Stress, Affect Systems and Eating Pathology in Problematic Weight Regulation
Problematic weight regulation as found in obesity and Anorexia Nervosa (AN) are chronic conditions which require long-term management. In order to develop long-term strategies to manage these conditions, a clearer understanding of the factors that can contribute to the development and also recovery from these conditions are a necessity. Although obesity and AN are at the opposite end of the bodyweight spectrum, some shared psychological processes may drive these states. One factor that has been suggested to contribute to problematic weight regulation is psychosocial stress whilst positive affect systems and affect regulation processes are important for regulating stress-related experiences. Gilbert (2005) describes an affect regulation system which consists of two positive affect systems known as social rank and attachment. Whilst the latter affect system refers to the attachment bond that develops between an infant and its caregiver (which extends to adult relationships), the former is used to form relationships that allow us to compete for limited resources and maintain our status in the social environment. Affect regulation processes in the current research are self-criticism and self-reassurance. Whilst self-critical thoughts and feelings can be triggered by perceptions of being low rank, the idea that people can be self-reassuring or being able to self-reassure at times of difficulty is nested in the positive infant-caregiver attachment bond and a consequence of internalizing parental soothing (Gilbert, 2006). Hence, as stress is suggested to be an important factor in problematic weight regulation and affect systems and processes are central to the regulation of emotional responses to stress-related experiences, the current series of studies examined these factors in relation to problematic weight regulation. The current research consisted of four studies designed to examine the role of stress and affect regulation in relation to weight change, weight regain following weight loss and recovery versus symptom maintenance in AN in women. A longitudinal study (Study One) was conducted to examine the change trajectories of stress, eating pathology and bodyweight, how these changes influence each other and the role of affect regulation systems and processes on these changes in a community based sample (N = 1157). Study Two examined the role of stress and affect regulation as predictors of weight regain in those who have lost weight (N = 42) and Study Three used a measure of life events and difficulties to investigate the role of stressful life changes and affect systems on recovery and relapse following AN (N = 30). Finally, in Study four, an expressive writing task which has been demonstrated to have a positive impact on stress-related health outcomes was used to explore the role of stress, affect systems and processes on problematic weight regulation and eating at times of stress (N = 57). The findings of the research studies demonstrated that there is a concurrent link between stress and the regulation of bodyweight and eating in a community-based sample of women. However, the proposed relationship between stress, bodyweight and eating behaviours was not confirmed when examined longitudinally in a community-based sample, over a 7-month period in women who have lost weight or when examined retrospectively as contributing to symptom maintenance in women with AN. However, the main finding of the current series of studies suggested that affect systems and affect regulation processes do have important implications for regulating stress-related experiences, bodyweight and eating behaviours. Perceived low social status, greater insecurity of attachment, more self-critical and less self-reassuring thoughts and feelings were related to increases in stress levels, higher bodyweight and higher levels of dysfunctional eating patterns. In addition, whilst expressive writing did not reduce stress, influence bodyweight or improve affect regulation at times of difficulty, writing about positive experiences had a positive impact on reducing dietary restraint behaviours during a stressful period. In conclusion, these findings suggest that it may not be stress per se that contributes to unhealthy changes in bodyweight and eating behaviours but how we use our affect systems and processes to manage our emotions at times of difficulty. Consequently, these findings have important implications for practice as weight loss programmes, Eating Disorder prevention programmes and stress management interventions should address the issues of perceived low social status, self-criticism and attachment insecurities.