Gender differences in the association between alexithymia and emotional eating in obese individuals

Sex-related differences in eating behaviors during COVID-19 pandemic: A systematic review with metanalysis

Eating behavior can be influenced by external factors; however, there is no consensus on the existence of differences in eating behavior between the sexes in stressful situations, such as the COVID-19 pandemic. This systematic review assessed whether there was a difference in eating behavior between sexes during the COVID-19 pandemic. A search of nine databases (Medline/Pubmed, Embase, Scielo, VHL, Scopus, PsycINFO, Web of Science, ProQuest, Google Scholar) was conducted in October 2023. Studies reporting eating behaviors in males and females during the COVID-19 pandemic were included. Methodological quality was assessed using the Joanna Briggs Institute Critical Appraisal Instrument. Stratified meta-analyses were conducted using the STATA software. Of the 2388 studies identified, 45 were included in the qualitative synthesis, and 36 in the meta-analysis, encompassing a total of 35,792 participants. Validated questionnaires were used to assess eating behavior, including the TFEQ (33.3%), DEBQ (24.4%), EEQ (22.2%), EES (11.1%), EOQ-5 (2.2%), AEBQ (2.2%), EAS (2.2%), and EMAQ (2.2%). Overall, males exhibited lower scores in emotional eating (Cohen's d = -0.32, 95%CI: 0.46 to -0.17) and restrained eating (Hedges'g = -0.11, 95%CI: 0.16 to -0.06) compared to females. However, the subgroup analysis indicated no differences in emotional eating (subgroup difference p = 0.39) or restrained eating (subgroup difference p = 0.30) according to the year of pandemic. These findings underscore the importance of sex-specific interventions, the address eating behaviors during periods of heightened insecurity in worldwide health emergencies, such as the COVID-19 pandemic. Additionally, our results emphasize the necessity for public health strategies to monitor and promote healthy eating behaviors to mitigate their impact on overall health outcomes, even in males, as their eating behavior may be affected over the course of a global health crisis, as well as females.

Emotion dysregulation and obesity: A conceptual review of the literature

Problematic eating behaviours are prevalent in individuals living with obesity and have been linked to weight gain over time. Furthermore, there is evidence that heightened negative emotionality is common in a subset of individuals living with obesity and that negative emotions often precede problematic eating behaviours. Consequently, several theories have highlighted emotion dysregulation as a potential explanatory mechanism of this relationship. However, to date, no comprehensive review has compiled the specific ways in which individuals living with obesity exhibit emotion dysregulation. The present review utilizes Gratz and Roemer's (2004) multidimensional conceptualization of emotion regulation and dysregulation as a framework to summarize the extant literature on emotion dysregulation in obesity. Specifically, this review examines research related to: (1) awareness and clarity of emotions; (2) acceptance of, and willingness to experience, emotion; (3) the ability to remain goal directed and inhibit impulsive behaviour when distressed; and (4) access to emotion regulation strategies. Overall, findings from the present review demonstrate that individuals living with obesity exhibit deficits in emotion clarity, and experience difficulty inhibiting impulsive behaviour and remaining goal directed when experiencing emotion. Strengths and limitations of the literature are reviewed, and future research directions and clinical implications are discussed in light of these findings.

Perceived Stress and Depressive Symptoms Are Associated With Emotional Eating but Not Nutritional Intake During Pregnancy: A Prospective Cohort Study

INTRODUCTION

Pregnancy is a major life event during which women may experience increased psychological distress and changes in eating behaviors. However, few studies have investigated the influence of psychological distress on pregnant women's eating behaviors. The primary objective of this prospective study was to examine the associations of changes in perceived stress and depressive symptoms with emotional eating and nutritional intake during pregnancy. In addition, we examined the direct and moderating effects of perceived social support.

METHODS

Participants were racially diverse pregnant women (14-42 years) from 4 clinical sites in Detroit, MI, and Nashville, TN (N = 678). We used multiple linear and logistic regression models to determine if changes in stress and depressive symptoms across pregnancy were associated with changes in emotional eating and nutritional intake. We examined residualized change in stress and depressive symptoms from second to third trimester of pregnancy; positive residualized change scores indicated increased stress and depressive symptoms.

RESULTS

Participants showed significant improvement in emotional eating and nutritional intake from second to third trimester of pregnancy (P < .001 for both). At second trimester, higher depressive symptoms were associated with a greater likelihood of emotional eating (P < .001) and worse nutritional intake (P = .044) at third trimester. Increased stress and depressive symptoms during pregnancy were both associated with increased risk, whereas increased perceived social support reduced risk of emotional eating at third trimester (stress: adjusted odds ratio [AOR], 1.17; 95% CI, 1.08-1.26; depressive symptoms: AOR, 1.05; 95% CI, 1.01-1.08; social support: AOR, 0.93; 95% CI, 0.88-0.99). None were associated with changes in nutritional intake. Perceived social support did not show any moderating effects.

