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

Modifying biased attention towards food stimuli in binge eating disorder: A multi-session training study

Individuals with binge eating disorder (BED) exhibit a biased attention towards food stimuli. Against this backdrop, the present study with pre-registered design (ID: DRKS00012984) tested whether (a) a training designed to reduce attentional food processing indeed modifies this bias, (b) this reduction is evident in several measures of food-related attention and (c) this is associated with reductions in craving, binge frequency over the past 28 days and calories eaten in a laboratory based bogus taste test. Individuals with BED were randomly allocated to four sessions of either an attentional bias modification training (ABMT; n = 39) or a comparable no-modification control training (CT; n = 27). In all measures assessed via eye-tracking - dwell time bias, dwell time bias variability and first fixation bias - food-related bias decreased in the ABMT relative to the CT. Against our hypothesis, no differential between-group effects were found for reaction time (RT) bias and its variability as well as for calories consumed in a bogus taste test. By contrast, reductions in binge frequency and subjective craving were found for both groups. Taken together, the tendency to preferentially process food seems a modifiable phenomenon in individuals with BED. However, modifying this selective viewing pattern does not seem a prerequisite for a successful reduction of binge frequency.

Changes in affect longitudinally mediate associations between emotion regulation strategy use and disordered eating

BACKGROUND

Trait-level emotion regulation (ER) difficulties are associated with eating disorders (EDs) transdiagnostically. However, little research has examined whether within-person fluctuations in ER longitudinally predict ED behaviors in daily life or the mechanisms of ER effects. Investigating daily ER could help us better understand why people experience ED behaviors at a given time. We examined whether day-to-day changes in adaptive (e.g., cognitive reappraisal) and maladaptive (e.g., rumination) ER longitudinally predicted core ED behaviors (binge eating, purging, dieting) and whether changes in affect mediated effects.

METHOD

Female participants (N = 688) ages 15-30 from the Michigan State University Twin Registry reported their adaptive and maladaptive ER use, negative affect (NA), positive affect (PA), binge eating, purging, and dieting on 49 consecutive days. Using structural equation modeling, we examined whether within-person fluctuations in ER predicted same- and next-day ED behaviors and whether changes in affect mediated longitudinal ER effects.

RESULTS

Greater maladaptive ER predicted increased likelihood of same-day binge eating and next-day binge eating and purging. The association between maladaptive ER and next-day binge eating and purging was mediated by increased next-day NA. In contrast, dieting was more closely related to changes in PA. Adaptive ER did not predict reduced likelihood of any ED behavior.

CONCLUSIONS

Maladaptive ER may longitudinally increase risk for binge eating and purging by amplifying NA. Interventions focused on decreasing maladaptive ER and subsequent NA might help disrupt binge eating-purging cycles. Conversely, results add to evidence that PA fluctuations may play a unique role in maintaining restrictive behaviors.

PUBLIC SIGNIFICANCE

Little is known about how daily changes in emotion regulation may impact disordered eating. We found that maladaptive emotion regulation (e.g., rumination) was associated with a higher likelihood of binge eating and purging on the next day because it predicted increased next-day negative affect. In contrast, dieting was more closely tied to fluctuations in positive affect. Targeting daily emotion regulation and affective processes may help disrupt cycles of disordered eating.

Tension and disordered eating behaviors in the daily lives of adolescents and young adults from the general population: Associations and moderating role of trait emotion regulation

Experiences of tension and difficulties in emotion regulation have been linked to eating pathology in clinical samples and are targeted in respective treatment approaches. The present study aimed to investigate the impact of tension on engagement in disordered eating behaviors (DEBs) and potential moderating effects of trait emotion regulation in young people from the general population. A subsample of 971 adolescents and young adults from an epidemiological cohort study reported on levels of tension and four different DEBs (skipping eating, restrained eating, eating large amounts of food, loss-of-control-eating) via ecological momentary assessment (EMA), as well as on trait emotion regulation via questionnaire. In multilevel models, momentary tension did not predict levels of subsequent DEBs. However, higher average levels of tension across the EMA period predicted higher levels of all DEBs. No interactions with emotion regulation emerged. Individuals experiencing overall higher levels of tension appear to be more prone to engaging in DEBs.

Maternal control and eating styles in children: The mediating role of emotion differentiation

Introduction: Theoretical accounts and empirical research suggest that mother-child interactions significantly influence the child's eating styles (emotional, external, and restrained eating). However, little or no research has explored the association between maternal psychological control and eating styles and whether other mechanisms may be involved in such association. To address this shortcoming, the present study aimed to investigate the mediating role of difficulties in differentiating emotions between maternal control and eating styles.Methods: Participants were 324 elementary school children (Girls = 172, 53.1%) aged between 8 and 11 years (Mage = 9.13, SD = .89) assessed through self-report measures. Parents provided information about weight and height.Results: Path analysis model showed an acceptable fit to the data (χ2 (3) = 3.966, p = .256; RMSEA = .032; CFI = .990; TLI = .911; SRMR = .018). Difficulties in differentiating emotions significantly mediated the relationship between maternal control and emotional eating (β = -.071, 95%CI [-.094, -.052]; p < .001). The model was invariant across genders.Conclusions: Our findings support the importance of dyadic interaction in enhancing the risk for dysfunctional eating style during infancy, showing that emotion differentiation deficits may be particularly salient in such relationship. Clinical and practical implications of these findings are discussed.

The impact of trauma-related symptoms and neuroticism on compensatory behaviors in a sample of adults with eating disorders

INTRODUCTION

Inappropriate compensatory behaviors (ICBs), including purging, restricting, and excessive exercising, are key symptoms of several eating disorders (EDs). Studies have found positive associations between trauma and ICBs, although few studies have explored mechanisms that may explain these relationships. Emotion dysregulation has been posited as a mechanism that explains associations among ICBs and trauma. Given that individuals with high neuroticism may be particularly likely to use ICBs to regulate emotions following a trauma, the purpose of this study was to test whether neuroticism moderated the relationship between trauma-related symptoms and each type of ICB (purging, restricting, and excessive exercise).

