Revisiting the affect regulation model of binge eating: a meta-analysis of studies using ecological momentary assessment

Differences in Affective Dynamics Among Eating Disorder Diagnostic Groups

Emotion regulation theories suggest that affect intensity is crucial in the development and maintenance of eating disorders. However, other aspects of emotional experience, such as lability, differentiation, and inertia, are not as well understood. This study is the first to use ecological momentary assessment (EMA) to examine differences in several daily negative affect (NA) indicators among adults diagnosed with anorexia nervosa (AN), bulimia nervosa (BN), or binge eating disorder (BED). Using EMA data from three large studies, a series of linear mixed models showed that participants in the AN and BN groups experienced significantly greater NA intensity and better emotion differentiation than participants in the BED group. Alternatively, the BN group demonstrated significantly greater NA lability than the AN group and greater NA inertia than the BED group. These results suggest that several daily affective experiences differ among eating disorders diagnostic groups and have implications towards distinct conceptualizations and treatments.

Threat appraisal partially mediates the relation between neuroticism and bulimic symptoms

Several studies support an association between neuroticism and bulimic symptoms; however, few studies have focused on how neuroticism exerts its influence. The purpose of this study was to extend the literature by investigating threat appraisal as a potential mediator of the relation between neuroticism and bulimic symptoms. One hundred and twenty women completed self-report measures of trait neuroticism, threat appraisal, and bulimic symptoms. Approximately half of the sample reported moderate or high levels of bulimic symptoms. Bootstrapping analyses revealed that neuroticism and threat appraisal were both positive predictors of bulimic symptoms. Further, threat appraisal partially mediated the association between neuroticism and bulimic symptoms. The findings suggest that women high in neuroticism may be vulnerable to experiencing bulimic symptoms, particularly during periods of heightened stress. These women may perceive bulimic behavior to be more effective in alleviating negative stressful emotions compared to more adaptive coping strategies. Based on the findings, women diagnosed with bulimia nervosa with high levels of neuroticism may benefit from interventions that specifically target threat appraisals to facilitate their ability to effectively adapt to stress.

Emotional reactivity and eating disorder related attitudes in response to the trier social stress test: An experimental study in people with anorexia nervosa and with bulimia nervosa

BACKGROUND

In order to experimentally asses the role of socio-emotional problems in Eating Disorder (ED) psychopathology, we have measured affective states and ED-related attitudes in response to an acute psychosocial stress and their relationships with interpersonal sensitivity in people with Anorexia Nervosa (AN) and Bulimia Nervosa (BN).

METHODS

Twenty-one women with AN, 21 with BN and 27 healthy women underwent an acute psycho-social challenge, the Trier Social Stress Test. Anxiety feelings, hunger perception, amount of desired food and body dissatisfaction were measured throughout the experimental procedure. The relationships between these variables and with interpersonal sensitivity measures were explored through Pearson's correlation and mediation analyses.

RESULTS

Stress-induced anxiety was increased in people with EDs. People with AN showed reduced hunger perception, decreased desire for food and a negative association between anxiety feelings and desire for food. In people with EDs, baseline ineffectiveness predicted post-stress body dissatisfaction through the mediation of post-stress anxiety levels.

LIMITATIONS

The relatively low sample size and the lack of an experimental control condition are the main limitations of the study.

CONCLUSIONS

The present findings show, for the first time, the relationships between socio-emotional distress and ED-related attitudes in people with EDs, providing experimental support to the interpersonal model of EDs. This gives empirical evidence to treatments targeting interpersonal problems in EDs.

The interplay between binge eating risk factors: Toward an integrated model

We aimed to assess the interplay between dietary restraint and emotion regulation (ER) difficulties as well as other well-known risk factors of binge eating in a community sample of women. Altogether 96 women (mean age 21.5 years; mean BMI 21.7) participated in the study using ecological momentary assessment. Structural equation modeling indicated that restraint and ER pathways are related yet operate independently in predicting binge eating in a unified model. ER difficulties moderated the effect of negative affect and fluctuations in negative affect in predicting binge eating while Neuroticism and preoccupation with body weight predicted binge eating indirectly.

Somatic symptoms and binge eating in women's daily lives

OBJECTIVE

The present study aimed to determine whether the momentary severity of women's somatic symptoms was concurrently and prospectively associated with their engagement in binge eating in naturalistic settings.

METHOD

Thirty women (M_age = 34.13, SD = 13.92) who had engaged in binge eating at least once over the month prior to study entry completed a 14-day ecological momentary assessment (EMA) protocol. During each of the 14 days, participants received five semi-random surveys via text message that assessed momentary somatic symptom severity (i.e., headaches, stomachaches/pain, chest/heart pain, faintness/dizziness, shortness of breath, fatigue) and disordered eating behaviors. Generalized estimating equations were used to determine whether momentary somatic symptoms were concurrently and prospectively (i.e., by participants' next assessment) associated with the occurrence of binge eating behavior, while controlling for age and body mass index.

RESULTS

At the within-person level, more severe stomachaches/pain, faintness/dizziness, shortness of breath, and fatigue were concurrently associated with an increased likelihood of engaging in binge eating. Further, at the between-person level, more severe stomachaches/pain, chest/heart pain, shortness of breath, and fatigue in general were associated with binge eating across the EMA protocol. Momentary stomachache/pain severity also prospectively predicted women's engagement in binge eating behavior at the next assessment.

CONCLUSIONS

The present results provide initial evidence that multiple somatic symptoms may serve as momentary correlates or proximal antecedents of binge eating behavior in women's daily lives. Somatic symptoms may consequently prove useful to target in eating disorder treatments, perhaps via interoceptive exposure interventions.

State-Based Markers of Disordered Eating Symptom Severity

Recent work using naturalistic, repeated, ambulatory assessment approaches have uncovered a range of within-person mood- and body image-related dynamics (such as fluctuation of mood and body dissatisfaction) that can prospectively predict eating disorder behaviors (e.g., a binge episode following an increase in negative mood). The prognostic significance of these state-based dynamics for predicting trait-level eating disorder severity, however, remains largely unexplored. The present study uses within-person relationships among state levels of negative mood, body image, and dieting as predictors of baseline, trait-level eating pathology, captured prior to a period of state-based data capture. Two-hundred and sixty women from the general population completed baseline measures of trait eating pathology and demographics, followed by a 7 to 10-day ecological momentary assessment phase comprising items measuring state body dissatisfaction, negative mood, upward appearance comparisons, and dietary restraint administered 6 times daily. Regression-based analyses showed that, in combination, state-based dynamics accounted for 34-43% variance explained in trait eating pathology, contingent on eating disorder symptom severity. Present findings highlight the viability of within-person, state-based dynamics as predictors of baseline trait-level disordered eating severity. Longitudinal testing is needed to determine whether these dynamics account for changes in disordered eating over time.

