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Emotion Coupling and Regulation in Anorexia Nervosa


Correspondence to: Dr John Fox, Clinical Psychology, School of Health in Social Science, University of Edinburgh, Medical School, Edinburgh EH8 9AG, UK.




The present study sought to investigate emotion regulation strategies in people with anorexia nervosa (AN) and whether the theoretical concept of ‘emotion coupling’ between anger and disgust could help to explain some of the specific eating disorder symptomatology in people with AN.


This ‘emotion coupling’ hypothesis was tested using a mood induction procedure within laboratory conditions, where individuals with AN (n = 22) were matched with control participants (n = 19). Participants completed a bank of different measures prior to the study, and these included measures of eating pathology, core beliefs about the self and others, and emotion regulation strategies. Within the experimental part of this study, anger, disgust and body size estimation were measured prior to and after an anger induction procedure (i.e., a repeated measures design).


People with AN demonstrated a significantly more internal-dysfunctional way to regulate their emotional states, when compared with matched controls. Within the ‘emotional coupling’ part of the study, participants showed a significant increase in levels of disgust and body size estimation following an anger induction when compared with matched controls.


The significance of these results was considered in the light of the new Schematic, Propositional, Analogical and Associative Representation Systems in eating disorders model. Copyright © 2012 John Wiley & Sons, Ltd.

Key Practitioner Message

  • Emotions and emotion processing are problematic for people with anorexia nervosa.
  • Overestimation in body size for people with anorexia nervosa may be due to the coupling of anger and disgust.
  • Clinicians need to consider the importance of automatic cognitive routes of emotion elicitation that may maintain certain eating disorder symptoms, such as poor body image.