The relationship between self-control and symptoms of anxiety and depression in patients with eating disorders: a cross-sectional study including exploratory longitudinal data

Plain English summaryEating disorders (EDs) are mental disorders characterized by a persevering behavioral disturbance in eating and distress in thoughts or emotions, significantly impairing psychosocial function and/or physical health. Anxiety and depression are common in patients with EDs.Studies have indicated that personality style may impact the onset, clinical presentation, and recovery from an ED. Personality style can be studied in terms of self-control, ranging from over- to undercontrol. However, it remains unknown how self-control relates to anxiety/depression in patients with EDs and its stability during ED treatment. This is what we aimed to investigate in this study, collecting data before treatment in 227 adult patients from a Swedish outpatient ED clinic, with 14 also completing post-treatment measurements.Our results indicated that global anxiety/depression levels in patients with EDs were not strongly correlated with levels of self-control, but rather with ED symptoms. Nevertheless, anxiety seemed to increase with increasing levels of undercontrol and extreme values of both over- and undercontrol showed a tendency to be associated with higher levels of depression. In the exploratory analyses self-control levels remained more stable during treatment than global anxiety/depression levels, which decreased significantly. BackgroundPersonality style can partly be described as the way an individual controls and regulates emotions and can be divided into over- and undercontrol. Studies have indicated that personality style may impact the onset, clinical presentation, and recovery from an eating disorder (ED). Furthermore, symptoms of anxiety and depression are common in patients with EDs. However, the association between self-control levels and anxiety/depression symptoms in patients with EDs remains unknown. The main aim of this study was to assess how levels of self-control relate to anxiety/depression symptoms in patients with EDs, with a secondary, exploratory aim to assess the stability of self-control during treatment.MethodsPatients were recruited from the outpatient ED clinic at the Uppsala University Hospital, between October 2014 and December 2019. In total, 227 patients (age: 25.4, SD: 7.1) were included at the start of their treatment, with 14 participants also completing post-treatment measurements. Self-control was assessed with the Ego Undercontrol scale (EUC-13), anxiety/depression symptoms with the Hopkins Symptoms Checklist (HSCL-25), and ED diagnosis and symptoms with the Eating Disorder Examination Interview (EDE-I) and Questionnaire (EDE-Q), respectively.ResultsA quadratic regression (n = 227) showed that levels of self-control accounted for about four percent of the variance in degree of global anxiety/depressive symptoms. Anxiety/depression symptoms were better explained by ED symptoms (R-2 = 0.24). Visualizations in boxplots revealed a tendency for extreme values of both over- and undercontrol to be associated with higher levels of depression, whereas symptoms of anxiety increased with increasing undercontrol. In the exploratory analyses (n = 14) levels of self-control remained more stable than symptoms of anxiety and depression, which decreased significantly during ED treatment.ConclusionsOur results indicated that anxiety/depression symptoms, in patients with EDs, were not strongly correlated with levels of self-control, but rather with ED symptoms. However, extreme values of both over- and undercontrol showed a tendency to be associated with higher levels of depression symptoms, whereas anxiety symptoms increased with increasing levels of undercontrol. Future studies could benefit from considering both over- and undercontrol as potentially dysfunctional.