The role of affect in the maintenance of binge-eating disorder: Evidence from an ecological momentary assessment study

Momentary mechanisms of binge-eating symptoms using ecological momentary assessment: The moderating role of food addiction

OBJECTIVE

Food addiction (FA) shows phenotypic and diagnostic overlap with eating disorders characterised by binge eating, though it is unknown how momentary processes driving binge-eating symptoms differ by FA. The present study examined the possible moderating influence of FA severity on momentary mechanisms underlying binge-eating symptomatology using ecological momentary assessment (EMA).

METHOD

Adults (N = 49, mean age = 34.9 ± 12.1, cis-gender female = 77.1%) who met criteria for FA and/or binge-eating disorder completed baseline measures including the Yale Food Addiction Scale (YFAS) followed by a 10-day EMA protocol. Generalised linear mixed models assessed main effects of YFAS, momentary antecedents (affect, impulsivity, food cue exposure, appetite, and eating expectancies) and two-way interactions between YFAS and within-person antecedents.

RESULTS

FA severity moderated momentary associations between food cue exposure and subsequent binge-eating symptoms: the association was stronger among participants with lower but not higher YFAS scores. No other interactions were significant.

CONCLUSIONS

Some functional associations underlying binge-eating symptoms vary based on individuals' level of FA symptoms. Future research to further understand how observed associations may differ amongst diverse populations and over course of illness may also inform future prevention and interventions.

A Naturalistic Assessment of the Relationship between Negative Affect and Loss of Control Eating Over Time Following Metabolic and Bariatric Surgery

Disordered eating behavior has been linked to suboptimal weight outcomes following metabolic and bariatric surgery (MBS), thereby threatening the most efficacious treatment for severe obesity. While up to 40% of patients may experience loss of control (LOC) eating following MBS, mechanisms driving this behavior are not fully understood. Preliminary evidence suggests that high levels of negative affect (NA) in the moment prompt LOC eating post-MBS; however, it remains unclear whether this momentary relationship is stable or changes over the first several years following surgery. Consequently, this study examined differences in the prospective relationship between NA and LOC eating severity over time post-MBS using three waves of ecological momentary assessment data collection. Participants (n=143, 87% female), were asked to rate momentary levels of NA and LOC eating severity on their smartphone ≥5 times/day for seven days at 1-, 2-, and 3-years post-MBS. Both NA and LOC eating were rated on a 1-5 Likert scale, with higher scores indicating more severe symptoms. NA was within- and between-person centered and used as a prospective predictor of LOC eating severity. Analyses evaluated if time post-MBS moderated the relationship. A generalized linear mixed model demonstrated that higher NA predicted more severe LOC eating at the next signal when centered within- and between-subjects. Time post-MBS moderated the within-NA to LOC eating severity effect, such that the relationship remained unchanged between years 1 and 2, but strengthened between years 2 and 3. Findings suggest that momentary NA becomes a more powerful predictor of LOC eating severity as time passes post-MBS, which has important implications for interventions aimed at reducing LOC eating and promoting optimal weight outcomes in the post-surgical period.

Evaluating the role of binge planning and binge inevitability within affect regulation models of binge eating

Affect regulation models posit that aversive affective states drive binge-eating behavior, which then regulates negative emotions. However, recent findings among individuals with binge-eating disorder (BED) suggest that food-related anticipatory processes may precede and potentially explain the negative affect thought to drive binge eating. Specifically, studies using ecological momentary assessment (EMA) demonstrate that the negative affective state of "Guilt" (from the Positive and Negative Affect Schedule) most strongly predicts later binge eating in the natural environment, and it has been hypothesized that planning a binge or feeling that a binge-eating episode is inventible may account for the increases in Guilt observed prior to binge episodes. In the present study, we tested the hypothesis that binge planning or inevitability may contribute to feelings of shame (a key facet of the broader Guilt construct), which then predict binge-eating episodes, using EMA in 43 individuals with BED. Consistent with hypotheses, feelings of binge inevitability and planning prospectively predicted binge-eating episodes. Further, binge planning predicted subsequent increases in shame. However, shame did not predict subsequent increases in binge planning. Finally, a mediation model revealed that binge planning (Time 1) predicted future binge eating (Time 3) directly and indirectly through increases in shame (Time 2). The results provide novel evidence that individuals with BED anticipate and actively plan for binge-eating episodes, and that binge planning may explain the increased shame/guilt typically observed before binge eating. Overall, accruing evidence suggests that negative affect, although predictive of binge eating, may be better conceptualized as a consequence of the anticipatory processes that lead to binge eating, rather than the starting point, at least among some individuals with BED. Future experimental research is needed to more conclusively test this hypothesis.

Trajectories of negative affect prior to and following disordered eating behaviors among women with eating disorder pathology: An examination of the role of state-interoception

OBJECTIVE

Affect regulation theories of eating disorders (ED) posit that negative affect increases in the hours before and decreases following disordered eating behaviors (DEBs) in daily life, yet findings from studies assessing affective changes post-DEBs are mixed. This inconsistency may be due to the previously unassessed role of other transdiagnostic processes in these associations, such as interoception (the ability to sense and integrate information from bodily sensations). To address this research gap, the present study examined whether different interoception dimensions moderated negative affect trajectories surrounding DEBs in the natural environment.

METHOD

150 women with ED pathology (Mage = 21.0, SD = 4.1) completed 4 surveys targeting affect and DEBs each day for a 10-day ecological momentary assessment period. Polynomial multilevel models examined negative affect trajectories pre- and post-DEBs (dietary restriction, overeating, loss of control eating), and whether these trajectories varied based on daily interoception dimensions (not distracting, self-regulation, body listening and trust).

RESULTS

Negative affect increased prior to loss of control eating-but not dietary restriction or overeating-and decreased following all DEBs. Further, the magnitude of the decrease in negative affect that emerged post-dietary restriction decreased in strength as daily "not distracting" interoception increased. The other interoception dimensions did not moderate negative affect trajectories surrounding DEBs.

CONCLUSIONS

Allowing oneself to experience (vs. distract from) uncomfortable bodily sensations may weaken affect dysregulation processes that follow dietary restriction in daily life and are theorized to maintain DEBs. These results provide insight that may strengthen EDs theories, research, and inform interoception-focused interventions.

A Psychophysiological Investigation of Mechanisms Underlying "Feeling Fat" in Women With and Without Binge Eating

OBJECTIVE

"Feeling fat", the somatic experience of being overweight not fully explained by objective body weight, is considered to be an eating pathology maintenance factor. The traditional clinical understanding of "feeling fat" is based on the body displacement hypothesis, which suggests that negative emotions are projected onto the body and experienced as "feeling fat" in lieu of adaptive emotion regulation. A more recent theory suggests that "feeling fat" occurs in response to thought-shape fusion (TSF), a cognitive distortion in response to the imagined consumption of perceived fattening food. The present experimental study compared the roles of these two proposed mechanisms of "feeling fat" using self-report and psychophysiological measures.

METHOD

Eighty-two women (41 with binge eating, 41 control participants) self-reported "feeling fat" and had their heart rate variability (HRV), a physiological index of emotion regulation, measured before and after imagined inductions. Participants imagined either a personalized negative affective experience or consuming a preferred, so-called 'fattening' food.

RESULTS

The TSF induction increased self-reports of "feeling fat" among participants with binge eating but not among control women. The negative affect induction did not increase self-reported "feeling fat" in either group. HRV did not significantly change in response to either induction for either group.

DISCUSSION

TSF may be a more potent precursor to "feeling fat" than negative affect for individuals with binge eating. This may suggest new treatment directions, such as cognitive defusion from TSF when patients experience "feeling fat." The utility of HRV in monitoring "feeling fat" is questionable.

Emotional food craving across the eating disorder spectrum: an ecological momentary assessment study

PURPOSE

Emotional eating during negative emotions might underlie disordered eating behavior (i.e., binge eating and food restriction). Positive emotions, by contrast, seem to promote healthier eating behavior. Naturalistic research on the links between emotions and eating across individuals with binge-eating disorder (BED), bulimia nervosa (BN), binge-purge anorexia nervosa (AN-BP), and restrictive anorexia nervosa (AN-R) is, however, lacking.

METHODS

Individuals without eating disorders (comparison group, CG, n = 85), and patients with BED (n = 41), BN (n = 50), AN-BP (n = 26), and AN-R (n = 29) participated in an ecological momentary assessment study. Six daily notifications over eight days prompted ratings of momentary food craving and emotional states differing in valence and arousal.

RESULTS

Results supported specific emotion-food-craving patterns in each group. Compared to the CG, arousing negative emotions and higher cravings co-occurred in patients with BN. In patients with AN-BP (at trend level also in patients with AN-R) less arousing negative emotions and lower cravings co-occurred. In patients with AN, positive emotions and higher cravings co-occurred whereas in patients with BED less arousing positive emotions and lower cravings co-occurred.

CONCLUSION

The found emotion-craving associations may underlie group-specific (dys-)functional eating behaviors, i.e., binge eating and food restriction during negative emotions in patients with BN and AN, and normalized appetitive responses during positive emotions in patients with BED and AN. Therapeutic efforts could target arousing negative emotions in patients with BN, and less arousing negative emotions in patients with AN. Positive emotions could be used in a salutogenetic approach in patients with BED and AN.

