Evaluating direct and indirect measures for the functional assessment of binge eating

The New Zealand eating behavior questionnaire - Validation study for a novel assessment tool to describe actionable eating behavior traits

Individualised management of obesity remains challenging and, to date, most treatment is based on clinical judgement. This study aimed to develop and validate a novel questionnaire-based tool to identify three pre-defined eating behavior (EB) traits, emotional eating, reduced satiety (constant hunger) and reduced satiation (feasters) that may predict selective medication response given their targeted actions. We recruited 977 individuals from a tertiary academic diabetes clinic to participate in this two-phase validation study. Participants self-reported weight management activities and were asked to self-assess their EB characteristics. The initial questionnaire included 42 visual analogue scale questions. In Phase I, 729 participants completed the questionnaire, including Māori (11.8%) and Pacific peoples (19.3%). After random division of the study sample, Exploratory Factor Analysis (EFA) confirmed a three-factor model as the best fit. Stepwise removal of items with inadequate factor loading retained 27 of 42 items, which accounted for 96% of the variance. Confirmatory Factor Analysis (CFA), performed on the second half of the sample, demonstrated good model fit with the final 27-item questionnaire. Internal consistency was high for factor (α = 0.82-0.95) and demographic subgroups, and similar to those obtained in the EFA. Test-retest reliability in a subset of 399 participants who repeated the questionnaire after a four-week interval (Phase II) showed moderate to good reliability. Participants classified into one of three EB types based on the highest median score among the factors. Test-retest reliability was robust for emotional eaters (71.25%) and constant hunger (68.9%). The correlation between aggregate EB score (sum of three EB scores) and BMI was significant (Spearman rho = 0.314, P = .0005). The questionnaire reliably identified three distinct EB traits, which may be informative for precision medicine applications for obesity management.

Psychosocial Factors of Subjective Well-Being in Women with Eating Disorders

Eating disorders are known as the most lethal mental health conditions, and lately there has been a significant increase in the prevalence of these disorders. The aim of this research was to determine the perceived quality of professional support, the relationship between subjective well-being, loneliness, resilience, and the quality of family functioning, and the possibility of predicting subjective well-being based on knowledge of psychosocial factors in people with eating disorders. Eighty-six women with a diagnosed eating disorder participated in the online survey. The Diener Subjective Well-Being Scale, the UCLA Loneliness Scale, the Brief Resilience Scale, and the Self-Report Family Inventory were used to measure the constructs. Questions were constructed to collect information about the perceived quality and availability of professional support. Results showed lower levels of life satisfaction and flourishing and more frequent negative experiences. Reports of medium levels of loneliness, lower levels of flourishing, and lower perceived quality of family functioning were also obtained. Significant predictors of subjective well-being were loneliness and resilience, while family cohesion was significant in predicting positive and negative experiences and flourishing. These findings can contribute to the recognition of aspects existent prior to the development of the disorder, based on which experts can determine what to focus on in the treatment process.

Experiences of loss of control eating in women after bariatric surgery: A qualitative study

OBJECTIVE

Loss of control (LOC) eating following bariatric surgery remains insufficiently understood, reflected in a lack of clear conceptualization, valid measurements, and effective treatments. This study explored patients' perspectives on LOC eating post-bariatric surgery, focusing on the relevance of the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) indicators of impaired control, and patients' experiences before (precipitating factors), during (eating patterns, perpetuating factors), and after the episodes (strategies used to stop eating).

METHODS

This was a qualitative study using descriptive phenomenology. Participants were adults who have undergone gastric bypass or sleeve gastrectomy and self-reported recent LOC eating. Data were collected by semi-structured interviews and analyzed using a combined inductive and deductive approach.

RESULTS

Participants were all women (N = 15; age: 34.5 ± 9.2 years). Results suggested that (1) except for feeling disgusted, guilty, or depressed after eating, other DSM-5 indicators did not seem to be highly relevant to this bariatric cohort; (2) LOC eating could occur across contexts, with food access, boredom, and food craving being consistent triggers; (3) the food amount consumed during a LOC episode was not necessarily considered excessive; (4) "mindlessness" and "satisfying hedonic, physiological, and mental needs" were the main perpetuating factors of LOC eating; and (5) self-talk and distracting attention were the most adopted strategies to stop eating.

DISCUSSION

Study findings have implications concerning the conceptualization, measurement, and intervention of LOC eating among bariatric patients. For example, results suggested the need for more data to determine the appropriate indicators of LOC eating and the inclusion of boredom as an intervention target in bariatric patients.

PUBLIC SIGNIFICANCE

Loss of control (LOC) eating is characterized by a sense of being unable to stop while eating. LOC eating is prevalent in patients who have undergone weight loss surgery and is associated with worse surgical outcomes. This qualitative study that explored post-bariatric surgery patients' experiences of LOC eating will inform efforts to better assess and intervene in this disordered eating behavior, thus ultimately optimizing patients' health following weight loss surgery.

