Regulation of emotions is necessary for successful attainment of short-term
and long-term goals. However, over-regulation may also have its costs. In
anorexia nervosa (AN), forgoing food intake despite emaciation and endocrine
signals that promote eating is an example of “too much” self-control. Here we
investigated whether voluntary emotion regulation in AN patients comes with
associated disorder-relevant costs. Thirty-five patients with acute AN and
thirty-five age-matched healthy controls (HCs) performed an established
emotion regulation paradigm during functional magnetic resonance imaging after
an overnight fast. The task required reducing emotions induced by positively
valenced pictures via distancing. We calculated a neural regulation score from
responses recorded in a reward-related brain region of interest (ventral
striatum; VS) by subtracting activation measured on “positive distance” trials
from that elicited under the “positive watch” (baseline) condition.
Complementing the imaging data, we used ecological momentary assessment (EMA)
to probe disorder-related rumination and affect six times/day for 2 weeks
following the scanning session. The neural regulation score indicating reduced
VS activation during emotion regulation was used as a predictor in
hierarchical linear models with EMA measures as outcomes. No group differences
in neural activity were found for the main contrasts of the task. However,
regulation of VS activity was associated with increased body-related
rumination and increased negative affect in AN, but not in HC. In line with
this finding, correlational analysis with longitudinal BMI measurements
revealed a link between greater VS regulation and poorer treatment outcome
after 60 and 90 days. Together, these results identify a neural correlate of
altered emotion regulation in AN, which seems to be detrimental to
psychological well-being and may interfere with recovery