Expectations, mood, and eating behavior in binge eating disorder. Beware of the bright side

The Detection of Acute Risk of Self-injury Project: Protocol for an Ecological Momentary Assessment Study Among Individuals Seeking Treatment

BACKGROUND

Nonsuicidal self-injury (NSSI) is a major mental health concern. Despite increased research efforts on establishing the prevalence and correlates of the presence and severity of NSSI, we still lack basic knowledge of the course, predictors, and relationship of NSSI with other self-damaging behaviors in daily life. Such information will be helpful for better informing mental health professionals and allocating treatment resources. The DAILY (Detection of Acute rIsk of seLf-injurY) project will address these gaps among individuals seeking treatment.

OBJECTIVE

This protocol paper presents the DAILY project's aims, design, and materials used. The primary objectives are to advance understanding of (1) the short-term course and contexts of elevated risk for NSSI thoughts, urges, and behavior; (2) the transition from NSSI thoughts and urges to NSSI behavior; and (3) the association of NSSI with disordered eating, substance use, and suicidal thoughts and behaviors. A secondary aim is to evaluate the perspectives of individuals seeking treatment and mental health professionals regarding the feasibility, scope, and utility of digital self-monitoring and interventions that target NSSI in daily life.

METHODS

The DAILY project is funded by the Research Foundation Flanders (Belgium). Data collection involves 3 phases: a baseline assessment (phase 1), 28 days of ecological momentary assessment (EMA) followed by a clinical session and feedback survey (phase 2), and 2 follow-up surveys and an optional interview (phase 3). The EMA protocol consists of regular EMA surveys (6 times per day), additional burst EMA surveys spaced at a higher frequency when experiencing intense NSSI urges (3 surveys within 30 minutes), and event registrations of NSSI behavior. The primary outcomes are NSSI thoughts, NSSI urges, self-efficacy to resist NSSI, and NSSI behavior, with disordered eating (restrictive eating, binge eating, and purging), substance use (binge drinking and smoking cannabis), and suicidal thoughts and behaviors surveyed as secondary outcomes. The assessed predictors include emotions, cognitions, contextual information, and social appraisals.

RESULTS

We will recruit approximately 120 individuals seeking treatment aged 15 to 39 years from mental health services across the Flanders region of Belgium. Recruitment began in June 2021 and data collection is anticipated to conclude in August 2023.

CONCLUSIONS

The findings of the DAILY project will provide a detailed characterization of the short-term course and patterns of risk for NSSI and advance understanding of how, why, and when NSSI and other self-damaging behaviors unfold among individuals seeking treatment. This will inform clinical practice and provide the scientific building blocks for novel intervention approaches outside of the therapy room that support people who self-injure in real time.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/46244.

Positive emotions and their upregulation increase willingness to consume healthy foods

While highly relevant for everyday life, it is unclear whether experiencing incidental positive or negative emotional states, and active emotion regulation, influence the weighting of perceived taste and health in food choices. In Experiment 1, we examined two emotion regulation strategies, reappraisal and distraction, used to decrease negative emotions. Participants were cued to experience or decrease their emotional response for either neutral or negative incidental emotion-inducing images. They subsequently rated their willingness to consume foods, which varied in their taste and health attributes. Mixed-effects model analysis showed that compared to neutral, negative emotions decreased willingness to consume, regardless of perceived taste and health, but neither emotion regulation strategy had a significant effect. Experiment 2 used images inducing incidental positive emotions in combination with three emotion regulation strategies: reappraisal, distraction, and increasing positive emotions. Experiencing positive emotions generally increased willingness to consume, with stronger effects for tasty and healthy foods. Decreasing positive emotions via reappraisal decreased willingness to consume, particularly for healthy foods. Increasing positive emotion intensity further increased willingness to consume, with stronger effects for healthy foods. The results suggest that experiencing positive emotions increases desire particularly strongly for healthy foods, which can additionally be modulated via emotion regulation. This has important implications for designing health-related interventions targeting mood improvement.

Solid or Liquid Food-The Intention to Eat Different Foods under Negative Emotions

Food can relieve an individual's emotions, especially for emotional eaters. For instance, chewing alleviates negative emotions. Solid and liquid foods comprise a huge part of our daily lives, and the chewiness of solid foods is always high. Here, we explored whether people, especially emotional eaters, have higher eating intentions to eat highly chewy foods while experiencing negative emotions by comparing their eating intentions toward solid and liquid foods. To this end, we conducted a survey of 147 participants using a questionnaire (Experiment 1) to understand their eating intention toward five types of food (purple potato, maize, black soya bean, mango, and soybean; each food group contained a solid food and a liquid food) while experiencing negative emotions. The results showed that individuals exhibited higher eating intention toward solid food compared with liquid food while experiencing negative emotions. In Experiment 2, we selected 85 and 65 high-emotional and low-emotional eaters, respectively, and further explored their preference for solid foods. The results showed that individuals with high levels of emotional eating exhibited higher intentions toward solid food while experiencing negative emotions compared with those with low levels of emotional eating. In conclusion, this study proved that individuals' higher eating intentions toward highly chewable food were pronounced among individuals with high levels of emotional eating under negative emotion conditions.

