Making Connections Between Anger and Eating Disorders

The connection between overt and suppressed anger and disordered eating has been the focus of research for some time. Recently researchers in London and Scotland compared two groups of women to determine if facets of anger are related to an individual’s core beliefs.

The two groups included women who met DSM-IV criteria for eating disorders and a control group. The authors also hoped to learn whether levels of different types of anger differ across individual eating disorder diagnoses and behaviors (Int J Eat Disord 2003; 34:118).

The study group included 20 women with anorexia nervosa of the restricting subtype, 39 with anorexia nervosa of the bulimic subtype, 68 with bulimia nervosa, and 13 with binge eating disorder. The 50 women volunteers in the control group were all undergraduates and none had a history of eating disorders. All the women filled out two self-report questionnaires that measure anger levels (State-Trait Anger Expression Inventory) and unhealthy core beliefs (Young’s Schema Questionnaire).

Higher anger levels reported in those with eating disorders

The study results showed that women with eating disorders had higher levels of state anger and anger suppression than did the control group, particularly when the eating disorder diagnosis included bulimic symptoms. Different aspects of anger were associated with specific bulimic behaviors. If women used binge-eating or vomiting, they had significantly higher levels of trait anger. In contrast, women who exercised excessively had significantly higher state anger scores. Those who used laxatives had significantly greater levels of suppressed anger than did the control group.

Suppressed anger was characteristic of bulimic patients

In contrast to earlier studies, this study suggests that suppressing anger is characteristic of patients who use bulimic behaviors. The study also reiterates research showing that bulimic attitudes are associated with anger suppression rather than with externally directed anger.

The authors note that it may be useful to examine anger as a multifaceted problem. They hypothesize that bulimic behaviors serve different emotional functions, and can be divided between the elements of anger that are influenced by “fast-acting” behaviors, such as binge eating, vomiting, and exercise, and those influenced by “slow-acting” behaviors, such as laxative abuse.

These findings suggest that high levels of state anger, trait anger, and anger suppression may need to be addressed during therapy. Treatment approaches may help patients replace emotion-focused coping strategies with a more adaptive problem-focused approach.

Among women without eating disorders, bulimic attitudes and behaviors have been specifically correlated with state anger and anger suppression, rather than with trait anger. This suggests that binge eating and vomiting behaviors may serve different functions with regard to anger. In an earlier study by Drs. R.J. Mulligan and G. Waller, of the University of London, Southampton, bulimic attitudes and behaviors appeared to reduce immediate anger states, particularly when the individual had a strong tendency to avoid expressing anger (Int J Eat Disord 2000; 248:446).