DISCUSSION

Increased psychological distress during pregnancy may increase emotional eating. Efforts to promote healthy eating behaviors among pregnant women should consider and address mental health.

Challenges and opportunities for conceptualizing intuitive eating in autistic people

Although intuitive eating (IE) has become an increasingly adopted intervention target, current conceptualisations of IE have yet to pivot away from (neuro)normative physiology and phenomenology. Autistic individuals commonly report disordered eating behaviours and/or poorer well-being but appear to benefit from adaptive interventions using an affirmative approach. This article uses autism as a case example to summarise challenges related to IE's prevailing conceptualisation, before proposing how future research and current practice can be extended to the autistic population. Scholars are encouraged to evaluate the full 10-principal IE framework while utilising a participatory-led approach. We argue that research using a mixed methods design is urgently needed to comprehensively explore the (re)conceptualisation of IE in autistic people. While IE shows promise for producing positive outcomes in the autistic population, we discuss the potential challenges for research and practice due to its current emphasis on accurate interoception, emotional awareness and processing, and executive functioning. This suggests the need for research and practice to integrate autistic needs and experiences into future developments with an affirmative approach. Public Significance: IE is an effective intervention for reducing disordered eating behaviours. Autistic individuals commonly present disordered eating behaviours and have unique nutritional needs which often require intervention. However, there is limited understanding of IE among the autistic population. Research-informed definitions involving autistic perspectives will support translating the IE framework to this underrepresented population.

Exploring tailored virtual emotion regulation approaches for individuals with emotional eating

BACKGROUND

Emotional eating is a complex problem fostering obesity and resulting from maladaptive emotion regulation. Traditional behavioural weight loss interventions have shown insignificant effect. They can be improved by targeting the specific needs of individuals with emotional eating.

OBJECTIVE

The current study explored a tailored online approach with the aim to positively influence affect (positive and negative) and emotion regulation by applying one of three exercises: body scan, opposite action, and positive reappraisal.

DESIGN

An embedded mixed-method design (questionnaire data (t0, t1, t2) and perceived usefulness of exercises in t2) was used to evaluate the effects of a two-week online quasi-experimental pilot study.

SUBJECTS/SETTING

In total, 80 participants with self-reported emotional eating difficulties (DEBQ-E; Memo = 3.48, SD = .64, range 1.62-4.92) finished baseline measurements; 15 completed the intervention. The study sample was predominantly female (95%), from 18 till 66 (Mage = 38,0 ± SD = 14.25).

RESULTS

Participants reported that the exercises helped them to pay attention to their physical sensations, and to see positive aspects in negative matters. The exercises were considered difficult by the participants, with too little explanation, and dull, due to minor variation. The observed changes revealed small, and moreover, not significant improvements of the three exercises on positive and negative affect and overall emotion dysregulation. Although the quantitative results did not reach significance, the qualitative data highlighted which aspects of the tailored exercises may have contributed to mood and emotion regulation outcomes. A notable observation in the present study is the substantial dropout rate, with the number of participants decreasing from 80 at baseline (T0) to 15 at the post-intervention stage (T2).

CONCLUSIONS

Future studies should identify tailored online exercises in emotion regulation skills in more detail and explore the contexts in which they are most effective in a personalized virtual coach virtual coach to be developed for individuals with emotional eating. Given the high dropout rate, more emphasis should be given to a proper presentation of the exercises, as well as more explanation of their usefulness and how to perform them.

Emotional Regulation Underlies Gender Differences in Pathological Eating Behavior Styles of Bariatric Surgery Candidates

Almost a third of bariatric surgery patients present suboptimal weight loss or important weight regain in the first five postoperative years. While the reasons underlying this are not fully understood, it is known that pathological eating styles (such as emotional or binge eating) can thwart efforts to maintain weight loss. However, detailed characterization and understanding of these eating styles have yet to be achieved. In particular, research on gender differences in pathological eating styles and psychiatric symptoms before bariatric surgery is lacking. To characterize gender differences in eating styles and their association with clinical symptoms, we prospectively enrolled 110 bariatric surgery candidates, collecting eating styles and clinical scores. Women displayed a higher frequency of emotional eating as compared to men (x2 = 9.07, p = 0.003), while men showed a higher frequency of quantitative eating behavioral style (x2 = 4.58, p = 0.044). Binge eating style was associated with higher Difficulties in Emotion Regulation Scale (DERS), Hamilton Depression Scale (HAM-D), and Hamilton Anxiety Scale (HAM-A) scores (p < 0.05). Emotional eating style was associated with higher HAM-D and HAM-A scores (p < 0.05). The present findings highlight the importance of understanding the role of gender differences in emotion regulation processes involved in the development and maintenance of pathological eating styles in bariatric surgery candidates. This paves the way to gender- and symptoms-specific interventions on eating behaviors to improve surgery long-term outcomes.

