The mediating role of social connectedness between inflexibility, the suppression of emotional expression, and symptoms of eating disorders and depression in adolescents with restrictive eating disorders referred for radically open dialectical behaviour therapy (RO DBT).

backgroundOvercontrol is a transdiagnostic phenotype which has been associated with restrictive eating disorders and depression. It is characterised by traits such as cognitive and behavioural inflexibility, risk aversion, suppression of emotional expression, reduced reward sensitivity and higher temperamental anxiety. Two aspects of the overcontrol phenotype (inflexibility and the suppression of emotional expression) have been particularly linked with poorer mental health. Additionally, social connectedness has been shown to protect against mental health symptom severity. The current study aimed to test whether the relationship between these factors and mental health symptom severity, namely, eating disorder and depression, is mediated by social connectedness.

methodsRoutine data were collected for adolescents with restrictive eating disorders presenting to either outpatient or intensive day programme treatment in a specialist eating disorder service. Four cross-sectional mediation analyses were planned. The first two models aimed to test the mediating role of social connectedness on the relationship between inflexibility (model 1) and the suppression of emotional expression (model 2) on eating disorder symptom severity. The second two models aimed to test the mediating role of social connectedness on the relationship between inflexibility (model 3) and the suppression of emotional expression (model 4) on depression symptom severity. Baseline weight and comorbid mental health symptom severity were controlled for in each model.

resultsThe sample consisted of 109 adolescents (mean age = 15.21 years, 96.3% female). Current findings indicate that social connectedness did not statistically mediate the relationships between inflexibility and eating disorder symptom severity (model 1; Path ab β = .02, 95% bootstrap CI 0.0002-0.05). The planned analysis examining the relationship between the suppression of emotional expression and eating disorder symptoms (model 2) was not tested as the variables did not significantly correlate. Findings also indicated that social connectedness statistically mediated the relationships between both inflexibility (model 3; Path ab β = .82, 95% bootstrap CI 0.33-1.40) and the suppression of emotional expression (model 4; Path ab β = .38, 95% bootstrap CI 0.13-0 .69) on depressive symptoms.

conclusionsFindings suggest targeting social connectedness, as is the case in Radically Open Dialectical Behaviour Therapy (RO DBT), may be a useful way to improve treatment outcomes for young people with restrictive eating disorders and co-morbid depressive symptoms. This fits with qualitative data that shows that taking a holistic approach during treatment, as opposed to being overly symptom focused, is needed and valued by young people and their family members.