Cognitive and emotional regulation in adolescents and young women with eating disorders



Eating disorders (EDs) are associated with a reduced ability to regulate emotion and impulses during the life span. Working memory and executive functions (EFs) are cognitive regulatory systems supported by networks involving the pre-frontal cortex. Studies in EDs found impaired functioning in these domains, showing an association between EDs and the reduced ability to control emotions and impulses.


To investigate EF in adolescents and young women with eating disorders (ED) using a quasi-experimental design, focusing on cognitive efficiency, emotional regulation (ER) and behavioural outcomes also taking into account pharmacological treatment and duration of illness.


A sample of 151 females belonging to two groups took part in this study. Twenty-six girls and young women (Mage 22;8 years) with ED and 125 typically developed girls and young women (Mage 17;4 years) completed a battery of cognitive tasks (Go–no-go, Stop-signal task, Symmetry span, Reading Span) and the Youth Self-Report and the Difficulties in Emotional Regulation Scale Performance. A series of ANOVA with the Brown–Forsythe test was used to compare the groups.


Participants with ED and controls did not show significant differences in EF tasks, whereas differences between younger and older participants with ED emerged. Moreover, ER difficulties seem to be associated with mainly internalizing problems in EDs. Further analysis on the full ED sample did not reveal any significant differences associated with the disorder persistence. Considering pharmacological treatment effects over cognitive, emotional and behavioural measures emerged.


The present study documented no specific differences in EF between control and participants with EDs, whereas important differences emerged in ER and behavioural outcomes perception in the clinical sample, together with a partial influence of pharmacological treatment.

Level of evidence

No level of evidence.

This is a preview of subscription content, access via your institution.

Fig. 1


  1. 1.

    Fischer S, Munsch S (2012) Self-regulation in eating disorders and obesity—implications for treatment. Verhaltenstherapie 22:158–164.

    Article  Google Scholar 

  2. 2.

    van Elburg A, Treasure J (2013) Advances in the neurobiology of eating disorders. Curr Opin Psychiatry 26:556–561.

    Article  PubMed  Google Scholar 

  3. 3.

    van Zutphen L, Maier S, Siep N, Jacob GA, Tüscher O, Tebartz van Elst L, Zeeck A, Arntz A, O’Connor M-F, Stamm H, Hudek M, Joos A (2018) Intimate stimuli result in fronto-parietal activation changes in anorexia nervosa. Eat Weight Disord 24:1155.

    Article  PubMed  Google Scholar 

  4. 4.

    Donofry SD, Roecklein KA, Wildes JE, Miller MA, Erickson KI (2016) Alterations in emotion generation and regulation neurocircuitry in depression and eating disorders: a comparative review of structural and functional neuroimaging studies. Neurosci BiobehavRev 68:911–927.

    Article  Google Scholar 

  5. 5.

    Nyman-Carlsson E, Birgegård A, Engström I, Gustafsson SA, Nevonen L (2019) Predictors of outcome among young adult patients with anorexia nervosa in a randomised controlled trial. Eur Eat Disorders Rev 27(1):76–85.

    Article  Google Scholar 

  6. 6.

    Giedd JN, Blumenthal J, Jeffries NO, Castellanos FX, Liu H, Zijdenbos A, Paus T, Evans AC, Rapoport L (1999) Brain development during childhood and adolescence: a longitudinal MRI study. Nat Neurosci 2:861–863.

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Miyake A, Friedman NP, Emerson MJ, Witzki AH, Howerter A, Wager TD (2000) The unity and diversity of executive functions and their contributions to complex “frontal lobe” tasks: a latent variable analysis. Cogn Psychol 41:49–100.

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Malagoli C, Usai MC (2018) The effects of gender and age on inhibition and working memory organization in 14- to 19-year-old adolescents and young adults. Cog Dev 45:10–23.

    Article  Google Scholar 

  9. 9.

    Huizinga M, Dolan CV, Van der Molen MW (2006) Age-related change in executive function. Developmental trends and latent variable analysis. Neuropsychologia 44:2017–2036.

    Article  PubMed  Google Scholar 

  10. 10.

    Finn AS, Kraft MA, West MR, Leonard JA, Bish CE, Martin RE (2014) Cognitive skills, student achievement tests, and schools. Psychol Sci 25:736–744.