Subjective Impact of Age-Related Hearing Loss Is Worse for Those Who Routinely Experience Boredom and Failures of Attention

OBJECTIVES

Despite extensive evidence supporting the benefits of hearing treatments for individuals affected by hearing loss, many leave their hearing issues unaddressed. This underscores the need to better understand the individual factors influencing decision-making regarding hearing loss treatments. One consideration regarding the low uptake of treatment is the finding that the subjective impact of hearing loss is greater for some individuals than for others, yielding a significant discrepancy between subjective measures of hearing loss (e.g., self-report hearing-handicap scales) and objective audiometric assessments (e.g., audiograms). The current study seeks to elucidate some of the cognitive-affective factors that give rise to these individual differences in the subjective impact of hearing loss. Specifically, we hypothesized that a stronger trait tendency to experience boredom would be correlated with more intensely negative experiences of hearing-related issues, and that this relationship would be mediated by underlying attentional difficulties.

METHODS

Through a partnership with hearing care clinics (Connect Hearing Canada), we recruited a large sample of older adults (n = 1840) through their network of hearing-care clinics. Audiometric thresholds provided an objective measure of hearing ability for each participant, while self-report questionnaires assessed individual differences in the subjective impact of hearing-related issues (hearing handicap), subjective strain experienced when listening (listening effort), tendency to experience boredom, tendency to experience difficulty maintaining task-focused attention (mind-wandering), and self-perceived level of cognitive functioning.

RESULTS

The subjective impact of hearing loss-both in terms of hearing handicap and strain when listening-was found to be more intensely negative for those who are characteristically more susceptible to experiencing boredom, and this relationship was shown to be mediated by self-reported differences in the ability to maintain task-focused attention. This relationship between trait boredom proneness and the subjective impact of hearing-related issues was evident across all levels of objective hearing abilities. Moreover, there was no evidence that the subjective impact of hearing loss is worse for those who routinely experience boredom because of objectively-poorer hearing abilities in those individuals.

CONCLUSIONS

A greater trait susceptibility to experiencing boredom was associated with a more aversive subjective experience of hearing loss, and this relationship is mediated by attentional difficulties. This is a novel discovery regarding the cognitive-affective factors that are linked to individual differences in the effect that hearing loss has on individuals' daily functioning. These results may be helpful for better understanding the determinants of hearing-rehabilitation decisions and how to improve the uptake of treatments for hearing loss. The observational nature of the current study restricts us from drawing any definitive conclusions about the casual directions among the factors being investigated. Further research is therefore needed to establish how individual differences in the characteristic tendency to experience boredom are related to attentional-control difficulties and the experience of hearing-related issues. More research is also required to determine how all of these factors may influence decisions regarding hearing-loss treatments.

A Comparison of Emotional Triggers for Eating in Men and Women with Obesity

OBJECTIVE

Emotional eating (EE) is prevalent in people seeking obesity treatment and is a contributor to poor weight loss outcomes. We aimed to delineate the emotions most associated with this type of eating, and whether they differ by sex in people undergoing obesity treatment.

METHODS

A cross-sectional study recruiting 387 adults from a hospital obesity management service. Emotional eating was measured using the Emotional Eating Scale (EES). Separate analyses included all participants, and those undergoing lifestyle interventions alone or in combination with obesity medication and/or bariatric surgery.

RESULTS

A total of 387 people (71% women) participated in the study (n = 187 receiving lifestyle modification alone; n = 200 in combination with additional treatments). Feeling 'bored' was most commonly and most strongly associated with the urge to eat, regardless of sex or treatment. Women had higher scores for total EES, for subscales of depression and anger, and individual feelings of 'blue', 'sad' and 'upset' compared to men.

CONCLUSIONS

Understanding why certain emotions differentially trigger an urge to eat in men and women, and finding strategies to break the link between boredom and eating may enable better personalisation of lifestyle interventions for people with obesity.

Effect and Mechanisms of State Boredom on Consumers' Livestreaming Addiction

With the rapid development of livestreaming marketing in China, consumers spend an increasing amount of time watching and purchasing on the platform, which shows a trend of livestreaming addiction. In the early stage of the COVID-19 pandemic, the addiction exacerbated by a surge of boredom caused by home quarantine. Based on the observation of this phenomenon, this research focused on whether state boredom could facilitate consumers' livestreaming addiction and explored the associated mechanisms of this relationship. Based on three studies, this research found that state boredom had a positive effect on consumers' livestreaming addiction, and this relationship worked through the mediating effect of consumers' sensation seeking. We further verified a moderated mediation effect of consumers' life meaning perception, where the indirect effect of state boredom on consumers' livestreaming addiction via consumers' sensation seeking existed for high and low levels of life meaning perception, but in opposite directions. The conclusions provided theoretical and practical implications of livestreaming marketing and healthy leisure consumption.

