Emotional overload in Bulimia Nervosa: an ERP study of emotion processing and regulation

People with Bulimia Nervosa (BN) self-report difficulties processing and regulating emotions. However, self-reports have been shown to be biased, particularly with people with BN who have difficulties describing their emotions. Self-reports also cannot easily disentangle between early processing and later regulatory stages, so it is not clear whether people with BN really do process their emotions more intensely or whether this is due to the aftermath of regulatory difficulties. This study aimed to use an objective way to measure (1) whether people with BN process their emotions with higher intensity compared to healthy controls (HC) and (2) whether they can successfully implement an emotion regulation strategy called cognitive reappraisal.

We developed a neuroimaging task using electroencephalography to answer these questions, using the Late Positive Potential (LPP) as an objective measure of emotional arousal at the processing and regulatory stages. We tested the task in females with BN (N = 32) and matched HC (N = 35).

We found that our BN group showed higher LPP compared to our HC group when viewing emotional pictures, demonstrating increased emotional intensity at the processing stage. We also found that the LPP for reappraisal took longer to get back to baseline for our BN group compared to the maintain condition and our HC group.

Our results suggest that people with BN process their emotions with higher intensity and may struggle to implement subsequent cognitive reappraisal strategies when affect is high. This has direct implications for clinicians who should be aware that when evoking affect in treatment, people with BN may need greater support in understanding and managing their emotions. Clinicians may also want to offer distress tolerance skills to reduce emotional arousal before suggesting using cognitive reappraisal skills to manage strong emotions.