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.