Depression mediates the relationship between alexithymia and obesity in the Northern Finland Birth Cohort 1966 (NFBC1966)

BACKGROUND

The fact that a complex relationship exists between alexithymia and body mass index (BMI) is well established, but the underlying mechanisms remain poorly understood. Here, we explore the relationship between alexithymia and depressive symptoms in relation to adiposity measures, including the direct and indirect effect of alexithymia and depressive symptoms on obesity over a 15-year time-period, in the Northern Finland Birth Cohort 1966 (NFBC1966).

METHODS

The study included individuals from the Northern Finland Birth Cohort 1966 (NFBC1966) who had available data for adiposity measures (body mass index and waist-to-hip ratio), alexithymia (measured by the 20-Item Toronto Alexithymia Scale: TAS-20), depressive symptoms (measured by the 13-item depression subscale of Hopkins Symptom Checklist: HSCL-13) at age of 31 years (n = 4773) and 46 years (n = 4431). Pearson's (r) correlation, and multiple linear regression were used to investigate the relationships between alexithymia, depressive symptoms, and adiposity measures. The potential mediating role of depressive symptoms was examined via Hayes' procedure (PROCESS).

RESULTS

Positive correlations were confirmed between adiposity measures (BMI and WHR) and the TAS-20 score (and its subscale), but not between obesity and HSCL-13 score. The strongest correlation was between the DIF (difficulty identifying feelings) subscale of the TAS-20 and HSCL-13 at both time points (31 y: r₍₃₀₁₃₎ = 0.41, p < 0.01, 46 y: r₍₃₀₁₃₎ = 0.43, p < 0.01). Depressive symptoms completely (z = 2.55 (±0.00003), p = 0.01) and partly (z = 2.16 (±0.0001), p = 0.03) mediated the alexithymia-obesity relationship over the 15-year time-period.

LIMITATIONS

Other psychological and environmental factors such as interoception, dietary intake and physical activities may also play a role as a potential mediating factor in alexithymia-obesity relationship.

CONCLUSIONS

Our findings provide additional insights of theoretical framework of depressive symptoms mediation effect in the relationship between alexithymia and obesity. Alexithymia and depression should, therefore, be considered in the design of future clinical obesity research.

Evaluation of perceived depression, anxiety, stress levels and emotional eating behaviours and their predictors among adults during the COVID-19 pandemic

OBJECTIVE

This study aimed to (1) evaluate the prevalence and predictors of perceived depression, anxiety, stress (DAS) levels and emotional eating behaviours and (2) determine the correlations between DAS levels and emotional eating behaviours during the pandemic.

DESIGN

An online cross-sectional study included questions about demographic and anthropometric characteristics, dietary habits, Emotional Appetite Questionnaire (EMAQ) and Depression Anxiety Stress Scales. The snowball sampling method was used.

SETTING

Türkiye.

PARTICIPANTS

The study population was 2002 adults aged ≥18 years.

RESULT

The mean age was 27·1 ± 9·52 years (72·1 % females and 27·9 % males). The prevalence of moderate to severe DAS was reported as 27·8 %, 30·5 % and 30·7 %, respectively. Skipping meals (OR = 1·32, 95 % CI (1·14, 1·49)) was associated with depression. Weight gain (OR = 1·43, 95 % CI (1·19, 1·66); OR = 1·30, 95 % CI (1·14, 1·49); OR = 1·39, 95 % CI (1·14, 1·64)), weight loss (OR = 1·45, 95 % CI (1·20, 1·70); OR = 1·37, 95 % CI (1·11, 1·62); OR = 1·46, 95 % CI (1·20, 1·72)), exercising at least 150 min/week (OR = 0·64, 95 % CI (0·46, 0·83); OR = 0·73, 95 % CI (0·55, 0·92); OR = 0·83, 95 % CI (0·63, 1·02)), and maintaining an adequate and balanced diet (OR = 0·52, 95 % CI (0·33, 0·71); OR = 0·53, 95 % CI (0·34, 0·73); OR = 0·63, 95 % CI (-0·15, 0·35)) were associated with DAS, respectively. BMI (r = 0·169, P < 0·001), weight (r = 0·152, P < 0·001), number of snacks (r = 0·102, P = 0·011), depression (r = 0·060, P = 0·007), anxiety (r = 0·061, P = 0·006) and stress (r = 0·073, P = 0·001) levels were positively correlated with EMAQ-negative scores.

CONCLUSION

Approximately one out of every three participants reported moderate to severe DAS levels. Emotional eating was significantly correlated with perceived DAS. The predictors obtained in the study suggest that a healthy diet and lifestyle behaviours are part of psychological well-being and emotional eating.

