Emotion Regulation in Response to Stress in the Daily Lives of Women With and Without Eating Disorders: An Ecological Momentary Assessment Study

OBJECTIVE: Emotion regulation difficulties are known risk/maintenance factors for eating disorders (EDs). Few studies have investigated use of adaptive/maladaptive emotion regulation strategies in people with EDs, especially using ecologically valid data. This study: (1) compared stressor endorsement and severity, use of adaptive and maladaptive emotion regulation strategies, and perceived helpfulness of these strategies among women with and without EDs; (2) investigated whether adaptive and maladaptive emotion regulation strategy use and perceived helpfulness predicted engagement in ED behaviors among women with EDs. METHOD: Participants were 188 women with diverse EDs and 49 women with no ED history. They completed five signal-contingent surveys per day for 14 days that asked about stressors, emotion regulation strategies, purging, and maladaptive exercise. Event-contingent surveys completed after eating assessed binge eating and restriction. RESULTS: Compared to women without EDs, women with EDs reported a greater number of stressors, greater stress severity, less adaptive strategy use, more maladaptive strategy use, and less perceived helpfulness from adaptive strategies. None of the within-person results survived Benjamini-Hochberg false discovery rate correction. However, using an adaptive strategy and perceiving it as more helpful were associated with a lower likelihood of subsequent binge eating. Using distraction was associated with future restriction, while perceiving distraction as unhelpful predicted future maladaptive exercise. DISCUSSION: Women with EDs have more stress in daily life and use less effective strategies to regulate it, which could help explain the development/maintenance of EDs. However, few relations between adaptive/maladaptive strategy use and subsequent ED behaviors among women with EDs were detected.