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Barakat S, McLean SA, Bryant E, Le A, Marks P, Touyz S, Maguire S. Risk factors for eating disorders: findings from a rapid review. J Eat Disord 2023; 11:8. [PMID: 36650572 PMCID: PMC9847054 DOI: 10.1186/s40337-022-00717-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/04/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Risk factors represent a range of complex variables associated with the onset, development, and course of eating disorders. Understanding these risk factors is vital for the refinement of aetiological models, which may inform the development of targeted, evidence-based prevention, early intervention, and treatment programs. This Rapid Review aimed to identify and summarise research studies conducted within the last 12 years, focusing on risk factors associated with eating disorders. METHODS The current review forms part of a series of Rapid Reviews to be published in a special issue in the Journal of Eating Disorders, funded by the Australian Government to inform the development of the National Eating Disorder Research and Translation Strategy 2021-2031. Three databases were searched for studies published between 2009 and 2021, published in English, and comprising high-level evidence studies (meta-analyses, systematic reviews, moderately sized randomised controlled studies, moderately sized controlled-cohort studies, or population studies). Data pertaining to risk factors for eating disorders were synthesised and outlined in the current paper. RESULTS A total of 284 studies were included. The findings were divided into nine main categories: (1) genetics, (2) gastrointestinal microbiota and autoimmune reactions, (3) childhood and early adolescent exposures, (4) personality traits and comorbid mental health conditions, (5) gender, (6) socio-economic status, (7) ethnic minority, (8) body image and social influence, and (9) elite sports. A substantial amount of research exists supporting the role of inherited genetic risk in the development of eating disorders, with biological risk factors, such as the role of gut microbiota in dysregulation of appetite, an area of emerging evidence. Abuse, trauma and childhood obesity are strongly linked to eating disorders, however less conclusive evidence exists regarding developmental factors such as role of in-utero exposure to hormones. Comorbidities between eating disorders and mental health disorders, including personality and mood disorders, have been found to increase the severity of eating disorder symptomatology. Higher education attainment, body image-related factors, and use of appearance-focused social media are also associated with increased risk of eating disorder symptoms. CONCLUSION Eating disorders are associated with multiple risk factors. An extensive amount of research has been conducted in the field; however, further studies are required to assess the causal nature of the risk factors identified in the current review. This will assist in understanding the sequelae of eating disorder development and in turn allow for enhancement of existing interventions and ultimately improved outcomes for individuals.
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Affiliation(s)
- Sarah Barakat
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Sydney, Australia. .,Faculty of Medicine and Health, Charles Perkins Centre (D17), InsideOut Institute, University of Sydney, Level 2, Sydney, NSW, 2006, Australia.
| | - Siân A McLean
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Emma Bryant
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Sydney, Australia
| | - Anvi Le
- Healthcare Management Advisors, Melbourne, Australia
| | - Peta Marks
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Sydney, Australia
| | | | - Stephen Touyz
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Sydney, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Sydney, Australia
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Wayda-Zalewska M, Grzegorzewski P, Kot E, Skimina E, Santangelo PS, Kucharska K. Emotion Dynamics and Emotion Regulation in Anorexia Nervosa: A Systematic Review of Ecological Momentary Assessment Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13659. [PMID: 36294238 PMCID: PMC9603728 DOI: 10.3390/ijerph192013659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Abstract
Altered emotion dynamics and emotion regulation (ER) have been indicated in theoretical descriptions of abnormal emotional functioning, which contributes to the development and maintenance of anorexia nervosa (AN). Ecological momentary assessment (EMA) has recently become popular in research on eating disorders. It is a source of new insights into the psychopathology of AN as it enables intensive long-term tracking of everyday experiences and behaviours of individuals through repeated self-reports. The following systematic review aims to synthesize research on the use of EMA when evaluating emotion dynamics and ER in AN. Specific studies were identified with the use of MEDLINE, PsycINFO, and Scopus databases. A supplemental search was performed in reference lists of the relevant publications. As a result, 27 publications were identified and included in the systematic review. The findings from the reviewed studies point to various disturbed components of emotion dynamics as well as to unique associations of maladaptive ER strategies with specific abnormalities in emotion dynamics in AN. Limitations of the studies were discussed as well. An outlook for further research in the field was provided in the last section of the paper.