METHOD

A community sample of adults with a DSM-5 ED (N = 263; 83.7 % female) completed measures of trauma-related symptoms, ED psychopathology, and personality.

RESULTS

Zero-inflated negative binomial models revealed that trauma-related symptoms alone predicted restricting and purging behavior. In addition, we found that neuroticism alone predicted the presence of excessive exercise. We found no significant interaction between trauma-symptoms and neuroticism.

CONCLUSION

Although past research has documented high rates of co-occurring ED and PTSD, the connections between trauma-related symptoms and ICBs are complex and may be unique to each type of ICB. Given that neuroticism may not influence the relationship between trauma-related symptoms and ICBs, more research should be done to establish an understanding of factors that could explain the relationship between ICBs and trauma-related symptoms. Novel interventions that simultaneously target restricting, purging, and trauma-related symptoms could be beneficial to explore.

Associations of positive childhood experiences with binge-eating disorder characteristics and intuitive eating among college students

Childhood experiences encompass both adverse and positive childhood events. Adverse childhood experiences are positively associated with binge-eating disorder characteristics and inversely associated with intuitive eating in adults. However, to what extent positive childhood experiences (PCEs) are associated with binge-eating disorder characteristics and intuitive eating remains unclear. This study examined the associations of cumulative and individual PCEs with binge-eating disorder characteristics and intuitive eating among college students. Data were collected from 828 college students in 2022 (54.5% female, Mage 20.9 ± 2.6 years). PCEs were assessed using the Benevolent Childhood Experiences scale. Binge-eating disorder characteristics were assessed with the Questionnaire on Eating and Weight Patterns-5. Intuitive eating was assessed with the Intuitive Eating Scale-2. Associations of PCEs with binge-eating disorder characteristics and intuitive eating were examined using modified Poisson regressions and linear regressions. PCEs were cumulatively associated with binge-eating disorder characteristics and intuitive eating (p for trend <.05). College students in the low PCEs category (0-4 PCEs) had 1.37-1.92 times the prevalence of binge-eating disorder characteristics and had 3.89 points lower intuitive eating score than those in the high PCEs category (9-10 PCEs). Among the individual PCEs, intrapersonal PCE (i.e., feeling comfortable with oneself during childhood) was associated with both a lower prevalence of binge-eating disorder characteristics (aPR = 0.56-0.76) and a higher score of intuitive eating (adjusted β = 1.87, 95% CI = 1.28-2.46) after adjustment for sociodemographic variables. Findings from this study suggest that PCEs may play a role in eating behaviors of college students. Future studies with nationally representative samples should prospectively examine associations of PCEs with binge-eating disorder characteristics and intuitive eating and explore the underlying mechanisms of the associations between PCEs and eating behaviors.

"If You Don't Lose Weight, the Government Will Take You Away": An Analysis of Memorable Messages and Eating Disorders in the LGBTQ+ Community

Family communication plays a key role in children's body image, disordered eating, and full-blown eating disorders;. However, much existing communication research on eating disorders has focused on general populations. As the LGBTQ+ community is disproportionately affected by eating disorders , more work is needed to better understand how family communication may be perceived as influencing eating disorders in the LGBTQ+ community. Thus, the current study aimed to further this understanding by examining familial memorable messages reported by LGBTQ+ individuals which they perceived to have influenced their eating disorders. In a Qualtrics survey, participants (n = 73) provided memorable messages received from family members and explained their significance. Results of a thematic analysis indicate five themes among the memorable messages: Problematic Body Size/Weight, Pathologized Eating, Emphasizing Appearance Ideals, Emotion Origins, and Other Focus. Findings support the theory of memorable messages and reveal the ways in which diet culture and LGBTQ+ identity stigma intersect within parent-child communication toward a perceived influence on LGBTQ+ eating disorders. Implications for future communication research on LGBTQ+ eating disorders, as well as practical applications, are discussed.

Effects of Bullying on Anxiety, Depression, and Posttraumatic Stress Disorder Among Sexual Minority Youths: Network Analysis

BACKGROUND

Bullying victimization is highly prevalent among sexual minority youths, particularly in educational settings, negatively affecting their mental health. However, previous studies have scarcely explored the symptomatic relationships among anxiety, depression, and posttraumatic stress disorder (PTSD) among sexual minority youths who experienced bullying on college campuses.

OBJECTIVE

The objectives of our study were to (1) characterize the anxiety-depression-PTSD network structures of gay or lesbian, bisexuals, and other sexual minority youths previously bullied on college campuses; and (2) compare symptomatic associations in the anxiety-depression-PTSD networks among bullied sexual minority youths and heterosexual youths' groups.

METHODS

This cross-sectional study recruited college participants from Jilin Province, China. Data were analyzed using a subset of the data extracted after screening for sexual orientation and history of bullying victimization. Sexual minority youths were then divided into 3 subgroups: gay or lesbian (homosexual), bisexual, and other. Mental health symptom severity was assessed using scales: the 7-item Generalized Anxiety Disorder Scale measuring anxiety, the 9-item Patient Health Questionnaire measuring depression, and the 10-item Trauma Screening Questionnaire measuring PTSD symptoms. Combining the undirected and Bayesian network analyses, the anxiety-depression-PTSD networks were compared among sexual minority youths subgroups, and the difference between heterosexual youths and sexual minority youths was investigated. Chi-square tests were used to compare the difference in categorical variables, while independent-sample t tests were run on continuous variables.