Experiential Avoidance During Mealtimes Among Individuals With Eating Disorders

The relationship between negative emotions and avoidance is widely theorized as a bidirectional cycle implicated in a range of psychopathology. Historically, research on this cycle has examined one type of negative emotion: anxiety. Yet, a broader range of internal experiences may be implicated in the maintenance of unhealthy avoidance cycles in psychopathology. This study examines prospective relationships among anxiety, guilt, physical discomfort, and experiential avoidance during mealtimes for individuals with eating disorders (EDs). Participants (N = 108) completed ecological momentary assessments four times a day for 25 days. We computed multilevel models to examine between- and within-person effects of negative emotions and physical discomfort on experiential avoidance. When including guilt and anxiety in one model, guilt, but not anxiety, explained the significant variance in experiential avoidance at the next meal. Mealtime physical discomfort and experiential avoidance evidenced reciprocal prospective relationships. Future research should test whether interventions targeting experiential avoidance and physical discomfort at mealtimes disrupt guilt.

An examination of state and trait urgency in individuals with binge-eating disorder

OBJECTIVE

Negative urgency (i.e., acting rashly when experiencing negative affect; NU), is a theorised maintenance factor in binge-eating type eating disorders. This study examined the association between trait NU and eating disorder severity, momentary changes in state NU surrounding episodes of binge eating, and the momentary mechanistic link between affect, rash action, and binge-eating risk.

METHODS

Participants were 112 individuals with binge-eating disorder (BED). Baseline measures included the UPPS-P Impulsive Behaviour Scale to assess trait NU and the Eating Disorders Examination to assess binge-eating frequency and global eating disorder severity. Ecological momentary assessment captured real-time data on binge eating, negative affect, and state NU.

RESULTS

Multiple regression analysis revealed a strong association between trait NU and eating disorder severity. Generalised estimating equations showed that state NU increased before and decreased after binge-eating episodes, and that this pattern was not moderated by trait-level NU. Finally, a multilevel structural equation model indicated that increases in rash action mediated the momentary relationship between states of high negative affect and episodes of binge eating.

CONCLUSION

These findings underscore the importance of both trait and state NU in binge-eating type eating disorders, and suggest NU as a potential key target for intervention.

Identifying mechanistic links between sleep disturbance and binge eating: the role of depressed mood

Global sleep disturbance is robustly linked with a subjective sense of loss-of-control over eating (LOC). Depressed mood has been proposed as a mechanism to explain the bi-directional relationship between sleep disturbance and LOC eating. The current study evaluated whether sleep disturbance indirectly affects LOC eating via depressed mood. Adults seeking treatment for a DSM-5 binge-spectrum eating disorder (e.g. bulimia nervosa, binge-eating disorder) were recruited (n = 79) and asked to complete self-report questionnaires assessing sleep disturbance and depression, and a semi-structured interview assessing LOC eating. Tests of indirect effects evaluated the effect of depressed mood on the association between global sleep disturbance and LOC frequency covarying for BMI and parent study. A significant indirect effect of depressed mood on the association between global sleep disturbance and frequency of LOC eating was identified (Est = 1.519, S.E. = 0.859, p = .033). The indirect effect of depressed mood on the association between sleep disturbance and LOC eating may indicate that depressed mood serves as a mechanistic link between sleep disturbance and LOC eating. The findings offer preliminary support for adjunctive treatments targeting both sleep disturbance and depressed mood for LOC eating. Future research should explore these pathways in a larger clinical sample.

A naturalistic examination of feeling fat: Characteristics, predictors, and the relationship with eating disorder behaviors

OBJECTIVE

Although literature implicates feeling fat in the maintenance of binge-spectrum eating disorders (EDs; e.g., bulimia nervosa, binge-ED), research in this area is small, nascent, and relies on retrospective self-report. The current study sought to understand the temporal pattern of feeling fat and its role as a precipitant and consequence of ED behaviors.

METHODS

Totally 106 treatment-seeking adults with binge-spectrum EDs completed 7-14-day ecological momentary assessments. They rated feeling fat, negative affect states, and reported on ED behaviors six times per day. Multilevel models evaluated whether feeling fat mediates prospective links between negative affect states and ED behaviors, assessed if negative affect states mediate the prospective association of feeling fat on ED behaviors, and examined the bidirectional prospective association between feeling fat and ED behaviors.

RESULTS

Feeling fat was highest in the early morning (6-8:59 a.m.). Individuals with binge-ED-spectrum EDs demonstrated greater variability in feeling fat than those with bulimia nervosa-spectrum EDs who had stable and high levels of feeling fat. Guilt, sadness, anxiety, and the overall NA at Time 2 mediated the prospective associations between at Time 1 feeling fat and Time 3 dietary restraint, actual dietary restriction, and compensatory exercise. There was a bidirectional prospective association between feeling fat and binge eating.

DISCUSSION

Feeling fat serves as a proximal predictor and mediator of the prospective association between guilt and binge eating. Feeling fat and binge eating mutually reinforce each other.

PUBLIC SIGNIFICANCE

Little is understood regarding the experience of feeling fat in natural environments among individuals with binge-spectrum eating disorders. We found that the risk for having the experience of feeling fat is high in the morning and evening. Feeling fat triggers guilt, anxiety, and sadness which in turn, increases engagement in dietary restraint/restriction and compensatory exercise. Feeling fat also triggers binge eating, and binge eating leads to feelings of fatness.

Associations between affect dynamics and eating regulation in daily life: a preliminary ecological momentary assessment study

Disordered eating behaviors consistently associated with emotion regulation difficulties. However, most studies have focused on affect intensity without considering dynamic affective patterns. We examined these patterns in relation to daily overeating, loss of control eating (LOCE), dietary restraint, and food craving in young adults using ecological momentary assessment (EMA).Adults (N = 24) completed a 10-day EMA protocol during which they reported momentary affect and eating patterns. Generalized linear mixed-models examined each index in relation to eating variable.Higher PA instability (within-person) was associated with higher ratings of binge-eating symptoms (B = 0.15, SE = 0.06, p = 0.007). Lower NA differentiation (within-person) was associated with higher levels of food craving (B = -10.11, SE = 4.74, p = 0.033).Our results support previous findings suggesting that acute fluctuations in PA may increase risk of binge-eating symptoms. Further, inability to differentiate between momentary states of NA was associated with cravings. This study highlights the importance of examining multiple facets of NA and PA in relation to eating regulation.Trial registration: ClinicalTrials.gov identifier: NCT02945475.

Cannabis use and binge eating: Examining the relationship between cannabis use and clinical severity among adults with binge eating

Cannabis use is prevalent among individuals with binge eating (BE; i.e., the inability to control eating behavior). Yet, only two studies to date (both over 20 years old) have tested if cannabis use relates to clinical severity among BE samples. Characterizing the relationship between cannabis use, eating disorder (ED) severity, and other psychiatric symptoms in BE samples is necessary for informing screening and clinical recommendations. The present study characterized cannabis use among adults with BE and tested between-group and within-group relationships between cannabis use and eating disorder symptoms, alcohol consumption and symptoms, and depression symptoms. Participants (N = 165) were treatment-seeking adults with at least once weekly BE in the past 3 months who completed clinical interviews and self-report measures before treatment. Over 23% of participants reported cannabis use in the past 3 months, with most persons using cannabis reported using "once or twice" or "monthly." Most persons using cannabis reported cannabis-related symptoms. Persons using cannabis reported significantly greater alcohol consumption and were more likely to report alcohol-related symptoms compared to persons not using cannabis. No associations were observed between cannabis use, eating disorder symptoms, and depressions symptoms. These findings indicate that a notable subset of patients with BE use cannabis and experience cannabis-related problems, and that cannabis and alcohol use may be related for these individuals. Considering legal and sociocultural shifts in cannabis availability and prevalence, results from the present study support screening for cannabis and alcohol use patterns in patients with BE. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Using item response theory to identify key symptoms of insomnia in a sample of university students with probable eating disorders

PURPOSE

Researchers have theorized that interactions between appetitive and circadian disruptions result in increased eating disorder (ED) symptoms and insomnia. However, it is unclear how specific insomnia symptoms present among people with EDs and if the latent structure of insomnia in this population is similar to that of people with insomnia disorder.

METHODS

We conducted a secondary analysis of data collected on ED and insomnia symptoms using a subset of students (N = 547; 79.52% female) with probable EDs at a large Midwestern American university. Item response theory (IRT) for polytomous items was performed to identify item difficulty, discrimination, and information parameters for the Insomnia Severity Index (ISI). IRT parameters were compared to those established in a 2011 study of people diagnosed with insomnia disorder by Morin and colleagues.

RESULTS

Clinically significant insomnia symptoms were common among students with ED pathology and symptom endorsement for each ISI item ranged from 40.77 to 86.65%. ISI items assessing insomnia-related impairment and distress showed better discriminative capacities and had higher item information than items assessing sleep behavior alterations (i.e., difficulties falling asleep, difficulties maintaining sleep, waking too early). Item discrimination was largely similar among the ED sample compared to previous IRT analyses in an insomnia disorder sample.

CONCLUSION

Insomnia symptoms are common among university students with probable EDs and similar to those reported by people with insomnia disorder. When considering insomnia assessment, items assessing sleep behaviors alone are likely inadequate to provide information about insomnia severity among people with EDs.

LEVEL V

Evidence obtained from a cross-sectional descriptive study.