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Affiliation(s)
| | - Piotr Grzegorzewski
- Institute of Psychology, Cardinal Stefan Wyszyński University in Warsaw, 01938 Warsaw, Poland
| | - Emilia Kot
- Faculty of Psychology, University of Warsaw, 00183 Warsaw, Poland
| | - Ewa Skimina
- Institute of Psychology, Cardinal Stefan Wyszyński University in Warsaw, 01938 Warsaw, Poland
| | | | - Katarzyna Kucharska
- Institute of Psychology, Cardinal Stefan Wyszyński University in Warsaw, 01938 Warsaw, Poland
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Nowak U, Wittkamp MF, Clamor A, Lincoln TM. Using the Ball-in-Bowl Metaphor to Outline an Integrative Framework for Understanding Dysregulated Emotion. Front Psychiatry 2021; 12:626698. [PMID: 34434124 PMCID: PMC8380846 DOI: 10.3389/fpsyt.2021.626698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 06/22/2021] [Indexed: 01/10/2023] Open
Abstract
Dysregulated emotion plays an important role for mental health problems. To elucidate the underlying mechanisms, researchers have focused on the domains of strategy-based emotion regulation, psychophysiological self-regulation, emotion evaluations, and resulting emotion dynamics. So far, these four domains have been looked at in relative isolation from each other, and their reciprocal influences and interactive effects have seldom been considered. This domain-specific focus constrains the progress the field is able to make. Here, we aim to pave the way towards more cross-domain, integrative research focused on understanding the raised reciprocal influences and interactive effects of strategy-based emotion-regulation, psychophysiological self-regulation, emotion evaluations, and emotion dynamics. To this aim, we first summarize for each of these domains the most influential theoretical models, the research questions they have stimulated, and their strengths and weaknesses for research and clinical practice. We then introduce the metaphor of a ball in a bowl that we use as a basis for outlining an integrative framework of dysregulated emotion. We illustrate how such a framework can inspire new research on the reciprocal influences and interactions between the different domains of dysregulated emotion and how it can help to theoretically explain a broader array of findings, such as the high levels of negative affect in clinical populations that have not been fully accounted for by deficits in strategy-based emotion regulation and the positive long-term consequences of accepting and tolerating emotions. Finally, we show how it can facilitate individualized emotion regulation interventions that are tailored to the specific regulatory impairments of the individual patient.
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The Roy Adaptation Model: A Theoretical Framework for Nurses Providing Care to Individuals With Anorexia Nervosa. ANS Adv Nurs Sci 2018; 40:370-383. [PMID: 28825933 DOI: 10.1097/ans.0000000000000175] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Using a nursing theoretical framework to understand, elucidate, and propose nursing research is fundamental to knowledge development. This article presents the Roy Adaptation Model as a theoretical framework to better understand individuals with anorexia nervosa during acute treatment, and the role of nursing assessments and interventions in the promotion of weight restoration. Nursing assessments and interventions situated within the Roy Adaptation Model take into consideration how weight restoration does not occur in isolation but rather reflects an adaptive process within external and internal environments, and has the potential for more holistic care.
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Vansteelandt K, Houben M, Claes L, Berens A, Sleuwaegen E, Sienaert P, Kuppens P. The affect stabilization function of nonsuicidal self injury in Borderline Personality Disorder: An Ecological Momentary Assessment study. Behav Res Ther 2017; 92:41-50. [PMID: 28257980 DOI: 10.1016/j.brat.2017.02.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 02/08/2017] [Accepted: 02/15/2017] [Indexed: 10/20/2022]
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Erdur L, Weber C, Zimmermann-Viehoff F, Rose M, Deter HC. Affective Responses in Different Stages of Anorexia Nervosa: Results from a Startle-reflex Paradigm. EUROPEAN EATING DISORDERS REVIEW 2017; 25:114-122. [DOI: 10.1002/erv.2502] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 12/10/2016] [Accepted: 12/19/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Laurence Erdur
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology; Charité - Universitätsmedizin Berlin; Germany
| | - Cora Weber
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology; Charité - Universitätsmedizin Berlin; Germany