RESULTS

In this large-scale sample of 89,342 participants, 12,249 identified as sexual minority youths, of which 1603 (13.1%, 95% CI 12.5%-13.7%) reported being bullied on college campuses in the past year. According to the expected influence (EI) and bridge expected influence (bEI) index, in the global network structure of anxiety, depression, and PTSD, sad mood (EI=1.078, bEI=0.635) and irritability (EI=1.077, bEI=0.954) were identified as central and bridge symptoms; emotional cue reactivity (EI=1.015) was a central symptom of PTSD in this global network. In the anxiety-depression-PTSD Bayesian network, anhedonia had the highest prediction priority for activating other symptoms; and feeling afraid linked symptoms from anxiety to the PTSD community. Compared to their heterosexual counterparts, sexual minority youths exhibited a stronger association between difficulty concentrating and appetite. The "sad mood-appetite" edge was strongest in the gay or lesbian network; the "irritability-exaggerated startle response" edge was strongest in the bisexual network.

CONCLUSIONS

For the first time, this study identified the most central and bridge symptoms (sad mood and irritability) within the depression-anxiety-PTSD network of sexual minority youths with past bullying-victim experiences on college campuses. Emotional cue reactivity, anhedonia, and feeling afraid were other vital symptoms in the comorbid network. Symptomatic relationships existed showing heterogeneity in bullied heterosexual youths and sexual minority youth networks, which also was present within the sexual minority youth subgroups. Consequently, refined targeted interventions are required to relieve anxiety, depression, and PTSD symptoms.

Dysfunctional decision-making in binge-eating disorder: A meta-analysis and systematic review

Binge-Eating Disorder (BED) involves anticipatory craving and urges, subjective loss-of-control during binge-eating episodes, and post-feeding psychological distress and guilt. Evidence indicates neurocognitive dysfunctions contribute to BED onset, maintenance, and treatment response. However, an integrated understanding of how cognitive processes underpin BED symptomology is lacking. We utilised a multi-stage decision-making model defining ten cognitive processes underpinning Preference Formation, Choice Implementation, Feedback Processing, and Flexibility/Shifting, to comprehensively review research published since 2013. We used preregistered PICOS criteria to assess 1966 articles identified from PubMed, PsycInfo, and Scopus database searches. This yielded 50 studies reporting behavioural cognitive tasks outcomes, comparing individuals with BED to controls with normal and higher weight. Meta-analyses revealed a unique profile of cognitive dysfunctions that spanned all decision-making stages. Significant deficits were evident in Uncertainty Evaluation, Attentional Inhibition, Choice Consistency, and Cognitive Flexibility/Set-shifting. We propose a novel model of dysfunctional decision-making processes in BED and describe their role in binge-eating behaviour. We further highlight the potential for cognitive interventions to target these processes and address the significant treatment gap in BED.

Reliability of gamified reinforcement learning in densely sampled longitudinal assessments

Reinforcement learning is a core facet of motivation and alterations have been associated with various mental disorders. To build better models of individual learning, repeated measurement of value-based decision-making is crucial. However, the focus on lab-based assessment of reward learning has limited the number of measurements and the test-retest reliability of many decision-related parameters is therefore unknown. In this paper, we present an open-source cross-platform application Influenca that provides a novel reward learning task complemented by ecological momentary assessment (EMA) of current mental and physiological states for repeated assessment over weeks. In this task, players have to identify the most effective medication by integrating reward values with changing probabilities to win (according to random Gaussian walks). Participants can complete up to 31 runs with 150 trials each. To encourage replay, in-game screens provide feedback on the progress. Using an initial validation sample of 384 players (9729 runs), we found that reinforcement learning parameters such as the learning rate and reward sensitivity show poor to fair intra-class correlations (ICC: 0.22-0.53), indicating substantial within- and between-subject variance. Notably, items assessing the psychological state showed comparable ICCs as reinforcement learning parameters. To conclude, our innovative and openly customizable app framework provides a gamified task that optimizes repeated assessments of reward learning to better quantify intra- and inter-individual differences in value-based decision-making over time.

One body, two faces: How double standards influence body evaluation in women with binge-eating disorder compared to mentally healthy women with higher weight and average weight

OBJECTIVE

Research has found evidence that women with anorexia nervosa (AN) and bulimia nervosa (BN) apply different standards for themselves than for others when evaluating bodies, an aspect of a disturbed body image. This study investigates whether women with binge-eating disorder (BED) likewise show self-deprecating double standards (DS).

METHODS

Women with BED (n = 40), women with higher weight (n = 40) and women with average weight (n = 40) viewed a presentation of different builds, including their individual ideal body, which were presented once with participants' own and once with an unknown woman's face. After each presentation, participants rated their emotional response regarding arousal and valence, and evaluated the body's attractiveness, body fat and muscle mass. DS were defined as the difference in ratings of the same body with one's own and the unknown face.

RESULTS

Women with BED showed a higher degree of negative emotions in response to a thin and a high-weight build, rated lower levels of body attractiveness for an athletic build, and displayed more arousal for almost all builds presented with their own compared to with another face. While women with BED showed a higher burden on measures of eating pathology and body image than the other groups, DS were not more pronounced in women with BED.

DISCUSSION

The findings contradict DS as a characteristic feature of BED, but underline "normative" DS for higher-weight/high-weight builds, reflecting weight stigmatization. Psychoeducation on these DS might complement cognitive-behavioral therapy in BED in order to reduce negative emotions.

PUBLIC SIGNIFICANCE

A bias in body evaluation has been proven in women with anorexia and BN, but no research has examined this in women with BED. This study provides evidence of DS in body evaluation in women with BED, compares the extent of DS between women with BED, higher weight, and average weight, and investigates individual body ideals in women with BED and higher weight.