Testing "Feeling Fat" as a Mediator of the Longitudinal Relationship Between Negative Emotions and Eating Disorder Behaviors

OBJECTIVE

Negative affect is central to eating disorder maintenance models; identifying mechanisms underlying this link may inform specific treatment targets. The current study evaluated which emotions (i.e., distress, fear, and moral emotions) were most strongly linked to feeling fat and tested feeling fat as a longitudinal mediator of the relationship between these emotions and restricting or binge eating (https://osf.io/3d5cq/).

METHOD

Community adults (N = 714, M[SD] age = 41.5[13.7], 84.6% female, 85.9% white) provided data at baseline, 3-month, and 6-month follow-up. Relative weights analysis examined which emotion categories exhibited the strongest longitudinal relationships with feeling fat. Cross-lagged panel models tested feeling fat as a mediator of the relationship between emotions and eating disorder behaviors.

RESULTS

Distress and moral emotions were the strongest emotional predictors of feeling fat. Feeling fat predicted binge eating (p's < 0.001), but not restricting (p's ≥ 0.832), in random effects cross-lagged panel models. Feeling fat partially mediated the longitudinal relationship between distress and binge eating (p = 0.044); however, this effect became nonsignificant after adjusting for BMI (p = 0.354). Feeling fat did not mediate relationships between moral emotions and binge eating or between either distress or moral emotions and restricting (p's ≥ 0.638).

DISCUSSION

Feeling fat was associated with binge eating, not restricting, highlighting the importance of specificity in maintenance models. Because the mediating effect of feeling fat was accounted for by body size, factors associated with body size, such as internalized weight stigma, may be more relevant mediators of the relationship between negative emotions and eating disorder behaviors. Future research on feeling fat should adjust for body size.

Person-specific and pooled prediction models for binge eating, alcohol use and binge drinking in bulimia nervosa and alcohol use disorder

BACKGROUND

Machine learning could predict binge behavior and help develop treatments for bulimia nervosa (BN) and alcohol use disorder (AUD). Therefore, this study evaluates person-specific and pooled prediction models for binge eating (BE), alcohol use, and binge drinking (BD) in daily life, and identifies the most important predictors.

METHODS

A total of 120 patients (BN: 50; AUD: 51; BN/AUD: 19) participated in an experience sampling study, where over a period of 12 months they reported on their eating and drinking behaviors as well as on several other emotional, behavioral, and contextual factors in daily life. The study had a burst-measurement design, where assessments occurred eight times a day on Thursdays, Fridays, and Saturdays in seven bursts of three weeks. Afterwards, person-specific and pooled models were fit with elastic net regularized regression and evaluated with cross-validation. From these models, the variables with the 10% highest estimates were identified.

RESULTS

The person-specific models had a median AUC of 0.61, 0.80, and 0.85 for BE, alcohol use, and BD respectively, while the pooled models had a median AUC of 0.70, 0.90, and 0.93. The most important predictors across the behaviors were craving and time of day. However, predictors concerning social context and affect differed among BE, alcohol use, and BD.

CONCLUSIONS

Pooled models outperformed person-specific models and the models for alcohol use and BD outperformed those for BE. Future studies should explore how the performance of these models can be improved and how they can be used to deliver interventions in daily life.

Evaluating dietary restriction as a maintaining factor in binge-eating disorder

OBJECTIVE

Prominent theories of binge-eating (BE) maintenance highlight dietary restriction as a key precipitant of BE episodes. Consequently, treatment approaches for eating disorders (including binge-eating disorder; BED) seek to reduce dietary restriction in order to improve BE symptoms. The present study tested the hypothesis that dietary restriction promotes BE among 112 individuals with BED.

METHODS

Participants completed a 7-day ecological momentary assessment (EMA) protocol before and after completing 17 weeks of either Integrative Cognitive-Affective Therapy or guided self-help cognitive behavioral therapy. Analyses examined whether dietary restriction on 1 day of the baseline EMA protocol predicted risk for BE later that same day, and on the following day. Changes in dietary restriction over the course of treatment were also evaluated as a predictor of change in BE from pre-treatment to post-treatment. Baseline dietary restraint was examined as a moderator of the above associations.

RESULTS

Dietary restriction did not predict BE later the same day, and changes in restriction were not related to changes in BE across treatment, regardless of baseline dietary restraint levels. Restriction on 1 day did predict increased BE risk on the following day for individuals with higher levels of dietary restraint, but not those with lower levels.

DISCUSSION

These findings challenge the assumption that dietary restriction maintains BE among all individuals with BED. Rather, results suggest that dietary restriction may be largely unrelated to BE maintenance in this population, and that reducing dietary restriction generally does not have the intended effect on BE frequency.

The role of habit in maintaining binge/purge behaviors: An ecological momentary assessment study

OBJECTIVE

Individuals with eating disorders transdiagnostically engage in binge eating (BE) and/or purging, despite life-threatening consequences. Little is known about factors that contribute to the persistence of these behaviors. This study explored whether habitual control over binge/purge (B/P) spectrum behaviors contributes to symptom persistence and whether negative reinforcement via reductions in negative affect is less influential in maintaining B/P behaviors that are under habitual control and are persistent.

METHOD

Women with BE and/or purging (N = 81) completed self-report measures assessing habit strength of BE and purging. Then, they completed a 14-day ecological momentary assessment (EMA) protocol during which they completed measures of negative affect, BE, and purging multiple times per day.

RESULTS

Habitual control over purging was associated with a greater frequency of purging during the EMA period. However, habitual control over BE was not associated with the severity of loss of control eating or the frequency of BE episodes. Habitual control did not moderate temporal relations between negative affect and B/P behaviors during the EMA period. However, exploratory analyses revealed that individuals with a longer duration of BE and greater habitual control over BE showed a less pronounced reduction in negative affect following BE.

DISCUSSION

Overall, these findings suggest that purging may be maintained by habitual stimulus-response learning. In addition, they support the possibility that reduction in negative affect may play a less prominent role in maintaining BE that is habitual and persistent.

PUBLIC SIGNIFICANCE

This study investigated whether habit contributes to the persistence of symptoms in women with binge/purge spectrum behaviors and whether negative reinforcement via reductions in negative affect is less influential in maintaining binge/purge behaviors that are under habitual control. The findings suggest that purging may be maintained through habit. This supports the potential utility of habit reversal interventions to decrease habitual purging.

The roles of negative affect and emotion differentiation in the experience of 'feeling fat' among undergraduate students: An ecological momentary assessment study

'Feeling fat' is the somatic experience of being overweight not fully explained by objective body mass. According to the body displacement hypothesis, 'feeling fat' occurs when diffuse negative emotions are projected onto the body in lieu of adaptive emotion regulation. Emotion differentiation, the ability to experience and label discrete emotions, is an important skill for adaptively addressing emotion that may reduce 'feeling fat.' We hypothesized that individuals with better negative emotion differentiation would be less likely to report 'feeling fat' when experiencing high negative emotion. We collected ecological momentary assessment data from 198 undergraduate students (52.24% female). Multilevel modeling revealed that both within-person increases in negative emotions and the tendency to experience greater negative emotion were associated with greater 'feeling fat.' Of the specific types of negative emotion, guilt and sadness predicted 'feeling fat.' Contrary to hypotheses, individuals with better emotion differentiation were more likely to report 'feeling fat' after experiencing elevated negative affect. These findings contradict the primary clinical conceptualization of 'feeling fat,' suggesting that factors beyond displacement of negative emotions onto the body may be responsible for 'feeling fat'. Results in a sample with pronounced shape/weight concern may better support the traditional clinical understanding of 'feeling fat.'

Neurocognitive reward processes measured via event-related potentials are associated with binge-eating disorder diagnosis and ecologically-assessed behavior

Altered reward processing has been implicated in the onset and maintenance of binge-eating disorder (BED). However, it is unclear which precise neurocognitive reward processes may contribute to BED. In the present study, 40 individuals with BED and 40 age-, sex-, and BMI-matched controls completed a reward (incentive delay) task while their neural activity was recorded using electroencephalography (EEG). Individuals with BED also completed a 10-day ecological momentary assessment (EMA) protocol assessing binge-eating behavior in the natural environment. Event-related potential (ERP) analysis of the EEG indicated that individuals with BED had stronger anticipatory (CNV) and outcome-related (RewP) neural reward activity to food and monetary rewards, compared to controls. However, within the BED group, greater frequency of binge eating during the EMA protocol was associated with stronger anticipatory (CNV) but weaker outcome-related (RewP) neural reward activity. These associations within the BED group were unique to food, and not monetary, rewards. Although preliminary, these results suggest that both anticipatory ("wanting") and outcome ("liking") reward processes may be generally amplified in BED. However, they also suggest that among individuals with BED, disorder severity may be associated with increased anticipatory reward processes ("wanting"), but relatively decreased reward-outcome processing ("liking"), of food rewards specifically.

Affective profiles of exercise episodes are associated with maladaptive and adaptive motivations for exercise

OBJECTIVE

Maladaptive exercise (i.e., driven and/or compensatory exercise) is common in binge-spectrum eating disorders (EDs; e.g., bulimia nervosa, binge ED) and associated with adverse treatment outcomes. Alternatively, individuals with EDs are often also engaging in adaptive exercise (e.g., for enjoyment or health improvement), and increasing adaptive exercise may decrease ED symptoms. The current study aimed to understand which exercise episodes are likely to be maladaptive/adaptive so that interventions can appropriately decrease/increase maladaptive and adaptive exercise.