Emotion Regulation Modulates Dietary Decision-Making via Activity in the Prefrontal-Striatal Valuation System

The consumption of indulgent, carbohydrate- and fat-rich foods is often used as a strategy to cope with negative affect because they provide immediate self-reward. Such dietary choices, however, can severely affect people's health. One countermeasure could be to improve one's emotion regulation ability. We used functional magnetic resonance imaging to examine the neural activity underlying the downregulation of incidental emotions and its effect on subsequent food choices. We investigated whether emotion regulation leads to healthier food choices and how emotion regulation interacts with the brain's valuation and decision-making circuitry. We found that 1) the downregulation of incidental negative emotions was associated with a subsequent selective increase in decisions for tasty but also for healthy foods, 2) food preferences were predicted by palatability but also by the current emotional state, and 3) emotion regulation modulated decision-related activation in the ventromedial prefrontal cortex and ventral striatum. These results indicate that emotional states are indeed important for food choice and that the process of emotion regulation might boost the subsequent processing of health attributes, possibly via neural reward circuits. In consequence, our findings suggest that increasing emotion regulation ability could effectively modulate food choices by stimulating an incidental upvaluation of health attributes.

Initial development and validation of the Online Appearance-Relevant Peer Conversations Scale

In this research, we present three studies on the development and validation of the Online Appearance-Relevant Peer Conversations Scale (OARPCS), a 12-item measure of (1) physical appearance and (2) life stressors as foci of online peer communications. In Study 1, young Chinese adults (N = 800) completed OARPCS items and measures of body image, Internet use, and general distress. Exploratory factor analyses supported the hypothesized two factor structure and within gender correlation analyses provided construct validity support. Study 2 replicated the EFA-derived OARPCS factor structure and validity further within confirmatory factor analyses of young adults from Chongqing (N = 750) and Macau (N = 994). Study 3 assessed the predictive validity of OARPCS dimensions in relation to prospective changes in cosmetic surgery consideration, eating disturbances and perceived stress over one year (N = 796). Independent of baseline responses on outcomes, baseline physical appearance and life stressor subscale scores, respectively, explained modest, significant variance in women's body image concerns and men's reported stress. Together, results underscored appearance-relevant content in online peer interactions as influences on body image and emotional status and provided psychometric support for a brief self-report measure of these factors.

Emotional eating in healthy individuals and patients with an eating disorder: evidence from psychometric, experimental and naturalistic studies

Emotional eating has traditionally been defined as (over)eating in response to negative emotions. Such overeating can impact general health because of excess energy intake and mental health, due to the risks of developing binge eating. Yet, there is still significant controversy on the validity of the emotional eating concept and several theories compete in explaining its mechanisms. The present paper examines the emotional eating construct by reviewing and integrating recent evidence from psychometric, experimental and naturalistic research. Several psychometric questionnaires are available and some suggest that emotions differ fundamentally in how they affect eating (i.e. overeating, undereating). However, the general validity of such questionnaires in predicting actual food intake in experimental studies is questioned and other eating styles such as restrained eating seem to be better predictors of increased food intake under negative emotions. Also, naturalistic studies, involving the repeated assessment of momentary emotions and eating behaviour in daily life, are split between studies supporting and studies contradicting emotional eating in healthy individuals. Individuals with clinical forms of overeating (i.e. binge eating) consistently show positive relationships between negative emotions and eating in daily life. We will conclude with a summary of the controversies around the emotional eating construct and provide recommendations for future research and treatment development.

Self-directed behaviors differentially explain associations between emotion dysregulation and eating disorder psychopathology in patients with or without objective binge-eating

BACKGROUND

Emotion dysregulation and negative self-directed behaviors are key characteristics of eating disorders (EDs), but their interaction in relation to ED psychopathology is insufficiently explored, and empirically robust and clinically relevant models are needed.

METHODS

This study examined whether the association between emotion dysregulation and ED psychopathology was mediated by different negative self-directed behaviors in 999 ED patients divided into two sub-samples based on absence or presence of objective binge-eating episodes (OBE). Several simple and extended mediation models were examined using the Difficulties in Emotion Regulation Scale (DERS) as independent variable, the Structural Analysis of Social Behavior (SASB) as mediator, and the Eating Disorder Examination Questionnaire (EDE-Q) as dependent variable.

RESULTS

An associational pathway was found where higher emotion dysregulation was associated with more negative self-directed behaviors, which in turn was associated with higher ED psychopathology. Self-directed behaviors of importance differed between patient groups. In participants without OBE, lower self-love and higher self-attack were influential, whereas in participants with OBE, lower self-affirmation and higher self-blame were influential.

CONCLUSIONS

Self-directed behaviors may help to explain the association between emotion dysregulation and ED psychopathology. Our findings have both theoretical and clinical implications that are pathology-specific. Addressing specific self-directed behaviors could be an important way of helping patients deal with their emotions in relation to ED psychopathology.

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

Affect regulation models of eating disorder behavior, which predict worsening of affect prior to binge-eating episodes and improvement in affect following such episodes, have received support in anorexia nervosa and bulimia nervosa. However, limited work has examined the trajectories of affect surrounding binge eating in binge-eating disorder (BED). In the current study, ecological momentary assessment data from 112 men and women with BED were used to examine the trajectories of positive affect (PA), negative affect (NA), guilt, fear, hostility, and sadness relative to binge-eating episodes. Prior to binge episodes, PA significantly decreased, whereas NA and guilt significantly increased. Following binge episodes, levels of NA and guilt significantly decreased and PA stabilized. Overall, results indicate improvements in affect following binge-eating episodes, suggesting that binge eating may function to alleviate unpleasant emotional experiences among individuals with BED, which is consistent with affect regulation models of eating pathology. Because improvements in negative affect were primarily driven by change in guilt, findings also highlight the relative importance of understanding the relationship between guilt and binge-eating behavior within this population. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Loss of Control Eating and Binge Eating in the 7 Years Following Bariatric Surgery

BACKGROUND

Although bariatric surgery is an effective intervention for severe obesity, a subset of patients demonstrates suboptimal weight outcomes. Postoperative loss of control eating (LOCE) and binge eating may influence weight outcomes, though research has not examined differences by surgical procedure, or factors that predict postoperative LOCE. This study aimed to [1] characterize LOCE and binge eating disorder (BED) over a 7-year period following bariatric surgery; [2] examine concurrent, prospective, and cumulative relationships between LOCE and weight loss; [3] assess whether these associations are moderated by surgery type; and [4] evaluate predictors of LOCE.

METHODS

Participants were 2156 patients who underwent laparoscopic adjustable gastric banding (LAGB) or Roux-n-Y gastric bypass (RYGB) in the multi-center Longitudinal Assessment of Bariatric Surgery-2 (LABS-2) study. Generalized linear mixed models examined relationships between LOCE and percent weight loss and predictors of LOCE.

RESULTS

LOCE and BED initially declined then increased after surgery, with a notable number of de-novo cases (25.6% and 4.8%, respectively). LOCE was related to less concurrent but not prospective or cumulative percent weight loss. Self-monitoring of eating, higher daily eating frequency, older age, male gender, and higher self-esteem were associated with a lower likelihood of LOCE.

CONCLUSIONS

Results suggest that LOCE and binge eating are clinically relevant behaviors that may impede weight loss, and findings highlight the importance of ongoing assessment of maladaptive eating following surgery.

