Nowadays, binge-eating disorder (BED) is one of the most common diseases among feeding and eating disorders in DSM-5 classification (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) . Its lifetime prevalence among the general population from United States is estimated to about 2,03% . BED manifests by recurrent episodes of eating large amounts of food in a discrete period (e. g. within 2 h), while experiencing a sense of lack of control . The binge-eating episodes are characterized by: (a) rapid pace of eating, (b) eating until feeling extremely full, (c) eating without a feeling of physical hunger, (d) feeling guilty and disgusted about oneself afterwards . Unlike bulimia nervosa (BN), inappropriate compensatory behaviors, such as purging, do not occur in BED . A recent study found that some specific metacognitive beliefs about food and eating may be a maintaining factor in binge-eating symptoms . Namely, three types of beliefs could be distinguished: negative beliefs (thoughts of having no control over one’s eating), positive beliefs (beliefs that eating improves one’s mood), and permissive beliefs (beliefs that one should allow oneself to binge-eat) . Furthermore, the dysfunctional mechanisms of emotion regulation seem to be one of the most problematic issues of the clinical picture of BED . Emotional regulation is a multidimensional construct that comprises all processes with which a person monitors, assesses, and modifies his or her emotional states . It can be regarded as the ability to inhibit impulsive, dysfunctional reactions to strong emotions regardless of their valence or refocusing attention while experiencing intense emotions or self-restraining physiological stimulation that accompanies them .
The inability to regulate emotions adaptively seems to be important not only for the development but also for sustaining binge-eating [7, 8]. There are several models in which researchers have tried to explain these associations. One of the oldest models, the escape from self-awareness model by Heatherton and Baumeister , depicted overeating as an attempt to escape the aversive perception of oneself by narrowing the field of attention, which relates to the use of evasive coping strategies . Fairburn’s transdiagnostic theory of eating disorders  raised an issue that intolerance of both positive and negative mood presents in some patients who overeat significantly hinders the effects of standard treatment (requiring additional interventions). However, the association between overeating episodes and the presence of negative emotions is particularly highlighted in the growing body of literature. The affect regulation model described by Polivy and Herman  sees the function of binges in alleviating negative affect, which secondarily reinforces a maladaptive coping means that becomes increasingly learned and automated. This model stays in line with extensive scientific literature, as follows: the systematic review by Leehr and coworkers , the meta-analysis by Cardi et al.  in conjunction with a significant part of the (electronic) diary studies [15,16,17,18]. According to the above-mentioned diary studies [15,16,17,18], negative affect in people with BED often becomes a trigger for overeating, which is not the case in people without this diagnosis, even in the case of obesity. However, Munsch et al.  state that it is not so much the occurrence or accumulation of negative emotions that is important, but their rapid increase, causing considerable tension, and consequently the breakdown of insufficiently efficient processes of regulating emotions. Giel et al. , on the other hand, stress the role of positive emotions associated with food consumption and the pleasure it may provide. Thus, making it more difficult to face impulses, which is particularly difficult in stressful situations . There is a lack of consistency among empirical results on the impact of overeating on emotions and mood. According to some results, the affective state improves [15, 18], while, according to others, it worsens [10, 16, 21] after engaging in binge-eating.
Researchers posit that especially in case of coping with aversive emotions, overeating appears a consequence of a lack of more adaptive strategies of emotion regulation . A wide range of possible strategies can be divided into adaptive and maladaptive ones, whereas the latter are related to psychopathology . Examples of adaptive emotional regulation strategies are: cognitive reappraisal (i.e. attempts to change emotions by changing the interpretation of a given situation) , acceptance of the situation, refocusing on planning actions to deal with it, positive refocusing (thinking of other, pleasant matters instead of the negative event), positive reappraisal (treating a difficult situation as an opportunity for development), or putting into perspective (associating the relativity of a difficult event with other events) . Maladaptive strategies of coping with difficult emotions would be, for example, overeating, , blaming oneself for a given situation or blaming others, catastrophic thinking, ruminating (persistent remembrance of a negative event and its consequences),  or suppression . Rumination is a characteristic strategy engaged in the psychopathology of eating disorders, [22, 26,27,28] including binge-eating [22, 27]. Moreover, some studies found that individuals with BED tend to reappraise their emotions less in comparison to healthy controls [29, 30]. However, there is a paucity of research on certain emotion regulation strategies applied by BED patients.
The aim of the present study was to identify various emotion regulation difficulties in individuals diagnosed with BED in comparison to a healthy control group. Previous research (e. g [31, 29].) focused mainly on a very few emotion regulation strategies in BED, such as rumination, suppression, and positive reappraisal. Therefore, little is known so far about the other strategies. To address this gap in the literature, this is the first study, to the authors’ best knowledge, which allowed to assess such a wide range of emotion regulation strategies (including self-blame, catastrophizing, others-blame, putting into perspective, acceptance, positive refocusing, refocus on planning, positive reappraisal), used by BED patients in comparison to healthy controls. Moreover, this study aimed to analyze a spectrum of potential correlative interactions between applied strategies and difficulties in emotion regulation, and clinical variables (severity of eating disorders, severity of anxiety and depression symptoms, and level of alexithymia) in both subject groups, as depression, anxiety, and alexithymia are often comorbid with BED and determine its course [32, 33]. To the best of authors’ knowledge, this is also the first study exploring associations between binge- eating-related beliefs (positive, negative, and permissive) and various emotional regulation strategies and difficulties in individuals diagnosed with BED. This is especially important as these beliefs seems to be maintaining factors in BED .
In line with existing literature, we hypothesized that: (1) patients with BED report greater difficulties in emotion regulation than healthy controls, (2) patients with BED use more maladaptive strategies and less adaptive strategies than healthy controls, (3) various difficulties in emotion regulation and using of maladaptive strategies in BED group are positively correlated with the severity of eating disorders symptoms, depression, anxiety, and alexithymia, whereas (4) the use of adaptive strategies is negatively correlated with the severity of eating disorders symptoms, depression, anxiety, and alexithymia (5) abnormal food-related beliefs are associated with emotion regulation strategies and difficulties.