Interactive influences of food, contexts and neurocognitive systems on addictive eating

Compulsive eating is a common symptom of different conditions, including obesity, binge eating disorder and bulimia. One hypothesis is that contemporary food products promote compulsive eating via addiction-like mechanisms. However, what is the addictive substance in food, and what is the phenotypic overlap between obesity / eating disorders and addictions are questions that remain unresolved. In this review, we applied a multilevel framework of addiction, which encompasses the 'drug' (certain foods), the person's mindset, and the context, to improve understanding of compulsive eating. Specifically, we reviewed evidence on the addictive properties of specific foods, the neurocognitive systems that control dietary choices, and their interaction with physical, emotional and social contexts. We focused on different target groups to illustrate distinct aspects of the proposed framework: the impact of food and contextual factors were examined across a continuum, with most studies conducted on healthy participants and subclinical populations, whereas the review of neurocognitive aspects focused on clinical groups in which the alterations linked to addictive and compulsive eating are particularly visible. The reviewed evidence suggest that macronutrient composition and level of processing are associated with the addictive properties of food; there are overlapping neuroadaptations in reward and decision-making circuits across compulsive eating conditions; and there are physical and social contexts that fuel compulsive eating by exploiting reward mechanisms and their interaction with emotions. We conclude that a biopsychosocial model that integrates food, neurobiology and context can provide a better understanding of compulsive eating manifestations in a transdiagnostic framework.

Anhedonia, positive affect dysregulation, and risk and maintenance of binge-eating disorder

Low positive affect has been identified as an antecedent of binge-eating episodes among individuals with binge-eating disorder (BED), yet positive affect has received far less attention in eating disorders research than its counterpart, negative affect. In this article, we argue that the low levels of positive affect which occur with anhedonia (i.e., loss of interest or pleasure in activities) may contribute to the onset and maintenance of BED. We introduce a theoretical model in which anhedonia increases the risk for BED through its interrelationships with dysregulated eating and weight gain, and we describe potential direct (e.g., reward-related processes) as well as indirect (e.g., influences on depressive symptoms and physical activity) pathways by which anhedonia may lead to adverse eating- and weight-related outcomes. We also propose a momentary maintenance model in which low positive affect and positive affect dysregulation occurring with anhedonia maintain binge eating directly and indirectly through maladaptive health behaviors, such as decreased physical activity, less healthy eating, and fewer social interactions, which in turn maintain anhedonia. We draw upon outside literature to present evidence that aligns with the proposed risk and maintenance models and conclude by outlining avenues for future research-including methodological/measurement, theoretical, and clinical research directions.

The momentary interplay of affect, attention bias, and expectancies as predictors of binge eating in the natural environment

OBJECTIVE

Affect regulation, eating expectancies, and attention toward food-related cues are interrelated constructs that have been implicated in the maintenance of binge eating. While these processes show considerable temporal variability, the momentary associations between these domains have not been elucidated. This study examined a model that posited momentary fluctuations in affect, eating expectancies, and attention bias (AB) would interact to predict subsequent binge eating.

METHOD

Forty women who endorsed recurrent binge eating completed a 10-day ecological momentary assessment protocol with ambulatory measures of AB (i.e., dot-probe task with palatable food and neutral cues) and self-report assessments of positive and negative affect, eating expectancies (i.e., the belief that eating would improve one's mood), and binge-eating symptoms.

RESULTS

Generalized linear mixed models indicated higher momentary AB toward palatable food was associated with increased risk of subsequent binge eating, and a two-way interaction showed that moments of higher eating expectancies and negative affect were associated with increased likelihood of subsequent binge eating. Also, a three-way interaction emerged, in that the association between eating expectancies and subsequent binge eating was strongest at lower levels of positive affect and higher AB.

DISCUSSION

Together, findings partially supported hypotheses and demonstrate meaningful within-person fluctuations in AB that precede binge eating. Further, results demonstrate that the momentary influence of eating expectancies on binge eating depends on both affective state and attentional processes.