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Romer D, Betancourt L, Giannetta JM, Brodsky NL, Farah M, Hurt H (2009) Executive cognitive functions and impulsivity as correlates of risk taking and problem behavior in pre-adolescents. Neuropsychologia 47:2916–2926.

    Article  PubMed  PubMed Central  Google Scholar 

  12. 12.

    Vitaro F, Ferland F, Jacques C, Ladouceur R (1998) Gambling, substance use, and impulsivity during adolescence. Psychol Addict Behav 12:185–194.

    Article  Google Scholar 

  13. 13.

    Fikke LT, Melinder A, Landro NI (2011) Executive functions are impaired in adolescents engaging in non suicidal self injury. Psychol Med 41:601–610.

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Wu M, Hartmann M, Skunde M, Herzog W, Friederich HC (2013) Inhibitory control in bulimic-type eating disorders. A systematic review and meta-analysis. PLoS ONE.

    Article  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Darcy AM, Fitzpatrick KK, Manasse SM, Datta N, Klabunde M, Colborn D, Aspen V, Stiles-Shields C, Labuschagne Z, Le Grange D, Lock J (2015) Central coherence in adolescents with bulimia nervosa spectrum eating disorders. Int J Eat Disord 48:487–493.

    Article  PubMed  Google Scholar 

  16. 16.

    Lopez C, Tchanturia K, Stahl D, Treasure J (2009) Weak central coherence in eating disorders: a step towards looking for an endophenotype of eating disorders. J Clin ExpNeuropsychol 31(1):117–125.

    Article  Google Scholar 

  17. 17.

    Roberts ME, Tchanturia K, Stahl D, Southgate L, Treasure J (2007) A systematic review and meta-analysis of set-shifting ability in eating disorders. Psychol Med 37:1075–1084.

    Article  PubMed  Google Scholar 

  18. 18.

    Kanakam N, Treasure J (2013) A review of cognitive neuropsychiatry in the taxonomy of eating disorders State, trait, or genetic? Cogn Neuropsychiatry 18:83–114.

    Article  PubMed  Google Scholar 

  19. 19.

    Brockmeyer T, Skunde M, Wu M, Bresslein E, Rudofsky G, Herzog W, Friederich HC (2014) Difficulties in emotion regulation across the spectrum of eating disorders. Compr Psychiatry 55:565–571.

    Article  PubMed  Google Scholar 

  20. 20.

    McClelland MM, Ponitz CC, Messersmith E, Tominey S (2010) Self-regulation: the integration of cognition and emotion. In: Lerner R (Series Ed) & Overton W (Vol Ed), Handbook of life-span development (Vol 1: Cognition, biology and methods, pp 509–553). Hoboken, NJ: Wiley

  21. 21.

    Demirci E (2018) Non suicidal self-injury, emotional eating and insomnia after child sexual abuse: Are those symptoms related to emotion regulation? J Forensic Leg Med 53:17–21.

    Article  PubMed  Google Scholar 

  22. 22.

    Rosenstein LK, Ellison WD, Walsh E, Chelminski I, Dalrymple K, Zimmerman M (2018) The role of emotion regulation difficulties in the connection between childhood emotional abuse and borderline personality features. Personal Disord 9(6):590–594.

    Article  PubMed  Google Scholar 

  23. 23.

    Brockmeyer T, Pellegrino J, Maier C, Münch HM, Harmer CJ, Walther S, Herzog W, Friederich HC (2019) Blunted emotion-modulated startle reflex in anorexia nervosa. Int J Eat Disord 52(3):270–277.

    Article  PubMed  Google Scholar 

  24. 24.

    Foye U, Hazlett DE, Irving P (2019) Exploring the role of emotional intelligence on disorder eating psychopathology. Eat Weight Disord 24:299.

    Article  PubMed  Google Scholar 

  25. 25.

    Laghi F, Bianchi D, Pompili S, Lonigro A, Baiocco R (2018) Metacognition, emotional functioning and binge eating in adolescence: the moderation role of need to control thoughts. Eat Weight Disord 23(6):861–869.

    Article  PubMed  Google Scholar 

  26. 26.