Having a Break or Being Imprisoned: Influence of Subjective Interpretations of Quarantine and Isolation on Boredom

Boredom has been identified as one of the greatest psychological challenges when staying at home during quarantine and isolation. However, this does not mean that the situation necessarily causes boredom. On the basis of 13 explorative interviews with bored and non-bored persons who have been under quarantine or in isolation, we explain why boredom is related to a subjective interpretation process rather than being a direct consequence of the objective situation. Specifically, we show that participants vary significantly in their interpretations of staying at home and, thus, also in their experience of boredom. While the non-bored participants interpret the situation as a relief or as irrelevant, the bored participants interpret it as a major restriction that only some are able to cope with.

Neuronal activities during palatable food consumption in the reward system of binge-like eating female rats

Binge eating disorder (BED), characterized by bingeing episodes and compulsivity, is the most prevalent eating disorder; however, little is known about its neurobiological underpinnings. In humans, BED is associated with desensitization of the reward system, specifically, the medial prefrontal cortex (mPFC), nucleus accumbens (Acb), and ventral tegmental area (VTA). Additionally, BED patients feel relieved during bingeing, suggesting that bingeing helps to decrease the negative emotions they were feeling prior to the binge episode. However, the mechanisms that underlie this feeling of relief in BED patients have not been well investigated. To investigate neuronal activity before and during palatable food consumption in BED, we performed in vivo electrophysiological recordings in a binge-like eating rat model (bingeing, n = 12 and non-bingeing, n = 14) and analyzed the firing rate of neurons in the mPFC, Acb, and VTA before and during access to sucrose solution. We also investigated changes in the firing rate of neurons in these regions during and between active bingeing, which may underlie the feeling of relief in BED patients. We found that neuronal firing rates of mPFC and VTA neurons in bingeing rats were lower than those in non-bingeing rats before and during sucrose consumption. Palatable food consumption increased neuronal firing rates during and between active bingeing in bingeing rats. Our results suggest a desynchronization in the activity of reward system regions, specifically in the mPFC, in bingeing rats, which may also contribute to BED. These results are consistent with those of functional magnetic resonance imaging (fMRI) studies that reported decreased activity in the reward system in BED patients. We propose that increased neuronal activity in the mPFC, Acb, or VTA produces an antidepressant effect in rats, which may underlie the sense of relief patients express during bingeing episodes.

Boredom Proneness and Self-Control as Unique Risk Factors in Achievement Settings

The state of boredom arises when we have the desire to be engaged in goal pursuit, but for whatever reason we cannot fulfil that desire. Boredom proneness is characterized by both frequent and intense feelings of boredom and is an enduring individual difference trait associated with a raft of negative outcomes. There has been some work in educational settings, but relatively little is known about the consequences of boredom proneness for learning. Here we explored the unique contributions of boredom proneness, self-control and self-esteem to undergraduate self-reported higher grade point average (GPA). Within educational settings, prior research has shown self-control and self-esteem to be associated with better academic performance. In contrast, boredom proneness is associated with lower levels of self-control and self-esteem. Our analyses replicate those previous findings showing that self-control acts as a positive predictor of GPA. Importantly, we further demonstrated, for the first time, that boredom proneness has a unique contribution to GPA over and above the contribution of self-control, such that as boredom proneness increases, GPA decreases. We discuss potential mechanisms through which boredom proneness may influence academic performance.

Psychological Meanings of Eating Disorders and Their Association With Symptoms, Motivation Toward Treatment, and Clinical Evolution Among Outpatients

Unlike patients suffering from egodystonic disorders, people with eating disorders sometimes attribute positive meanings to their symptoms, and this attribution process contributes to the maintenance of the disorder. This study aims at exploring psychological meanings of eating disorders and their associations with symptoms, motivation toward treatment, and clinical evolution. Eighty-one adults with an eating disorder (anorexia nervosa, n = 46 and bulimia nervosa, n = 35) treated in a day-hospital program were asked, each week over an 8-week period, to identify the psychological meanings they ascribed to their eating disorder. Avoidance was the most frequently identified meaning, followed by mental strength, security, death, confidence, identity, care, and communication. Avoidance was more frequently mentioned by participants with bulimia than in cases of anorexia. Security and mental strength were associated with less motivation toward treatment. Death was associated with more depressive and anxious symptoms. An exploratory factor analysis showed that these meanings formed three main dimensions: Avoidance, Intrapsychic, and Relational. Findings suggest that psychological meanings associated with eating disorders can be assessed and used as a clinical tool to increase treatment acceptability and effectiveness.

A Failure to Launch: Regulatory Modes and Boredom Proneness

Boredom is a ubiquitous human experience characterized as a state of wanting but failing to engage with the world. Individuals prone to the experience of boredom demonstrate lower levels of self-control which may be at the heart of their failures to engage in goal-directed, meaningful behaviors. Here we develop the hypothesis that distinct self-regulatory profiles, which in turn differentially influence modes of goal pursuit, are at the heart of boredom proneness. Two specific regulatory modes are addressed: Locomotion, the desire to 'just do it,' an action oriented mode of goal-pursuit, and Assessment, the desire to 'do the right thing,' an evaluative orientation toward goal pursuit. We present data from a series of seven large samples of undergraduates showing that boredom proneness is negatively correlated with Locomotion, as though getting on with things acts as a prophylactic against boredom. This 'failure to launch' that we suggest is prevalent in the highly boredom prone individual, could be due to an inability to appropriately discriminate value (i.e., everything is tarred with the same gray brush), an unwillingness to put in the required effort to engage, or simply a failure to get started. In contrast, boredom proneness was consistently positively correlated with the Assessment mode of self-regulation. We suggest that this association reflects a kind of rumination that hampers satisfying goal pursuit.

