Emotion generation and regulation in anorexia nervosa: a systematic review and meta-analysis of self-report data.

Oldershaw A, Lavender T, Sallis H, Stahl D, Schmidt U.

Clin Psychol Rev. 2015 Jul;39:83-95.


This systematic review sought to examine the generation and regulation of emotion in people with Anorexia Nervosa (AN). Key databases (Medline, Embase, PsychINFO and Web of Science) were searched for peer-reviewed articles published by March 2015 yielding 131 studies relevant to emotion generation and emotion regulation (ER) processes as defined by Gross (1998). Meta-analyses determined pooled group differences between AN and healthy control (HC) groups. More maladaptive schemata were reported by people with AN than HCs, with largest pooled effects for defectiveness/shame (d=2.81), subjugation (d=1.59) and social isolation (d=1.66). Poorer awareness of and clarity over emotion generated and some elevated emotionality (disgust and shame) were reported. A greater use of 'maladaptive' ER strategies was reported by people with AN than HCs, alongside less use of 'adaptive' strategies. Pooled differences of particularly large effect were observed for: experiential avoidance (d=1.00), negative problem-solving style (d=1.06), external/social comparison (d=1.25), submissiveness (d=1.16), attention concentration (worry/rumination; d=1.44) and emotion suppression (d=1.15), particularly to avoid conflict (d=1.54). These data support the notion that emotion regulation difficulties are a factor in AN and support use of associated cognitive-affective models. The implications of these findings for further understanding AN, and developing models and related psychological interventions are discussed.

Looking for helpful resources to share with your patients and their carers?

View resources for patients and carers

Register with FREED to access the professional training platform and toolkit

An online training package and implementation toolkit for services interested in adopting FREED. This material is free for NHS professionals but requires registration to access.

Register now

Help & Support

The sooner you seek support, the sooner things can start to get better. We can help you find the right option for you.

Don’t want to use the tool? Download our guide to seeking help and support for more general information and advice.

Discover FREED

What is FREED?

Resources for Patients & Carers

Your Questions Answered

Get Help & Support

Discover FREED

What is FREED?

Science & Research Behind FREED

The FREED Network

Resources for Healthcare Professionals

Register for Training & Toolkit