Emotion differentiation and disordered eating behaviors: The role of appearance schemas

Emotion differentiation, or the ability to distinguish between discrete emotions in the moment, has been linked to maladaptive behaviors, including disordered eating. Appearance schemas may impact this relationship, as it has been suggested that individuals who are preoccupied with appearance-related information in their environment have limited attentional resources to devote to other internal processes. This study sought to expand existing research by examining: 1) the relationships between emotion differentiation and self-reported eating disorder symptomatology, and 2) strength of implicit appearance schemas as a moderator of these relationships. Participants were 118 female undergraduate students who completed a self-report disordered eating symptomatology questionnaire and a word stem completion task (measuring implicit appearance schemas) at baseline. Participants then reported their daily disordered eating behaviors and emotions through ecological momentary assessment for seven days. Emotion differentiation indices were calculated from negatively-valenced (NED) and positively-valenced (PED) daily affect ratings using intraclass correlation coefficients. Analyses demonstrated significant relationships between NED, severity of eating disorder symptomology, and frequency of compensatory behaviors; however, these relationships did not emerge with PED. Strength of appearance schemas was a moderator, suggesting that poor NED paired with stronger appearance schemas resulted in more severe eating disorder symptoms and more frequent engagement in compensatory behaviors. Multilevel models revealed that better NED predicted daily engagement in dietary restriction. By examining the relationship between emotion differentiation and disordered eating symptoms, this study contributes clinically significant information regarding a facet of emotional experience that may be important to our understanding of eating disorder symptomatology.

Unhealthy weight control behaviors among Ethiopian female adolescents

BACKGROUND

Unhealthy weight control behaviors are a serious concern, impairing the quality of life in adolescents. Although recent epidemiological studies indicate a high level of disordered eating in developing countries, such data in Ethiopia are scarce. Thus, this study aimed to determine the extent of unhealthy weight control behaviors (i.e., purging and nonpurging) and corresponding associated factors among urban Ethiopian adolescents.

METHOD

A cross-sectional study using self-administered questionnaires was applied to 690 randomly selected female high school adolescents in Addis Ababa, Ethiopia in 2017. Measures included unhealthy weight control behaviors, body mass index, subjective perception of body weight, appearance satisfaction, depressive symptoms, and socio-demographic factors. Logistic regression was applied for data analyses, that is, adjusted odds ratio (aOR) with 95% confidence interval (CI).

RESULTS

The level of unhealthy weight control behaviors (i.e., a score of at least once a week in the last 1 month) was 30.7% (N = 208). Specifically, the extent of purging and nonpurging weight control behaviors was 1.5% (N = 10) and 29.8% (N = 202), respectively. Factors that were significantly associated with unhealthy weight control behaviors were perception of being overweight [aOR = 3.01; 95%CI: 1.11-8.11], being overweight [aOR = 3.28; 95%CI: 1.54-7.01], severe depression [aOR = 4.09; 95%CI: 1.73-9.96], and high socio-economic status [aOR = 2.07; 95%CI: 1.30-2.80].

CONCLUSION

This study reveals a considerable level of unhealthy weight control behaviors among female adolescents in an urban setting in Ethiopia. Researchers and policy makers should focus their attention upon this emerging public health challenge and develop associated strategies.

Associations between latent trait negative affect and patterns of food-intake among girls with loss-of-control eating

OBJECTIVE

Momentary negative affect (NA) has been shown to predict eating patterns in the laboratory, yet, more stable mood states have not been studied in relation to eating patterns in the laboratory among youth at high risk for binge-eating disorder and obesity.

METHOD

One-hundred-eight adolescent girls (14.5 ± 1.7 years) with BMI between the 75th-97th percentile who reported loss-of-control (LOC)-eating completed measures of trait anxiety and depressive symptoms. Food-intake patterns were measured from a laboratory test meal (9,385 kcal). Latent factor analysis of depressive symptoms and trait anxiety was used to compute latent trait NA. Multivariate general linear models predicted total energy, snacks, and macronutrient intake from trait NA, adjusting for age, race, height, lean-mass, and percentage fat-mass.

RESULTS

Trait NA was significantly positively related to total energy-intake, and, specifically, snacks, sweet snacks, and percentage sweet fats (ps ≤ .03), and negatively related to percentage protein consumed (p = .04).

DISCUSSION

Expanding on affect theory, trait NA may relate to palatable food-intake among girls with LOC-eating. Further data are needed to determine whether those with LOC-eating and trait NA are at heightened risk for the development of binge-eating disorder and obesity.

Examining associations between emotion-based rash action and dysregulated eating symptoms in men and women

Negative urgency (NU: tendency to act rashly when distressed) is the facet of impulsive personality that has been most predictive of binge eating, but less is known about the relative role of positive urgency (PU: tendency to act rashly in response to positive emotions). In addition, most studies have exclusively focused on women and the examination of pathological eating outcomes, using a dimensional symptom approach, has been somewhat limited. This study aimed to replicate and extend upon prior work. We examined the extent to which NU and/or PU are uniquely associated with dysregulated eating, using a latent factor comprised of dimensional symptoms, and directly tested whether effects differ by sex. Two independent cross-sectional samples of women and men were used (Sample 1: Midwestern university, 437 females, 348 males; Sample 2: Southwestern university, 301 females, 236 males). NU and PU were assessed with the UPPS-P Impulsive Behavior Scale, and dysregulated eating symptoms (i.e., binge eating, loss of control eating, eating concerns) were assessed with well-validated self-report questionnaires. Although both NU and PU showed significant positive associations with dysregulated eating, NU showed the strongest unique relationship with dysregulated eating in both samples. The relative role of PU was weakened in Sample 1 and completely attenuated in Sample 2 once its shared variance with NU was accounted for. All results were similar in men and women. Overall, findings continue to suggest that NU is the form of impulsivity that is most relevant to dysregulated eating in both men and women.

Wanting to eat matters: Negative affect and emotional eating were associated with impaired memory suppression of food cues

OBJECTIVE

Previous studies have linked emotional eating with negative affect and decreased inhibitory control. However, studies on inhibitory control have generally focused on motor inhibition. How to stop higher-level cognitive processes, such as food-related memory retrieval or voluntary thoughts, received few direct investigation in field of food intake or food-related decision making. The current study, adopting Anderson and Green's Think/No-Think paradigm, aimed to investigate the relationship between emotional eating, negative affect and food-related memory suppression.

METHOD

Sixty-one young females participated in the current study, during which they finished food specific Think/No-Think task. Their positive and negative affect and eating style were measured using Positive Affect and Negative Affect Schedule and Dutch Eating Behavior Question. The reward value of the food item used in the Think/No-Think task was measured using liking and wanting ratings.

RESULTS

As hypothesized, negative affect and emotional eating were associated with decreased memory suppression of palatable food cues. Further analysis showed that higher emotional eating was associated with greater wanting only among the food items which were previously suppressed however remembered later.

DISCUSSION

The current study presents the first evidence that negative affect and emotional eating were associated with impaired memory suppression of palatable food cues, and it provided insight into the interaction between reward valuation for the food cues and hippocampal memory mechanisms during retrieval suppression.