Characterizing emotional overeating among patients with and without binge-eating disorder in primary care

OBJECTIVE

Emotional overeating and loss-of-control eating are associated with poorer weight-related and psychiatric outcomes, yet our understanding of the relationship between these variables is limited, particularly among individuals in primary care. This study examined the frequency of emotional overeating and relationship with loss-of-control eating among patients with and without binge-eating disorder (BED) seeking weight loss treatment in primary care.

METHOD

Participants were 131 adults (n = 105 female) with overweight/obesity seeking weight loss treatment in primary care. Participants completed the Eating Disorder Examination (semi-structured interview) and Yale Emotional Overeating Scale, which measures emotional overeating episodes. Height and weight were measured. Mean age and BMI were 47.60 years and 35.31 kg/m², respectively. BED criteria were met by n = 35 (26.7%) participants.

RESULTS

Participants with BED endorsed more frequent emotional overeating episodes compared to those without BED. While total emotional overeating scores were not associated with loss-of-control eating, discrete types of emotional overeating episodes (e.g., loneliness) were associated with loss-of-control eating. Emotional overeating was most often reported in response to loneliness, boredom, or anxiety, which varied by BED status.

CONCLUSIONS

Most participants endorsed recent episodes of emotional overeating; those with BED endorsed more frequent episodes. Future research examining the impact of emotional overeating on weight loss treatment outcomes is warranted.

Boredom proneness predicts quality of life in outpatients diagnosed with schizophrenia-spectrum disorders

BACKGROUND

There is increasing recognition of the clinical significance of boredom associated with functional impairments in schizophrenia. Previous work has highlighted the importance of motivational deficits more broadly, although no study has yet explored the unique effects of boredom on community outcomes.

AIMS

This study aims to measure boredom proneness among outpatients diagnosed with schizophrenia to determine whether it is elevated in this population and to determine its relation to quality-of-life outcomes.

METHODS

A self-report measure of boredom proneness along with standard measures of symptoms and functional status was administered to a community-dwelling sample of schizophrenia outpatients.

RESULTS

Boredom proneness was found to be elevated in this population and was associated with reduced quality of life, specifically with leisure activity dissatisfaction and reduced sense of financial well-being. Negative symptoms were determined to be associated with reduced work and school functioning.

CONCLUSION

This pattern of unique effects on quality of life highlights the clinical relevance of identifying a subjective state of boredom and has theoretical importance in distinguishing boredom proneness specifically from more general avolitional and amotivational conditions that have tended to be the focus of clinical observation and previous research.

The Unengaged Mind: Defining Boredom in Terms of Attention

Our central goal is to provide a definition of boredom in terms of the underlying mental processes that occur during an instance of boredom. Through the synthesis of psychodynamic, existential, arousal, and cognitive theories of boredom, we argue that boredom is universally conceptualized as "the aversive experience of wanting, but being unable, to engage in satisfying activity." We propose to map this conceptualization onto underlying mental processes. Specifically, we propose that boredom be defined in terms of attention. That is, boredom is the aversive state that occurs when we (a) are not able to successfully engage attention with internal (e.g., thoughts or feelings) or external (e.g., environmental stimuli) information required for participating in satisfying activity, (b) are focused on the fact that we are not able to engage attention and participate in satisfying activity, and (c) attribute the cause of our aversive state to the environment. We believe that our definition of boredom fully accounts for the phenomenal experience of boredom, brings existing theories of boredom into dialogue with one another, and suggests specific directions for future research on boredom and attention.

Validation of the Spanish version of the Multidimensional State Boredom Scale (MSBS)

Background

Boredom, which is a common problem in the general population, has been associated with several psychiatric disorders. The Multidimensional State Boredom Scale (MSBS) was developed, based on a theoretically and empirically grounded definition of boredom, to assess this construct. The aim of the present study was to assess the psychometric properties of the Spanish validated version of the MSBS in a multi-age sample recruited from the general population.

Methods

The patients (N = 303) were recruited from primary care settings. In addition to the sociodemographic variables and the MSBS, the General Health Questionnaire 28 items (GHQ-28), Positive and Negative Affect Scale (PANAS), Negative subscale and the Mindful Attention Awareness Scale (MAAS) were administered. We used confirmatory factor analysis (CFA) to analyse the dimensionality of the MSBS. Cronbach’s α coefficient was used to analyse the internal consistency of the scale. The consistency of the MSBS over time (test-retest reliability) was assessed using the intra-class correlation coefficient. The construct validity was examined by calculating Pearson’s r correlations between the MSBS with theoretically related and unrelated constructs. Cronbach’s α for MSBS was 0.89 (95 % CI, 0.87–0.92), ranging from 0.75 to 0.83 for the 5 subscales.