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

OBJECTIVE

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

METHOD

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

RESULTS

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

DISCUSSION

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

PUBLIC SIGNIFICANCE

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

Eating Disorders in Youth with Chronic Health Conditions: Clinical Strategies for Early Recognition and Prevention

Youth with chronic health conditions face an elevated risk of eating disorders and disordered eating behaviors. Contributors to this phenomenon may include the unique threats faced by this vulnerable population to their body image, their relationships with food and eating, and their mental health and self-esteem. However, youth with chronic health conditions may also experience more severe medical complications and mortality from eating disorder behaviors because of the additional risks conveyed by their underlying conditions. In this review, clinical strategies are provided to support youth with chronic health conditions through early recognition of eating disorder behaviors and prompt referral to treatment, which is important for a better prognosis. Suggestions are also given to mitigate their risk of developing eating disorders by proactively addressing risk factors and offering thoughtful anticipatory guidance that promotes a positive relationship with food and eating.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

DISCUSSION

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

Temporal associations between experiential avoidance and disordered eating behaviors in adolescents and young adults: findings from an epidemiological cohort study with ecological momentary assessment

PURPOSE

Previous studies linking experiential avoidance (EA) and eating pathology have largely relied on single measurements based on traditional retrospective questionnaires. Taking advantage of available repeated assessments of EA and disordered eating behaviors (DEBs) in the everyday lives of young people from an epidemiological cohort, we aimed to investigate ecologically valid temporal associations between these constructs.

METHODS

A random population sample of N = 1180 14-21-year-olds from Dresden, Germany, participated at baseline (2015/2016). As part of smartphone-based ecological momentary assessment (EMA), participants reported on engagement in EA and four DEBs (skipping eating, eating large amounts of food, loss-of-control eating, and restrained eating) up to eight times per day for four days. Multilevel modeling of concurrent and time-lagged associations between EA and DEBs, was conducted among those with at least 50% EMA-compliance (n = 1069).

RESULTS

EA was associated with higher concurrent levels of all four types of concurrent DEBs. In addition, EA significantly predicted subsequent levels of restrained eating. Only loss-of-control eating significantly predicted subsequent EA, and this effect depended on the timespan between consecutive assessments. When this timespan was short, higher Loss-of-control eating predicted lower subsequent EA, while it predicted higher subsequent EA when the timespan was longer.

CONCLUSION

The present findings suggest that EA is temporally closely linked to greater engagement in DEBs, supporting theoretical assumptions that DEBs may serve an attempted avoidance function in the context of unpleasant inner experiences. Future studies may benefit from examining samples with more pronounced eating pathology.

LEVEL OF EVIDENCE

Level IV: Evidence obtained from multiple time series with or without the intervention, such as case studies.

Social media and dating app use are differentially related to same- and next-day disordered eating pathology in young men with loss of control eating

OBJECTIVE

To evaluate whether social networking site (SNS) and dating app use is associated with disordered eating in young men.

METHODS

42 men (18-35y) who reported ≥4 loss of control (LOC) eating episodes in the prior month completed a 14-day ecological momentary assessment (EMA) protocol. Five times throughout the day, participants responded to prompts regarding their dietary restraint, body dissatisfaction, and LOC eating. Each night at ~10 pm, participants reported their total time spent on SNSs and dating apps/websites within the last day.

RESULTS

39 out of 42 cisgender men (M_age = 25.1 ± 5.3 years; 47 % non-Hispanic White, 29 % Black or African American; 63 % non-students; 87 % heterosexual) reported using SNSs and/or dating apps. Neither SNS nor dating app use was associated with body dissatisfaction. Dating app use with associated with higher same- (r² equivalent = 0.022, p = .003) and next-day dietary restraint (r² equivalent = 0.016, p = .02); SNS use was not. More SNS use was associated with lower odds of same- (OR [95 % CI] = 0.86 [0.75, 0.99], p = .044) and next-day LOC eating (OR [95 % CI] = 0.82 [0.71, 0.96], p = .011); links with dating app use were non-significant.

DISCUSSION

Non-significant links for SNS and dating app use with body dissatisfaction, and inverse associations with LOC eating, are contrary to research conducted with girls and women. Research is needed to evaluate whether the quality of SNS and dating app engagement (e.g., specific sites) are more closely related to men's disordered eating, and this work should consider muscularity concerns.

Loss of control may uniquely predict negative affect among the disinhibited eating experiences of high-risk young men

OBJECTIVE

Loss of control (LOC) eating is a disordered eating behavior that is prevalent but understudied among men. It is common for men with LOC eating to concurrently engage in diverse eating behaviors characterized as disinhibited. It remains unclear which eating qualities are most distressing for men. This study evaluated the link between disinhibited eating qualities and subsequent negative affect in young men.

METHODS

42 men (18-35 y) who reported engaging in ≥4 LOC eating episodes in the prior month completed a 14-day ecological momentary assessment protocol. For each meal and snack, participants were asked to rate the extent to which they felt they overate; lost control; ate more than planned; ate mindlessly; had concerns about wasting food; and were encouraged to eat more by others. State negative affect was evaluated during random intervals five times per day.

RESULTS

After adjusting for previous negative affect and time between ratings, five of the six eating qualities were significantly and positively associated with subsequent negative affect according to between-participant findings (ps < 0.026). In within-participant analyses, only LOC was significantly and positively associated with subsequent negative affect (p = 0.044).

DISCUSSION

While a range of disinhibited eating qualities are correlated with negative affect in a sample of young men, a sense of LOC while eating may be a promising target for interventions focused on improving the psychological functioning of high-risk young men.

A daily diary study of emotion regulation as a moderator of negative affect-binge eating associations

BACKGROUND

While negative affect (NA) typically increases risk for binge eating, the ultimate impact of NA may depend on a person's ability to regulate their emotions. In this daily, longitudinal study, we examined whether emotion regulation (ER) modified the strength of NA-dysregulated eating associations.

METHODS

Women (N = 311) from the Michigan State University Twin Registry first reported dimensional binge eating symptoms and broad ER difficulties (e.g., limited emotional awareness, difficulty controlling emotional impulses). Participants then rated use of adaptive (cognitive reappraisal, social sharing, situation modification, and acceptance) and maladaptive (rumination, expressive suppression, and self-criticism) ER strategies, emotional eating (EE), objective binge eating (OBE), and NA once daily for 49 consecutive days.

RESULTS

There were several main effects of ER on binge-eating pathology in both between-person (i.e., comparing women who differed on average) and within-person (i.e., examining fluctuations in variables day-to-day) analyses. Between-person, greater broad ER difficulties, greater maladaptive strategy use, and lower adaptive strategy use were all associated with greater binge-eating pathology. Within-person, greater maladaptive strategy use was associated with greater odds of OBE on that day and on the following day. However, neither broad ER difficulties nor use of specific strategies moderated associations between NA and dysregulated eating in between- or within-person analyses.

