title: Emotional Intolerance and Core Features of Anorexia Nervosa: A Dynamic Interaction during Inpatient Treatment? Results from a Longitudinal Diary Study.
abstract: The role of emotion dysregulation with regard to the psychopathology of anorexia nervosa (AN) is increasingly discussed. It is both assumed that AN symptoms have an impact on difficulties in tolerating aversive emotions and that-conversely-emotion dysregulation influences AN. To date, such conclusions are drawn on the basis of cross-sectional data not allowing for inferences on the temporal dynamics. The current study investigates the longitudinal interaction between emotional intolerance and core AN symptoms over the course of inpatient treatment by comparing patients with high (BMI<15 kg/m2) vs. low symptom severity (HSS vs. LSS).
  
  
  
  The study adopted a longitudinal, process-oriented design with N = 16 analysed electronic diaries. Throughout the course of their inpatient treatment, the patients answered questions daily about emotional intolerance and their AN-specific cognitions and behaviours. The temporal dynamics between emotional intolerance and these variables were analysed using a multivariate time series approach.
  
  
  
  The time series of the processes under investigation adequately reflected the individual treatment courses. The majority of significant linear time trends was found for HSS patients. Most importantly, analysis revealed significant temporal interactions between emotional intolerance and AN symptoms in almost 70% of HSS patients. Thereby, up to 37% of variance in eating restraint and up to 23% in weight concern could be attributed to changes in emotional intolerance.
  
  
  
  The findings support the notion that intolerable unpleasant emotions in severely affected AN patients influence their psychopathology. Additionally, time series analysis outlined the inter-individual heterogeneity of psychosomatic treatment courses of AN patients.
authors.affiliation: Department of General Internal Medicine and Psychosomatics, Medical University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Esther
authors.initials: E
authors.lastname: Stroe-Kunold
authors.affiliation: Department of General Internal Medicine and Psychosomatics, Medical University Hospital Heidelberg, Heidelberg, Germany.|Department of Psychosomatic Medicine and Psychotherapy, LVR-Clinics, University Düsseldorf, Düsseldorf, Germany.
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Friederich
authors.affiliation: Department of Psychological Methods and Statistics, University Ulm, Ulm, Germany.
authors.forename: Tatjana
authors.initials: T
authors.lastname: Stadnitski
authors.affiliation: Department of General Internal Medicine and Psychosomatics, Medical University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Daniela
authors.initials: D
authors.lastname: Wesche
authors.affiliation: Department of General Internal Medicine and Psychosomatics, Medical University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Herzog
authors.affiliation: Department of General Internal Medicine and Psychosomatics, Medical University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Schwab
authors.affiliation: Department of General Internal Medicine and Psychosomatics, Medical University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Beate
authors.initials: B
authors.lastname: Wild
mesh_terms: D000328:Adult; D000856:Anorexia Nervosa / Q000175:diagnosis* / Q000523:psychology* / Q000628:therapy; D003430:Cross-Sectional Studies; D004644:Emotions; D005260:Female; D006801:Humans; D007297:Inpatients; D008137:Longitudinal Studies; D010641:Phenotype; D012307:Risk Factors; D011795:Surveys and Questionnaires; D055815:Young Adult