Results

The characteristics of the final sample (N = 303) were that the participants were primarily female (66.77 %) with a mean age of 49.32 years (SD, 11.46) and primarily European (94.71 %). The CFA of the MSBS confirmed that the original five-factor model showed good fit indices: CFI = .96; GFI = .94; SRMR = .05; and RMSEA = .06 [.05–.08]. Cronbach’s α for MSBS was 0.89 (95 % CI, 0.87–0.92), ranging from 0.75 to 0.83 for the 5 subscales. The MSBS showed a test-retest coefficient measured with an ICC of 0.90 (95 % CI, 0.88–0.92). The ICC for the 5 subscales ranged from 0.81 to 0.89. The MSBS showed a significant negative correlation with MAAS and a significant positive correlation with the GHQ (total score and subscales) and PANAS-Negative Affect.

Conclusions

The Spanish version of the MSBS has been validated as a reliable instrument for measuring boredom in the general population. This study will facilitate the assessment of boredom for clinical and research purposes in Spanish-speaking populations.

Food consumption as affect modulation in borderline personality

The present study examined relationships among negative affect, borderline personality features, and eating behavior through the experimental manipulation of mood. Undergraduate women (N = 307) completed a baseline mood assessment, viewed a 39-minute sad film either with or without concurrent food presentation, then completed a second mood assessment and questionnaires assessing personality and eating attitudes/behaviors. Women reporting more borderline personality features exhibited greater negative affect across time and were more reactive to the sad film. Food presentation appeared to have a small ameliorative effect on sadness and general negative affect. However, quantity of food consumption was associated with improvements in mood only for women reporting higher levels of borderline personality features. These data suggest that women with borderline personality characteristics may be at elevated risk for developing problems with binge eating, because consuming larger quantities of food appeared to have a tempering effect on their negative mood and feelings of sadness.

Watching TV and food intake: the role of content

Obesity is a serious and growing health concern worldwide. Watching television (TV) represents a condition during which many habitually eat, irrespective of hunger level. However, as of yet, little is known about how the content of television programs being watched differentially impacts concurrent eating behavior. In this study, eighteen normal-weight female students participated in three counter-balanced experimental conditions, including a ‘Boring’ TV condition (art lecture), an ‘Engaging’ TV condition (Swedish TV comedy series), and a no TV control condition during which participants read (a text on insects living in Sweden). Throughout each condition participants had access to both high-calorie (M&Ms) and low-calorie (grapes) snacks. We found that, relative to the Engaging TV condition, Boring TV encouraged excessive eating (+52% g, P = 0.009). Additionally, the Engaging TV condition actually resulted in significantly less concurrent intake relative to the control ‘Text’ condition (−35% g, P = 0.05). This intake was driven almost entirely by the healthy snack, grapes; however, this interaction did not reach significance (P = 0.07). Finally, there was a significant correlation between how bored participants were across all conditions, and their concurrent food intake (beta = 0.317, P = 0.02). Intake as measured by kcals was similarly patterned but did not reach significance. These results suggest that, for women, different TV programs elicit different levels of concurrent food intake, and that the degree to which a program is engaging (or alternately, boring) is related to that intake. Additionally, they suggest that emotional content (e.g. boring vs. engaging) may be more associated than modality (e.g. TV vs. text) with concurrent intake.

Binge eating in binge eating disorder: a breakdown of emotion regulatory process?

Current explanatory models for binge eating in binge eating disorder (BED) mostly rely on models for bulimia nervosa (BN), although research indicates different antecedents for binge eating in BED. This study investigates antecedents and maintaining factors in terms of positive mood, negative mood and tension in a sample of 22 women with BED using ecological momentary assessment over a 1-week. Values for negative mood were higher and those for positive mood lower during binge days compared with non-binge days. During binge days, negative mood and tension both strongly and significantly increased and positive mood strongly and significantly decreased at the first binge episode, followed by a slight though significant, and longer lasting decrease (negative mood, tension) or increase (positive mood) during a 4-h observation period following binge eating. Binge eating in BED seems to be triggered by an immediate breakdown of emotion regulation. There are no indications of an accumulation of negative mood triggering binge eating followed by immediate reinforcing mechanisms in terms of substantial and stable improvement of mood as observed in BN. These differences implicate a further specification of etiological models and could serve as a basis for developing new treatment approaches for BED.

