Today’s paper is by researchers from Jordan, Australia, and Italy. It’s entitled, The Difficulties in Emotional Regulation among a Cohort of Females with Lipedema, and it was published in the International Journal of Environmental Research and Public Health in October 2022.
This study aims to investigate the difficulties that patients with lipedema may have with emotional regulation and anxiety compared to healthy people who don’t have lipedema.
First, let’s define some terms.
Definition of Terms
Here is a definition of emotional regulation from a paper from the Cornell University research program.
Emotional regulation is “a person’s ability to effectively manage and respond to an emotional experience. People unconsciously use emotion regulation strategies to cope with difficult situations many times throughout each day.”
To further define emotional regulation for you, here are some examples of healthy versus unhealthy strategies for emotional regulation that the Cornell paper provides: It would be healthy to talk with friends, exercise, or write a journal, but it would be unhealthy to abuse drugs or alcohol, injure yourself, or become verbally or physically aggressive.
Why study this issue?
The authors wanted to study this because it is often noted in the literature that patients with lipedema face difficulties on multiple fronts and all of these issues could result in psychological disorders such as anxiety, depression, eating disorders, post-traumatic stress disorder, and panic disorders. Some of these difficulties include:
- Challenges getting diagnosed and getting access to proper treatment, delays that can last up to several decades in some cases
- Difficulties with seemingly unstoppable changes in their body that can lead to reduced mobility, impact their ability to work, and to care for themselves and their family
- Additional burden of severe pain symptoms
- Suffering from poor body image and lowered self-esteem as well as being stigmatized because of their weight
All of this can lead to social isolation and emotional difficulties. For these reasons, the authors felt that this issue was important to study.
Who were the participants?
This cross-sectional study assessed differences in emotional regulation and anxiety between two groups: 26 patients with lipedema and 26 women who were age-matched but did not have lipedema served as the control group.
The two groups were matched for age (40 years) and all participants were female. The lipedema group had a higher average BMI (30.5 vs 24.8 in the control group.) The average time that the lipedema group had symptoms of lipedema was approximately 8 ½ years. All participants had lipedema in their legs and 12 out of 26 also had lipedema in their arms.
Using the 3-stage model of lipedema, there were 13 participants with stage 1, 7 with stage 2, and 6 with stage 3 lipedema. Eight participants in the lipedema group had undergone liposuction in their legs. Nobody in either group had been diagnosed with a psychological or cognitive impairment.
Participants for the lipedema group were recruited at two clinics in Italy between April 2019 and January 2020. In order to be included in the study, they must have been diagnosed by a specialist at the San Giovanni Battista Hospital in Rome (one of the participating clinics.) Participants could be at any stage of lipedema, but could not have a current diagnosis or history of mental illness, use psychiatric medications, or have an acute health-threatening disease. Participants also could not have a drug addiction, be pregnant, or currently breastfeeding.
The control group was recruited at the same time from the same clinics. These participants had the same exclusions to being part of this study and additionally could not have a diagnosis of lipedema.
What assessments were used?
Two assessments were used in the study, the Difficulties in Emotion Regulation Scale (DERS), and the Hamilton Anxiety Scale (HAM-A).
The DERS assesses emotional regulation in six domains: impulse control, goal-directed behavior, awareness, clarity, non-acceptance, and strategies. This is a 36-item self-report questionnaire. A higher score indicates more severe difficulties with emotional regulation.
The HAM-A assesses anxiety levels. The survey has two parts: the first part includes items related to mood or behavior symptoms related to anxiety, while the second part has items related to physical symptoms of anxiety. Once again, higher scores indicate higher levels of anxiety.
What were the results?
Here are some findings of this study:
- Lipedema patients had more difficulty with emotional regulation and a higher level of anxiety than those without lipedema.
- There were significant positive correlations between BMI, anxiety, and emotional regulation. In other words, a higher BMI was associated with more significant anxiety and more difficulty with emotional regulation.
- There was a strong positive correlation between anxiety and all of the subscales used to assess emotional regulation.
- The participants in the lipedema group had particular difficulty with three domains of the emotional regulation domains: emotional clarity, non-acceptance emotions, and emotional regulation strategies. Difficulty in these areas remained even when adjusted for BMI, meaning that these difficulties were not driven by weight.
Suggestions for intervention
The authors made a few suggestions for improving emotional regulation skills, such as:
- Mindfulness interventions to learn skills in emotional clarity, awareness, and acceptance of emotions by having training and practice in attention and acceptance
- Acceptance and Commitment Training (ACT)
- Compassion-Focused Therapy (CFT)
Both of the last two interventions help you to accept your emotions and learn how to make a commitment to taking appropriate action by learning healthy strategies to compassionately address painful and complex emotions.
What are the limitations of the study?
The authors reported several potential limitations of this study. One is there may have been a bias because the instruments were both self-report surveys. This type of survey requires a high level of cognitive ability and introspection, so the authors suggest another tool that could allow for varying levels of cognitive ability may be useful.
For future studies, they recommend also assessing pain levels and also comparing a lipedema group to other chronic disorders such as fibromyalgia instead of using healthy controls.
What were the conclusions?
The authors suggest that these results indicated that patients with lipedema may have significant difficulties in describing and understanding their emotions. Having the ability for emotional processing is really important to be able to cope with emotions.
The authors also point out that previous studies have shown that impulsiveness has been linked to obesity and weight gain, but the emotional regulation issues seem to be not linked to the actual weight of the participant in this study. They urge healthcare providers who work with the lipedema population to look at the psychological issues that their patients may be suffering from and give the appropriate referrals for help.
Takeaways
This study looking at emotional regulation and anxiety demonstrated for me, a valuable insight into why some patients with lipedema have difficulty adhering to intervention strategies such as a ketogenic diet. If you have difficulties with emotional regulation, you will have issues with impulse control, therefore, may face challenges when you are faced with the temptation of a favorite food that may be off of your chosen eating plan.
Learning skills that can help you recognize, accept, and regulate your emotions will make it easier to meet your goals for improved quality of life. This is an area of support and learning that you can find with programs at Lipedema Simplified.
For more updates on the latest research regarding lipedema, check out Lipedema Simplified’s Flash Briefings. It’s our daily mini-podcast where we share tips, tools, and research pertaining to Lipedema.
~ Leslyn Keith, OTD, CLT-LANA
Board President, Director of Research | The Lipedema Project