    Oldershaw A, Lavender T, Sallis H, Stahl D, Schmidt U (2015) Emotion generation and regulation in anorexia nervosa: a systematic review and meta-analysis of self-report data. Clin Psychol Rev.

    Article  PubMed  Google Scholar 

  27. 27.

    Segal A, Golan M (2016) Differences in emotion regulation along the eating disorder spectrum: cross sectional study in adolescents out patient care. J Psychol Clin Psychiatry 6(1):00314.

    Article  Google Scholar 

  28. 28.

    Stice E (2002) Risk and maintenance factors for eating pathology: a meta-analytic review. Psychol Bull 128:825–848.

    Article  PubMed  Google Scholar 

  29. 29.

    Whiteside U, Chen E, Neighbors C, Hunter D, Lo T, Larimer M (2007) Difficulties regulating emotion: do binge eaters have fewer strategies to modulate and tolerate negative affect? Eat Behav 8:162–169.

    Article  PubMed  Google Scholar 

  30. 30.

    Aldao A, Nolen-Hoeksema S, Schweizer S (2010) Emotion-regulation strategies across psychopathology: a meta-analytic review. Clin Psychol Rev 30:217–237.

    Article  PubMed  Google Scholar 

  31. 31.

    Goossens L, Van Malderen E, Van Durme K, Braet C (2016) Loss of control eating in adolescents: associations with adaptive and maladaptive emotion regulation strategies. Eat Behav 22:156–163.

    Article  PubMed  Google Scholar 

  32. 32.

    Adambegan M, Wagner G, Nader IW, Fernandez-Aranda F, Treasure J, Karwautz A (2012) Internalizing and externalizing behaviour problems in childhood contribute to the development of anorexia and bulimia nervosa—a study comparing sister pairs. Eur Eat Disord Rev 20:116–120.

    Article  PubMed  Google Scholar 

  33. 33.

    Malagoli C, Usai MC (2018) WM in adolescence: What is the relationship with emotional regulation and behavioral outcomes? Front Psychol 9:844.

    Article  PubMed  PubMed Central  Google Scholar 

  34. 34.

    Logan GD (1994) On the ability to inhibit thought and action: a user’s guide to the stop signal paradigm. In: Dagenbach D, Carr TH (eds) Inhibitory processes in attention, memory, and language. Academic Press, San Diego, pp 189–239

    Google Scholar 

  35. 35.

    Verbruggen F, Logan GD (2008) Response inhibition in the stop-signal paradigm. Trends Cogn Sc 12:418.

    Article  Google Scholar 

  36. 36.

    Donders FC (1969) On the speed of mental processes. Acta Psycho 30:12–431

    Google Scholar 

  37. 37.

    Hare TA, Tottenham N, Davidson MC, Glove GH, Casey BJ (2005) Contributions of amygdala and striatal activity in emotion regulation. Biol Psychiatry 57:624–632.

    Article  PubMed  Google Scholar 

  38. 38.

    Kane MJ, Hambrick DZ, Tuholski SW, Wilhelm O, Payne TW, Engle RW (2004) The generality of working memory capacity: a latent-variable approach to verbal and visuospatial memory span and reasoning. J Exp Psychol Gen 133:189–217.

    Article  PubMed  Google Scholar 

  39. 39.

    Daneman M, Carpenter PA (1980) Individual differences in working memory and reading. J Verbal Learning Verbal Behav 19:450–466.

    Article  Google Scholar 

  40. 40.

    Giromini L, Velotti P, de Campora G, Bonalume L, Zavattini GC (2012) Cultural adaptation of the difficulties in emotion regulation scale: reliability and validity of an Italian version. J Clin Psychol 68:989–1007.

    Article  PubMed  Google Scholar 

  41. 41.

    Achenbach T (2001) YSL ages 11-18, ASEBA, University of Vermont (USA). Italian version by A Frigerio (ed.)

  42. 42.

    Riniolo TC (1999) Using a large control group for statistical comparison: evaluation of a between-groups median test. J Exp Educ 68(1):75–88.

    Article  Google Scholar 

  43. 43.

    Del Pozo A, Harbeck S, Zahn S, Kliem S, Kröger C (2018) Cognitive distortions in anorexia nervosa and borderline personality disorder. Psychiatry Res.

    Article  PubMed  Google Scholar 

  44. 44.