Associations between eating expectancies and Eating disorder symptoms in men and women

Eating expectancies, or learned expectations that an individual has about eating, prospectively predict eating disorder (ED) symptoms. Most studies examining eating expectancies have focused on one or two eating expectancies and their relation with bulimic symptoms. In addition, these studies have been conducted mostly in women. Thus, it is unclear whether: 1) associations between eating expectancies and ED symptoms vary between men and women, and 2) extend to ED symptoms other than bulimic symptoms. The current study (N = 197 undergraduate men and 246 undergraduate women) investigated sex variance in a model of eating expectancies and ED symptoms, including factors associated with ED symptoms (i.e., negative urgency, negative affect, alcohol use, drug use, and body mass index). Sex variance was tested using path analysis in a model including eating expectancies and associated factors, with excessive exercise, negative attitudes toward obesity, restricting, cognitive restraint, binge eating, purging, muscle building, and body dissatisfaction as dependent variables. Unconstrained (i.e., unconstrained paths across men and women) and constrained (i.e., constraining paths across men and women) models were tested. The unconstrained and constrained models differed significantly, indicating that the models varied by sex. For both sexes, eating expectancies were uniquely associated with ED symptoms. For men, Eating Manages Negative Affect was significantly associated with the most ED symptoms. In contrast, for women, Eating Leads to Feeling Out of Control was associated with the most ED symptoms. Previous findings regarding eating expectancies and ED symptoms in women may not generalize to men. Intervening on eating expectancies in a sex-specific way may help reduce specific ED symptoms.

Partial sleep deprivation and food intake in participants reporting binge eating symptoms and emotional eating: preliminary results of a quasi-experimental study

Sleep deprivation consistently increases food intake. This study aimed to evaluate the effect of partial sleep deprivation on food intake in individuals reporting binge eating, controlling for self-reported depressive emotional eating. Fourteen young adults reporting binge eating symptoms and 14 controls denying any eating disorders symptoms were offered a large and varied breakfast after a night of habitual sleep (HN) and after a night of partial sleep deprivation (DN). Food intake was unobtrusively measured while daily food intake was measured via a food diary. Results revealed only a significant effect of the Night on fibre consumed at breakfast and on the amount of daily snacks: both groups consumed less fibre and more snacks after DN compared to after HN. However, when controlling for depressive emotional eating, results showed that individuals reporting low depressive emotional eating ate less after DN than after HN at breakfast, but then they ate more throughout the day. Partial sleep deprivation may decrease fibre consumption and increase daily snacks regardless of binge eating symptoms, while daily food intake may increase only in individuals who do not report emotional eating.

LEVEL OF EVIDENCE

Experimental study, Level 1.

Screening for Binge Eating Disorder in people with obesity

The Risk factors for Binge Eating Disorder in Overweight (REO) questionnaire is a screening tool for nutritionists to discriminate between individuals with obesity with and without Binge Eating Disorder (BED). The first study tested the discriminative ability of the REO and identified an optimal cut-off value. In the second study this cut-off value was used to identify individuals with and without BED from a sample of individuals with obesity visiting a nutritionist and compared clinical and personality characteristics with a group of individuals officially diagnosed with BED. Results showed that the REO has a sensitivity of 95.1%, specificity of 81.5%, a good internal consistency of α=.96, and an exploratory factor analysis showed four underlying factors of the REO that explained a total variance of 63.7%. Characteristics of individuals with BED symptoms identified by the REO and those officially diagnosed with BED were comparable and differed from individuals with obesity without BED symptoms. By screening individuals with obesity with the REO those presenting with BED symptoms are more easily identified, and can be referred to psychological treatment facilities for further assessment and appropriate treatment.

Emotion Regulation in Binge Eating Disorder: A Review

The purpose of the present review is to provide a summary of the research findings on emotion regulation in Binge Eating Disorder (BED). Negative emotions and maladaptive emotion regulation strategies play a role in the onset and maintenance of binge eating in BED. Anger and sadness, along with negative emotions related to interpersonal experiences (i.e., disappointment, being hurt or loneliness), seem to be particularly relevant. Individuals with BED have a tendency to suppress and ruminate on their unwanted emotions, which leads to increased psychopathological thoughts and symptoms. Compared to healthy controls, they use adaptive strategies, such as reappraisal, less frequently. Evidence concerning the causal relation between negative affect and binge eating is inconclusive and still very limited. While experimental studies in a laboratory setting lack ecological validity, ecological momentary assessment studies offer more promise at unraveling the causal relationship between emotions and binge eating. Increases in negative affect are found to be antecedents of binge eating in BED. However, there seems to be less support for the possibility that binge eating serves as a means to alleviate negative affect. Finally, BED seems to be related to other forms of maladaptive emotion regulation strategies, such as substance abuse and self-harm.

