Introduction

1.1 Prevalence and Psychological Impact of Eating Disorders

Eating disorders (EDs), such as anorexia nervosa, bulimia nervosa, and binge-eating disorder, are serious mental health conditions characterized by abnormal eating behaviours and excessive concerns about body weight and shape (American Psychiatric Association, 2013). These disorders can lead to severe physical complications, including malnutrition and cardiovascular issues, as well as psychological problems like anxiety and depression (Hay & Mitchison, 2014). The prevalence of EDs among university students varies globally, influenced by cultural, regional, and methodological differences in studies. In the United States, estimates suggest that between 10% and 20% of college women and 4% to 10% of college men suffer from an eating disorder, with rates on the rise (Jacobson, 2023). Similarly, a study in Ethiopia reported that about 7% of university students had EDs, with the majority being young adult females (Ma et al., 2019). These statistics highlight the significant presence of EDs within the university student population across diverse cultural contexts.

EDs profoundly affect individuals' interpersonal relationships, leading to difficulties in social interactions and emotional connections. Patients with EDs often exhibit interpersonal problems characterised by being overly friendly and non-assertive (Akey et al., 2013). Anorexia nervosa, in particular, is associated with impairments in socio-emotional functioning, including challenges in relationships with parents and peers, as well as difficulties in identifying and expressing emotions (Hay & Mitchison, 2014). Contemporary theoretical models have further underscored the importance of interpersonal difficulties in the maintenance of EDs. The Cognitive-Interpersonal Maintenance Model (Schmidt & Treasure, 2006) posits that traits such as perfectionism, emotional avoidance, and rigid thinking styles, combined with problematic interpersonal patterns (e.g. social withdrawal or excessive compliance) can reinforce disordered eating behaviours and impede recovery. Similarly, the Transdiagnostic Model identifies shared maintaining mechanisms across different types of EDs, including low self-esteem, mood intolerance, and interpersonal conflict (Fairburn et al., 2003). These frameworks emphasise the need to address interpersonal functioning in treatment, since such difficulties may not only exacerbate symptoms but also reduce the effectiveness of intervention efforts.

Nowadays, EDs are increasingly prevalent among university students, characterised by persistent disturbances in eating behaviours and excessive concerns about body shape and weight (Stice et al., 2013). Quick and Byrd-Bredbenner (2013) applied the Eating Disorders Examination Questionnaire ( EDE-Q) to over 2,400 U.S. college students and found that 6% female students and 1& male students scored in the clinically significant range on global ED measures, and nearly one in five female students exhibiting severe concerns about body shape. The transition to university life, characterised by increased academic pressure, social comparison, and newfound independence, is considered a key risk factor contributing to the onset or exacerbation of ED behaviours (Tavolacci et al., 2015). EDs have profound effects on students' mental health, interpersonal relationships, and academic performance. Individuals with EDs often experience heightened levels of anxiety, depression, and stress, which not only reinforce disordered eating behaviours but also impair their overall well-being (Prunty et al., 2022). Additionally, societal pressures and cultural ideals emphasising thinness and physical appearance can influence body image concerns among students, leading to unhealthy eating practices (Hay & Mitchison, 2014).​ Academically, these individuals often struggle with concentration difficulties, absenteeism, and reduced motivation, further exacerbating the negative consequences of their condition (Colombo et al., 2008). EDs are prevalent among university students worldwide, affecting a substantial proportion of this population. Understanding the prevalence and consequences of EDs among university students is crucial for developing effective prevention and intervention strategies tailored to this vulnerable group.