A model of post-traumatic stress symptoms on binge eating through emotion regulation difficulties and emotional eating

Individuals who struggle with binge eating often report a history of trauma and post-traumatic stress symptoms (PTSS), but there is still a paucity of studies on the relationship between PTSS (as opposed to trauma exposure) and binge eating specifically. The current study aimed to contribute to a small body of literature surrounding the link between PTSS and binge eating. Binge eating may be a behavioral coping mechanism against negative affect; however, it has been proposed that additional psychological mechanisms (e.g. emotion regulation difficulties and emotional eating) may explain the link between PTSS and binge eating. It was hypothesized that increased PTSS severity would predict greater emotion regulation difficulties, leading to greater emotional eating, and ultimately predict more severe binge eating in a trauma-exposed sample. Cross-sectional data were collected from 360 U.S. based MTurk workers (i.e. convenience sample) who reported trauma-exposure. Demographic and relevant covariates were included in the hypothesized serial mediation model and the results suggest a significant effect of PTSS severity on binge eating problems through emotion regulation difficulties and emotional eating. When both mediators were included in the model, the direct effect of PTSS on binge eating severity was no longer significant; thus, the association between PTSS and binge eating was partly explained by emotion regulation difficulties and emotional eating. This study expands the understanding of the mechanisms underlying PTSS and binge eating and provides support for complementing therapy approaches for PTSS with methods that target emotion regulation and acceptance.

The effect of California's paid family leave policy on parent health: A quasi-experimental study

The U.S. is the only high-income country without a national paid family leave (PFL) policy. While a handful of U.S. states have implemented PFL policies in recent years, there are few studies that examine the effects of these policies on health. In this study, we tested the hypothesis that California's PFL policy-implemented in 2004-improved parent health outcomes. Data were drawn from the 1993-2017 waves of the Panel Study of Income Dynamics, a large diverse national cohort study of U.S. families (N = 6,690). We used detailed longitudinal sociodemographic information about study participants and a quasi-experimental difference-in-differences analytic technique to examine the effects of California's PFL policy on families who were likely eligible for the paid leave, while accounting for underlying trends in these outcomes among states that did not implement PFL policies in this period. Outcomes included self-rated health, psychological distress, overweight and obesity, and alcohol use. We found improvements in self-rated health and psychological distress, as well as decreased likelihood of being overweight and reduced alcohol consumption. Improvements in health status and psychological distress were greater for mothers, and reductions in alcohol use were greater for fathers. Results were robust to alternative specifications. These findings suggest that California's PFL policy had positive impacts on several health outcomes, providing timely evidence to inform ongoing policy discussions at the federal and state levels. Future studies should examine the effects of more recently implemented state and local PFL policies to determine whether variation in policy implementation and generosity affects outcomes.

Experiences of shame and guilt in anorexia and bulimia nervosa: A systematic review

OBJECTIVES

Emotional states may play an important role in the development and maintenance of anorexia (AN) and bulimia nervosa (BN). This systematic review aimed to examine the evidence regarding the relationship that shame and guilt have with two eating disorders, AN and BN.

METHODS

Four major databases (Pubmed, PsychINFO, Web of Science, Medline) were searched (up until April 2018) for studies measuring guilt or shame in clinically diagnosed AN and BN groups. Included papers were evaluated for risk of bias.

RESULTS

Twenty-four papers met the inclusion criteria. Several methodological issues were noted within the reviewed studies, including a lack of longitudinal data and unaccounted confounding variables. Nonetheless, shame was typically more common in those with AN and BN than controls, was positively related to the severity of symptoms, and associated with the onset of eating disorder-related difficulties (e.g., binging or purging). Effect sizes were typically moderate to large. The role of guilt was less clear, with few studies and mixed results.

DISCUSSION

There is preliminary evidence that shame is implicated in the aetiology of AN and BN presentations, whilst there is currently insufficient evidence of such a role for guilt. It remains unclear whether shame is a risk factor for the development of AN and BN or a consequence of these difficulties.

PRACTITIONER POINTS

Elevated shame appears to be a feature of anorexia (AN) and bulimia nervosa (BN). Shame appears to fluctuate with the occurrence of eating disordered behaviours like binging, purging or restricted eating. Guilt is less consistently linked to AN and BN presentations. Interventions directed at shame may be helpful for these populations. A lack of longitudinal data means the temporal features of these relationships are still unclear.

Sexual orientation correlates with baseline characteristics but shows no moderating effects of dissonance-based eating disorder prevention programs for women

This study provided the first test of whether sexual orientation (categorized as heterosexual vs. sexual minority) is associated with baseline eating disorder risk factors and symptoms, moderated the intervention effects of variants of the dissonance-based Body Project, or moderated the relation of baseline risk factors to future change in eating disorder symptoms. A total of 680 women with body image concerns were randomized to clinician-or peer-led Body Project groups, the eBody Project, or educational video control and completed assessment of eating disorder risk factors and symptoms at pretest, posttest, and at six-, 12-, 24-, and 36-month follow-up. Results indicated that sexual minority women had significantly higher negative affect and impaired psychosocial functioning at baseline, but did not differ on other eating disorder risk factors or symptoms. We found no evidence that sexual orientation moderates the effects of the Body Project on risk factor or symptom change over follow-up or the relation of baseline risk factors to future change in eating disorder symptoms. Overall, sexual minority and heterosexual women differ on two, less specific eating disorder-related risk factors at baseline, but did not differ in response to different versions of the Body Project or the relations of risk factors to future symptom change.

Low body mass and ethnic identity exploration exacerbate the association between body image concerns and loss of control eating in Hispanic/Latino men

OBJECTIVE

Although Hispanic/Latino populations have some of the highest rates of obesity in the United States, little is known about their loss of control (LOC) eating, a robust predictor of excess weight gain. This study examined the association between body image concerns and LOC eating frequency in a sample of young Hispanic/Latino men. Body mass index (BMI), ethnic identity, and acculturation were examined as potential moderators.

METHOD

The sample included 271 Hispanic/Latino men between the ages of 18 and 30 years (M_age = 23.89 ± 3.54; M_BMI = 26.46 ± 5.82). Participants completed an online survey and reported on height, weight, and demographic characteristics; concerns with muscularity and body fat; LOC eating frequency in the last 28 days; ethnic identity; and perceived acculturation.

RESULTS

Negative binomial regression models were conducted, adjusting for BMI, income, education, and presence of a psychiatric diagnosis. Concerns with muscularity and body fat were positively associated with LOC eating frequency (ps < .001). Low BMI exacerbated the link between concerns with body fat and LOC eating frequency (p = .03). The positive association between concerns with muscularity and LOC eating frequency was exacerbated among those who reported low ethnic identity exploration (p = .01). While acculturation did not function as a moderator (ps = .14-.27), it was inversely associated with LOC eating frequency (p < .001).

DISCUSSION

BMI and ethnic identity are important individual factors to consider in the link between body image concerns and LOC eating among young Hispanic/Latino men.