Set-shifting abilities, mood and loss of control over eating in binge eating disorder: An experimental study

Executive functions play an important role in problem-solving and self-control. Set-shifting is an aspect of executive functioning and represents cognitive flexibility. The inability to control eating in Binge Eating Disorder (BED) may imply deficits in set-shifting which could be exacerbated by negative mood and depressive symptoms. The aim of the study was to test whether there is a causal relationship between set-shifting ability, changes in mood and loss of control over eating in BED. Seventy-five participants diagnosed with BED were randomly assigned to a negative or neutral mood induction. Set-shifting abilities, depressive symptoms, current mood and loss of control over eating were assessed. Having depressive symptoms and poorer set-shifting abilities resulted in a more negative mood after a negative mood induction, whereas this was not observed in the neutral mood induction. Post-hoc analyses revealed that individuals with poorer set-shifting abilities and more changes in negative mood, experienced more feelings of loss of control over eating than individuals whose set-shifting abilities were better and whose mood did not change. The results suggest that both depressive symptoms and deficits in set-shifting abilities may decrease an individual's ability to handle negative affect and increase loss of control over eating in individuals with BED.

Happy eating: the underestimated role of overeating in a positive mood

Emotional eaters are often presumed to eat in response to negative emotions, while positive emotions have been largely neglected. The current study induced a positive, negative, or neutral mood in a student sample and subsequently measured food intake. In addition, the relation between caloric intake and mood improvement was assessed. It was expected that emotional eaters would consume more food than non-emotional eaters in the emotional conditions, and also more than in the neutral condition. Moderated regression analyses indeed showed a significant increase in food intake for emotional eaters in the positive compared to the neutral condition, and a trend towards higher food consumption than non-emotional eaters. No effects were found in the negative condition. With regard to mood changes during food intake, Pearson correlations demonstrated an association between amount of calories consumed and mood improvement after 5min of food consumption. However, there was no evidence for differences between emotional and non-emotional eaters. The current findings underline the importance of positive emotions in emotional eating, and provide new insights on the relationship between eating and mood melioration.

Eating Expectancies in Relation to Eating Disorder Recovery

This study examined the relation between eating expectancies, assessed via the Eating Expectancy Inventory, and eating disorder recovery. Individuals formerly seen for an eating disorder were categorized as having an active eating disorder (n = 53), as partially recovered (n = 15), or as fully recovered (n = 20). The expectancies of these groups were compared to each other and to 67 non-eating disorder controls. Results revealed that three of the five eating expectancies differed across groups. Non-eating disorder controls and fully recovered individuals endorsed similar levels of the expectancies that eating helps manage negative affect, eating is pleasurable and useful as a reward, and eating leads to feeling out of control. Partially recovered individuals looked more similar to active eating disorder cases on these expectancies. The other two expectancies did not differ across groups. Results provide some indication that certain eating expectancies may be associated with eating disorder recovery.

Binge Eating Disorder psychopathology in normal weight and obese individuals

OBJECTIVE

Although Binge Eating Disorder (BED) is associated with obesity and unstable weight and the diagnosis was originally predicated with the obese in mind, obesity is not a criterion for BED. In fact, BED is not uncommon in nonobese individuals. The aim of this study was to compare the psychopathology of obese (BMI >30) and nonobese individuals (BMI < 30) with BED.

METHOD

Within a group of 174 individuals diagnosed with BED, 51 (29%) were classified as nonobese and 123 (71%) as obese. The Eating Disorder Examination (EDE) and Beck Depression Inventory (BDI) were administered to assess eating disorder psychopathology and depressive symptoms.

RESULTS

The nonobese BED group was significantly younger and was less likely to receive treatment. The obese group had more concerns about weight and reported more objective binge eating episodes. No differences were found on any other subscales of the EDE or BDI.

DISCUSSION

Our main finding was that there are more similarities than differences between the nonobese and obese individuals with BED. The severity of the psychopathology does not seem to be related to BMI. More awareness of the existence of nonobese individuals with BED is needed. Early detection and treatment may prevent the development of overweight and it's consequences.

Emotion and eating in binge eating disorder and obesity

This study compares 20 binge eaters (BED), 23 obese patients (OB) and 20 normal weight controls (CO) with regard to everyday emotions and the relationship between emotions, the desire to eat and binge eating. Modified versions of the Differential Affect Scale and Emotional Eating Scale were used and the TAS-20 and Symptom-Check-List-27 administered to assess overall psychopathology and alexithymia. BED-subjects show a more negative pattern of everyday emotions, higher alexithymia scores and the strongest desire to eat, especially if emotions are linked to interpersonal aspects. The emotion most often reported preceding a binge was anger. Feelings of loneliness, disgust, exhaustion or shame lead to binge eating behaviour with the highest probability.