CONCLUSIONS

While ER is independently associated with risk for dysregulated eating, it may not fully mitigate the impact of NA. Additional strategies (e.g., decreasing environmental stressors and increasing social support) may be needed to minimize NA and its impact on dysregulated eating.

PUBLIC SIGNIFICANCE

Negative affect (NA; e.g., sadness, guilt) increases dysregulated eating risk. Because NA is sometimes unavoidable, we examined whether emotion regulation (ER; i.e., how a person responds to their emotions) might impact whether NA leads to dysregulated eating. Although more effective ER was associated with less dysregulated eating overall, ER did not impact the association between NA and dysregulated eating. Other approaches may therefore be needed to mitigate NA-dysregulated eating associations.

The efficacy of a transdiagnostic emotion regulation skills training in the treatment of binge-eating disorder-Results from a randomized controlled trial

OBJECTIVES

Deficits in emotion regulation (ER) have been shown to be associated with binge-eating disorder (BED). To further clarify the causal nature of this association, we tested whether systematically enhancing ER skills would reduce symptoms of BED.

METHODS

We randomly allocated N = 101 individuals meeting the criteria for BED to a transdiagnostic ER skills training or to a waitlist control condition (WLC). Primary outcome was the reduction in binges during the treatment-vs.-waiting period as assessed with the Eating Disorder Examination (EDE) interview.

RESULTS

Mixed-model ANOVAs indicated that the average pre-to-post decrease in binges assessed with the EDE was significantly greater in the ER skills training condition than in the WLC (d = 0.66). These effects were stable over the 6-month follow-up period (d = 0.72). Remission rates at post/follow-up were 34.4/45.0% in the skills training and 7.5/20.0% in the WLC. Additionally, we found a greater reduction in general eating disorder psychopathology, of food consumption in a bogus taste test and of depression in the ER skills training condition. Moreover, the greater reduction in binge-eating episodes in the training condition was (partially) mediated by a greater increase in ER skills.

CONCLUSIONS

The findings provide further support for the assumed importance of deficits in ER as a maintaining factor and, hence, as a target in the treatment of BED. As ER skills trainings have been shown to also reduce other kinds of psychopathology, they might be considered a promising transdiagnostic add-on component to disorder-specific interventions.

The Role of Emotion Regulation in Eating Disorders: A Network Meta-Analysis Approach

Background

Previous theoretical models and reviews have documented a strong connection between emotion dysregulation eating disorder (ED) psychopathology among the general and clinical populations. The aim of this review was to build on this previous work by conducting a network meta-analysis to explore associations between adaptive and maladaptive emotion regulation strategies and ED psychopathology trans-diagnostically across the ED spectrum to identify areas of emotion dysregulation that have the strongest association with symptomatology.

Methodology

A total of 104 studies were included in the meta-analysis and correlation coefficient representing the associations between specific emotion regulation strategies and ED symptomatology were extracted. We ran a Bayesian random effects network meta-analysis and the initial network was well-connected with each emotion regulation strategy being linked to at least one other strategy. We also conducted a network meta-regression to explore whether between-study differences in body mass index (BMI), age, and whether the sample consisted of solely female participants explained any possible network inconsistency.

Results

The network meta-analysis revealed that ruminations and non-acceptance of emotions were most closely associated with ED psychopathology. There was no significant network inconsistency but two comparisons approached significance and thus meta-regressions were conducted. The meta-regressions revealed a significant effect of BMI such that the associations between different emotion regulation strategies and ED symptomatology were weaker among those with low BMI.

Discussion

The present findings build on previous work and highlight the role of rumination and difficulties with accepting emotions as key emotion regulation difficulties in EDs. Additionally, the finding that the associations were weaker among ED patients with low BMI may point toward a complex relationship between ED behaviors and emotion regulation. Taken together, our findings call for interventions that target emotion regulation, specifically rumination and difficulties accepting emotions, in the treatment of EDs.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021249996, PROSPERO, identifier: CRD42021249996.

Emotion Dysregulation and Eating Disorder Symptoms: Examining Distinct Associations and Interactions in Adolescents

Emotion dysregulation has been posited as a key transdiagnostic factor of mental health difficulties, including eating disorders. However, how this transdiagnostic factor interacts with the disorder-specific factor of weight and shape concerns remains unclear. The current study examined whether emotion dysregulation is associated with eating disorder behaviors over and above the association between weight and shape concerns and whether these two factors interacted. The current study used data from two samples, a community sample of high school students (n = 2699), and a clinical sample of adolescents receiving outpatient treatment for an eating disorder (n = 149). Participants completed self-report measures on their eating behaviors, weight/shape concerns, and emotion dysregulation. Findings showed that emotion dysregulation had a unique association with engaging in binge eating and purging (community sample only). Weight and shape concerns were found to have a unique association with engaging in binge eating, fasting, purging, and driven exercise (community sample only). Additionally, weight and shape concerns moderated the association between emotion dysregulation and the probability of engaging in binge eating and driven exercise, whereby the strongest association between emotion dysregulation and these behaviors were observed among adolescents with the lowest levels of weight and shape concerns. Regarding the frequency of eating disorder behaviors, emotion dysregulation had a unique association with severity of binge eating and fasting. Weight and shape concerns were uniquely associated with severity of fasting and driven exercise (community sample only). Findings suggest that emotion dysregulation is a distinct factor of eating disorder behaviors among adolescents.