Emotional disorder symptoms, anhedonia, and negative urgency as predictors of hedonic hunger in adolescents

Affect and reward are associated with unhealthy eating and weight; however, less research has examined affective predictors of hedonic hunger (i.e., extreme reward responsivity, pleasure toward, and drive for food), particularly among adolescents. Whether symptoms indicative of emotional disturbance increase risk of adverse reward-based eating-related symptoms such as hedonic hunger, is unknown. Such evidence could explain why emotional problems increase risk of eating and weight problems among adolescents, when eating-related health problems often originate. This report examined baseline emotional disorder symptoms, negative urgency (i.e., tendency to act impulsively in response to negative affect), and anhedonia (i.e., loss of interest in activities and decreased pleasure) as prospective predictors of increases in hedonic hunger in adolescents; associations between changes in emotional disturbance problems and hedonic hunger were also examined. Ninth-grade students (N = 2598) from high schools completed paper-and-pencil surveys at baseline and a 1-year follow-up. In a multivariable model controlling for the covariance of emotional problems, higher negative urgency, general anxiety, and obsessive-compulsive symptoms, and lower anhedonia at baseline independently predicted increases in hedonic hunger one year later. Also, increases in negative urgency, general anxiety, and obsessive-compulsive symptoms and decreases in anhedonia independently predicted increases in hedonic hunger. Affect- and reward-related variables may be important contributors to risk of hedonic hunger in adolescence.

Dialectical behavior therapy adapted for binge eating compared to cognitive behavior therapy in obese adults with binge eating disorder: a controlled study

BACKGROUND

Current guidelines recommend cognitive behavior therapy (CBT) as the treatment of choice for binge eating disorder (BED). Although CBT is quite effective, a substantial number of patients do not reach abstinence from binge eating. To tackle this problem, various theoretical conceptualizations and treatment models have been proposed. Dialectical behavior therapy (DBT), focusing on emotion regulation, is one such model. Preliminary evidence comparing DBT adapted for BED (DBT-BED) to CBT is promising but the available data do not favor one treatment over the other. The aim of this study is to evaluate outcome of DBT-BED, compared to a more intensive eating disorders-focused form of cognitive behavior therapy (CBT+), in individuals with BED who are overweight and engage in emotional eating.

METHODS

Seventy-four obese patients with BED who reported above average levels of emotional eating were quasi-randomly allocated to one of two manualized 20-session group treatments: DBT-BED (n = 41) or CBT+ (n = 33). Intention-to-treat outcome was examined at post-treatment and at 6-month follow-up using general or generalized linear models with multiple imputation.

RESULTS

Overall, greater improvements were observed in CBT+. Differences in number of objective binge eating episodes at end of treatment, and eating disorder psychopathology (EDE-Q Global score) and self-esteem (EDI-3 Low Self-Esteem) at follow-up reached statistical significance with medium effect sizes (Cohen's d between .46 and .59). Of the patients in the DBT group, 69.9% reached clinically significant change at end of the treatment vs 65.0% at follow-up. Although higher, this was not significantly different from the patients in the CBT+ group (52.9% vs 45.8%).

CONCLUSIONS

The results of this study show that CBT+ produces better outcomes than the less intensive DBT-BED on several measures. Yet, regardless of the dose-difference, the data suggest that DBT-BED and CBT+ lead to comparable levels of clinically meaningful change in global eating disorder psychopathology. Future recommendations include the need for dose-matched comparisons in a sufficiently powered randomized controlled trial, and the need to determine mediators and moderators of treatment outcome.

TRIAL REGISTRATION

Nederlands Trial Register: NL3982 (NTR4154). Date of registration: 2013 August 28, retrospectively registered.

The role of emotion dysregulation in the association between subjective social status and eating expectancies among college students

Objective: Research suggests that college is a risky period for changes in eating behavior and beliefs. Although social health determinants relate to health behavior changes, research has not explored subjective social status, one's societal standing, in terms of eating expectancies among college students. The present study examined the emotion dysregulation in association between subjective social status and eating expectancies among college students. Participants: Participants were a diverse sample of 1,589 college students (80.4% females; M_age = 22.2 years, SD = 5.27) from an urban university. Results: Results showed a significant indirect association of subjective social status via emotion dysregulation in relation to expectancies of eating to help manage negative affect, to alleviate boredom, and to lead to feeling out of control. Conclusion: These findings provide evidence that college students with lower subjective social status may have a higher risk for dysregulated emotions, and consequently, expressing maladaptive eating expectancies.

An examination of the interpersonal model of binge eating over the course of treatment

The current study examined the interpersonal model of binge eating, which posits that interpersonal problems lead to negative affect, which results in binge eating, over the course of two psychotherapy treatments (interpersonal psychotherapy and cognitive behavioural therapy) in 162 adults with binge-eating disorder. A series of longitudinal simple mediation analyses preliminarily showed that treatment addresses the mechanisms of the interpersonal model of binge eating as theoretically proposed in predicting reductions in binge eating, the primary dependent variable, and the secondary dependent variables including global eating disorder psychopathology, shape concern, and weight concern, but not reductions in restraint or eating concern. Moderated mediation analyses did not fully support treatment differences, as changes in the mechanisms of the interpersonal model occurred in both treatments and suggest both treatments addressed negative affect and interpersonal precipitants of eating disorder symptomatology. Future research should replicate this study using variables that do not overlap in time to investigate causation of the model, and more generally, further examine theoretical treatment models and treatment mediators as this research could help improve efficacy of treatment for binge-eating disorder.

mHealth Assessment and Intervention of Depression and Anxiety in Older Adults

Mobile technology is increasingly being used to enhance health and wellness, including in the assessment and treatment of psychiatric disorders. Such applications have been referred to collectively as mHealth, and this article provides a comprehensive review and clinical perspective of research regarding mHealth in late-life mood and anxiety disorders. The novel data collection offered by mHealth has contributed to a broader understanding of psychopathology, to an increased diversity of psychological interventions, and to novel methods of assessment that may ultimately provide individually adaptive mental health care for this population. Older adults face challenges (e.g., transportation, mobility) that limit their ability to receive medical and mental health care services, and mHealth may improve the capacity to reach this population. Although several mobile interventions exist for health-related issues in older adults (e.g., balance, diabetes, medication management), mHealth targeting psychiatric disorders is limited and most often focuses on problems related to dementia, cognitive dysfunction, and memory loss. Given that depression and anxiety are two of the most common mental health concerns among this population, mHealth has strong potential for broad public health interventions that may improve effectiveness of mental health care via individualized assessments and treatments.

Inter-goal conflict and facilitation as predictors of adherence to dieting goals: an ecological momentary assessment study

Objectives: To examine dieting goals within a system of individual goals, and the patterns by personally-relevant goals might interfere or facilitate each other.Design: 94 dieters completed an assessment of goals using Little's personal project analysis. Participants identified 7 goals; one of which was pre-defined as adhering to diet. Over the beginning 14 days of their diet, participants completed an Ecological Momentary Assessment study recording their food intake in real-time. Every evening, participants reported their goal engagement and which goals conflicted or facilitated with each other.Main outcome measures/results: Over the study duration, 1452 days of food intake and goal conflict/facilitation were recorded. Participants completed an average of 1.54 (SD = 0.85) snacks, an average of 0.94 (SD = 1.81) goal conflicts, and 4.16 (SD = 4.70) goal facilitations per day. Inter-goal conflict was associated with a significant but small improvement on individuals' mood, but was not associated with daily dietary intake or long-term weight-loss. Similarly, inter-goal facilitation was not associated with daily dietary intake or long-term weight-loss. Daily food intake was a significant predictor of long-term weight-loss.Conclusions: The results of this study suggest the impact of inter-goal conflict and facilitation on dieting is not via overall snack or food consumption.