Training in Emotion Regulation as a Treatment for Binge Eating: A Preliminary Study

Binge eating within Binge Eating Disorder (BED) may represent ineffective management of, and inappropriate escape from, strong, dysphoric emotions, but treatments have been slow to incorporate an emotion regulation focus. Eleven women meeting criteria for BED participated in 11 sessions (2 hours per week) of a psychoeducational group program providing training in emotion recognition and management, problem-solving, assertion training, relaxation and stress management. Outcome was evaluated using a multiple-baseline design replicated across groups. Binges were self-monitored daily, and self-report questionnaires assessed wellbeing and emotion regulation at pretreatment, posttreatment and follow-up. Cognitive changes from pre to posttreatment were evaluated by Articulated Thoughts in Simulated Situations. The program was effective in reducing binge eating, alexithymia, stress and depression, and it improved coping and positive cognitions. No participant met criteria for BED at follow-up. The findings provide support for the inclusion of training in emotion recognition and regulation in treatments for BED and for affect regulation models of binge eating.

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

The affect regulation model of binge eating, which posits that patients binge eat to reduce negative affect (NA), has received support from cross-sectional and laboratory-based studies. Ecological momentary assessment (EMA) involves momentary ratings and repeated assessments over time and is ideally suited to identify temporal antecedents and consequences of binge eating. This meta-analytic review includes EMA studies of affect and binge eating. Electronic database and manual searches produced 36 EMA studies with N = 968 participants (89% Caucasian women). Meta-analyses examined changes in affect before and after binge eating using within-subjects standardized mean gain effect sizes (ESs). Results supported greater NA preceding binge eating relative to average affect (ES = 0.63) and affect before regular eating (ES = 0.68). However, NA increased further following binge episodes (ES = 0.50). Preliminary findings suggested that NA decreased following purging in bulimia nervosa (ES = -0.46). Moderators included diagnosis (with significantly greater elevations of NA prior to bingeing in binge eating disorder compared to bulimia nervosa) and binge definition (with significantly smaller elevations of NA before binge vs. regular eating episodes for the Diagnostic and Statistical Manual of Mental Disorders definition compared to lay definitions of binge eating). Overall, results fail to support the affect regulation model of binge eating and challenge reductions in NA as a maintenance factor for binge eating. However, limitations of this literature include unidimensional analyses of NA and inadequate examination of affect during binge eating, as binge eating may regulate only specific facets of affect or may reduce NA only during the episode.

Development and Validation of the Multidimensional State Boredom Scale

This article describes the development and validation of the Multidimensional State Boredom Scale (MSBS)—the first and only full-scale measure of state boredom. It was developed based on a theoretically and empirically grounded definition of boredom. A five-factor structure of the scale (Disengagement, High Arousal, Low Arousal, Inattention, and Time Perception) was supported by exploratory factor analyses and confirmatory factor analyses of two independent samples. Furthermore, all subscales were significantly related to a single, second-order factor. The MSBS factor structure was shown to be invariant across gender. MSBS scores were significantly correlated with measures of trait boredom, depression, anxiety, anger, inattention, impulsivity, neuroticism, life satisfaction, and purpose in life. Finally, MSBS scores distinguished between participants who were experimentally manipulated into a state of boredom and those who were not, above and beyond measures of trait boredom, negative affect, and depression.

On boredom and social identity: a pragmatic meaning-regulation approach

People who feel bored experience that their current situation is meaningless and are motivated to reestablish a sense of meaningfulness. Building on the literature that conceptualizes social identification as source of meaningfulness, the authors tested the hypothesis that boredom increases the valuation of ingroups and devaluation of outgroups. Indeed, state boredom increased the liking of an ingroup name (Study 1), it increased hypothetical jail sentences given to an outgroup offender (Study 2 and Study 3), especially in comparison to an ingroup offender (Study 3), it increased positive evaluations of participants' ingroups, especially when ingroups were not the most favored ones to begin with (Study 4), and it increased the appreciation of an ingroup symbol, mediated by people's need to engage in meaningful behavior (Study 5). Several measures ruled out that these results could be explained by other affective states. These novel findings are discussed with respect to boredom, social identity, and existential psychology research.

The measurement of boredom: differences between existing self-report scales

There are two commonly used measures of boredom: the Boredom Proneness Scale (BPS) and the Boredom Susceptibility Scale (ZBS). Although both were designed to measure the propensity to experience boredom (i.e., trait boredom), there are reasons to think they may not measure the same construct. The present research sought to evaluate this proposition in several stages. Specifically, relationships between the BPS, ZBS, and important causal (Study 1, N = 837), correlational (Study 2, N = 233), and outcome variables (Study 3, N = 137) were examined in university students. Taken together, results support the notion that the BPS and ZBS do not measure the same construct. Specifically, higher BPS scores were associated with higher levels of neuroticism, experiential avoidance, attentional and nonplanning impulsivity, anxiety, depression, dysphoria, and emotional eating. Conversely, higher ZBS scores were associated with higher levels of motor impulsivity, sensitivity to reward, gambling, and alcohol use and lower levels of neuroticism, experiential avoidance, and sensitivity to punishment.

