اختلالات خاص تنظیم احساسات در افسردگی اساسی و بی اشتهایی عصبی

Emotion regulation (ER) difficulties have been considered to play an important role in the development and maintenance of various mental disorders such as depression and anorexia nervosa. However, previous research has failed to provide detailed insight into the disorder-specificity of ER difficulties. Therefore, the present study investigated specific ER difficulties in female samples of patients with major depression, patients with anorexia nervosa, and healthy controls (total sample: N=140). As compared to healthy controls, both clinical groups reported greater ER difficulties concerning both the experience and the differentiation as well as the attenuation and the modulation of emotions. Patients in both clinical groups reported comparably elevated ER difficulties regarding the experience and differentiation of emotions. However, depressed patients reported stronger ER difficulties regarding the attenuation and modulation of emotions as compared to patients with anorexia nervosa. These findings support the notion of ER difficulties as transdiagnostic phenomena, and suggest that depression may be characterized by broader and greater ER difficulties than anorexia nervosa.

Adaptive emotion regulation (ER) has been proposed to involve a range of cognitive and behavioral processes concerning the experience and differentiation as well as the attenuation and modulation of emotions (Gross and Muñoz, 1995, Gratz and Roemer, 2004 and Gratz and Tull, 2010). Recent etiological models of mood and of eating disorders have attached great importance to deficits in ER (Gross and Muñoz, 1995, Taylor et al., 1997, Campbell-Sills and Barlow, 2007, Kring and Sloan, 2010 and Haynos and Fruzzetti, 2011), supporting the notion that ER deficits may be regarded as transdiagnostic factors (Gross and Muñoz, 1995, Taylor et al., 1997, Campbell-Sills and Barlow, 2007 and Kring and Sloan, 2010). In line with these theoretical models, previous empirical research observed impaired ER in depression (Liverant et al., 2008, Pfeiffer et al., 2011 and Brockmeyer et al.,) as well as in eating disorders such as anorexia nervosa (Gilboa-Schechtman et al., 2006, Harrison et al., 2009 and Brockmeyer et al., 2011). Common symptoms of both disorders have been considered to serve an ER function. For example, rumination can be considered a rather abstract and verbal style of information processing which may thereby protect the depressed individual from aversive imagery and associated physiological arousal (Watkins and Moulds, 2007). In anorexia nervosa, restrictive eating, weight loss, and excessive exercising have been considered to provide an escape from aversive emotional arousal (Haynos and Fruzzetti, 2011). However, the question whether certain ER difficulties are more strongly associated with certain mental disorders than with others has barely been addressed directly in empirical research. In their recent meta-analysis, Aldao et al. (2010) have delineated the relationships between various ER strategies and specific mental disorders. Their results indicated that dysfunctional ER strategies (e.g., avoidance, suppression, rumination) were generally more closely associated with depression and anxiety disorders than with eating and substance use disorders. However, this meta-analysis was primarily based on studies that (i) used only samples with symptoms of one specific disorder each, (ii) have not controlled for the potential influence of comorbid disorders, and that (iii) have investigated different ER strategies with heterogeneous instruments. In consequence, the meta-analysis did not allow concluding stringently whether specific mental disorders were differentially associated with ER deficits. To overcome these shortcomings, Aldao and Nolen-Hoeksema (2010) tested various ER strategies simultaneously in subject samples suffering from symptoms of different mental disorders. In their study, they found that maladaptive strategies (i.e., rumination, suppression) were associated more strongly with symptoms of depression, anxiety, and eating disorders than adaptive strategies (i.e., reappraisal, problem-solving). However, this study used a student sample rather than a clinical sample. Furthermore, the authors investigated some variables (e.g., rumination, problem-solving) that can best be considered antecedents of and responses to emotions (Gross, 1999 and Gross and John, 2003) rather than being inherent components of the ER process itself in the sense of experiencing, differentiating, attenuating, and modulating emotions (Gratz and Roemer, 2004). In studies that compared women suffering from clinical eating disorders and female healthy controls, initially observed differences regarding ER deficits disappeared when levels of depression and anxiety were statistically controlled for (Eizaguirre et al., 2004 and Gilboa-Schechtman et al., 2006). Only a few studies have compared clinical samples of patients with eating disorders and patients with mood and/or anxiety disorders so far. These previous studies failed to find any difference between these groups regarding ER deficits (Brockmeyer et al., 2011 and Svaldi et al.,). However, these studies were based on rather small sample sizes and thus may have been underpowered. For example, Svaldi et al. (in press) compared, amongst others, 20 patients with anorexia nervosa, 16 patients with major depressive disorder, and 42 healthy controls. The authors concluded that their findings are in line with the notion of ER deficits as transdiagnostic risk and/or maintaining factors that do not appear to be disorder-specific. Yet, they called for replications with larger samples of patients. To overcome some of the limitations of previous studies, the present study compared larger samples of patients suffering from either a major depressive disorder or an eating disorder (anorexia nervosa) regarding central ER difficulties. Based on theoretical assumptions of ER deficits as transdiagnostic phenomena (Taylor et al., 1997, Campbell-Sills and Barlow, 2007 and Kring and Sloan, 2010) and in line with previous studies that separately demonstrated impaired ER in both disorders (Brockmeyer et al., 2011, Brockmeyer et al.,, Gilboa-Schechtman et al., 2006, Liverant et al., 2008, Harrison et al., 2009 and Pfeiffer et al., 2011) it was expected that the two patient groups will show greater ER difficulties than healthy controls, but that they will not differ from each other concerning the extent of ER difficulties.