Gonadal hormone contributions to individual differences in eating disorder risk

PURPOSE OF REVIEW

Females experience eating disorders at substantially higher rates than males. Although sociocultural factors have traditionally been thought to underlie this sex disparity, accumulating evidence implicates differential exposure to gonadal hormones early in life. Gonadal hormones also impact within-sex variability in disordered eating, helping to explain why not all women develop an eating disorder, and some men do. We review recent findings regarding these gonadal hormone effects and their implications for the etiology of eating disorders.

RECENT FINDINGS

Males are exposed to significantly higher testosterone levels than females perinatally, and this exposure appears to protect against later binge eating in males relative to females. Within-sex, higher estradiol levels among females and higher testosterone levels among males appear to be protective. Progesterone exhibits minimal direct phenotypic effects on disordered eating but appears to counteract the protective effects of estrogen in adult females. Importantly, gonadal hormone effects may be moderated by psychosocial factors.

SUMMARY

Evidence suggests that gonadal hormones play a critical role in the etiology of disordered eating. Overall, higher testosterone and estrogen appear to be protective across development. Additional research is needed to identify mechanisms underlying these effects and further explore interactions between hormonal and psychosocial risk.

The interplay between self-regulation and affectivity in binge eating among adolescents

Binge eating among adolescents is associated with negative developmental outcomes. From a cognitive perspective, the role of impaired self-regulation is increasingly emphasized as an underlying factor in binge eating, whereas the affect regulation model proposes that affectivity is a key factor in explaining binge eating. Studies combining both perspectives are scarce, but necessary to add to the understanding of this pathological eating behavior. Therefore, the aim of the current study was to investigate unique and joint contributions of both factors in understanding binge eating among adolescents. Participants were 301 adolescents (10-17 years; 67.2% girls; M_age = 13.46 years; SD = 1.99) from the general community. Adolescents self-reported on different types of binge eating episodes (loss of control over eating in general, objective and subjective binge eating in particular), self-regulation (general self-regulation and inhibitory control) and affectivity (positive and negative). The parents were questioned about their children's self-regulatory capacities. Results revealed main effects of self-regulatory capacities (adolescent report) and negative affectivity in predicting objective binge eating. In addition, negative affectivity interacted with self-regulation (parent report) to predict objective binge eating, whereas positive affectivity interacted with self-regulation (adolescent report) to predict subjective binge eating. No significant effects were found for loss of control over eating specifically. Both self-regulation and affectivity each make unique as well as joint contributions to binge eating among adolescents, with results differing across types of binge eating episodes and informants. Theoretical and practical implications are discussed.

Moving beyond self-report data collection in the natural environment: A review of the past and future directions for ambulatory assessment in eating disorders

OBJECTIVE

In recent years, ecological momentary assessment (EMA) has been used to repeatedly assess eating disorder (ED) symptoms in naturalistic settings, which has allowed for increased understanding of temporal processes that potentiate ED behaviors. However, there remain notable limitations of self-report EMA, and with the rapid proliferation of technology there are ever-increasing possibilities to improve ambulatory assessment methods to further the understanding and treatment of EDs. Therefore, the purpose of this review was to (a) systematically review the studies in EDs that have utilized ambulatory assessment methods other than self-report, and (b) provide directions for future research and clinical applications.

METHOD

A systematic literature search of electronic databases was conducted, and data regarding study characteristics and methodological quality were extracted.

RESULTS

The search identified 17 studies that used ambulatory assessment methods to gather objective data, and focused primarily on autonomic functioning, physical activity, and cognitive processes in ED and control groups.

DISCUSSION

Together the literature demonstrates the promise of using a range of ecologically valid ambulatory assessment approaches in EDs, though there remains limited research that has utilized methods other than self-report (e.g., wearable sensors), particularly in recent years. Going forward, there are several technology-enhanced momentary assessment methods that have potential to improve the understanding and treatment of EDs.

Verbesserung der Impuls- und Emotionsregulation bei Binge-Eating-Störungen

Zusammenfassung. Impulsivität beeinflusst die Verarbeitung von störungsspezifischen Reizen und die Handlungskompetenz hinsichtlich der Nahrungsaufnahme. Neuere Studien adressieren daher unterschiedliche Facetten impulsiven Erlebens und Verhaltens, um eine Reduktion von Essanfällen und des Körpergewichts bei der Binge-Eating-Störung (BES) zu erzielen. ImpulsE ist ein Therapieprogramm zur Verbesserung der Impuls- und Emotionsregulationsfertigkeiten, welches mit einem computergestützten nahrungsbezogenen Inhibitionstraining kombiniert und mit einer Standardbehandlung (TAU) verglichen wurde. N = 31 Personen mit BES nahmen teil (n = 22 ImpulsE, n = 9 TAU). Die Ergebnisse zeigten Verbesserungen in der nahrungsbezogenen Verhaltensinhibition und der allgemeinen Essstörungspathologie in beiden Gruppen, während sich die Anzahl von Essanfällen nur bei ImpulsE signifikant senkte. Die Ergebnisse stellen erste Hinweise auf die Wirksamkeit eines solchen Trainings dar. Eine Adaption an Jugendliche erscheint sinnvoll.

Ecological momentary assessment of eating and dietary intake behaviors in children and adolescents: A systematic review of the literature

The objective of this review was to summarize associations between ecological momentary assessment (EMA)-measured contextual factors and eating and dietary intake behaviors in children and adolescents. The inclusion criteria were availability of the study in English and use of EMA to study eating and dietary intake behaviors among children and/or adolescents (ages<18). Literature searches were conducted in PsycInfo and PubMed databases across all dates until December 2018. A modified Checklist for Reporting EMA Studies was used to assess quality of studies. Eighteen articles from 15 independent studies were included in the systematic review. Contextual factors examined in relation to children's eating in studies included affect and stress; cognitive factors; social and environment factors; behavioral factors; and caregiver-related factors. Studies suggested there is strong evidence that cognitive and social factors have an effect on eating and dietary intake behaviors while the association between affect and eating and dietary intake behaviors remains mixed. Future studies should consider timing of effects, measure choice, individual difference and contextual factors, and developmental context.

Reduced Sensory-Evoked Locus Coeruleus-Norepinephrine Neural Activity in Female Rats With a History of Dietary-Induced Binge Eating

Noradrenergic pathways have been implicated in eating pathologies. These experiments sought to examine how dietary-induced binge eating influences the neuronal activity of the locus coeruleus (LC)-norepinephrine (NE) system. Young adult female Sprague Dawley rats (7-8 weeks old) were exposed to a repeated intermittent (twice weekly) cycle of 30-min access to a highly palatable sweetened fat (i.e., vegetable shortening with 10% sucrose) with or without intermittent (24 h) calorie restriction (Restrict Binge or Binge groups, respectively). Age- and weight-matched female control rats were exposed to standard chow feeding (Naive group) or intermittent chow feeding (Restrict group). The Binge and Restrict Binge groups demonstrated an escalation in sweet-fat food intake after 2.5 weeks. On week 3, in vivo single-unit LC electrophysiological activity was recorded under isoflurane anesthesia. Restrict Binge (20 cells from six rats) and Binge (27 cells from six rats) had significantly reduced (approximate 20% and 26%, respectively) evoked LC discharge rates compared with naive rats (22 cells, seven rats). Spontaneous and tonic discharge rates were not different among the groups. Signal-to-noise ratio was reduced in the groups with intermittent sweetened fat exposure. In order to investigate the neuropeptide alterations as a consequence of dietary binge eating, relative gene expression of neuropeptide Y (NPY), glucagon-like peptide 1 receptor (GLP-1r), prodynorphin, and related genes were measured in LC and hypothalamic arcuate (Arc) regions. Glp-1r, Npy2r, and Pdyn in LC region were reduced with repeated intermittent restriction. Npy1r was reduced by approximately 27% in ARC of Restrict compared with Naive group. Such data indicate that dietary-induced binge eating alters the neural response of LC neurons to sensory stimuli and dampens the neural stress response.