Link between emotional and external eating behaviors, peripheral neuropeptide Y, and β-hydroxybutyrate in participants with obesity on 12-week ketogenic diet

Objective: Understanding the impact of stress on emotional and external eating behaviors and the psychological and the associated metabolic factors can help in designing subsequent interventions to protect health. In particular, psychological trait-like construct related to eating has been shown to be an important target for intervention. Methods and measures: This study aimed to investigate the biochemical variables associated with a decrease in emotional and external eating behaviors due to 12-week ketogenic diet (12KD) in 35 adult participants (12 males) with obesity. Results: Absolute changes in emotional and external eating were independent of changes in body mass, nutritional intake, and Δ cortisol, but were predicted with increases in serum β-hydroxybutyrate (BHB) and decreases in serum peripheral neuropeptide Y (pNPY) (all p's < 0.050). Decrease in pNPY was also associated with an increase in BHB but was independent of anthropometrical changes, Δ fasting glucose, and Δ insulin. Conclusion: The reductions in emotional and external eating behaviors in participants with obesity were uniquely predicted by an increase in BHB and a decrease in pNPY after 12KD. In ketosis, emotional and external eating dropped independently of body mass change. Change in pNPY predicted changes in emotional and external eating. The role of BHB in modulating eating behavior should be further explored.

A systematic review of the relationship between alexithymia and emotional eating in adults

Elucidating psychological characteristics associated with emotional eating may further inform interventions for this behaviour related to eating psychopathology. The present systematic review aimed to examine the relationship between alexithymia and self-reported emotional eating in adults, and provide a narrative synthesis of the existing literature. Using the PRISMA method for systematic reviews, six databases (MEDLINE, PsycInfo, PsycArticles, PubMed, SCOPUS, and Web of Science) were searched for peer-reviewed, quantitative research published between January 1994 and 20^th July 2021, when the searches were conducted. Eligible articles investigated the association between alexithymia, as measured by the Toronto Alexithymia Scale (Bagby, Parker, & Taylor, 1994), and emotional eating, as measured by any validated self-report instrument. Nine cross-sectional articles were reviewed, and risk of bias was assessed using the Appraisal Tool for Cross-Sectional Studies (Downes, Brennan, Williams, & Dean, 2016). A narrative synthesis of articles suggests positive associations between alexithymia and self-reported emotional eating. Five measures of emotional eating were used across articles, with limited but consistent evidence for the relationship between alexithymia and emotional eating as measured by the Dutch Eating Behaviour Questionnaire (Van strien et al., 1986). Further research is required to add evidence to the nature of the relationship between alexithymia and emotional eating, and to explore mechanisms that might underpin any relationships. Understanding the association between alexithymia and emotional eating may support strategies and interventions for those seeking help for emotional eating and related eating behaviours.

Negative emodiversity is associated with emotional eating in adolescents: An examination of emotion dynamics in daily life

INTRODUCTION

Emotional eating is a mental health concern, common in adolescents, that develops as a result of their tendency to use high-energy food to regulate their fluctuating emotions. Due to their highly fluctuating emotional life, adolescents tend to have unique within-person profiles of emotional experiences that change across moments and days, often lost in global assessments of emotions. Hence, it is imperative to examine individual differences in dynamics of emotions, as experienced in daily life, in relation to emotional eating in adolescents.

METHODS

In an Ecological Momentary Assessment study, we examined individual differences in three within-person dynamic characteristics (baseline levels, intraindividual variability, and emodiversity) of emotions in 158 dominantly Hispanic adolescents in the United States, aged 14-17 years old, predicting trait-level emotional eating.

RESULTS

Results indicated that higher negative emodiversity, baselines, and variability in stress were predictive of emotional eating in adolescents. When all considered together, negative emodiversity (i.e., variety of the types of negative emotions experienced in one's daily life) remained the only significant predictor of emotional eating.

CONCLUSIONS

This study affirms the importance of diversity in emotional experiences in relation to emotional eating, particularly in daily contexts of adolescents' lives. Additionally, the study emphasizes the importance of distinguishing between diversity (i.e., variety in types) in positive versus negative emotional experiences with regard to emotional eating. By taking into account the ecological validity of adolescents' daily lives and individual differences in dynamical changes in emotions, we are taking a step forward by shedding light on how the dynamics of negative emotions-in terms of within-person baselines, variability, and diversity-might be related to general levels of emotional eating in adolescents.

What about males? Exploring sex differences in the relationship between emotion difficulties and eating disorders

OBJECTIVE

While eating disorders (EDs) are more commonly diagnosed in females, there is growing awareness that men also experience EDs and may do so in a different way. Difficulties with emotion processing and emotion regulation are believed to be important in EDs, but as studies have involved predominantly female samples, it is unclear whether this is also true for males.

METHODS

In a sample of 1604 participants (n = 631 males), we assessed emotion processing and emotion regulation in males with EDs (n = 109) and compared results to both females with EDs (n = 220) and males from the general population (n = 522). We also looked at whether emotion processing and emotion regulation difficulties predicted various aspects of eating psychopathology and whether this was moderated by sex. We assessed emotion processing with the Toronto Alexithymia Scale, emotion regulation with the Difficulties in Emotion Regulation Scale and the Emotion Regulation Questionnaire, and eating psychopathology with the Eating Disorder Examination Questionnaire.

