Beyond symptoms: longitudinal perspectives on relapse, recovery, and emotion regulation in eating disorders

Abstract

Eating disorders such as anorexia nervosa, bulimia nervosa, and binge‑eating disorder profoundly affect daily life, influencing not only physical health but also emotions, relationships, and self‑image. Many individuals experience fluctuating periods of recovery and relapse, making the long‑term course difficult to predict. This dissertation aimed to deepen understanding of the factors that contribute to relapse, recovery, and long‑term trajectories of eating disorders, using data from the Netherlands Eating Disorders Registry (NER).

A key finding is that depressive symptoms play a major role in how eating disorders develop over time. Individuals with higher levels of depressive symptoms are more likely to relapse and less likely to recover. These symptoms relate both to objectively measured indicators and to people’s subjective sense of recovery. This highlights the importance of early recognition and proactive treatment of depressive symptoms.

The dissertation also examined emotion‑regulation skills and their relation to body dissatisfaction. Although these emotional factors did not predict long‑term outcomes, emotion suppression was consistently associated with greater body dissatisfaction. Furthermore the virtual‑reality experiment showed that adaptive emotion‑regulation strategies reduced anxiety among individuals with more severe eating‑disorder symptoms, showing VR’s potential as a safe environment to practice difficult situations.

Overall, the findings underscore the value of long‑term monitoring and offer practical insights for tailoring treatment, preventing relapse, and integrating new technologies to support recovery.