Investigating phenotypes of emotional eating based on weight categories: A latent profile analysis

OBJECTIVE

We aimed to investigate the phenotypes of individuals with emotional eating (EE) based on their levels of positive and negative EE, body mass index (BMI), and preoccupation with weight, and to assess differences in eating pathology and emotion regulation (ER) difficulties among them.

METHOD

A community sample of 605 women (mean age = 29.8 years, SD = 9.6; mean BMI = 23.4 kg/m² , SD = 4.7) filled out the Positive-Negative Emotional Eating Scale, Eating Disorders Assessment Scale, and Difficulties in Emotion Regulation Scale. Data of BMI, positive EE, negative EE, and preoccupation with body weight were submitted to a latent profile analysis.

RESULTS

A four-profile model was discovered with normal weight individuals without EE (63%), normal weight individuals with EE (23%), overweight individuals without EE (9%), and obese individuals with EE (5%). A five-profile model was also included, as a class of normal weight individuals with positive EE was found. Obese and normal weight individuals with EE showed the highest level of ER difficulties and eating pathology. Overweight individuals without EE showed moderate levels of eating pathology and low levels of ER difficulties, suggesting that high BMI itself might not be related to eating disorder (ED) psychopathology. Normal weight individuals with positive EE showed low levels of eating pathology, but moderate levels of ER difficulties.

DISCUSSION

Our results suggest that negative EE could be an important risk factor for disordered eating, independent of BMI. Further, individuals with EE could benefit from learning adaptive ER strategies to prevent the onset or maintenance of ED or weight gain.

Is comfort food actually comforting for emotional eaters? A (moderated) mediation analysis

An important but unreplicated earlier finding on comfort eating was that the association between food intake and immediate mood improvement appeared to be mediated by the palatability of the food, and that this effect was more pronounced for high than for low emotional eaters [26]. This has not yet been formally tested using mediation and moderated mediation analysis. We conducted these analyses using data from two experiments on non-obese female students (n = 29 and n = 74). Mood and eating satisfaction in Study 1, and mood, tastiness and emotional eating in Study 2 were all self-reported. In Study 1, using a sad mood induction procedure, emotional eaters ate more food, and when mood was assessed immediately after food intake, 'eating satisfaction' acted as mediator between food intake and mood improvement (decrease in sadness or increase in happiness). In Study 2, where we measured the difference in actual food intake after a control or a stress task (modified Trier Social Stress Test), and assessed mood during the food intake after stress, we found significant moderated mediation. As expected, there was a significant positive mediation effect of tastiness between food intake and mood improvement in the high emotional eaters, but also a significant negative mediation effect of tastiness between food intake and mood improvement in the low emotional eaters. This suggests that tastiness promotes 'comfort' from food in female emotional eaters, but conflicts in non-emotional eaters with a tendency to eat less when stressed. In conclusion, palatable food may indeed provide comfort specifically for high emotional eaters during eating.

Mood instability contributes to impulsivity, non-suicidal self-injury, and binge eating/purging in people with anxiety disorders

OBJECTIVES

The purpose of this study was to determine whether mood instability in people with anxiety disorders contributes to trait impulsivity, non-suicidal self-injury, and binge eating/purging.

METHODS

Data were analysed from a general population sample of 7,221 adults (M_age  = 51.0 years; 56.9% female). Logistic regression analyses with effect decompositions were used to establish the associations of five anxiety disorders (generalized anxiety disorder, social phobia, panic disorder, agoraphobia, and obsessive-compulsive disorder) with impulsivity, non-suicidal self-injury, and binge eating/purging, and then to determine the extent that adding mood instability to each model reduced these relationships.

RESULTS

Participants with an anxiety disorder were more likely to report impulsivity compared to participants without an anxiety disorder (ORs = 2.40-3.92, all p < .001), but these relationships reduced by 59-78% and became non-significant when mood instability was added to the models. Participants with an anxiety disorder were also more likely to report non-suicidal self-injury (ORs = 3.86-18.9, all p < .001) and binge eating/purging (ORs = 4.05-14.9, all p < .01); adding mood instability to the models reduced these relationships by at least 30%.

CONCLUSIONS

Mood instability and impulsivity are common in people with anxiety disorders. Anxiety disorders are associated with impulsivity largely because of the association between mood instability and impulsivity. Mood instability may contribute to non-suicidal self-injury and binge eating/purging in people with anxiety disorders. Treatments for mood instability in addition to standard anxiety disorder treatment may reduce impulsivity, non-suicidal self-injury, and binge eating/purging in people with anxiety disorders.

PRACTITIONER POINTS

Many patients with anxiety disorders experience mood instability, which is associated with impulsivity, non-suicidal self-injury, and binge eating/purging. Treating mood instability alongside anxiety may help reduce impulsivity, non-suicidal self-injury, and binge eating/purging in people with anxiety disorders.

Impulsivity and affect reactivity prospectively predict disordered eating attitudes in adolescents: a 6-year longitudinal study

Eating disorders (EDs) are associated with significant psychological and physical comorbidities, and adolescence is a particularly high-risk time for the development of EDs. Impulsivity (i.e., acting with little conscious judgment or forethought) and affect reactivity (i.e., changes in negative affect in response to a stressor) are hypothesized to contribute to the development of binge/purge ED pathology. The current study is the first to examine the prospective relationships between impulsivity and affect reactivity as predictors of the development of ED attitudes in adolescents over time. Two hundred six adolescents participated in a longitudinal study examining the development of psychopathology. ED attitudes were assessed via the College Eating Disorders Screen annually for 6 years. Baseline impulsivity and affect reactivity were also assessed. Affect reactivity, impulsivity, and their interaction were examined as baseline predictors of changes in ED attitudes over time using latent growth modeling. Results of latent growth modeling indicated that ED attitudes increased over time. The interaction between impulsivity and affect reactivity significantly predicted the slope of ED attitudes, such that the relationship between impulsivity and ED attitudes was strongest for those with elevated levels of affect reactivity. Findings suggest that greater levels of affect reactivity and impulsivity are key risk factors for the development of ED attitudes in adolescents. Subsequent research should examine the relation between affect reactivity and impulsivity in predicting objectively measured ED behaviors, in addition to ED attitudes. Further investigation may implicate affect reactivity and impulsivity as important targets for early intervention to prevent onset of ED symptoms in adolescents.