RESULTS

We found that males with ED, like their female counterparts, suffered from emotion processing and emotion regulation deficits. We did find some sex differences, in that males with EDs tended to report more difficulties with their emotions as well as a more externally oriented thinking style compared to females with EDs. Difficulties with emotion processing and emotion regulation were strongly predictive of various aspects of eating psychopathology in both sexes. Importantly, we found that sex moderated the relationship between cognitive reappraisal and eating restraint. As such, low use of reappraisal was found to be associated with higher levels of restraint in females but not in males.

DISCUSSION

Difficulties with emotion processing and emotion regulation are associated with eating psychopathology in both males and females. Reappraisal was not found to be associated with reduced eating psychopathology in males, suggesting a cautious approach to interventions targeting this strategy. Research around explanatory mechanisms and interventions must adopt a broader viewpoint including those that are traditionally overlooked in EDs.

Judgment towards emotions as a mediator of the relationship between emotional eating and depression symptoms in bariatric surgery candidates

PURPOSE

Emotional eating is common in bariatric surgery candidates, and often is associated with depression and poorer weight loss outcomes following surgery. However, less is known about other modifiable risk factors that may link depression and emotional eating. The aim of the current study was to examine facets of mindfulness as potential mediators of the relationship between emotional eating and depression severity in bariatric surgery candidates.

METHODS

Bariatric surgery candidates (n = 743) were referred by their surgeons for a comprehensive psychiatric pre-surgical evaluation that included self-report questionnaires assessing depression severity, emotional overeating, and facets of mindfulness. Mediation effects were examined for each mindfulness facet based on prior research.

RESULTS

Only the nonjudging mindfulness facet significantly mediated the relationship between emotional eating and depression, suggesting that greater emotional eating may be associated with greater depression severity through higher levels of judgement towards thoughts and emotions. A reverse mediation analysis showed that depression severity was not a significant mediator of the relationship between nonjudging and emotional eating.

CONCLUSION

Fostering a nonjudgmental stance towards thoughts and feelings may be helpful in improving eating habits that would support greater post-surgical success. Other clinical and research implications are discussed.

LEVEL OF EVIDENCE

Level V, descriptive study.

A Tailored Gender-Sensitive mHealth Weight Loss Intervention (I-GENDO): Development and Process Evaluation

BACKGROUND

Given the increase in the prevalence of overweight and obesity worldwide, the number of digital weight loss interventions has also risen. However, these interventions often lack theoretical background and data on long-term effectiveness. The consideration of individual and gender differences in weight-related psychological parameters might enhance the efficacy and sustainability of mobile-based weight loss interventions.

OBJECTIVE

This paper presented an introduction to and the process evaluation of a 12-week gender-sensitive mobile health (mHealth) weight loss intervention (I-GENDO) combining computer-based and self-tailoring features.

METHODS

Between August 2020 and August 2021, individuals with overweight (BMI 25.0-29.9 kg/m²), those with obesity class I (BMI 30.0-34.9 kg/m²), and those with obesity class II (BMI 35.0-39.9 kg/m²) were recruited to the I-GENDO project, a multicenter study in Germany. The mHealth intervention aimed at targeting individual psychological factors associated with the development and persistence of overweight and obesity (eg, emotional eating) using computer-based tailoring. Moreover, the intervention took a gender-sensitive approach by implementing self-tailoring of gender-targeted module versions. The computer-based assignment of the main modules, self-selection of gender-targeted module versions, and use patterns were evaluated while considering gender. Moreover, gender differences in the usability assessment were analyzed.

RESULTS

Data from the intervention arm of the study were processed. A total of 116 individuals with overweight and obesity (77/116, 66.4% women; age mean 47.28, SD 11.66 years; BMI mean 33.58, SD 3.79 kg/m2) were included in the analyses. Overall, the compliance (90/109, 82.6%) and satisfaction with the app (mean 86% approval) were high and comparable with those of other mobile weight loss interventions. The usability of the intervention was rated with 71% (5.0/7.0 points) satisfaction. More women obtained the main module that focused on emotion regulation skills. Most men and women selected women-targeted versions of the main modules. Women used the app more frequently and longer than men. However, women and men did not differ in the progress of use patterns throughout the intervention.

CONCLUSIONS

We developed a tailored gender-sensitive mHealth weight loss intervention. The usability of and engagement with the intervention were satisfactory, and the overall satisfaction with the intervention was also high. Gender differences must be considered in the evaluation of the effectiveness and sustainability of the intervention.

Nutritional behavior during the COVID-19 pandemic: the association of fear and sleep quality with emotional eating

PURPOSE

Even though it is known that fear and poor sleep quality trigger emotional eating, whether fear and poor sleep quality are associated with emotional eating during the COVID-19 pandemic is not clear. This study aimed to evaluate the association of fear of COVID-19, sleep quality, and some sociodemographic characteristics with emotional eating during the COVID-19 pandemic.

