Poor improvement of emotional regulation skills between ages 3 and 7 associated with increased risk of anorexia nervosa

Association of emotion regulation trajectories in childhood with anorexia nervosa and atypical anorexia nervosa in early adolescence

1. Children who were found to have poor improvement of emotional regulation skills between 3 to 7 years of age were at increased risk for broad anorexia nervosa

Evidence Rating: 2 (Good)

Anorexia nervosa is a highly prevalent psychiatric disorder characterized by restriction of food consumption and debilitating anxiety regarding one’s eating habits, body shape, and weight gain. The majority of cases begin in early adolescence, and as such, childhood interventions have been thought to be a potential effective means of reducing incidence of the disorder. One of the suggested interventions is the facilitation of appropriate development of emotional regulation skills, as clinical samples have found affected individuals to be show suboptimal skills compared to the general population. As prior literature is limited to case control studies in adults however, further investigations are needed to characterize the longitudinal relationship between the two variables. In this population-based birth cohort study, data from 15,896 children born between September 1 2000 to January 11 2002 were analyzed to address this gap in literature. Mothers completed the Children’s Social Behaviour Questionnaire to report their child’s emotion regulation skills at 3, 5, and 7 years. Univariable and multivariable logistic regression models were then used to test their association with symptoms consistent with a DSM-5 diagnosis of anorexia nervosa or atypical anorexia nervosa at 14 years of age, with appropriate adjustments for factors such as cognitive development, family socioeconomic characteristics, and other potential confounding factors. Interestingly, there was no association found between lower emotional regulation ability at 3 years of age and development of symptoms of broad anorexia nervosa (odds ratio [OR],1.21; 95%CI, 0.91-1.63). Rather, a lack of improvement of emotion regulation skills over childhood at 7 years of age was associated with higher odds of developing broad anorexia nervosa (OR, 1.45; 95%CI, 1.16-1.83). This study represents one of the first using longitudinal data to investigate the relationship between emotion regulation and the development of anorexia nervosa. With further research, this may identify an important area that can be used to identify at-risk individuals early in childhood and foster the appropriate development of emotion regulation skills as a means of preventing the disorder. Specifically, the development of fundamental skills such as stress management, overcoming frustration, and building tolerance for discomfort for example, may play a preventative role in the development of anorexia nervosa and other eating disorders.

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