Emotion regulation and body image across the eating disorder symptom severity spectrum: a comparative analysis of young and middle-aged women

Eating disorders (EDs) are rising, yet research predominantly focuses on younger women, leaving midlife women understudied. This study examined how emotion dysregulation and body image concerns relate to disordered eating symptoms across emerging adulthood (EA, 18–30 years) and middle adulthood (MA, 45–65 years) and across levels of ED symptom severity. Participants were 1055 women (317 EA lower-symptom-severity, 298 MA lower-symptom-severity, 211 EA higher-symptom-severity, 229 MA higher-symptom-severity). Emotion dysregulation was measured with the Difficulties in Emotion Regulation Scale-18 (DERS-18), body image concerns with the Body Image Concerns Inventory (BICI), and disordered eating symptoms with the Eating Disorder Examination Questionnaire (EDE-Q) and the Eating Attitudes Test-26 (EAT-26). Psychometric analyses, including confirmatory factor analyses and measurement invariance testing are detailed in the Supplemental Materials. Multiple-group structural equation modeling (MGSEM) was conducted to examine whether associations between predictors and outcomes differed by age and symptom severity. Associations varied across age and symptom severity. Difficulties with emotional clarity, impulse control, and appearance dissatisfaction were consistently associated with higher ED symptoms, whereas greater emotional awareness was linked to lower symptoms in some groups. Difficulties with goal-directed behaviors, nonacceptance, limited access to emotion regulation strategies, and social avoidance showed both positive and negative associations depending on age and symptom severity. Findings underscore the need for developmentally informed, transdiagnostic approaches to ED prevention beyond early adulthood. Subscale-level analyses revealed that commonly defined “risk factors” may also be associated with adaptive or protective patterns, highlighting the complexity of these associations across the female lifespan. These insights support more nuanced, strength-based approaches to inform early detection, prevention, and intervention across the ED spectrum. Eating disorders (EDs) can affect individuals at any age, yet most research has focused on young women, leaving women in midlife underrepresented. This study explored how difficulties with managing emotions and concerns about body image relate to ED symptoms in younger (emerging adult) and middle-aged women, and across different levels of symptom severity. We found that body image concerns were strongly linked to ED symptoms in all groups, though in some cases, appearance-related avoidance was also associated with lower body dissatisfaction, suggesting a more complex role. Emotion regulation difficulties were more strongly tied to ED symptoms in middle-aged women, and some aspects of emotion regulation—such as emotional awareness—were consistently linked to lower ED symptoms, showing potential resilience. These findings highlight the importance of considering both age and severity when understanding and treating EDs. They also point to the need for prevention and treatment approaches that are tailored to women’s emotional and body image experiences at different stages of life.