METHOD

This cross-sectional descriptive study was completed with 495 participants in Turkey. The participants filled out a questionnaire that asked about sociodemographic characteristics, fear of COVID-19, nutritional behaviors, sleep quality, and self-reported weight and height through email or social media.

RESULTS

The fear of COVID-19 score (β: 0.090, p < 0.05) and sleep quality score (β: 0.289, p < 0.001) were associated with the emotional eating score at the rate of 0.8% and 8.3%, respectively. The association of fear of COVID-19 with emotional eating disappeared when combined with various factors. The collective association of all factors, fear of COVID-19 (β: 0.042, p > 0.05), sleep quality (β: 0.246, p < 0.001), BMI (β: 0.275, p < 0.001), age (β:  - 0.259, p < 0.001) and gender (β:  - 0.169, p < 0.001) were associated with the emotional eating score at the rate of 18.3%.

CONCLUSIONS

These findings suggest that fear of COVID-19, sleep quality, BMI, age, and gender were associated with emotional eating during the pandemic. We hope that this study will help in the development of guidelines and strategies through understanding the factors associated with nutritional behavior during the pandemic period.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Going beyond the DSM in predicting, diagnosing, and treating autism spectrum disorder with covarying alexithymia and OCD: A structural equation model and process-based predictive coding account

Background

There is much overlap among the symptomology of autistic spectrum disorders (ASDs), obsessive compulsive disorders (OCDs), and alexithymia, which all typically involve impaired social interactions, repetitive impulsive behaviors, problems with communication, and mental health.

Aim

This study aimed to identify direct and indirect associations among alexithymia, OCD, cardiac interoception, psychological inflexibility, and self-as-context, with the DV ASD and depression, while controlling for vagal related aging.

Methodology

The data involved electrocardiogram (ECG) heart rate variability (HRV) and questionnaire data. In total, 1,089 participant's data of ECG recordings of healthy resting state HRV were recorded and grouped into age categories. In addition to this, another 224 participants completed an online survey that included the following questionnaires: Yale-Brown Obsessive Compulsive Scale (Y-BOCS); Toronto Alexithymia Scale 20 (TAS-20); Acceptance and Action Questionnaire (AAQII); Depression, Anxiety, and Stress Scale 21 (DAS21); Multi-dimensional Assessment of Interoceptive Awareness Scale (MAIA); and the Self-as-Context Scale (SAC).

Results

Heart rate variability was shown to decrease with age when controlling for BMI and gender. In the two SEMs produced, it was found that OCD and alexithymia were causally associated with autism and depression indirectly through psychological inflexibility, SAC, and ISen interoception.

Conclusion

The results are discussed in relation to the limitations of the DSM with its categorical focus of protocols for syndromes and provide support for more flexible ideographic approaches in diagnosing and treating mental health and autism within the Extended Evolutionary Meta-Model (EEMM). Graph theory approaches are discussed in their capacity to depict the processes of change potentially even at the level of the relational frame.

Alexithymia and binge eating: Maladaptive emotion regulation strategy or deficient interoception?

Alexithymia has been linked to various excessive behaviors as a likely risk factor, including binge eating. Such relationships are often attributed to deficient emotional self-regulation in alexithymia, ostensibly leading to the use of maladaptive, externalized behaviors as strategies for coping with distress. An alternative view is that alexithymia reflects a fundamental deficit of interoceptive awareness that, in the case of binge eating, would suggest that internal satiety cues are poorly recognized, promoting overconsumption. The present study assessed the relationship between alexithymia and binge eating in the context of these competing hypotheses. A large online sample of young adults (n = 532) completed validated measures of alexithymia, emotion regulation, interoception, binge eating, emotional eating motivation, and sensitivity to reward and punishment. Correlations were as expected except for interoception, which showed minimal association with alexithymia or binge eating. In a hierarchical regression controlling for age, gender, education level and student status as covariates, binge eating was predicted by emotional eating motivation, emotion regulation (a negative predictor), alexithymia, and reward sensitivity, with the final model explaining 53% of variance in binge eating. Bootstrapped path analyses controlling for all other variables indicated that the relationship between alexithymia and binge eating was mediated by deficient emotion regulation but not deficient interoception, and that the relationships of both alexithymia and emotion regulation with binge eating were mediated by emotional eating motivation. Results are consistent with the notion that the association of alexithymia with binge eating reflects deficient emotion regulation in alexithymia, which can lead to adoption of maladaptive, externalized behaviors such as binge eating for coping with distress.

Gender and Emotional Representation Matter: Own Illness Beliefs and Their Relationship to Obesity

Background

Current treatments of obesity often fail to consider gender and psychological aspects, which are essential for weight loss and weight maintenance. The aim of our study was to analyze subjective illness representations (SIRs) of adults with obesity according to the Common-Sense Self-Regulation Model (CSM) by assessing their associations with weight-related variables and gender.