METHOD

We used latent profile analysis (LPA) to identify pre-exercise affective profiles of 661 exercise episodes among 84 individuals with binge-spectrum EDs and examined associations between LPA-identified profiles and subsequent exercise motivations using ecological momentary assessment.

RESULTS

A two-profile solution best fit our data: Profile 1 (n = 174), 'positive affectivity,' and Profile 2 (n = 487), 'negative affectivity.' Episodes in the 'negative affectivity' profile were more likely to be endorsed as both driven and intended to influence body shape/weight. Episodes in the 'positive affectivity' profile were more likely to be endorsed as exercising for enjoyment.

CONCLUSIONS

Results support two phenotypes of exercise episodes, and differential associations of these phenotypes with adaptive and maladaptive motivations for exercise.

Latent profiles of emotion dysregulation among individuals with binge-spectrum eating disorders: Associations with eating disorder pathology

OBJECTIVE

Emotion dysregulation (i.e., a multi-component term comprising nonacceptance of emotional responses, difficulty engaging in goal-directed behaviour, impulse control difficulties, lack of emotional awareness, limited access to emotion regulation strategies, and lack of emotional clarity) is a well-established transdiagnostic risk and maintenance factor for eating disorders. To date, there is limited information on how varying scores on subdomains of emotion dysregulation may yield distinct profiles in individuals with binge-spectrum eating disorders (B-EDs), and how these emotion dysregulation profiles may inform resultant symptomatology.

METHOD

In the current study, treatment-seeking individuals with B-EDs (n = 315) completed the Difficulties in Emotion Regulation Scale (DERS) and Eating Disorder Examination. Latent profile analysis was conducted on the six subscales of the DERS. Identified latent profiles were examined as predictors of eating disorder pathology using linear regression, and a two-class model of emotion dysregulation fit the data.

RESULTS

Class 1 (n = 113) was low in all of the DERS subscales, while Class 2 (n = 202) was high in all of the DERS subscales. Individuals in Class 2 had a significantly higher frequency of compensatory behaviours in the past month (F(1,313) = 12.97, p < 0.001), and significantly higher restraint scores (F(1,313) = 17.86, p < 0.001). The classes also significantly differed in terms of eating concern (F(1,313) = 20.89, p < 0.001) and shape concern (F(1,313) = 4.59, p = 0.03), with both being higher for Class 2.

DISCUSSION

We found only two distinct classes of emotion dysregulation in B-ED's such that individuals were simply high or low in emotion dysregulation. These results suggest that it may be more valuable for future research to evaluate emotion dysregulation as a cohesive whole rather than conceptualising the construct as having truly distinct subdomains.

Interpersonal Characteristics and Binge Eating among Patients Pursuing Bariatric Surgery

BACKGROUND

Preoperative binge eating behavior has been associated with difficulties in weight loss maintenance among patients pursuing bariatric surgery. However, limited data exists on the relationship between interpersonal difficulties and binge eating.

OBJECTIVES

To identify interpersonal factors linked with binge eating among bariatric surgery candidates.

SETTING

One hundred and seventeen adult bariatric surgery candidates (BMI = 42.2 ± 5.2) from three different hospitals completed questionnaires on the day of their bariatric committee meeting for operation approval.

METHODS

Binge eating was assessed using the Questionnaire on Eating and Weight Patterns-5 (QEWP-5) as a dichotomous variable. Self-esteem was measured using the Rosenberg Self-Esteem Scale (RSES), and interpersonal characteristics were evaluated using the short version of the Inventory of Interpersonal Problems (IIP-32). Sociodemographic variables (age, gender, income, education) and BMI were considered as confounders.

RESULTS

Approximately 25% of bariatric surgery candidates reported experiencing binge eating episodes within the previous three months. Participants with binge eating exhibited significantly lower self-esteem and more interpersonal difficulties, particularly in the domains of aggressiveness and dependence, compared to those without binge eating. Logistic regression analysis revealed that aggressiveness was a significant predictor of binge eating in this sample.

CONCLUSIONS

This study is the first, to the best of our knowledge, to investigate the relationship between interpersonal difficulties and binge eating among bariatric surgery candidates. The findings highlight the significant contribution of aggressiveness to binge eating and emphasize the importance of clinicians assessing patients' interpersonal functioning, particularly with regard to aggressiveness, as a factor that may contribute to the maintenance and occurrence of binge eating behaviors.

Examining specific and non-specific symptoms of the best-fitting posttraumatic stress disorder model in conflict-exposed adolescents

BACKGROUND

The 5th revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) construes PTSD symptoms into 4 clusters (intrusion, avoidance, negative alterations in cognitions and mood, alterations in arousal and reactivity; Model 1). However, recent literature has shown that this symptom structure does not best represent PTSD. Unfortunately, the findings of studies investigating the proposed alternative models are from consensus. Adding to the complexity of the issue of symptom-grouping models is the identification of specific and non-specific symptoms of PTSD. The present study aims to address these gaps by identifying the best-fitting PTSD model and subsequently examining what symptoms are considered specific and non-specific to PTSD in adolescent-survivors of armed political conflict and violence.

METHODS

The study utilized a sample of 641 adolescent victim survivors. We conducted CFA analyses and compared nested models through the scaled χ2 difference test, while comparison of non-nested models was done using the Bayesian information criterion (BIC). The best-fitted model was used in the consequent analysis, where we statistically controlled for the effect of non-specific psychological distress on PTSD by comparing the factor loadings and factor correlations before and after accounting for distress using the Aroian z-test.

RESULTS

The results provide support for the 7-factor hybrid model of PTSD over other proposed models for the current sample. Moreover, the data reveal that only 7 items could be construed as core symptoms, while the rest of the symptoms can be considered non-PTSD specific.

CONCLUSIONS

Overall, the findings provide support for the validity of the hybrid PTSD model among political conflict-exposed adolescents. The results also show that the DSM-5 PTSD has both specific and non-specific features in the present sample of conflict-exposed adolescents. This has potential implications for theory, practice, and treatment of the disorder.

Explicating the role of amygdala substructure alterations in the link between hypoleptinemia and rumination in anorexia nervosa

OBJECTIVE

The amygdaloid complex plays a pivotal role in emotion processing and has been associated with rumination transdiagnostically. In anorexia nervosa (AN), we previously observed differential reductions of amygdala nuclei volumes (rostral-medial cluster substantially affected) and, in another study, elevated food-/weight-related rumination. Both amygdala volumes and rumination frequency correlated with characteristically suppressed leptin levels in AN. Thus, we hypothesized that amygdala nuclei alterations might be associated with AN-related rumination and potentially mediate the leptin-rumination relationship in AN.

METHODS

Rumination (food-/weight-related) was assessed using ecological momentary assessment for a 14-day period. We employed frequentist and Bayesian linear mixed effects models in females with AN (n = 51, 12-29 years, majority admitted to inpatient treatment) and age-matched healthy females (n = 51) to investigate associations between rostral-medial amygdala nuclei volume alterations (accessory basal, cortical, medial nuclei, corticoamygdaloid transitions) and rumination. We analyzed mediation effects using multi-level structural equation models.

RESULTS

Reduced right accessory basal and cortical nuclei volumes predicted more frequent weight-related rumination in AN; both nuclei fully mediated the effect of leptin on weight-related rumination. In contrast, we found robust evidence for the absence of amygdala nuclei volume effects on rumination in healthy females.

CONCLUSION

This study provides first evidence for the relevance of specific amygdala substructure reductions regarding cognitive symptom severity in AN and points toward novel mechanistic insight into the relationship between hypoleptinemia and rumination, which might involve the amygdaloid complex. Our findings in AN may have important clinical value with respect to understanding the beneficial neuropsychiatric effects of leptin (treatment) in AN and potentially other psychiatric conditions such as depression.

Shame facets as predictors of problematic eating behaviors: An ecological momentary assessment study

It is well-established that negative affect acts as predictor and maintenance factor of problematic eating behaviors. However, the relevance of different facets of negative affect is unclear. While guilt was consistently shown as having a relevant contribution in relation with problematic eating patterns, shame might play a similar role. The current study used an ecological momentary assessment design to assess associations between facets of shame and subsequent disturbed eating behaviors. The study included 57 females with high levels of eating disorders (ED) symptomatology who completed five surveys per day for 14 consecutive days. Participants completed measures of facets of shame (i.e., general shame, body shame, shame around eating), negative affect and problematic eating behaviors (i.e., binge eating, restriction, weighting, body checking, purging, taking laxative/diuretics and excessive exercise). Data were analyzed using multilevel models. In general, between-subjects facets of shame were associated with more disturbed eating behaviors, with shame explaining a significantly and clinically relevant percent of the variance of these problematic eating behaviors. At the within-subject level, facets of shame predicted subsequent binge eating, body checking and excessive exercise. These findings support the role of shame in ED symptomatology and the relevance of directly tackling shame in psychological treatments.

Time-of-day and day-of-week patterns of binge eating and relevant psychological vulnerabilities in binge-eating disorder

OBJECTIVE

The present study sought to characterize the temporal patterns of binge eating and theorized maintenance factors among individuals with binge-eating disorder (BED).

METHOD

Ecological momentary assessment of 112 individuals and mixed-effects models were used to characterize the within- and between-day temporal patterns of eating behaviors (binge eating, loss of control only eating, and overeating only), positive and negative affect, emotion regulation difficulty, and food craving.