Race, weight, and correlates of binge eating in female college students

This study examined the correlates of race, weight status, and binge eating among 715 female undergraduate students (77% Caucasian; 13% African American) enrolled at an urban university. Approximately 21.7% of Caucasians and 36.8% of African-Americans (AA) were overweight/obese. Higher BMI was associated with BED, and severity of binge eating symptoms. After removing participants who endorsed compensatory behaviors ≥ 1×/week from the analyses, 8.4% of the sample met criteria for BED (2.4% of the AA and 9.9% of the Caucasian students) and 44% reported severe binge eating symptoms. AA students were less likely to have BED than Caucasian students and reported less severe binge eating symptomatology. For Caucasian students, mood, cognitive restraint, drive for thinness, and BMI all contributed significant individual variance in binge eating severity. For African Americans, mood, body image dissatisfaction, and drive for thinness were found to be unique contributors. For those meeting criteria for BED, retrospectively recalled predictors of binge eating included negative affect (e.g., self-anger, worry, guilt), but not hunger. Behavioral triggers for binge behavior differed by race, as well, with African American students retrospectively reporting lower levels of anxiety prior to bingeing. Results from this study suggest that there are racial differences in binge eating behaviors. Future studies are needed to examine differences in eating practices among racial groups (e.g., grazing, large portions, high fat food preparation) that may contribute to early onset weight gain and obesity. The results suggest the importance of sensitive tailored weight and disordered eating interventions for college women from diverse backgrounds.

Evaluation of a functional treatment for binge eating associated with bulimia nervosa

Binge-eating disorders (BED) are a common problem affecting up to 5 percent of the American population in any given 6-month period. Currently, the most widely accepted treatment is some variation of Cognitive Behavior Therapy, although the abstinence rates following this type of treatment are only around 50%. A recent study by Bosch et al. explored the effects of extinction with four women who engaged in binge-eating behavior associated with BED and bulimia nervosa (BN). The treatment was successful, with three of the four participants obtaining abstinence. To date, this has been the only study examining this procedure. The purpose of the current study was to further evaluate extinction of binge eating with four young women who met diagnostic criteria for BN. The results showed that the treatment decreased binge eating to zero for all four women, although one dropped out of the study shortly after beginning the intervention.

Refining the relationships of perfectionism, self-efficacy, and stress to dieting and binge eating: Examining the appearance, interpersonal, and academic domains

OBJECTIVE

This study investigated domain-specific (appearance, interpersonal, and academic) interactive relationships of perfectionism, self-efficacy, and stress to dieting and binge eating, positing that the level of weight/shape self-efficacy would be pivotal in identifying elevated dieting versus elevated binge eating.

METHOD

Participants were 406 randomly selected undergraduate women. At two time points (T1 and T2), 11 weeks apart, participants completed measures of dieting and binge eating attitudes/behaviors as well as domain-specific measures of perfectionism and self-efficacy (e.g., perfectionism related to appearance). Between T1 and T2, participants completed inventories weekly on the previous week's weight/shape, interpersonal, and academic stressors.

RESULTS

The combination of high interpersonal perfectionism, low interpersonal self-efficacy, high interpersonal stress, and high weight/shape self-efficacy was associated with the most elevated dieting. The hypothesized interactions related to the appearance and academic domains where not supported.

CONCLUSION

These results highlight the interpersonal context for dieting and the unique relationship between weight/shape self-efficacy and dieting.

What's driving the binge in binge eating disorder?: A prospective examination of precursors and consequences

OBJECTIVE

Previous research, mostly using retrospective reports, indicated a relation of negative affect and dietary restraint with the occurrence of binge episodes in binge eating disorder (BED). We employed Ecological Momentary Assessment (EMA) to better understand precursors and consequences of binge eating.

METHOD

Thirty-three females with BED carried a handheld computer for 7 days, and were periodically prompted to indicate their current emotions, hunger, and binge status.

RESULTS

Negative mood and hunger were significantly higher at prebinge than at nonbinge times, but negative mood was even higher at postbinge. Participants attributed binge episodes to mood more frequently than to hunger or abstinence violation.

CONCLUSION

The finding that negative mood is actually heightened subsequent to a binge suggests the need to further investigate what is reinforcing about a binge, including possible escape from self-awareness. Strengths of EMA technology are discussed, as well as its broad utility in BED assessment and treatment.

An evaluation of affect and binge eating

The affect regulation model of binge eating suggests that binge eating occurs because it provides momentary relief from negative affect. The purpose of this study was to evaluate change in affect during binge eating to evaluate the merits of this model. Participants were young adult women from a midwestern university. Binge eaters recorded their level of pleasantness using the affect grid at 2-minute intervals before, during, and after binge eating episodes and regular meals. Controls recorded in a similar manner during meals. The results showed a different pattern of affect for binge eaters during binge eating episodes and normal meals and for binge eaters and controls at normal meals. The results support the affect regulation model of binge eating and suggest that binge eating is negatively reinforced because it produces momentary relief from negative affect.

