Emotion regulation and body image across the eating disorder symptom severity spectrum: a comparative analysis of young and middle-aged women.
Article
Bazo Perez, Maria, de Carvalho, Pedro Henrique Berbert, Frazier, Leslie D. (2026). Emotion regulation and body image across the eating disorder symptom severity spectrum: a comparative analysis of young and middle-aged women.
. 14(1), 57. 10.1186/s40337-026-01531-y
Bazo Perez, Maria, de Carvalho, Pedro Henrique Berbert, Frazier, Leslie D. (2026). Emotion regulation and body image across the eating disorder symptom severity spectrum: a comparative analysis of young and middle-aged women.
. 14(1), 57. 10.1186/s40337-026-01531-y
Eating disorders (EDs) are rising, yet research predominantly focuses on younger women, leaving midlife women understudied. This study examined how emotion dysregulation and body image concerns relate to disordered eating symptoms across emerging adulthood (EA, 18-30 years) and middle adulthood (MA, 45-65 years) and across levels of ED symptom severity.
Methods
Participants were 1055 women (317 EA lower-symptom-severity, 298 MA lower-symptom-severity, 211 EA higher-symptom-severity, 229 MA higher-symptom-severity). Emotion dysregulation was measured with the Difficulties in Emotion Regulation Scale-18 (DERS-18), body image concerns with the Body Image Concerns Inventory (BICI), and disordered eating symptoms with the Eating Disorder Examination Questionnaire (EDE-Q) and the Eating Attitudes Test-26 (EAT-26). Psychometric analyses, including confirmatory factor analyses and measurement invariance testing are detailed in the Supplemental Materials. Multiple-group structural equation modeling (MGSEM) was conducted to examine whether associations between predictors and outcomes differed by age and symptom severity.
Results
Associations varied across age and symptom severity. Difficulties with emotional clarity, impulse control, and appearance dissatisfaction were consistently associated with higher ED symptoms, whereas greater emotional awareness was linked to lower symptoms in some groups. Difficulties with goal-directed behaviors, nonacceptance, limited access to emotion regulation strategies, and social avoidance showed both positive and negative associations depending on age and symptom severity.
Conclusions
Findings underscore the need for developmentally informed, transdiagnostic approaches to ED prevention beyond early adulthood. Subscale-level analyses revealed that commonly defined "risk factors" may also be associated with adaptive or protective patterns, highlighting the complexity of these associations across the female lifespan. These insights support more nuanced, strength-based approaches to inform early detection, prevention, and intervention across the ED spectrum.
