What about males? Exploring sex differences in the relationship between emotion difficulties and eating disorders

Abstract Objective: While eating disorders (ED) are more commonly diagnosed in females, there is growing awareness that men also experience ED and may do so in a different way. Difficulties with emotion processing and emotion regulation are believed to be important in ED, but as studies have involved predominantly female samples, it is unclear whether this is also true for males.Methods: In the largest sample to date, consisting of 1604 participants (n=631 males), we assessed emotion processing and emotion regulation in males with ED and compared results to both females with ED and males from the general population. We also looked at whether emotion processing and emotion regulation difficulties predicted various aspects of eating psychopathology and whether this was moderated by sex. We assessed emotion processing with the Toronto Alexithymia Scale, and emotion regulation with the Difficulties in Emotion Regulation Scale and the Emotion Regulation Questionnaire.Results: We found that males with ED, like their female counterparts, suffered from emotion processing and emotion regulation deficits. We did find some sex differences, in that males with ED tended to report more difficulties with their emotions as well as a more externally oriented thinking style compared to females with ED. Difficulties with emotion processing and emotion regulation were strongly predictive of various aspects of eating psychopathology in both sexes. Importantly, we found that sex moderated the relationship between reappraisal and eating restraint. As such, low use of reappraisal was found to be associated with higher levels of restrictive eating in females but not in males. Discussion: Difficulties with emotion processing and emotion regulation are associated with eating psychopathology in both males and females. Reappraisal was not found to be associated with reduced eating psychopathology in males, suggesting a cautious approach to interventions targeting this strategy. Research around explanatory mechanisms and interventions must adopt a broader viewpoint including those who are traditionally overlooked in ED.