1.2 Emotion Regulation in Eating Disorders

Emotion regulation (ER) refers to the processes by which individuals influence the emotions they experience when they experience them, and how they express these emotions. James Gross's process model of emotion regulation is one of the most influential frameworks in this field. This model delineates ER strategies based on their temporal occurrence in the emotion-generative process, categorizing them into antecedent-focused and response-focused strategies. Antecedent-focused strategies, such as situation selection, situation modification, attentional deployment, and cognitive reappraisal, occur before the full activation of the emotional response. In contrast, response-focused strategies, like expressive suppression, are employed after the emotional response has been fully generated (Gross, 1998).​ Cognitive reappraisal involves changing one's interpretation of a situation to alter its emotional impact, thereby reducing negative emotional experiences. Expressive suppression, on the other hand, entails inhibiting the outward expression of emotions without addressing the internal emotional experience, which may lead to increased physiological arousal and negative health outcomes (Gross & John, 2003).​ Research indicates that individuals with eating disorders (EDs) often exhibit significant deficits in emotion regulation. These deficits manifest in various ways, including a propensity for emotion avoidance, impulsivity, and reliance on maladaptive behaviours, such as disordered eating, to manage emotions.​ For instance, individuals with anorexia nervosa may use restrictive eating as a means to exert control over their emotions, while those with bulimia nervosa might engage in binge eating and purging behaviours to cope with negative affect (Haynos & Fruzzetti, 2011). Similarly, individuals with binge-eating disorder often report using food consumption as a strategy to alleviate distressing emotions, leading to a temporary reduction in negative affect followed by feelings of guilt and shame (Whiteside et al., 2007).​ Furthermore, studies have shown that ED patients are more likely to employ maladaptive ER strategies, such as expressive suppression, and less likely to use adaptive strategies like cognitive reappraisal. This imbalance contributes to the maintenance and exacerbation of ED symptoms (Aldao et al., 2010).​

The role of ER in the maintenance of EDs is further elaborated in the Cognitive-Interpersonal Maintenance Model (Schmidt & Treasure, 2006). The model highlights how ineffective ER contributes to a cycle in which disordered eating functions as a strategy to escape or suppress aversive emotional states, particularly in the context of strained relationships or social anxiety. Compared with the cognitive-interpersonal model, which emphasises the social and personality-driven influences on ER difficulties, the transdiagnostic model situates ER deficits within a general psychopathological structure that applies across diagnostic categories. It suggests that individuals with EDs are more likely to use behaviours such as binge eating or excessive dieting to modulate affective states in response to stressors, including those arising from interpersonal conflict (Fairburn et al., 2003). Conclusively, these models demonstrate that emotion dysregulation is not merely a symptom of EDs but a central mechanism that interacts with cognitive style and interpersonal functioning.

1.3 Conflict Management and the Role of Emotion Regulation

The majority of existing research has concentrated on how emotion regulation deficits contribute to the development and maintenance of eating disorders. These studies have provided valuable insights into the intrapersonal aspects of EDs, highlighting the role of maladaptive ER strategies in perpetuating disordered eating behaviours.​ Despite the well-established link between ER deficits and EDs, one area that remains underexplored is how individuals with EDs manage interpersonal conflicts. Interpersonal conflicts are emotionally charged situations that require individuals to regulate their emotions effectively. For individuals with EDs, poor conflict management skills may exacerbate emotional distress, leading to increased reliance on disordered eating behaviours as a coping mechanism (Rieger et al., 2010; Treasure et al., 2012). Addressing this gap could inform more comprehensive treatment approaches that encompass both individual emotion regulation skills and interpersonal effectiveness strategies.

The Thomas-Kilmann Conflict Mode Instrument (TKI) is a widely recognised framework that categorises individuals' responses to conflict into five distinct styles: competing, collaborating, compromising, avoiding, and accommodating. These styles are delineated along two dimensions: assertiveness, reflecting the extent to which an individual seeks to satisfy their own concerns, and cooperativeness, indicating the degree to which they aim to satisfy the concerns of others (Thomas & Kilmann, 1974). For instance, a competing style, characterised by high assertiveness and low cooperativeness, involves pursuing one's own interests at the expense of others. Conversely, an accommodating style, marked by low assertiveness and high cooperativeness, entails neglecting one's own concerns to satisfy those of others. The TKI framework provides a nuanced understanding of conflict behaviours, emphasising that individuals may adopt different styles depending on the context and their personal dispositions. However, this measure has not been used in an eating disorder population.