Methods

Data was collected via online self-assessment between April 2017 and March 2018. SIRs were operationalized by the revised Illness Perception Questionnaire (IPQ-R) and illness outcomes according to the CSM were defined as BMI, eating behaviour, physical wellbeing, bodyweight satisfaction, and shape concerns. The sample consisted of 427 adults (M = 42.2 years, SD = 10.9; 82% female) with obesity (BMI: M = 42.3 kg/m², SD = 9.0). Student's t-tests and multiple hierarchical regression analyses were conducted with the control variables (age and BMI) and subjective illness representations and gender as independent variables.

Results

The explanation of outcome variances was moderate to high (21-43%) except for restraint eating behaviour (10%). Subjective illness representations showed several significant associations with weight-related variables, especially timeline and emotional representations. Female gender was significantly associated with more restraint eating behaviour [F_{(1, 400)} = 4.19, p < 0.001] and females had unfavourable values of the weight-related variables as well as a more cyclic [t₍₄₂₅₎ = 3.68, p < 0.001], and more emotional representation [t₍₁₀₀₎ = 5.17, p < 0.001] of their obesity.

Conclusion

The results of this study indicate that gender and subjective illness representations, especially the emotional representation, play an important role for weight-related variables. Therefore, the assessment of SIRs may constitute an economic tool to identify specific individual deficits of self-regulation.

The Relationship Between Fears of Compassion, Emotion Regulation Difficulties, and Emotional Eating in College Students: A Moderated Mediation Model

Although previous research has found the impact of fears of compassion on eating disorders, the mechanism underlying the relationship between fears of compassion and emotional eating remains to be examined. This study aimed to examine the mediating role of emotion regulation difficulties in the relationships between fears of compassion and emotional eating in college students, as well as the gender difference in the mediation model. The Fears of Compassion Scale, Difficulties in Emotion Regulation Scale, and Dutch Eating Behavior Questionnaire were completed by 673 college students in Fujian Province, China. Structural Equation Modeling was primarily employed to analyze the data. The results showed that both fear of compassion for self and fear of compassion from others were positively associated with emotion regulation difficulties, which in turn were related to emotional eating for female college students. Emotion regulation difficulties played a significant mediating effect in the relationship between fears of compassion and emotional eating. Comparatively, for male college students, only fear of compassion for self was positively associated with emotion regulation difficulties, but emotion regulation difficulties were not related to emotion eating. Moreover, the mediating effect of emotion regulation difficulties was not significant in the relationship between fears of compassion and emotion eating for male college students. The findings suggest that it is important to improve individuals' fears of compassion to reduce emotional eating, particularly for female college students.

Metric Goodness and Measurement Invariance of the Italian Brief Version of Interpersonal Reactivity Index: A Study With Young Adults

The Interpersonal Reactivity Index (IRI) is a widely used multidimensional measure to assess empathy across four main dimensions: perspective taking (PT) empathic concern (EC) personal distress (PD) fantasy (F). This study aimed to replicate the Italian validation process of the shortened IRI (Interpersonal Reactivity Index) scale in order to confirm its psychometric properties with a sample of young adults. The Gender Measurement Invariance of empathy in this age group was also an objective of the work in order to increase the data on this aspect. A total of 683 Italian university students participated in a non-probabilistic sampling. The 16-item version was confirmed in its four-factor structure but with changes to some items. The model showed good fits with both the CFA and the gender Measurement Invariance. The internal consistency measures were found to be fully satisfactory. Convergent validity was tested by the correlations with the Prosocialness Scale for Adults and The Toronto Alexithymia Scale-20. As hypothesized the measure proved good convergent validity with Prosocialness, i.e., the willingness to assist, help, share, care and empathy with others, and a relevant inverse association with the External Oriented Thinking, characterizing individuals with emotionally poor thinking. This research provided additional evidence for a link between alexithymia and poor empathic abilities in young adults.

Self-reported emotional eaters consume more food under stress if they experience heightened stress reactivity and emotional relief from stress upon eating

Group data means from individuals who self-assess as emotional eaters do not reliably show increased food intake in response to stress or negative emotions. This inconsistency in predictive validity of self-reported emotional eating (EE) could be attributable to unconsidered moderation of the relationship between self-reported EE and behavioral measures of EE. Greater emotional relief from stress by eating may provide enhanced negative reinforcement and promote future EE in response to stress as a form of self-medication. Thus, we predicted that greater emotional relief from stress by eating (decrease in negative affect from stress to post-eating) would moderate the extent to which heightened stress reactivity (measured by systolic blood pressure, SBP) moderates the relationship between self-reported EE and food intake post-stress. We also hypothesized that self-reported EE would not predict greater food consumption on the rest day. 43 undergraduate women completed online assessments of eating behaviors. Participants were given snacks to eat after a mental stress task (TSST) or rest period on separate days in counterbalanced order. Our prediction was supported, as the moderated moderation model (PROCESS model 3) was highly significant on the stress day. Self-reported EE predicted increased food intake post-stress only under conditions of high stress reactivity and high emotional relief. On the rest day, self-reported EE predicted greater snack food intake only when SBP was high. This conditional increased intake substantiates stress as a promoter of snack food consumption for women with greater EE. Overall, our findings identified factors that may distinguish the subset of self-reported emotional eaters who are more likely to display EE behaviors in a laboratory setting, yet further studies are needed to directly test whether negative reinforcement via emotional relief from stress by eating drives enhanced EE following stress.