Direct and retrospective assessment of factors contributing to compulsive buying

Compulsive buying is a disorder that has begun to receive attention from researchers in recent years. The results of a handful of studies suggest that compulsive buying occurs in response to negative emotions and results in a decrease in the intensity of the negative emotions. In this investigation, we used interview and self-monitoring methods to evaluate the antecedents and consequences of compulsive buying in a sample of women who met criteria for compulsive buying on the compulsive buying scale (J. Consumer Res. 19 (1992) 459). As a group, the participants reported negative emotions as the most common antecedents to compulsive buying, and euphoria or relief from the negative emotions as the most common consequence of compulsive buying. These findings were consistent across the interview and self-monitoring assessment methods. The implications for assessment and treatment are discussed.

Functional assessment of binge eating in a clinical sample of obese binge eaters

The aim of this study was to assess the antecedents and consequences of binge eating in ten obese binge eaters. The subjects completed retrospective measures and monitored themselves at the time binge eating occurred. The results show that the common temporally remote antecedents to binge eating included being very busy throughout the day, feeling unusually tired/fatigued, having consumed too much food during the day, and feeling down or irritable. A number of affective variables (e.g., anxiety, anger, frustration, sadness, guilt, agitation) temporarily decreased during a binge eating episode, yet increased again following binge eating. Furthermore, the antecedents and consequences surrounding binge eating episodes were moderately to highly variable both between and within subjects, thus supporting the need for individualised functional assessments of the antecedents and consequences of binge eating. The implications for treatment and future research are discussed.

The use of ecological momentary assessment approaches in eating disorder research

OBJECTIVE

Eating disorder (ED) research is increasingly focusing on the proximal antecedents to disordered eating behavior. Such antecedents may include cognitions, environmental stimuli, social interactions, and affective states. Current ED theories suggest that the relationships between antecedents and eating behavior may be complex, including interaction associations, time-lagged effects, and associations that persist only for brief periods of time. Similarly, these theories often include the consequences of behavior-influencing variables of interest (e.g., short-term reductions in negative affect). Careful examination of such theories, however, has been limited by a reliance on data collection methods not appropriate for testing these effects.

METHOD

This study examines alternative methods for data collection and analysis that overcome previously noted limitations, using data collected in several studies with eating-disordered participants.

RESULTS

The development of a technique called ecological momentary assessment (EMA) allows the ongoing study of behavior in its natural context and reduces biases associated with retrospective recall. The development of technology that allows the sophisticated collection and storage of such data (e.g., palm-top computers), along with statistical procedures for analyzing hierarchically nested, repeated measures data, allow precise testing of complex theoretical models.

DISCUSSION

We demonstrate several important features of this research: (1) patients are willing and able to engage in EMA studies, (2) data not possible to collect using other designs are obtainable, (3) complex theoretical models can be evaluated using these data and appropriate statistical methods, and (4) the collection and analysis of EMA data present unique difficulties to ED researchers. Finally, we endorse and provide recommendations for the use of EMA in future ED research and practice.

Does binge eating play a role in the self-regulation of moods?

Self-reported emotional experiences and eating behaviors were studied in college students in an attempt to determine what types of emotional experiences precede and follow binge eating and how specific types of compensatory behaviors modify these experiences. First-year male and female students (N=390) were surveyed for depression, anxiety, health status, life satisfaction, and eating attitudes (EAT-26). Those reporting recurrent binge eating episodes were asked to describe their emotional feelings before and after bingeing and before and after compensatory activities. EAT-26 scores corresponding to scores previously reported for eating disordered patients were found in 9.7% of students. Binge eating was nearly twice as frequent among females (16.4%) as males (8.6%). Among females, positive relationships were found between specific EAT-26 factors scores and both anxiety and depression scores. The emotional antecedents and consequences of binge eating and of compensatory activities were compared in three sub-groups of individuals who reported recurrent bingeing with loss of self-control during binges. The three sub-groups consisted of individuals who reported, 1) bingeing without engaging in compensatory activities, 2) bingeing and compensating by means other than vomiting (fasting, exercising, or use of laxatives or diuretics), and 3) bingeing and compensating by vomiting. Regardless of the type of activity, those individuals who engaged in compensatory activities reported greater negative affect preceding binge episodes than those who did not compensate. In addition, contrary to expectations, negative affect did not decrease, but instead increased significantly, following binge episodes and decreased immediately before and after compensatory activities.

A descriptive analysis of factors contributing to binge eating

This study was designed to examine temporally proximal and remote antecedents as well as immediate and delayed consequences of binge eating behavior. Participants included 16 undergraduate females who reported engaging in binge eating at least two times per week and experiencing a sense of lack of control during binge eating episodes on the Questionnaire of Eating and Weight Patterns. Results indicated that the most frequent proximal antecedents to binge eating were negative emotions such as feeling depressed, angry, empty, hopeless, worried, or dissatisfied. The most frequent consequences of binge eating included relief from negative feelings and thoughts and decrease in hunger or craving. The results of this study suggest that the function of binge eating can be identified through assessment of antecedents and consequences with real time recording and retrospective reports. Treatment implications are discussed.