    Johnston J, Shu CY, Hoiles KJ, Patrick JF, Clarke PJF, Watson HJ, Dunlop PD, Egan SJ (2018) Perfectionism is associated with higher eating disorder symptoms and lower remission in children and adolescents diagnosed with eating disorders. Eat Behav 30:55–60.

    Article  PubMed  Google Scholar 

  45. 45.

    Katterman SN, Kleinman BM, Hood MM, Nackers LM, Corsica JA (2014) Mindfulness meditation as an intervention for binge eating, emotional eating, and weight loss: a systematic review. Eat Behav 15:197–204.

    Article  PubMed  Google Scholar 

  46. 46.

    Doba K, Berna G, Constant E, Nandrino JL (2018) Self-differentiation and eating disorders in early and middle adolescence: a cross-sectional path analysis. Eat Behav 29:75–82.

    Article  PubMed  Google Scholar 

  47. 47.

    Kaye WH, Frank GK, Bailer UF, Henry SE (2005) Neurobiology of anorexia nervosa: clinical implications of alterations of the function of serotonin and other neuronal systems. Int J Eat Disord 37:S15–S19.

    Article  PubMed  Google Scholar 

  48. 48.

    Di Bernardo M, Barciulli E, Ricca V, Mannucci E, Moretti S, Cabras PL, Rotella CM (1998) Binge eating scale in obese patients: validation of the Italian version. Minerva Psichiatr 39:125–130.

    Article  Google Scholar 

  49. 49.

    Cuzzolaro M, Vetrone G, Marano GF, Battacchi MW (1999) BUT: una nuova scala per la valutazione del disagio relativo all’immagine del corpo. Psichiatria dell’Infanzia e dell’adolescenza 66:417–428

    Google Scholar 

  50. 50.

    Cuzzolaro M, Vetrone G, Marano G, Garfinkel P (2006) The Body Uneasiness Test (BUT): development and validation of a new body image assessment scale. Eat Weight Disord 11:1–13.

    CAS  Article  PubMed  Google Scholar 

  51. 51.

    Calugi S, Sartirana M, Milanese C, El Ghoch M, Riolfi F, Dalle-Grave R (2018) The clinical impairment assessment questionnaire: validation in Italian patients with eating disorders. Eat Weight Disord 23:685.

    Article  PubMed  Google Scholar 

  52. 52.

    Garner DM, Olmsted MP, Polivy J (1983) Development and validation of a multidimensional EDI for anorexia nervosa and bulimia. Int J Eat Disord 2:15–34

    Article  Google Scholar 

  53. 53.

    Giannini M, Pannocchia L, Dalle Grave R, Muratori F (2008) Viglione V EDI-3 eating disorder inventory-3: manuale. O.S. Organizzazioni Speciali, Firenze

    Google Scholar 

  54. 54.

    Bressi C, Taylor G, Parker J, Bressi S, Brambilla V, Aguglia E, Invernizzi G (1996) Cross validation of the factor structure of the 20-item toronto alexithymia scale: an Italian multicenter study. J Psychosom Res 41(6):551–559.

    CAS  Article  PubMed  Google Scholar 

  55. 55.

    Sarno I, Preti E, Prunas A, Madeddu F (2011) SCL-90-R Symptom Checklist-90-R Adattamento italiano Firenze: Giunti, Organizzazioni Speciali

Download references


This work was supported by a doctoral grant and a research fellowship awarded to Chiara Malagoli by the University of Genoa and Accademia Ligure di Scienze e Lettere, respectively.

Author information



Corresponding author

Correspondence to Chiara Malagoli.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research committee (Ethical Code of Italian Psychology Order and the Ethical Guidelines of the Italian Association of Psychology) and with the 1964 Helsinki Declaration and its later amendments. At the time we collected the data, no ethical committee was yet present to which we could refer to in our organization.

Informed consent

Informed written consent was obtained from the participants or their parents if they were minor before data collection.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Malagoli, C., Cerro, P.F., Vecchiato, C. et al. Cognitive and emotional regulation in adolescents and young women with eating disorders. Eat Weight Disord 26, 375–383 (2021).

Download citation


  • Eating disorders
  • Cognitive processes
  • Emotional regulation
  • Behavioural outcomes
  • Adolescence