*Limitations and Strengths*

The present study should be evaluated within the context of its limitations. First, as we only assessed patients with ED that were seeking treatment in a clinical setting, the patient cohorts may not be representative of all patients with ED. In addition, ER difficulties were assessed by means of the DERS. Although this is a validated instrument for the assessment of ER, it may not capture other relevant aspects of ER, such as ER strategies or skills (e.g., reappraisal, stimulus control, etc.). Finally, due to the study's cross-sectional design, no conclusions can be drawn with regard to response to treatment between genders.

Notwithstanding these limitations, the current study has also several strengths that should be noted. One of the strengths of our study includes the relatively large number of males with ED in our sample and our comparison with females with ED, as well as with male and female healthy controls. For the first time, we addressed ER in a large sample of males with ED, including different DSM-5 types. As far as we know, this is the first study assessing predictors of difficulties in ER in females and males with ED.

## **5. Conclusions**

There is a growing interest in addressing difficulties in ER in the treatment of patients with ED. However, most ER-based studies were performed in females with ED and, to date, no study was carried out in males with all DSM-5 ED diagnoses. Our findings suggest that treatments focusing on enhancing ER abilities are likely to be beneficial to both female and male patients with ED. Our findings also suggest a bidirectional relationship, that is, if we improve eating symptomatology and general psychopathology, we could improve ER in these patients. However, our results also

provide evidence for the need to design specific treatments for males and females with ED that address shared and differential gender-related features associated to emotion dysregulation, such as impulsivity and reward dependence in females, and persistence in males with ED. Taking into account all of the aforementioned factors, further research should be addressed to validate and complement our results, including other measures of ER. Likewise, longitudinal designs may offer insight into gender-related responses of ER difficulties to ED treatments. Findings of this kind may, in fact, provide further evidence for the need of gender-specific, ER-centered treatments as a further step toward individualized psychotherapy.

**Supplementary Materials:** The following are available online at http://www.mdpi.com/2077-0383/8/2/161/s1, Table S1: SEM: tests of direct, indirect and total effects (ED subsample, *n* = 718).

**Author Contributions:** Conceptualization: Z.A., I.S., J.S.-G., S.J.-M., and F.F.-A.; Methodology: Z.A. and R.G.; Formal Analysis: R.G.; Investigation: Z.A. and G.P.; Data Curation: Z.A. and R.G.; Writing-Original Draft Preparation: G.P., R.G., and Z.A.; Writing-Review & Editing: L.M., I.S., J.G.-S., Z.A., T.S., S.J.-M., and F.F.-A.; Supervision: Z.A., F.F.-A., and S.J.-M.; Funding Acquisition: F.F.-A. and S.J.-M.

**Funding:** We thank CERCA Programme / Generalitat de Catalunya for institutional support. This research was funded by Instituto de Salud Carlos III (ISCIII) (grant numbers: PI14/00290 and PI17/01167), by Ministerio de Economía y Competitividad (grant number PSI2015-68701-R), by Ministerio de Sanidad, Servicios Sociales e Igualdad (grant number PR338/17), PERIS (Generalitat de Catalunya, SLT006/17/00077), and co-funded by FEDER funds /European Regional Development Fund (ERDF), a way to build Europe. CIBERObn is an initiative of ISCIII.

**Conflicts of Interest:** The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, and in the decision to publish the results.