RESULTS

Risk for binge eating and overeating only was highest around 5:30 p.m., with additional binge-eating peaks around 12:30 and 11:00 p.m. In contrast, loss of control eating without overeating was more likely to occur before 2:00 p.m. Risk for binge eating, loss of control only eating, and overeating only did not vary across days in the week. There was no consistent pattern of change in negative affect throughout the day, but it decreased slightly on the weekend. Positive affect showed a decrease in the evenings and a smaller decrease on the weekend. The within-day patterns of food craving, and to some extent emotion regulation difficulty, resembled the pattern of binge eating, with peaks around meal times and at the end of the night.

DISCUSSION

Individuals with BED appear most susceptible to binge-eating around dinner time, with heightened risk also observed around lunch time and late evening, though the effects were generally small. These patterns appear to most strongly mimic fluctuations in craving and emotion dysregulation, although future research is needed to test the temporal relationships between these experiences directly.

PUBLIC SIGNIFICANCE

It is unknown which times of the day and days of the week individuals with binge-eating disorder are most at risk for binge eating. By assessing binge-eating behaviors in the natural environment across the week, we found that individuals are most likely to binge in the evening, which corresponds to the times when they experience the strongest food craving and difficulty with regulating emotions.

Relations between forms of dietary restraint, restriction, and loss-of-control eating among adolescents seeking weight control: An ecological momentary assessment study

OBJECTIVE

This study aimed to: 1) compare rates of dietary restraint and restriction between adolescents with and without loss-of-control (LOC) eating who were seeking weight control and 2) examine temporal relations between restraint/restriction and LOC eating.

METHOD

37 adolescents seeking weight control (mean age: 15.4 ± 1.5; 62 % White; 57 % female; mean BMI percentile = 97.3 ± 3.1) completed a one-week ecological momentary assessment protocol and reported on dietary restraint/restriction and eating behavior prior to beginning a weight control intervention. Chi-square tests examined differences in frequency of restraint/restriction between participants with and without LOC eating. Multilevel models examined associations between dietary restraint/restriction and LOC eating at the next survey and on the next day.

RESULTS

Of 37 participants, 15 (41 %) reported engaging in LOC eating. Participants with LOC eating more frequently endorsed several forms of restraint and restriction versus participants without LOC eating. Attempting to avoid enjoyable foods and attempting to limit eating at one survey predicted greater likelihood of LOC eating at the next survey.

CONCLUSIONS

Findings suggest that attempted restraint, but not actual restriction, was associated with LOC eating. Research should explore additional factors that may influence these relationships, which could inform weight control treatments that address restraint/restriction.

Integrating aspects of affect, reward, and cognition to develop more comprehensive models of binge-eating pathology

Reward-related processes are an increasing focus of eating disorders research. Although evidence suggests that numerous distinct reward processes may contribute to eating pathology (e.g., reward learning and delay discounting), existing etiological models of reward dysfunction tend to focus on only a limited number of reward processes, and frequently lack specificity when identifying the individual reward processes hypothesized to contribute to dysregulated eating behavior. Moreover, existing theories have been limited in their integration of reward-related processes with other demonstrated risk and maintenance factors for eating disorders (e.g., affect and cognition), potentially contributing to underdeveloped models of eating pathology. In this article, we highlight five distinct reward processes with theorized or demonstrated relevance to eating disorders involving binge-eating, followed by a review of two well-established risk/maintenance factors for binge-eating pathology. We then introduce two novel models of binge eating onset and maintenance that integrate these factors (i.e., the Affect, Reward, Cognition models), and discuss methods for testing each of the models in future research. Ultimately, we hope that the proposed models provide a springboard for the continued evolution of more precise and comprehensive theories of reward dysfunction in the eating disorders, as well as the development of novel intervention approaches. PUBLIC SIGNIFICANCE STATEMENT: Eating disorders are associated with abnormalities in multiple domains of reward functioning. However, models of reward dysfunction within the eating disorders have not been well-integrated with prominent models of affect and cognition. This article presents two novel models of onset and maintenance for binge-eating pathology, which attempt to integrate observed reward abnormalities with other affective and cognitive processes implicated in binge-type eating disorders.

Ecological momentary assessment of state affect prior to and following loss of control eating in young men

OBJECTIVE

Loss of control (LOC) eating is prevalent but understudied among young men. Affect regulation models propose that LOC eating functions as a maladaptive effort to escape from distressing affective states. As such, negative affect is thought to increase before and decrease after LOC eating. However, examinations with young men are lacking and it remains unclear whether specific emotional experiences are differentially implicated in their LOC eating.

METHODS

The current study examined the temporal roles of affect in LOC eating in 31 young men (18-35 years; Mage = 25.74 ± 5.61y; 46.7 % White; 30 % Black/African American; 10 % Hispanic/Latino, 10 % South Asian) who reported engaging in recurrent LOC eating. Participants completed a 14-day ecological momentary assessment protocol and recorded all eating episodes each day and their state affect five times per day. Generalized linear mixed models were conducted to examine the trajectories of global and item-level negative and positive affect pre- and post-LOC eating episodes.

RESULTS

Negative affect did not change significantly before or after LOC eating (ps > .05). Positive affect did not change significantly before LOC eating (ps > .05). Global positive affect, excitement, and happiness decreased significantly after LOC eating (ps ≤ .001).

DISCUSSION

Study findings contradict extant theory and empirical data largely from female samples. Negative affect did not increase risk for LOC eating, nor did LOC eating function to improve participants' mood; rather, positive mood slightly decreased after LOC eating. Further investigation around the observed decline in positive affect after LOC eating will clarify if this is a relevant intervention point in this population.

Longitudinal associations of binge eating with internalized weight stigma and eating self-efficacy

INTRODUCTION

Internalized weight stigma (IWS) is linked to binge eating disorder (BED) symptoms and reduced self-efficacy, yet it unknown how changes in these factors may interrelate. The current study examined cross-sectional and longitudinal associations of BED with IWS and eating self-efficacy among treatment-seeking adults with high body weight. Disinhibited eating was explored as a mediator.

METHODS

Seventy-one adults with high weight and elevated IWS were included in this secondary analysis of a clinical trial that provided 26 weeks of behavioral weight loss (BWL) treatment with (versus without) an additional IWS intervention. Participants underwent a BED diagnostic interview at screening and completed validated measures of binge eating, IWS (including weight bias internalization, self-devaluation, and stereotype endorsement), eating self-efficacy, and disinhibited eating at baseline and week-26. Cross-sectional mediation models tested associations of BED with IWS and eating self-efficacy, explained by disinhibited eating. Linear and logistic regression models, controlling for treatment condition, tested if baseline BED predicted changes in IWS, self-efficacy, and disinhibited eating, and if decreased binge episodes were associated with improved outcomes.

RESULTS

At baseline, disinhibited eating mediated the relationship between BED and weight self-devaluation (95 % CI = 0.66,3.58), stereotype endorsement (CI = 0.15,0.56), and eating self-efficacy (CI:-14.40,-4.29). Baseline BED did not predict changes in outcomes. Participants with decreased binge episodes reported greater improvements in weight bias internalization (p = 0.04) and eating self-efficacy (p < 0.001).

CONCLUSION

This study provides novel evidence of longitudinal associations between binge eating, IWS, and eating self-efficacy. IWS warrants further consideration as a treatment target and outcome in studies of BWL and BED.

Using Wearable Passive Sensing to Predict Binge Eating in Response to Negative Affect Among Individuals With Transdiagnostic Binge Eating: Protocol for an Observational Study

BACKGROUND

Binge eating (BE), characterized by eating a large amount of food accompanied by a sense of loss of control over eating, is a public health crisis. Negative affect is a well-established antecedent for BE. The affect regulation model of BE posits that elevated negative affect increases momentary risk for BE, as engaging in BE alleviates negative affect and reinforces the behavior. The eating disorder field's capacity to identify moments of elevated negative affect, and thus BE risk, has exclusively relied on ecological momentary assessment (EMA). EMA involves the completion of surveys in real time on one's smartphone to report behavioral, cognitive, and emotional symptoms throughout the day. Although EMA provides ecologically valid information, EMA surveys are often delivered only 5-6 times per day, involve self-report of affect intensity only, and are unable to assess affect-related physiological arousal. Wearable, psychophysiological sensors that measure markers of affect arousal including heart rate, heart rate variability, and electrodermal activity may augment EMA surveys to improve accurate real-time prediction of BE. These sensors can objectively and continuously measure biomarkers of nervous system arousal that coincide with affect, thus allowing them to measure affective trajectories on a continuous timescale, detect changes in negative affect before the individual is consciously aware of them, and reduce user burden to improve data completeness. However, it is unknown whether sensor features can distinguish between positive and negative affect states, given that physiological arousal may occur during both negative and positive affect states.

OBJECTIVE

The aims of this study are (1) to test the hypothesis that sensor features will distinguish positive and negative affect states in individuals with BE with >60% accuracy and (2) test the hypothesis that a machine learning algorithm using sensor data and EMA-reported negative affect to predict the occurrence of BE will predict BE with greater accuracy than an algorithm using EMA-reported negative affect alone.

METHODS

This study will recruit 30 individuals with BE who will wear Fitbit Sense 2 wristbands to passively measure heart rate and electrodermal activity and report affect and BE on EMA surveys for 4 weeks. Machine learning algorithms will be developed using sensor data to distinguish instances of high positive and high negative affect (aim 1) and to predict engagement in BE (aim 2).

