Emotional overload in bulimia nervosa: An ERP study of emotion processing and regulation.

Abstract

Abstract Objective People with Bulimia Nervosa (BN) self-report difficulties processing and regulating emotions. However, self-reports have been shown to be biased, particularly with people with BN who have difficulties describing their emotions. Self-reports also cannot easily disentangle between early processing and later regulatory stages, so it is not clear whether people with BN really do process their emotions more intensely or whether this is due to the aftermath of regulatory difficulties. This study aimed to use an objective way to measure (1) whether people with BN process their emotions with higher intensity compared to healthy controls (HC) and (2) whether they can successfully implement an emotion regulation strategy called cognitive reappraisal. Methods We developed a neuroimaging task using electroencephalography to answer these questions, using the Late Positive Potential (LPP) as an objective measure of emotional arousal at the processing and regulatory stages. We tested the task in females with BN (N = 32) and matched HC (N = 35). Results We found that our BN group showed higher LPP compared to our HC group when viewing emotional pictures, demonstrating increased emotional intensity at the processing stage. We also found that the LPP for reappraisal took longer to get back to baseline for our BN group compared to the maintain condition and our HC group. Discussion Our results suggest that people with BN process their emotions with higher intensity and may struggle to implement subsequent cognitive reappraisal strategies when affect is high. This has direct implications for clinicians who should be aware that when evoking affect in treatment, people with BN may need greater support in understanding and managing their emotions. Clinicians may also want to offer distress tolerance skills to reduce emotional arousal before suggesting using cognitive reappraisal skills to manage strong emotions. Plain English summary Research has shown that people with Bulimia Nervosa (BN) often have trouble managing their emotions. We wanted to understand why this happens. For example, we were wondering whether people with BN feel emotions more strongly than others, or do they just have trouble finding ways to cope with their feelings? Or maybe both? We created a new task to look at what the brain is doing when people with BN experience and manage their emotions. We tested the task in 32 females with BN and 35 healthy females with no eating disorders. The results showed two main things. First, we showed that women with BN tend to feel emotions more intensely than those without BN. Second, we found that women with BN may have difficulties using cognitive reappraisal, a strategy that involves looking at situations from different angles to find more positive aspects. These findings are important because they suggest that people with BN might need extra help in two areas: they may need support in dealing with the strength of their emotions, and in finding alternative ways to manage their feelings and reduce distress. This research could lead to better ways to support people with BN in the future.