Early adaptive schemas, emotional regulation, and cognitive flexibility in eating disorders: subtype specific predictors of eating disorder symptoms using hierarchical linear regression

J S Mitchell; T Huckstepp; A Allen; P J Louis; T E Anijärv; D F Hermens

doi:10.1007/s40519-024-01682-4

Early adaptive schemas, emotional regulation, and cognitive flexibility in eating disorders: subtype specific predictors of eating disorder symptoms using hierarchical linear regression

Eat Weight Disord. 2024 Aug 29;29(1):54. doi: 10.1007/s40519-024-01682-4.

Authors

J S Mitchell¹, T Huckstepp², A Allen^{2

3}, P J Louis⁴, T E Anijärv^{2

5}, D F Hermens²

Affiliations

¹ Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia. jules.mitchell@research.usc.edu.au.
² Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia.
³ School of Health, University of Sunshine Coast, Sippy Downs, QLD, Australia.
⁴ USCI University, Kuala Lumpur, Malaysia.
⁵ Clinical Memory Research Unit, Lund University, Lund, Sweden.

Abstract

Purpose: Understanding how early adaptive schemas, cognitive flexibility, and emotional regulation influence eating disorder (ED) symptoms, and whether this differs across diagnostic subtypes is critical to optimising treatment. The current study investigated the relationship between these variables and ED symptomology in individuals self-reporting an ED diagnosis and healthy controls.

Methods: A dataset of 1576 online survey responses yielded subsamples for anorexia nervosa (n = 155), bulimia nervosa (n = 55), binge eating disorder (n = 33), other specified feeding or eating disorder (n = 93), and healthy participants (n = 505). The hierarchical linear regression analysis included Eating Disorder Examination Questionnaire 6.0 Global Score as the dependent variable; Young Positive Schema Questionnaire, Emotional Regulation Questionnaire, and Cognitive Flexibility Inventory subscale scores as the independent variables; and demographic measures as the covariates.

Results: The number of significant predictors varied considerably by ED sub-group. Amongst the anorexia nervosa, bulimia nervosa, and healthy subsamples, the adaptive schema Self-Compassion and Realistic Expectations was associated with lower ED symptom severity. In comparison, age and body mass index were the strongest predictors for binge eating disorder, whilst the Expressive Suppression (a subscale of the Emotional Regulation Questionnaire) was the strongest predictor for other specified feeding or eating disorders.

Conclusion: Early adaptive schemas, cognitive flexibility, and emotional regulation vary across ED subtype, suggesting the need for tailored treatment that disrupts the self-reinforcing cycle of ED psychopathology. Future research investigating how early adaptive schemas may predict or be associated with treatment response across diagnostic subtypes is needed.

Level of evidence: Level IV, evidence obtained from multiple time-series with or without the intervention, such as case studies.

Keywords: Cognitive flexibility; Early adaptive schemas; Eating disorders; Emotional regulation.

MeSH terms

Adaptation, Psychological*
Adolescent
Adult
Anorexia Nervosa / diagnosis
Anorexia Nervosa / psychology
Bulimia Nervosa / diagnosis
Bulimia Nervosa / psychology
Cognition* / physiology
Emotional Regulation* / physiology
Feeding and Eating Disorders* / diagnosis
Feeding and Eating Disorders* / psychology
Female
Humans
Linear Models
Male
Middle Aged
Surveys and Questionnaires
Young Adult