Emotion regulation strategy use and eating disorder symptoms in daily life

OBJECTIVE

Emotion regulation is posited to be disrupted in eating disorders, but studies have yet to examine the linkage between eating disorder symptoms and emotion regulation strategy use in daily life. We conducted an experience sampling study investigating associations between trait-level difficulties with emotion regulation, daily emotion regulation strategy use, and eating disorder symptoms in daily life.

METHOD

Fifty-three undergraduate women completed a trait-level measure of difficulties with emotion regulation, then reported their use of emotion regulation strategies four times per day for seven days. At the end of each day, they also reported daily disordered eating symptoms and behaviors.

RESULTS

Reduced access to emotion regulation strategies at the trait-level was associated with dimensional eating disorder symptoms and food restriction across the study period. In addition, greater use of maladaptive strategies and attentional deployment and less use of adaptive strategies on a given day were associated with a higher likelihood of food restriction on that day. Moderation analyses based on baseline eating disorder symptoms indicated that associations were consistent across symptom severity.

CONCLUSIONS

These findings suggest that certain eating disorder symptoms are associated with difficulties in regulating emotions at the trait-level and in daily life.

Prospective associations of negative mood and emotion regulation in the occurrence of binge eating in binge eating disorder

Retrospective and experimental data demonstrate the importance of emotion regulation (ER) in the maintenance of binge episodes in binge eating disorder (BED). The current study tested whether mood and ER prospectively influence binge episodes in individuals with BED via ecological momentary assessment (EMA). Individuals with BED (n = 79) completed two weeks of EMA. Each sampling point consisted of a series of questions pertaining to participants' mood, ER, and eating behaviour. Successful application of adaptive ER strategies predicted subsequent abstinence, while rumination predicted subsequent binge episodes. However, neither successful application of adaptive ER, nor maladaptive ER, moderated the association between negative mood and probability of binge episodes. This naturalistic study emphasizes the importance of promoting the successful application of adaptive ER skills and cessation of rumination in treatment interventions designed to decrease the occurrence of binge episodes in BED.

The influence of oxytocin on risk-taking in the balloon analogue risk task among women with bulimia nervosa and binge eating disorder

Previous theoretical models of bulimia nervosa (BN) and binge eating disorder (BED) have implicated cross-domain risk-taking behaviour as a significant maintenance factor in both disorders. The present study aimed to test this hypothesis by administering the Balloon Analogue Risk Task (BART) to 25 women with BN or BED and 27 healthy comparison women without a history of an eating disorder. Furthermore, we tested the effect of a divided dose of 64 IU of oxytocin on risk-taking behaviour in the BART. Contrary to our hypothesis, women with BN or BED did not exhibit baseline differences in performance on the BART in the placebo condition (t = 1.42, df = 50, P = 0.161, d = 0.39). Oxytocin did not have a main effect on performance in the BART (F = 0.01, df = 1, P = .907, η²_partial  < 0.001); however, there was an interaction, such that participants in the BN/BED participant group, compared to the healthy comparison group, demonstrated safer behaviour on the BART in the oxytocin condition, but not in the placebo condition (F = 4.29, df = 1, P = 0.044, η²_partial  = 0.082). These findings cast doubt on the common assumption that individuals with BN and BED exhibit greater risk-taking behaviour in all domains and add to the evidence that oxytocin plays a functional role in modulating behaviours that entail trade-offs between reward approach and risk in humans. We recommend that future dose-response studies investigate the effect of oxytocin on reward approach behaviour further in women with recurrent binge eating behaviour, as well as the clinical significance of this effect.

Family mealtime negativity and adolescent binge-eating: A replication and extension study in a community sample

OBJECTIVE

To explore differences in family mealtime characteristics and family mealtime emotions among adolescents who report engaging in binge-eating in comparison to those who do not.

METHOD

Adolescents (N = 495) recruited from UK schools/colleges reported on their family mealtime frequency and atmosphere, family mealtime emotions, anxiety, depression and eating psychopathology.

RESULTS

No significant differences were found between adolescents who reported binge-eating (n = 32 boys; n = 82 girls) and those who did not (n = 196 boys; n = 185 girls) on family mealtime frequency or mealtime atmosphere scores. However, boys and girls who binge-eat reported significantly lower levels of positive family mealtime emotions and significantly higher levels of family mealtime anxiety and anger (girls only), compared with their peers who did not report binge-eating.

DISCUSSION

Adolescents who binge-eat experience significantly greater negative emotional responses to family mealtimes than their peers. Further research should explore why these experiences are more negative, including broader familial factors and interactions.

Testing virtual reality-based cue-exposure software: Which cue-elicited responses best discriminate between patients with eating disorders and healthy controls?

PURPOSE

Virtual reality (VR) technologies have been proposed as a new tool able to improve on in vivo exposure in patients with eating disorders. This study assessed the validity of a VR-based software for cue exposure therapy (CET) in people with bulimia nervosa (BN) and binge eating disorder (BED).

METHODS

Fifty eight outpatients (33 BN and 25 BED) and 135 healthy participants were exposed to 10 craved virtual foods and a neutral cue in four experimental virtual environments (kitchen, dining room, bedroom, and cafeteria). After exposure to each VR scenario, food craving and anxiety were assessed. The frequency/severity of episodes of uncontrollable overeating was also assessed and body mass index was measured prior to the exposure.

RESULTS

In both groups, craving and anxiety responses when exposed to the food-related virtual environments were significantly higher than in the neutral-cue virtual environment. However, craving and anxiety levels were higher in the clinical group. Furthermore, cue-elicited anxiety was better at discriminating between clinical and healthy groups than cue-elicited craving.

CONCLUSIONS

This study provides evidence of the ability of food-related VR environments to provoke food craving and anxiety responses in BN and BED patients and highlights the need to consider both responses during treatment. The results support the use of VR-CET in the treatment of eating disorder patients characterized by binge-eating and people with high bulimic symptoms.

Rapid improvements in emotion regulation predict eating disorder psychopathology and functional impairment at 6-month follow-up in individuals with bulimia nervosa and purging disorder

OBJECTIVE

We previously demonstrated that early improvements in access to emotion regulation strategies during the first 4 weeks of intensive cognitive behavior therapy (CBT)-based eating disorder (ED) treatment predicted a range of post-treatment outcomes. This follow-up article examines whether early improvements in access to emotion regulation strategies continue to predict good treatment outcomes at 6 months post-treatment.

METHOD

Participants were 76 patients with bulimia nervosa or purging disorder who participated in the original study and the 6-month follow-up assessment. Hierarchical regression models were used to examine whether early improvements in emotion regulation strategies predicted 6-month follow-up outcomes.

RESULTS

After controlling relevant covariates and rapid and substantial behavior change, greater early improvements in access to emotion regulation strategies during the first 4 weeks of intensive treatment predicted lower overall ED psychopathology and ED-related functional impairment 6 months after treatment. They did not predict abstinence from binge, vomit, and laxative use behaviors during the follow-up period.

DISCUSSION

Individuals who learn early in treatment that they can use skills to more effectively regulate emotions have better treatment outcomes on some variables 6 months after treatment. Teaching emotion regulation skills in the first phase of CBT for ED may be beneficial, particularly for individuals with baseline difficulties.