| | | | - Matthias Rose
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology; Charité - Universitätsmedizin Berlin; Germany
- Quantitative Health Sciences, Outcomes Measurement Science; University of Massachusetts Medical School; Worcester MA USA
| | - Hans-Christian Deter
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology; Charité - Universitätsmedizin Berlin; Germany
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Kockler TD, Tschacher W, Santangelo PS, Limberger MF, Ebner-Priemer UW. Specificity of emotion sequences in borderline personality disorder compared to posttraumatic stress disorder, bulimia nervosa, and healthy controls: an e-diary study. Borderline Personal Disord Emot Dysregul 2017; 4:26. [PMID: 29276606 PMCID: PMC5738798 DOI: 10.1186/s40479-017-0077-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 12/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with borderline personality disorder (BPD) exhibit dysregulated emotion sequences in daily life compared to healthy controls (HC). Empirical evidence regarding the specificity of these findings is currently lacking. METHODS To replicate dysregulated emotion sequences in patients with BPD and to investigate the specificity of the sequences, we used e-diaries of 43 female patients with BPD, 28 patients with posttraumatic stress disorder (PTSD), 20 patients with bulimia nervosa (BN), and 28 HC. To capture the rapid dynamics of emotions, we prompted participants every 15 min over a 24-h period to assess their current perceived emotions. We analyzed group differences in terms of activation, persistence, switches, and down-regulation of emotion sequences. RESULTS By comparing patients with BPD to HC, we replicated five of the seven previously reported dysregulated emotion sequences, as well as 111 out of 113 unaltered sequences. However, none of the previously reported dysregulated emotion sequences exhibited specificity, i.e., none revealed higher frequencies compared to the PTSD group or the BN group. Beyond these findings, we revealed a specific finding for patients with BN, as they most frequently switched from anger to disgust. CONCLUSIONS Replicating previously found dysregulated and unaltered emotional sequences strengthens the significance of emotion sequences. However, the lack of specificity points to emotion sequences as transdiagnostic features.
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Affiliation(s)
- Tobias D Kockler
- Karlsruhe Institute of Technology, Mental mHealth Lab, Karlsruhe, Germany
| | - Wolfgang Tschacher
- University of Bern, University Hospital of Psychiatry, Bern, Switzerland
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Lavender JM, Mason TB, Utzinger LM, Wonderlich SA, Crosby RD, Engel SG, Mitchell JE, Le Grange D, Crow SJ, Peterson CB. Examining affect and perfectionism in relation to eating disorder symptoms among women with anorexia nervosa. Psychiatry Res 2016; 241:267-72. [PMID: 27208513 PMCID: PMC4912862 DOI: 10.1016/j.psychres.2016.04.122] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 03/10/2016] [Accepted: 04/29/2016] [Indexed: 01/08/2023]
Abstract
This study examined personality and affective variables in relation to eating disorder symptoms in anorexia nervosa (AN). Women (N=118) with DSM-IV AN completed baseline questionnaires (Beck Depression Inventory, Frost Multidimensional Perfectionism Scale) and interviews (Eating Disorder Examination, Yale-Brown-Cornell Eating Disorder Scale), followed by two weeks of ecological momentary assessment (EMA) involving multiple daily reports of affective states and eating disorder behaviors. Hierarchical regression analyses were conducted using eating disorder symptoms as dependent variables (i.e., EMA binge eating, EMA self-induced vomiting, eating disorder rituals, eating disorder preoccupations, dietary restraint). Predictor variables were maladaptive perfectionism (baseline), depressive symptoms (baseline), and affect lability (EMA). Results revealed that affect lability was independently associated with binge eating, whereas depressive symptoms were independently associated with self-induced vomiting. Depressive symptoms were independently associated with eating disorder rituals, whereas both depressive symptoms and maladaptive perfectionism were independently associated with eating disorder preoccupations. Finally, maladaptive perfectionism and affect lability were both independently associated with dietary restraint. This pattern of findings suggests the importance of affective and personality constructs in relation to eating disorder symptoms in AN and may highlight the importance of targeting these variables in the context of treatment.