Characterising binge eating over the course of a feasibility trial among individuals with binge eating disorder and bulimia nervosa

Binge eating disorder and bulimia nervosa are eating disorders that are characterized by recurrent binge eating episodes. The highly contextualized nature of binge eating makes naturalistic research a particularly suitable means of understanding the context within which binge eating occurs. The present study aimed to characterise binge eating days with regards to the frequency and probability of negative affect, food craving, meal skipping, and dietary restriction. In addition, it aimed to examine whether a combined intervention that targets the experience of 'loss of control' over eating can decrease these potential maintenance factors that often precede binge eating episodes. Seventy-eight participants with bulimia nervosa (N = 40) or binge eating disorder (n = 38), who were randomly allocated to a food-specific or general intervention combining inhibitory control training and implementation intentions, completed mood and food diaries over four weeks. Results suggest that negative affect and food craving were elevated on binge eating days, but that dietary restraint and meal skipping did not characterise binge eating days. Moreover, meal skipping, binge eating, restriction, and compensation decreased throughout the intervention period, while negative affect and food craving did not. This suggests that some interventions may successfully reduce binge eating frequency without necessarily decreasing negative affect or food craving, thus pointing to the different routes to targeting binge eating and providing implications for future interventions.

Baseline and momentary predictors of ecological momentary assessment adherence in a sample of adults with binge-eating disorder

Ecological Momentary Assessment (EMA) is a widely used methodology to examine psychological and behavioral phenomena among individuals with eating disorders (EDs). While EMA overcomes limitations associated with traditional retrospective self-report, it remains subject to potential methodological limitations, including poor adherence to the EMA protocol, which may bias findings. Little is known about baseline and momentary predictors of missing EMA data in ED research; however, such work may help clarify the correlates of missingness and illuminate steps to address potential bias. The purpose of this study was to investigate predictors of EMA adherence in a sample of adults with binge-eating disorder (BED) enrolled in a randomized treatment trial. Prior to treatment, 110 patients completed self-report questionnaires assessing demographics, psychopathology, and transdiagnostic risk/maintenance factors. Participants then responded to EMA questions regarding their eating behavior and internal states six times a day for seven days. A series of generalized-linear and mixed-effect models were conducted to examine baseline and momentary predictors of EMA adherence. No significant baseline predictors were identified, suggesting that participants' overall level of missing data was not related to person-level characteristics (e.g., gender, level of ED pathology). However, lower positive affect, lower hunger, signals later in the day, later days in the EMA protocol, and missed prior signals predicted greater odds of signal non-response, suggesting certain contextual factors may impact the likelihood that a participant with BED will respond to the subsequent EMA signal. Ultimately, these findings have implications for future eating disorder EMA research.

Influence of suppression and reappraisal on eating-related symptoms and ruminative thinking in anorexia nervosa and bulimia nervosa

The goal of the present study was to investigate the influence of expressive suppression and cognitive reappraisal on eating-related symptomatology in anorexia nervosa (AN) and bulimia nervosa (BN). Secondly, on the background of theoretical models proposing a reciprocal relationship between suppression and rumination, we sought to understand whether inhibition of emotional expression also affects ruminative thinking in eating disorders. Women with AN (n = 39), BN (n = 37) and a control group (CG, n = 41) were randomly assigned to either engage in suppression or reappraisal during a sadness-eliciting film clip. Levels of drive to eat, anticipated loss of control over eating and ruminative thoughts were rated before and after the induction of emotion regulation. Induced expressive suppression led to a decrease of reported drive to eat in AN and an increase of anticipated loss of control over eating in BN. All groups responded to suppression with greater rumination, whereas no significant changes were found for reappraisal. Mediation analyses on trait questionnaires pointed to rumination as a partial mediator of the correlation between suppression and eating disorder pathology. Results are discussed in line with recent empirical research and current emotion regulation theories.

Personality type, eating behaviour and suicide risk in women in treatment for obesity

OBJECTIVES

To determine the personality types of women in treatment for obesity and the associations among their personality characteristics, eating behaviour and suicide risk.

SUBJECTS

Sixty women in pharmacological treatment for obesity (clinical group: CG) and 60 women post-bariatric gastric bypass surgery (surgical group: SG) were evaluated.

METHODS

This was an observational and transversal study conducted in a specialized outpatient unit. Personality types were evaluated through the Myers-Briggs Type Indicator (MBTI) test. A semi-structured questionnaire that investigated sociodemographic and lifestyle characteristics was applied, along with the Binge Eating Scale (BES) and the Columbia-Suicide Severity Rating Scale (C-SSRS).

RESULTS

Among the 16 possible personality types, the ISFJ (Introversion, Sensing, Feeling, Judging) and ESFJ (Extraversion, Sensing, Feeling, Judging) types were more frequent. In the SG, 32% of the participants presented with the ISFJ type, and 18.3% presented with the ESFJ type. In the CG, 33% presented with the ISFJ type and 25% presented with the ESFJ type. There was a higher prevalence of binge eating behaviour in the CG (Cohen's d: - 0.47; p < 0.0001) and a higher tendency to graze in the SG (p = 0.005). Participants with introverted attitudes showed a higher prevalence of severe binging (13.3% vs 3.3%, p = 0.07), suicidal thoughts throughout life (STTL) (69.5% vs 45.1%, p = 0.007), and recent suicidal thoughts (RSTs) (30.4% vs 11.7%, p = 0.01) in comparison to extraverted participants. BMI was associated with a higher chance of STTL (37.96 ± 6.41 kg/m² with STTL vs 33.92 ± 4.68 kg/m² without STTL; p = 0.01) in the CG compared to the SG. RSTs were associated with BMI in the SG (34.47 ± 3.86 kg/m² with RSTs vs 30.61 ± 5.72 kg/m² without RSTs; p = 0.01). In the multivariable analysis, personality type (ISFJ) was an independent predictor of STTL (OR: 3.6; CI 1.3-10.2; p = 0.01) and Suicidal Behaviour (SB) (OR: 9.7; CI 2.44-38.9; p = 0.001). Conversely, while BMI was an independent factor associated with binge eating, personality type was not.

