, prenatal and perinatal factors, child’s cognitive development and maternal attachment.

Among 9,912 individuals with complete exposure and outcome data who were included in the analytical sample, 1% (n = 97) exhibited symptoms consistent with a broad anorexia nervosa diagnosis at age 14 years. Henderson and colleagues found no evidence of an increased risk for later reporting symptoms of broad anorexia nervosa among children with lower emotion regulation ability at age 3 years (OR = 1.21; 95% CI, 0.91-1.63); however, those who did not exhibit improvement in emotion regulation skills over childhood and who had greater problems with emotion regulation at age 7 years had increased risk for having broad anorexia nervosa at age 14 years (OR = 1.45; 95% CI, 1.16-1.83).

“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,” Henderson and colleagues wrote.