What about males? Exploring sex differences in the relationship between emotion difficulties and eating disorders

Objective: While eating disorders (EDs) are more commonly diagnosed in females, there is growing awareness that men also experience EDs and may do so in a different way. Difficulties with emotion processing and emotion regula-tion are believed to be important in EDs, but as studies have involved predominantly female samples, it is unclear whether this is also true for males. Methods: In a sample of 1604 participants (n =631 males), we assessed emotion processing and emotion regula-tion in males with EDs (n =109) and compared results to both females with EDs (n =220) and males from the general population (n =522). We also looked at whether emotion processing and emotion regulation difficulties predicted various aspects of eating psychopathology and whether this was moderated by sex. We assessed emotion process-ing with the Toronto Alexithymia Scale, emotion regulation with the Difficulties in Emotion Regulation Scale and the Emotion Regulation Questionnaire, and eating psychopathology with the Eating Disorder Examination Questionnaire. Results: We found that males with ED, like their female counterparts, suffered from emotion processing and emotion regulation deficits. We did find some sex differences, in that males with EDs tended to report more difficulties with their emotions as well as a more externally oriented thinking style compared to females with EDs. Difficulties with emotion processing and emotion regulation were strongly predictive of various aspects of eating psychopathology in both sexes. Importantly, we found that sex moderated the relationship between cognitive reappraisal and eating restraint. As such, low use of reappraisal was found to be associated with higher levels of restraint in females but not in males. Discussion:Difficulties with emotion processing and emotion regulation are associated with eating psychopathol-ogy in both males and females. Reappraisal was not found to be associated with reduced eating psychopathology in males, suggesting a cautious approach to interventions targeting this strategy. Research around explanatory mecha-nisms and interventions must adopt a broader viewpoint including those that are traditionally overlooked in EDs. Plain English summary While eating disorders (EDs) are more common in females, males also suffer from these conditions and are generally neglected in research around EDs. Difficulty identifying and managing emotions is believed to be important in the development and maintenance of EDs, but as studies have been conducted mostly in females, it is unclear whether this is also true for males. We recruited 1604 participants (631 were males, and 329 were diagnosed with EDs comprising 109 males and 220 females) and compared how males and females processed and regulated their emotions. We found that males with EDs, like their female counterparts, suffered from difficulties identifying and regulating their emotions, though they showed a slightly different profile of difficulties. While difficulties with emotions were associated with ED behaviours in both sexes, difficulties using reappraisal, an emotion regulation strategy where one reinterprets an event from a different perspective, were associated with restraint in females but not in males. This suggests that while interventions to help with emotional functioning could be beneficial for both women and men with EDs, the different emotional profiles of men with EDs must be considered, as interventions targeting particular emotional processes (e.g. reappraisal) may be relevant for women but not men.

Automated summary

This study focuses on the presence of eating disorders in males and highlights the importance of understanding the gender-specific differences in emotion processing and regulation. The findings suggest that difficulties with emotion processing and regulation are associated with eating psychopathology in both males and females, but there are some differences between the two genders. Importantly, the study also reveals that the relationship between cognitive reappraisal and eating restraint is moderated by sex, emphasizing the need for tailored interventions for male and female individuals with eating disorders.