CONCLUSIONS

Women who were in pharmacological treatment for obesity or were post-bariatric surgery present specific types of personality. Introversion was associated with a higher BMI and a higher risk of suicidal thoughts.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

State emotion modulation and loss-of-control eating in individuals with obesity: A preliminary ecological momentary assessment study

There is ample evidence linking broad trait emotion regulation deficits and negative affect with loss-of-control (LOC)-eating among individuals with obesity and binge eating, however, few studies have examined emotion regulation at the state-level. Within and across day fluctuations in the ability to modulate emotion (or regulate emotional and behavioral responses), one facet of state emotion regulation, may be a more robust momentary predictor of LOC-eating than momentary negative affect and trait emotion regulation ability. As such, the current study tested if daily emotion modulation, and daily variability in emotion modulation differed on days with and without LOC-eating episodes, and if momentary emotion modulation was associated with subsequent LOC-eating episodes. For two weeks individuals (N = 14) with obesity and binge eating completed surveys as part of an ecological momentary assessment study. Participants reported on current ability to modulate emotion, LOC-eating, and current negative affect. On LOC-eating days compared to non-LOC-eating days, ability to modulate emotion was poorer (β =0.10, p < .001) and average variability in ability to modulation emotions was greater (β = 0.56, p = .008), even when controlling for negative affect. Greater momentary difficulty modulating emotion was associated with a 40% increase in subsequent risk for LOC-eating (ß = 0.34, p = .071, OR = 1.40). Findings from this pilot study suggest that individuals with obesity report poorer ability to modulate emotion and greater variability in ability to modulate emotion on LOC-eating days, even when controlling for negative affect. Future research should replicate findings and further elucidate the relationships between state emotion regulation, negative affect, and LOC-eating.

Affect Dysregulation in Context: Implications and Future Directions of Experience Sampling Research on Affect Regulation Models of Loss of Control Eating

Loss of control eating is a core, transdiagnostic eating disorder symptom associated with psychological distress, functional impairment, and reduced quality of life. However, the factors that contribute to persistent loss of control eating despite negative consequences are not fully understood. Understanding the mechanisms that maintain loss of control eating is crucial to advance treatments that interrupt these processes. Affect regulation models of loss of control eating hypothesize that negative emotions trigger loss of control eating, and that loss of control eating is negatively reinforced because it temporarily decreases negative affect. Several variations on this basic affect regulation model have been proposed, including theories suggesting that negative affect decreases during loss of control eating rather than afterwards (escape theory), and that loss of control eating replaces one negative emotion with another that is less aversive (trade-off theory). Experience sampling designs that measure negative affect and eating behavior multiple times per day are optimally suited to examining the nuanced predictions of these affect regulation models in people's everyday lives. This paper critically reviews experience sampling studies examining associations between negative affect and loss of control eating, and discusses the implications for different affect regulation models of loss of control eating. The review concludes by proposing an expanded affect-focused model of loss of control eating that incorporates trait-level individual differences and momentary biological and environmental variables to guide future research. Clinical implications and recommendations are discussed.

Gender-Dependent Associations of Anxiety and Depression Symptoms With Eating Disorder Psychopathology in a Representative Population Sample

Background: Evidence shows that anxiety and depressive disorders play an important role in eating disorder behavior. However, given the epidemiology of eating disorders, there is a need to investigate potentially gender-specific connections. Method: This study tested the associations of anxiety and depression symptoms with eating disorder symptoms and behaviors and explored whether they differed between men and women. Within a population-representative survey (N = 2,510; ages 14-94), participants completed measures of depression symptoms (PHQ-2), anxiety symptoms (GAD-2), and eating disorder symptoms (EDE-Q8). We conducted linear regression analyses of the EDE-Q8 sum score and General Linear Models on the three behaviors overeating, binge eating, and compensatory behaviors (self-induced vomiting/use of laxatives/excessive exercising). Results: Depression and anxiety symptoms were related to more eating disorder symptoms in men and women (irrespective of BMI, age, and income). The association of depression and eating disorder symptoms was slightly stronger in women. Overeating was more common in men and in depressed individuals, whereas compensatory behaviors were more common among anxious individuals, especially anxious women. Conclusion: The study extends previous research by using gender-specific methods in a representative sample. It indicates similarities and differences between men and women regarding disordered eating on a population level.

Ecological momentary assessment in eating disorders research: recent findings and promising new directions

PURPOSE OF REVIEW

Ecological momentary assessment (EMA) is an important tool for clarifying common precipitants and consequences of eating disorder symptoms that might be meaningfully targeted in treatments for these pernicious disorders. This article reviews recent advances in EMA work conducted within clinical eating disorder samples.

RECENT FINDINGS

Published studies from the past 2.5 years can broadly be categorized as involving functional analysis of eating disorder behaviors, examining hypothesized predictors of eating disorder symptoms, or applying novel approaches to EMA data. Examples of the latter category include the use of latent profile analysis with EMA data, integration of neurocognitive (e.g., ambulatory inhibitory control task) or biological indicators (e.g., fMRI, plasma leptin), and examining changes in associations between momentary variables over time through multiwave EMA data collection.

SUMMARY

EMA studies in eating disorders have advanced significantly in recent years, with findings demonstrating strong support for the emotion regulation function of eating disorder behaviors and momentary predictors of distinct eating disorder symptoms. The use of novel statistical and data collection approaches represent exciting areas of growth, with likely implications for intervention approaches, including those that utilize ambulatory technology to deliver treatment.