RESULTS

This project will be funded from November 2022 to October 2024. Recruitment efforts will be conducted from January 2023 through March 2024. Data collection is anticipated to be completed in May 2024.

CONCLUSIONS

This study is anticipated to provide new insight into the relationship between negative affect and BE by integrating wearable sensor data to measure affective arousal. The findings from this study may set the stage for future development of more effective digital ecological momentary interventions for BE.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/47098.

Anhedonia in cognitive behavioral therapy for binge eating spectrum disorders

Anhedonia is theorized as being relevant to binge eating spectrum disorders (BESDs) by palatable foods substituting the pleasure typically obtained from day-to-day activities. The current study examined whether anhedonia is associated with eating pathology at baseline and whether it predicts cognitive behavioral therapy (CBT) outcomes alone and when controlling for non-anhedonia depression symptoms. Ninety-three individuals from two randomized controlled trials completed the Eating Disorder Examination and Beck Depression Inventory-II at pre-, mid-, and post-treatment. Results showed that anhedonia was positively associated with global eating pathology at baseline, and larger pre- to mid-treatment anhedonia and non-anhedonia reductions predicted larger pre- to post-treatment global eating pathology reductions, though the anhedonia association was no longer significant when controlling for non-anhedonia depression. Anhedonia appears to be related to global eating pathology in CBT for BESDs, but not loss of control eating. Further research is needed to elucidate the relationship between anhedonia and BESDs.

Measuring affect in daily life: A multilevel psychometric evaluation of the PANAS-X across four ecological momentary assessment samples

While there is strong evidence for the psychometric reliability of the Positive and Negative Affect Schedule-Expanded Form (PANAS-X) in cross-sectional studies, the between- and within-person psychometric performance of the PANAS-X in an intensive longitudinal framework is less understood. As affect is thought to be dynamic and responsive to context, this study investigated the multilevel reliability of PANAS-X Positive Affect, Negative Affect, Fear, Sadness, and Hostility scales. Generalizability theory and structural equation modeling techniques (coefficient ω) were employed in four ecological momentary assessment samples (N = 309; 41,261 reports). Results demonstrate that the PANAS-X scales, including short versions of the Positive and Negative Affect scales, can reliably detect between-person differences. PANAS-X scales also were able to reliably measure within-person change, though these estimates may be impacted by scale content and study design. These results support the use of the PANAS-X in daily life research to intensively measure affect in the natural environment. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Examining the role of urgency in predicting binge size in bulimia nervosa

Greater binge size within bulimia nervosa is associated with elevated distress and impairment. Theoretical models posit that emotion dysregulation predicts binge eating, but little research has investigated the potential for dispositional traits that reflect difficulty in emotion regulation to predict binge size among women with bulimia nervosa. Research supports that negative urgency, the tendency to act rashly when feeling distressed, is associated with binge eating behavior among individuals with bulimia nervosa. Relatively fewer studies have explored associations between binge eating and positive urgency, the tendency to act rashly when feeling extreme positive affect. The urgency traits may predict greater binge size within bulimia nervosa. The current study sought to examine negative urgency and positive urgency as predictors of test meal intake in a sample of 50 women, n = 21 with bulimia nervosa and n = 29 healthy controls. Dispositional levels of positive urgency, negative urgency, positive affect, and negative affect were measured prior to a laboratory binge eating paradigm. Participants in the bulimia nervosa group scored higher on negative urgency, positive urgency, and negative affect than participants in the control group. Across participants, lower levels of negative affect were associated with greater test meal intake. Elevated levels of positive urgency predicted significantly greater test meal intake, but only for participants with bulimia nervosa. No other dispositional traits predicted test meal intake when the interaction of positive urgency and group was included in the model. Findings suggest positive urgency is an underappreciated, but potentially important, risk factor for greater binge size in bulimia nervosa.

Positive affect dysregulation and its relation to binge eating size and frequency

Negative affect is an established predictor of binge eating, yet less is known about positive affect. Low positive affect has been theorized to increase binge eating, but a better understanding is needed on the relationship between positive affect and binge eating frequency and size. Participants were 182 treatment-seeking adults (76% self-identified as female; 45% self-identified their race as Black and 40% as White; and 25% self-identified their ethnicity as Hispanic/Latino) with self-reported recurrent binge eating (≥12 binge episodes in the past 3  months). Participants completed the positive and negative affect schedule (PANAS) survey and the eating disorder examination to assess frequency of objective binge episodes (OBEs) and subjective binge episodes (SBEs) over the past 3  months. OBEs and SBEs also were combined to yield total binge episodes over the past 3  months. Independent t-tests and linear regression analyses were used to test associations between positive affect scores and binge episode size and frequencies, and to compare low versus higher positive affect on binge frequency. Additional exploratory models were conducted controlling for negative affect, identity characteristics, and socio-demographic variables. Lower positive affect was significantly associated with more frequent total binge episodes, but not OBEs and SBEs when assessed independently. Findings remained consistent when controlling for covariates and when comparing individuals with the lowest versus higher positive affect levels. Overall, results lend support to the theory that low positive affect is associated with binge eating. Increasing positive affect may be an important treatment consideration for those with recurrent binge eating.

Divergent trajectories of positive affect following maladaptive and non-maladaptive exercise among individuals with binge-spectrum eating disorders

OBJECTIVE

Individuals with eating disorders (EDs) often engage in maladaptive exercise (e.g., feeling driven, or to "compensate" for eating) which maintains eating pathology. Maladaptive exercise has been theorized to help individuals with EDs regulate emotions by enhancing positive affect (PA) and reducing negative affect (NA) associated with binge episodes and poor body image. However, no research has considered the presence of non-maladaptive exercise or evaluated this theory in binge-spectrum EDs.

METHODS

This study evaluated affective trajectories pre- and post-exercise and examined exercise type (maladaptive or non-maladaptive) as a moderator. We recruited adults with binge-spectrum EDs (N = 107; n = 84 endorsed exercise) to complete a 7- to 14-day ecological momentary assessment protocol assessing NA (anxiety, guilt, and sadness), PA (excitement and cheerfulness), and exercise.

RESULTS

There was a significant quadratic trajectory of PA pre-exercise, suggesting that the upward trajectory of PA leveled out as it moved closer to an exercise episode. Exercise type significantly moderated the cubic trajectory of PA post-exercise, such that the upward trajectory of PA accelerated in the hours following non-maladaptive exercise episodes while the downward trajectory of PA accelerated in the hours following maladaptive exercise episodes. No trajectories of NA demonstrated significant effects.

CONCLUSIONS

Pre-exercise trajectories of PA may reflect positive expectancies around exercise. Post-exercise trajectories of PA suggest that non-maladaptive exercise promotes increased PA. Future research should evaluate when, and for whom, exercise serves to regulate affect and examine other momentary risk factors of exercise in EDs.

PUBLIC SIGNIFICANCE

Individuals with EDs often engage in maladaptive exercise (e.g., feeling driven, or to "compensate" for eating). Maladaptive exercise has been theorized to help individuals with EDs regulate emotions. This study evaluated affective trajectories pre- and post-exercise and examined whether exercise type (maladaptive or non-maladaptive) changed these trajectories. Pre-exercise trajectories of PA may reflect positive expectancies around exercise. Post-exercise trajectories of PA suggest that non-maladaptive exercise promotes increased PA.

Differentiating types of dietary restraint and their momentary relations with loss-of-control eating

OBJECTIVE

Despite evidence supporting the link between dietary restraint (i.e., attempts at dietary restriction) and loss of control (LOC) eating among individuals with binge-spectrum eating disorders (EDs), some research suggests that dietary restraint may not be linked to LOC eating in all contexts. It is currently unknown how often dietary restraint results in successful dietary restriction, or which types of restraint/restriction confer highest risk for LOC eating. Furthermore, little research has evaluated momentary, temporal associations between dietary restraint and LOC eating. Thus, the present study aimed to (1) characterize dietary restraint and restriction, among individuals with LOC eating, and (2) examine temporal relationships between restraint/restriction and LOC eating within- and between-subjects.

METHOD

The current study recruited adults with binge spectrum EDs (n = 96, 80.4% female) to complete a 7-14-day ecological momentary assessment protocol assessing ED symptoms. Multilevel models and linear regression evaluated within- and between-subjects associations between momentary restraint/restriction and LOC eating, respectively.

RESULTS

Attempted avoidance of enjoyable foods, limiting the amount eaten, and any restraint predicted greater likelihood of LOC eating at the next survey. Attempts to delay eating predicted reduced likelihood of LOC eating at the next survey, though this effect was no longer statistically significant after correcting for multiple comparisons. Diagnostic presentation moderated the association between attempted avoidance of enjoyable foods and LOC eating such that this association was significantly stronger for those on the BN-spectrum.

DISCUSSION

Dietary restraint seems to be more predictive of LOC eating than dietary restriction both within- and between-subjects. Future treatments should target dietary restraint to reduce LOC eating.

PUBLIC SIGNIFICANCE

Some research suggests that dietary restriction (i.e., reduced calorie intake) and restraint (i.e., attempted restriction) may not be linked to LOC eating in all contexts. We found that dietary restraint is more predictive of LOC eating than dietary restriction both within and between individuals. Future treatments should target dietary restraint to reduce LOC eating.

