Does Evidence Support an Emotion Regulation Model of Anorexia Nervosa? A Systematic Review of Over a Decade of Research

Objective: Over a decade ago, a model was proposed to explain the role of emotion regulation in the development and maintenance of anorexia nervosa (AN). Research on emotion regulation in AN has since rapidly increased, prompting a need to revisit the evidence base regarding whether AN may be considered a disorder of emotion regulation. Method: We conducted a systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines across PubMed, PsychInfo, and Web of Science on the emotion regulation literature in the years following the proposal of this emotion regulation model. Inclusion criteria were: (a) empirical and quantitative articles in English; (b) human samples; (c) analysis pertaining to AN; and (d) focused on a domain of emotion regulation. The review yielded 134 eligible articles (from a pool of 562 nonduplicate studies) examining emotion regulation constructs in AN, encompassing individual-level emotional and environmental vulnerabilities, use of adaptive and maladaptive emotion regulation strategies, and eating disorder behaviors as emotion regulation. Results: Overall, evidence supported the relevance of emotion regulation to the conceptualization of AN. Individuals with AN demonstrated greater individual and environmental vulnerabilities to dysregulation, less adaptive and more maladaptive emotion regulation strategies, and greater tendency to engage in eating disorder behaviors to regulate emotions. Findings on emotional reactivity were more mixed. Discussion: Results highlight that continued research on emotion regulation across restrictive eating presentations is needed. Furthermore, treatments directly targeting emotion regulation warrant further investigation. Emotion regulation models continue to hold promise in characterizing the core mechanisms of AN.