ER significantly influences the conflict management strategies individuals employ. Effective ER enables individuals to modulate their emotional responses, facilitating more constructive conflict resolution approaches. For instance, individuals with proficient ER skills are more likely to engage in collaborating or compromising strategies, as they can manage negative emotions and consider multiple perspectives. Conversely, individuals with poor ER skills may struggle to control emotional responses, leading to the adoption of less constructive strategies such as avoiding or competing. For example, heightened emotional arousal can impair cognitive processing, reducing the capacity for empathy and problem-solving, which are essential for collaborative conflict resolution (Gross, 2002). Individuals with EDs may display heightened emotional reactivity during conflicts to prioritise their own concerns in an attempt to regain a sense of control, showing characteristics of the competing conflict resolution style; or accommodating to others to avoid conflict which is consistent with the accomodating style in TKI (Svaldi et al., 2012). While another research indicates that individuals with eating disorders (EDs) often exhibit avoidant behaviours in familial contexts, particularly concerning conflict situations. For example, a study found that adolescents with anorexia nervosa demonstrated higher levels of conflict avoidance within family interactions compared to their non-clinical counterparts (Botta & Dumlao, 2002). The results of the above two studies were inconsistent and both only indicated the behavioural patterns of people with ED when faced with conflict, instead of emphasising their conflict resolution strategies.

University students frequently encounter interpersonal conflicts in various settings, including academic group work, social relationships, and residential living environments. Research suggests that university students tend to favour compromising and avoiding strategies when dealing with conflicts, as these approaches are perceived as less confrontational and help maintain social harmony (Rahim, 2017). Compromising allows both parties to achieve a partial resolution by finding a middle ground, which is particularly relevant in academic group settings where cooperation is essential (Miller, 2014). Avoidance, on the other hand, is often employed in situations where individuals perceive the conflict as minor or believe confrontation may escalate tensions unnecessarily (Barker et al., 2019). However, the collaborative style, which promotes open dialogue and mutual problem-solving, is considered the most constructive but is less commonly adopted by university students, particularly those with lower emotional regulation abilities (Gross & John, 2003). Research indicates that students with higher emotional intelligence are more likely to engage in collaborative conflict resolution, as they can regulate their emotions effectively and empathise with others’ perspectives (Zeidner et al., 2006). Conversely, students experiencing high levels of academic stress or personal insecurity may resort to competing or accommodating strategies. The competing style, characterised by high assertiveness and low cooperativeness, is often observed in individuals who prioritise personal goals over social relationships, whereas the accommodating style, marked by low assertiveness and high cooperativeness, is frequently seen in students who avoid confrontation at the cost of their own interests (Thomas & Kilmann, 1974). Understanding these general conflict management tendencies among university students is crucial for evaluating how university students with eating disorders may differ in their approach to interpersonal conflicts. Given their deficits in emotion regulation, they are more likely to exhibit extreme avoidance or heightened emotional reactivity in conflict situations, which could contribute to further relational difficulties and psychological distress (Svaldi et al., 2012). Examining these distinctions allows for a more comprehensive understanding of the interplay between conflict management, emotional regulation, and disordered eating behaviours.

1.4 Rationale and Research Aims

Conclusively, existing research predominantly focuses on how individuals with EDs regulate their own emotions, often highlighting deficits in emotion regulation that contribute to the development and maintenance of these disorders. However, there is a notable gap in understanding how these individuals manage conflicts within social environments, particularly among university students. University students represent a unique demographic undergoing a critical transitional phase marked by heightened autonomy, diverse social interactions, and academic pressures (Mulaudzi, 2023). Research shows that students aged 20-25 experience more severe social challenges than students over 25 years old (Osafo et al., 2025). Effective conflict resolution skills are essential during this period, as they can impact relationship satisfaction, stress levels, and overall mental health (Adham, 2023).

This study aims to address the following research questions:

What conflict resolution styles do university students with EDs predominantly employ compared to their non-ED counterparts?​

Does the presence of an ED influence the preference for specific conflict management strategies among university students?​

The hypothesis is that university students without EDs are more likely to report utilising compromising and avoiding strategies, whereas university students with EDs will report competing, accommodating, and avoiding behaviours, measured using the Eating Disorder Examination–Questionnaire Short (EDE-QS) and the Conflict Resolution Questionnaire (CRQ).