Neural correlates of Type A personality: Type A personality mediates the association of resting-state brain activity and connectivity with eating disorder symptoms

BACKGROUND

Type A personality (TAP) was characterized by impatience, competitiveness, aggressiveness, and hostility. Higher TAP was proved to be associated with more eating disorder symptoms (EDS). While little is known about the underlying neural substrates of TAP and how TAP is linked to EDS at the neural level.

METHODS

To investigate the neural basis of TAP, we adopted fractional amplitude of low-frequency fluctuations (fALFF) and resting-state functional connectivity (RSFC) via resting-state functional magnetic resonance imaging (rs-fMRI) (N = 1620). Mediation models were examined to explore the relationship between TAP, EDS, and brain activity.

RESULTS

TAP was associated with decreased fALFF in the left middle frontal gyrus (MFG) and increased fALFF in the left precentral gyrus (PreCG). Furthermore, TAP was positively correlated to RSFC between the left MFG and left inferior temporal gyrus (ITG) and between the left PreCG and right middle temporal gyrus (MTG). Mediation analysis showed TAP fully mediated the association of the left MFG activity, MFG-ITG connectivity, and PreCG-MTG connectivity with EDS.

LIMITATIONS

The cross-sectional design of this study precludes us from specifying the causal relationship in the associations we observed.

CONCLUSIONS

Our results suggested spontaneous activity in the left MFG and PreCG is associated with TAP, and even in general sample, people with higher TAP showed more EDS. The present study is the first to investigate the neurobiological underpinnings of TAP in a large sample and further offered new insights into the relation between TAP and EDS from a neural basis perspective.

Human habit neural circuitry may be perturbed in eating disorders

Circuit-based mechanisms mediating the development and execution of habitual behaviors involve complex cortical-striatal interactions that have been investigated in animal models and more recently in humans. However, how human brain circuits implicated in habit formation may be perturbed in psychiatric disorders remains unclear. First, we identified the locations of the sensorimotor putamen and associative caudate in the human brain using probabilistic tractography from Human Connectome Project data. We found that multivariate connectivity of the sensorimotor putamen was altered in humans with binge eating disorder and bulimia nervosa and that the degree of alteration correlated with severity of disordered eating behavior. Furthermore, the extent of this circuit aberration correlated with mean diffusivity in the sensorimotor putamen and decreased basal dopamine D2/3 receptor binding potential in the striatum, consistent with previously reported microstructural changes and dopamine signaling mediating habit learning in animal models. Our findings suggest a neural circuit that links habit learning and binge eating behavior in humans, which could, in part, explain the treatment-resistant behavior common to eating disorders and other psychiatric conditions.

Temporal dynamics of interoceptive attention and positive and negative affect in adults engaging in disordered eating and nonsuicidal self-injury

OBJECTIVE

Interoception (the sense of the body's state) is associated with eating disorders and nonsuicidal self-injury, potentially through relationships with affect. We examined the relationship between interoceptive attention and both positive and negative affect.

METHODS

Participants (N = 128) who reported recent self-harm (i.e., disordered eating and/or non-suicidal self-injury) completed ecological momentary assessment for 16 days. Participants completed multiple daily assessments of affect and interoceptive attention. We then tested the temporal dynamic relationship between interoceptive attention and affect.

RESULTS

There was a relationship between positive affect and interoceptive attention such that people with higher average positive affect, and times when people were above their typical positive affect, were associated with higher interoceptive attention. There was a negative relationship between negative affect and interoceptive attention, such that people with higher average negative affect, and times when people were above their own typical negative affect, were associated with lower interoceptive attention.

CONCLUSIONS

Better mood may associate with greater willingness to attend to body sensations. Our findings support active inference models of interoception and highlight the importance of refining our understanding of the dynamic nature of interoception and its relationship with affect.

Reward mediates the association between engagement in noneating activities and state body dissatisfaction: An ecological momentary assessment study

OBJECTIVE

Momentary worsening (i.e., greater than one's average levels) of state body dissatisfaction (BD) has been implicated as a proximal risk factor for eating disorder (ED) behaviors in binge-spectrum EDs. Yet, research exploring the prospective association between noneating activities in daily life (e.g., chores, self-care/coping) and momentary state BD remains limited. Understanding the momentary link between engagement in noneating activities and state BD, and pathways through which engagement in said activities influences momentary state BD is critical to informing treatments. The current ecological momentary assessment (EMA) study examined whether (1) engagement in noneating activities at Time 1 prospectively predicted momentary state BD at Time 2 and (2) reward drawn from noneating activities at Time 1 mediates the prospective association between engagement in noneating activities at Time 1 and momentary state BD at Time 2.

METHOD

Sixty-six adults with transdiagnostic binge eating completed an EMA protocol over 7-14 days. Participants received six EMA signals per day (total EMA observations = 4038). Multilevel modeling was used to examine the research questions.

RESULTS

Engagement in an indoor hobby, outdoor recreation, socializing, and self-care/coping strategies prospectively predicted momentary state BD improvements, while using TV/social media and cooking prospectively predicted momentary state BD worsening. Reward drawn from engagement in these noneating activities mediated the associations.

DISCUSSION

If replicated, these findings suggest that increasing the frequency of certain noneating activities and enhancing their rewarding aspects to improve state BD and decrease ED behavior risk during treatment may be worthy of further exploration.

PUBLIC SIGNIFICANCE

Momentary worsening of state body dissatisfaction (BD) is a risk factor for eating disorder behaviors in individuals with binge eating. This study found that engaging in certain noneating activities (e.g., socializing) prospectively predicted momentary improvements in state BD, while other noneating activities (e.g., cooking) predicted momentary worsening of state BD. Reward drawn from activities mediated these relations. To improve state BD, treatments should target the frequency of, and reward obtained from these noneating activities.

Hedonic Appetite, Affect, and Loss of Control Eating: Macrotemporal and Microtemporal Associations in Adolescents

OBJECTIVE

Loss of control eating (LOC) is a dysregulated eating behavior relevant to eating disorders and weight-related health concerns. Hedonic appetite and affect (positive/negative) are dynamic microtemporal processes that influence LOC, but they have been studied predominantly in a static, macrotemporal manner. The present study examined associations of hedonic appetite and positive/negative affect, on macrotemporal and microtemporal levels, with LOC in adolescents.

METHODS

Adolescent participants 13-18 years old (n = 43; Mage = 15.1, SD  = 1.6; 69.8% female) completed smartphone surveys for 6 evenings, assessing LOC, hedonic appetite, and positive/negative affect. Scores on items were calculated to create microtemporal and macrotemporal assessments of these constructs. Multilevel models were run to examine associations between hedonic appetite and positive/negative affect with LOC.

RESULTS

Both macrotemporal and microtemporal hedonic appetite were significantly positively related to LOC (β = .73, p < .001; β = .47, p < .001, respectively). Macrotemporal positive affect was significantly negatively associated with LOC (β = -.09, p < .001). Macrotemporal negative affect was significantly positively associated with LOC (β = .13, p < .001). No significant relationships emerged between microtemporal positive/negative affect and LOC.

CONCLUSIONS

Hedonic appetite appears to be associated with LOC on both microtemporal and macrotemporal levels, suggesting that both momentary fluctuations and having higher hedonic appetite than others can be risk factors for LOC. However, affect appears to be associated with LOC only at the macrotemporal level. Findings may inform theoretical work and clinical and research assessment strategies.

Impulsivity and reward sensitivity facets as predictors of weight change in children: Differences by binge-eating disorder diagnostic status

BACKGROUND

Impulsivity and reward sensitivity are personality traits associated with obesity and binge-eating disorder (BED), but little research has examined prospective associations between these traits and body mass index z-score (BMI-z) differentially for children with and without BED.

OBJECTIVE

Using data from the Adolescent Brain and Cognitive Development study, the present analysis examined predictive associations between impulsivity and reward sensitivity facets with BMI-z 1 year later in children with versus without BED.

METHODS

Nine-to-ten-year-old children were recruited across the United States and completed self-report questionnaires and clinical interviews at baseline, and height and weight were taken at baseline and 1-year follow-up. Multivariable models were run with baseline impulsivity and reward sensitivity facets predicting 1-year BMI-z in children with versus without BED.

RESULTS

Reward sensitivity and impulsivity were unrelated to BMI-z at follow-up in children without BED. Greater negative urgency (i.e., proclivity to act rashly without forethought in response to negative emotions) and lower positive urgency (i.e., proclivity to act rashly without forethought due to positive emotions) predicted increased BMI-z at 1-year follow-up in children with BED subsample.

CONCLUSIONS

Findings indicate the importance of developing theoretical models and interventions for obesity prevention in children with BED that address emotional impulsivity.

Eating disorder psychopathology and resilience in Iranian college students: A network analysis

OBJECTIVE

Eating disorder (ED) psychopathology is common among Iranian college students. Resilience (i.e., the ability to bounce back and adapt in the face of adverse and stressful conditions) has been found to be a protective factor against ED psychopathology in the West. However, no research to date has examined resilience as a protective factor against ED psychopathology in Iran. The current study used network analysis to examine an ED and resilience network in an Iranian sample.

METHOD

Participants were Iranian college students (N = 478) who completed the Farsi-Eating Disorder Examination-Questionnaire and Farsi-Brief Resilience Scale. We estimated a network of ED symptoms and resilience processes and identified central and bridge symptoms.

RESULTS

Central ED and resilience nodes were discomfort in seeing one's own body, feeling guilty about eating due to shape/weight, and thinking about shape and weight making it difficult to concentrate. Having a hard time making it through stressful events bridged with binge eating and fear of losing control over eating.

