Affective Lability: A Clue to Maladaptive Behavior

Clinicians and researchers have long tried to discover if certain characteristics might help  identify patients with bulimia nervosa (BN) who are at risk of self-injury or substance abuse. A recent study focused on the role affective lability may play in maladaptive behaviors among such patients (Int J Eat Disord 2009; 42:259).

Individuals who chronically experience rapidly fluctuating emotions seem to show impaired coping skills, and thus are more vulnerable to engaging in destructive behaviors when they are upset. To better understand the relationship between affective lability and behavioral dysregulation, the authors examined data collected from a sample of women who either met the criteria for or who were in various stages of recovery from eating disorders, specifically those with current DSM-IV diagnoses of BN.

A total of 204 female patients were recruited from eating disorder clinics and communities in five Midwestern cities. One-hundred and thirty-four met the criteria for a current DSM-IV diagnosis of BN, and thus were included in the study. The women ranged in age from 18 years to 55 years, and 98.5% (132 patients) met the DSM-IV criteria for BN purging type; 1.5% (2 patients) met criteria for non-purging type BN. Most had moderate symptoms. All participants were given a semistructured interview, using the Structured Clinical Interview for DSM-IV, Patient Edition (SCID-P), and only those who currently met criteria for BN were included in the analyses. All other data were collected through the women’s response on several self-report questionnaires such as the Spielberger State/Trait Anxiety Inventory and the Michigan Assessment Screening Test/Alcohol.

One finding was excessive reassurance-seeking

Even controlling for age, depressive symptoms, state and trait anxiety, and general impulsivity, affective lability significantly predicted the Impulsive Behavior Scale score and excessive reassurance-seeking. As the authors note, this finding is consistent with research that has proposed that excessive reassurance-seeking is a marker for behavioral dysregulation. That is, their findings were consistent with those of a previous study showing that anxiety and self-esteem mediated the relationship between negative life events and excessive reassurance-seeking and that the onset of the behavior is prompted by a need to reduce negative affect and cognitions.

Using treatment that targets affect as well as CBT

The overall message from the study presents a strong case that women with BN who also engage in other impulsive behaviors show highly labile emotions. Faced with chronically shifting affective states, these women could potentially be less able to cope and forced to do so more often than are individuals whose emotions are more stable. One possible explanation might be that women with BN who engage in other dysregulated behavior either meet the diagnositc criteria for borderline personality disorder or at least show symptoms of this disorder.

According to the authors, individuals who show highly labile behaviors might benefit from treatment targeting management and understanding of affect as well as traditional cognitive behavioral therapy.