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Affiliation(s)
- Jason M. Lavender
- Neuropsychiatric Research Institute, Fargo, North Dakota, USA
,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Heath Sciences, Fargo, North Dakota, USA
,Corresponding author at: Neuropsychiatric Research Institute, 120 8th Street South, Fargo, North Dakota, 58103, USA.
| | - Tyler B. Mason
- Neuropsychiatric Research Institute, Fargo, North Dakota, USA
| | - Linsey M. Utzinger
- Neuropsychiatric Research Institute, Fargo, North Dakota, USA
,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Heath Sciences, Fargo, North Dakota, USA
| | - Stephen A. Wonderlich
- Neuropsychiatric Research Institute, Fargo, North Dakota, USA
,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Heath Sciences, Fargo, North Dakota, USA
| | - Ross D. Crosby
- Neuropsychiatric Research Institute, Fargo, North Dakota, USA
,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Heath Sciences, Fargo, North Dakota, USA
| | - Scott G. Engel
- Neuropsychiatric Research Institute, Fargo, North Dakota, USA
,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Heath Sciences, Fargo, North Dakota, USA
| | - James E. Mitchell
- Neuropsychiatric Research Institute, Fargo, North Dakota, USA
,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Heath Sciences, Fargo, North Dakota, USA
| | - Daniel Le Grange
- Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Scott J. Crow
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
,The Emily Program, St. Paul, Minnesota, USA
| | - Carol B. Peterson
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
,The Emily Program, St. Paul, Minnesota, USA
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Abstract
We discuss three varieties of affective dynamics (affective instability, emotional inertia, and emotional differentiation). In each case, we suggest how these affective dynamics should be operationalized and measured in daily life using time-intensive methods, like ecological momentary assessment or ambulatory assessment, and recommend time-sensitive analyses that take into account not only the variability but also the temporal dependency of reports. Studies that explore how these affective dynamics are associated with psychological disorders and symptoms are reviewed, and we emphasize that these affective processes are within a nexus of other components of emotion regulation.
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Affiliation(s)
- Timothy J Trull
- Department of Psychological Sciences, University of Missouri, USA
| | - Sean P Lane
- Department of Psychological Sciences, University of Missouri, USA
| | - Peter Koval
- School of Psychology, Australian Catholic University, Australia Research Group of Quantitative Psychology and Individual Differences, KU Leuven, Belgium
| | - Ulrich W Ebner-Priemer
- Department of Sport and Sport Science and House of Competence, Karlsruhe Institute of Technology, Germany
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Santangelo P, Reinhard I, Mussgay L, Steil R, Sawitzki G, Klein C, Trull TJ, Bohus M, Ebner-Priemer UW. Specificity of affective instability in patients with borderline personality disorder compared to posttraumatic stress disorder, bulimia nervosa, and healthy controls. JOURNAL OF ABNORMAL PSYCHOLOGY 2015; 123:258-72. [PMID: 24661176 DOI: 10.1037/a0035619] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Affective instability is a core feature of borderline personality disorder (BPD). The use of advanced assessment methodologies and appropriate statistical analyses has led to consistent findings that indicate a heightened instability in patients with BPD compared with healthy controls. However, few studies have investigated the specificity of affective instability among patients with BPD with regard to relevant clinical control groups. In this study, 43 patients with BPD, 28 patients with posttraumatic stress disorder (PTSD), 20 patients with bulimia nervosa (BN), and 28 healthy controls carried e-diaries for 24 hours and were prompted to rate their momentary affective states approximately every 15 minutes while awake. To quantify instability, we used 3 state-of-the-art indices: multilevel models for squared successive differences (SSDs), multilevel models for probability of acute changes (PACs), and aggregated point-by-point changes (APPCs). Patients with BPD displayed heightened affective instability for emotional valence and distress compared with healthy controls, regardless of the specific instability indices. These results directly replicate earlier studies. However, affective instability did not seem to be specific to patients with BPD. With regard to SSDs, PACs, and APPCs, patients with PTSD or BN showed a similar heightened instability of affect (emotional valence and distress) to that of patients with BPD. Our results give raise to the discussion if affective instability is a transdiagnostic or a disorder-specific mechanism. Current evidence cannot answer this question, but investigating psychopathological mechanisms in everyday life across disorders is a promising approach to enhance validity and specificity of mental health diagnoses.
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Affiliation(s)
- Philip Santangelo
- Department of Sport and Sport Science, Karlsruhe Institute of Technology
| | - Iris Reinhard
- Department of Biostatistics, Central Institute of Mental Health Mannheim
| | | | - Regina Steil
- Department of Psychology and Sports Sciences, Johann Wolfgang Goethe University
| | - Günther Sawitzki
- Statlab, Institute for Applied Mathematics, University of Heidelberg
| | - Christoph Klein
- Klein, Department of Child and Adolescent Psychiatry and Psychotherapy, Freiburg University
| | - Timothy J Trull
- Department of Psychological Sciences, University of Missouri-Columbia
| | - Martin Bohus
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University
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