CONCLUSION

Processes related to managing stress and binge eating appear to maintain the association between ED symptoms and resilience processes.

Relative food abundance predicts greater binge-eating symptoms in subsequent hours among young adults experiencing food insecurity: Support for the "feast-or-famine" cycle hypothesis from an ecological momentary assessment study

Food insecurity (FI) may increase risk for binge eating through a "feast-or-famine" cycle, where fluctuations in food availability correspond to alternating periods of food restriction and opportunities for binge eating, but research on this topic is limited. To clarify the relationship between food availability and binge eating in the context of FI, this study examined the association between momentary food security level and subsequent binge-eating symptoms among individuals in food-insecure households and investigated how this association differs by factors that may modify the extent to which food availability fluctuates. Ecological momentary assessment data were collected in 2020-2021 from 75 young adults (Mage = 25.3 ± 1.8 years; 72% female; 72% Black, Indigenous, or a Person of Color) in the United States who had experienced past-month household FI. For 14 days, participants reported four times per day on food security and eating episodes, and binge-eating symptoms were assessed for each reported eating episode. About 35% of the variance in momentary food security ratings was accounted for by within-person variability over time. A significant within-person association was observed in multilevel analyses, indicating that instances of greater food security relative to one's average level predicted greater subsequent binge-eating symptoms. Moderation analyses revealed that this association was significant only among individuals reporting use of food assistance programs, high engagement in resource trade-off coping strategies (e.g., skipping bill payments to buy food), or low food security-related self-efficacy. Overall, findings offer support for the "feast-or-famine" cycle hypothesis as an explanation for the link between FI and binge eating, emphasize the importance of identifying approaches to promote more stable access to adequate food, and suggest potential intervention targets to reduce risk for binge eating in populations experiencing FI.

Novel digital methods for gathering intensive time series data in mental health research: scoping review of a rapidly evolving field

Recent technological advances enable the collection of intensive longitudinal data. This scoping review aimed to provide an overview of methods for collecting intensive time series data in mental health research as well as basic principles, current applications, target constructs, and statistical methods for this type of data.In January 2021, the database MEDLINE was searched. Original articles were identified that (1) used active or passive data collection methods to gather intensive longitudinal data in daily life, (2) had a minimum sample size of N ⩾ 100 participants, and (3) included individuals with subclinical or clinical mental health problems.In total, 3799 original articles were identified, of which 174 met inclusion criteria. The most widely used methods were diary techniques (e.g. Experience Sampling Methodology), various types of sensors (e.g. accelerometer), and app usage data. Target constructs included affect, various symptom domains, cognitive processes, sleep, dysfunctional behaviour, physical activity, and social media use. There was strong evidence on feasibility of, and high compliance with, active and passive data collection methods in diverse clinical settings and groups. Study designs, sampling schedules, and measures varied considerably across studies, limiting the generalisability of findings.Gathering intensive longitudinal data has significant potential to advance mental health research. However, more methodological research is required to establish and meet critical quality standards in this rapidly evolving field. Advanced approaches such as digital phenotyping, ecological momentary interventions, and machine-learning methods will be required to efficiently use intensive longitudinal data and deliver personalised digital interventions and services for improving public mental health.

Tonight, I'm disordered eating: The effects of food delivery app use, loneliness, and mood on daily body dissatisfaction and disordered eating urges

With the recent proliferation of food delivery applications ('apps'; FDAs), accessing a meal is more convenient and immediate than ever. However, these apps may foster dysregulated eating behaviours, including maladaptive eating to cope with negative emotional states. Using ecological momentary assessment (EMA), the current study assessed whether FDA use at baseline predicted levels of EMA-assessed disordered eating urges and body dissatisfaction, whether negative mood and loneliness impacted disordered eating urges and body dissatisfaction at the state level, and whether the latter relationships were moderated by FDA usage frequency. Participants (N = 483; 78.7% women; 20.1% men; 1.2% other) completed a baseline questionnaire and were characterised as current FDA users (49.3%) or non-users (50.7%). Participants then completed a smartphone-facilitated investigation into their experiences of loneliness, negative mood, body dissatisfaction, and disordered eating urges, six times per day for 7-days. Across the entire sample, current FDA users at baseline reported greater EMA-assessed urges to overeat. At the state level, loneliness and negative mood predicted greater body dissatisfaction, with the latter also predicting greater urges for restrictive eating and overeating. Among current FDA users at baseline, at the state level, loneliness predicted greater body dissatisfaction, and negative mood predicted greater body dissatisfaction and urges for overeating. No moderating effects were observed for baseline FDA usage frequency. These results elucidate FDA use and daily experiences of loneliness and negative mood as factors elevating eating disorder (ED)-related risk. Further extensions of this research with nuanced measures of state FDA use are required.

The role of eating expectancies and eating motives in the association between mood and loss-of-control eating: A national sample daily diary study

Loss-of-control eating (LOCE, the subjective inability to refrain from eating or cease eating), is highly mood-driven. Mood-related eating motives and eating expectancies have been identified as contributors to binge eating. However, little is known about how these factors relate to LOCE, much less their relationship with daily-level LOCE. This study assessed the impact of trait eating expectancies and daily eating motives on the relationship between daily affective states and LOCE. United States adults (n = 109) reporting recent LOCE participated in a ten-day diary study, completing two surveys per day regarding eating behaviors, mood, and motives. Data were analyzed at the within- and between-subject levels utilizing a Bayesian approach to examine pathways from mood to LOCE, mediated by eating motives and accounting for a moderating impact of baseline eating expectancies on the path leg between mood and motives. Negative mood was associated with LOCE at both the within- and between-subjects level by way of coping motives, and directly at the within-subjects level. Negative affect (NA) reduction expectancies did not moderate the indirect pathway. Positive mood was only associated with LOCE at the within-subjects level, via pleasure motives. This relationship was potentiated via reward expectancies. Therefore, although negative mood appears be a robust predictor of LOCE regardless of trait NA reduction expectancies, positive mood appears to have a specific set of conditions under which individuals are at increased likelihood of LOCE at the within-subjects level. These findings suggest that eating expectancies and motives for eating may be meaningful targets in LOCE interventions.

Emotional eating and disordered eating behaviors in children and adolescents with type 1 diabetes

Disordered eating behaviors (DEB) are more common in adolescents with type 1 diabetes (T1D) than in peers without diabetes. Emotional eating is a risk factor for binge eating in children and adolescents in the general population and is associated with increased intake of high energy-dense foods rich in sugars and fats. The primary objective is to evaluate whether emotional eating is associated with the metabolic control (glycated hemoglobin, plasma lipids and uric acid) in children and adolescents with type 1 diabetes and whether subjects with DEB (DEPS-R ≥ 20) have higher emotional eating than those without DEB. The secondary objective is to evaluate whether emotional eating is associated with the different symptoms of DEB. Emotional eating is positively correlated with HbA1c, total and LDL cholesterol values in children and adolescents with T1D. Subjects with DEB have a higher emotional eating score than subjects without DEB. Disinhibition is the most common disordered eating behavior in children and adolescents with T1D and is associated with a higher emotional eating score. Early identification and treatment of emotional eating could be tools for preventing DEB in people with type 1 diabetes. A total of 212 adolescents with T1D completed two self-administered questionnaires: the Diabetes Eating Problem Survey-Revised (DEPS-R) and the Emotional Eating Scale for Children and Adolescents (EES-C). Demographic (age, sex, duration of the disease), anthropometric (weight, height, BMI, BMI-SDS), therapeutic (type of insulin therapy, daily insulin dose) and metabolic (HbA1c, total cholesterol, HDL, LDL, triglycerides, uric acid) data were taken from the patients' medical records. The presence of other autoimmune diseases was also recorded.

Eating disorder psychopathology dimensions based on individual co-occurrence patterns of symptoms over time: a dynamic time warp analysis in a large naturalistic patient cohort

PURPOSE

Most of the network approaches in eating disorders found the highest degree of centrality for symptoms related to weight and shape concerns. However, longitudinal analyses are scarce and may increase our insight of the complex characteristics and dynamics over time. In the current study, an alternative non-linear method to perform longitudinal network analyses, the dynamic time warp approach, was used to examine whether robust dimensions of eating disorder psychopathology symptoms could be found based on the individual dynamic interplay of eating disorder symptoms co-occurrence patterns in time.

METHODS

The study sample included a naturalistic cohort of patients (N = 255) with all eating disorder subtypes who were assessed with the eating disorder examination questionnaire (EDE-Q) at a minimum of four times during treatment. Dynamic time warp analyses yielded distance matrices within each individual patient, which were subsequently aggregated into symptom networks and dimensions at the group level.

RESULTS

Aggregation of the individual distance matrices at the group level yielded four robust symptom dimensions: 1. restraint/rules, 2. secret eating/fasting, 3. worries/preoccupation, and 4. weight and shape concern. The items 'fear of weight gain' and 'guilt' were bridge symptoms between the dimensions 1, 3 and 4.

CONCLUSION

Dynamic time warp could capture the within-person dynamics of eating disorder symptoms. Sumscores of the four dimensions could be used to follow patients over time. This approach could be applied in the future to visualize eating disorder symptom dynamics and signal the central symptoms within an individual and groups of patients.

LEVEL OF EVIDENCE

Level III: evidence obtained from well-designed cohort or case-control analytic studies. .