Emotional dysregulation, obsessive-compulsive traits, and eating disorders: three constructs for one spectrum?

Purpose: Dysfunctional eating behaviors are associated with emotional dysregulation and obsessive-compulsive symptoms. Traditionally, obsessiveness has been linked to anorexia nervosa (AN), while dysregulation has been associated with bulimia nervosa (BN) and binge eating disorder (BED). However, this dichotomous view fails to account for the frequent diagnostic crossover observed among individuals with eating disorders (EDs). This study aimed to identify specific clusters in individuals with EDs based on emotional dysregulation, obsessive-compulsive symptoms, eating symptoms, and body uneasiness. Methods: An observational cross-sectional study was conducted at the ED Unit of Clinical Psychiatry, Bologna, Italy. Participants (N = 360) completed the Difficulties in Emotion Regulation Scale (DERS), Obsessive Compulsive Inventory-Revised (OCI-R), Eating Disorders Examination Questionnaire (EDE-Q), and Body Uneasiness Test (BUT). Hierarchical and two-step cluster analyses were applied. Cluster differences were examined using Kruskal-Wallis tests and post-hoc comparisons. Results: The analysis identified three clusters with increasing levels of emotional dysregulation, obsessive-compulsive symptoms, eating symptoms, and body uneasiness (Cluster size ratio = 2.04; Silhouette = 0.30). Symptom severity ranged from more functional (Cluster 1) to moderate (Cluster 2) to more dysfunctional (Cluster 3). Conclusion: This study identified three clusters representing a progressive gradient in the symptoms assessed, challenging the traditional dichotomy linking obsessiveness solely to AN and dysregulation solely to BN/BED.