Contributions of Emotional Overload, Emotion Dysregulation, and Impulsivity to Eating Patterns in Obese Patients with Binge Eating Disorder and Seeking Bariatric Surgery

Background: Binge eating disorder (BED) is very frequently observed in patients considered for weight loss surgery and seems to influence their outcome critically. Literature highlights a global emotional overload in individuals with BED, but little is known on the mechanisms involved. The present study aimed to focus on emotion regulation, impulsivity, depression, and anxiety in people with and without BED and fulfilling inclusion criteria for bariatric surgery. Doing so, we sought to individualize factors related to BED. Then, we examined the contribution of depression, anxiety, emotion regulation difficulties, and impulsivity to inappropriate eating behaviors observed in patients with BED. Methods: A sample of 121 individuals (79.3% female, mean age: 40.82 ± 9.26, mean current body mass index (BMI): 44.92 kg/m² ± 7.55) seeking bariatric surgery were recruited at the Champagne Ardenne Specialized Center in Obesity in Reims, France from November 2017 to October 2018. They were stratified as with or without BED according to the binge eating scale. Characteristics identified in univariate analyses as differentiating the two groups were then included in multivariable analyses. Results: Multivariable analyses showed that limited access to emotional regulation strategies was significantly associated with BED. Furthermore, inappropriate eating behaviors were independently associated with age, depression severity, anxiety, emotional dysregulation, and impulsivity in BED group. Conclusions: The present findings are indicative of an association between emotion deficit and BED in obese patients seeking bariatric surgery. Patients with BED could benefit from the addition of an emotion regulation intervention.

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

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

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

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

Examining intra-individual variability in food-related inhibitory control and negative affect as predictors of binge eating using ecological momentary assessment

Binge eating presents in the context of several eating disorders (EDs) and has been shown to be associated with negative affectivity and inhibitory control deficits. While considerable ecological momentary assessment (EMA) work in EDs has demonstrated the importance of intra-individual variability in affect in predicting binge episodes, no research has considered how fluctuations in inhibitory control and negative affect together influence binge eating, or the extent to which these relationships may differ across ED diagnoses. Therefore, the present EMA study assessed the extent to which daily inhibitory control moderated momentary associations between negative affect and binge eating, and whether the presence of regular compensatory behaviors influenced these associations. Participants were 40 women reporting regular binge eating (anorexia nervosa binge-purge type [AN-BP], bulimia nervosa [BN], binge-eating disorder [BED]/subthreshold BED) who completed a 10-day EMA protocol that included measures of affect, eating, and a daily ambulatory Go/No-go task that included palatable food and neutral stimuli. Results of generalized estimating equations indicated greater between-person food-related inhibitory control deficits were associated with greater binge likelihood, and there was a three-way interaction between momentary negative affect, daily food-related inhibitory control, and compensatory behavior group. For individuals with BN or AN-BP, the relationship between momentary negative affect and subsequent binge eating was stronger on days characterized by reduced inhibitory control, whereas no main or interactive effects of negative affect or inhibitory control were observed for those with BED/subthreshold BED. Together these results demonstrate the importance of intra-individual variability in executive functioning and affective processes that underlie binge eating, as well as meaningful individual differences in these momentary associations.

How Is the Sexual Function of Premenopausal Chinese Women Without Hyperlipidemia?

Introduction

Most premenopausal women in China have normal lipid profiles while the sexual function among them was scarcely demonstrated.

Aim

To find out the characteristics of the sexual function in premenopausal Chinese women without hyperlipidemia using the Female Sexual Function Index (FSFI) and the Golombok Rust Inventory of Sexual Satisfaction (GRISS).

Methods

This cross-sectional study was performed to find out the characteristics of sexual function in premenopausal Chinese women without hyperlipidemia. Between January 2019 and March 2019, we recruited 216 women, 25–49 years of age. Data from questionnaires and health checkups were collected and analyzed.

Main Outcome Measure

We report the prevalence of and factors related to female sexual dysfunction (FSD) in premenopausal Chinese women without hyperlipidemia in accordance with the FSFI and the GRISS.

Results

The prevalence of FSD in our study was 46.2%. The mean age was 38.07 ± 6.94 years. More highly educated women suffered from FSD than those in the control group (61.1% vs 35.2%, P < .05). Binge eating was significantly different between the groups (P = .023). Multiple logistic regression analyses demonstrated that total cholesterol level was positively associated with low desire (OR, 2.13; 95% CI, 1.10–4.13; P = .025) and so was the low-density lipoprotein level (OR, 2.18; 95% CI, 1.03–4.62; P = .0.041). The high-density lipoprotein level was inversely associated with infrequency (OR, 0.18; 95% CI, 0.06–0.59; P = .004). More women with FSD had orgasm disorder than those in the control group, for 83.3% vs 35.2% in the FSFI (P < .001), 88.9% vs 54.3% in the GRISS (P < .001), respectively. Dissatisfaction remained the most common issue for the control group in both the FSFI and the GRISS (90.50% and 58.10%, respectively).

Conclusions

FSD is frequent in premenopausal Chinese women without hyperlipidemia. Dissatisfaction as the common problem influenced over half of them and orgasm disorder is a severe sexual issue for women with FSD.

Xiang Y, Tang Y, Li J, et al. How Is the Sexual Function of Premenopausal Chinese Women Without Hyperlipidemia. J Sex Med 2019;8:65–75.

Eye-tracking study on the effects of happiness and sadness on body dissatisfaction and selective visual attention during mirror exposure in bulimia nervosa

OBJECTIVE

Abundant research points to the central role of body image disturbances in the occurrence of eating disorders (ED). While emotional arousal has been identified as a trigger for binge eating in bulimia nervosa (BN), empirical knowledge on the influence of emotions on body image in individuals with BN is scarce. The present study sought to experimentally examine effects of a positive and negative emotion induction on body dissatisfaction and selective attention towards negatively valenced body parts among people with BN.

METHOD

In a randomized-controlled cross-over design, happiness and sadness were induced by film clips one-week apart in women with BN (n = 23) and non-ED controls (n = 26). After the emotion induction, participants looked at their body in a full-length mirror, while their attentional allocation was recorded with the help of a mobile eye tracker. Participants repeatedly rated their momentary body dissatisfaction.

RESULTS

Induction of happiness led to a significant decrease in self-reported body dissatisfaction. Furthermore, attentional bias (higher gaze duration and frequency) towards the most disliked body part relative to the most liked body part was significantly greater in the sadness than happiness condition in BN. No significant effects of emotion induction on gaze duration and gaze frequency during mirror exposure were found for controls.

DISCUSSION

In line with assumptions of current models on ED, findings support the notion that emotional state influences the body image of patients with BN.