Food olfactory cues reactivity in individuals with obesity and the contribution of alexithymia

Obesity has been associated with increased reward sensitivity to food stimuli, but a few studies have addressed this issue by using odors. This study investigated whether obesity is associated with increased liking and wanting of food odors and whether alexithymia, a psychological construct characterized by diminished affective abilities, contributes to altered responsiveness to food. Liking and wanting for food and pleasant non-food odors were measured through explicit (self-report ratings) and implicit measures (heart rate and skin conductance) in 23 women with healthy weight (HW) and 20 women with overweight/obesity (OW/OB). Differently from the HW group, the OW/OB group explicitly liked food odors less than non-food odors; but, at the implicit level, there were no differences in heart rate response for both types of odors, indicating that they were equally liked. Moreover, at variance with the HW group, the OW/OB group did not exhibit increased skin conductance response for food compared to nonfood odors. Alexithymia was associated with increased implicit liking and explicit wanting of food odors, in particular in the HW group. These findings show that obesity is characterized by high levels of implicit food liking and low levels of implicit food wanting. Moreover, both affective and motivational responses to food reward seem to be affected by alexithymia, which should be taken into account by studies evaluating the effect of cue exposure intervention for obesity treatment.

Systematic Review of Alexithymia in the Population of Hemodialysis Patients

Alexithymia is a construct defined as the inability to differentiate between emotional experiences and bodily sensations. According to existing knowledge, alexithymia may have a major effect on the process of treatment and the outcome of the hemodialysis disease. The objective of this literature review was to determine the significance that alexithymia has for compliance and variables of clinical and mental health in the population of hemodialysis patients. For the above purpose, bibliographic databases “MEDLINE” and “Web of Science” were searched. The matrix method was used in analysis of articles. Searching both databases resulted in 248 articles. After applying exclusion and inclusion criteria, we included results of 13 articles in the literature review. The results of the search are findings regarding the prevalence and correlation of alexithymia with variables of clinical and mental health in hemodialysis patients. Alexithymia is significantly more common in the population of hemodialysis patients, and it has a negative effect on their mental and somatic health. Alexithymia levels in hemodialysis patients are more pronounced in cases where there is a greater number of comorbidities. Alexithymia is the predictor of high mortality rate in the population of hemodialysis patients, independent of other comorbidities.

Parent-Infant Attachment Insecurity and Emotional Eating in Adolescence: Mediation through Emotion Suppression and Alexithymia

Emotional eating (EE), the propensity to eat in response to emotions, is thought to have its origins in the early parent–infant relationship. This study tested the hypothesis that infant attachment insecurity results in EE in adolescence through the increased use of the emotion regulation strategy suppression of emotions and subsequent alexithymia. At the age of 15 months, parent–infant attachment security (n = 129) was observed with two abbreviated attachment measures: the shortened strange situation procedure (SSSP), and the shortened attachment Q-set (S-AQS). At the age of 12 years, children completed self-report questionnaires to assess the suppression of emotions, alexithymia, and EE. At the age of 16 years, EE was measured again. The mediation models indicated that lower parent–infant attachment security predicted increased use of suppression of emotions, which was related to increased alexithymia, and in turn more EE at the age of 12 years. These results were similar and significant for both attachment measures, and also (marginal) significant with EE at the age of 16 years as an outcome. Lastly, when parental caregiving quality was included, the models with the SSSP as predictor remained significant, but the models with the S-AQS became insignificant. These results indicated that to a certain extent, infant attachment security could predict adolescent EE above and beyond parental caregiving quality.

Associations Between Mental Health, Interoception, Psychological Flexibility, and Self-as-Context, as Predictors for Alexithymia: A Deep Artificial Neural Network Approach

Background: Alexithymia is a personality trait which is characterized by an inability to identify and describe conscious emotions of oneself and others.

Aim: The present study aimed to determine whether various measures of mental health, interoception, psychological flexibility, and self-as-context, predicted through linear associations alexithymia as an outcome. This also included relevant mediators and non-linear predictors identified for particular sub-groups of participants through cluster analyses of an Artificial Neural Network (ANN) output.

Methodology: Two hundred and thirty participants completed an online survey which included the following questionnaires: Toronto alexithymia scale; Acceptance and Action Questionnaire 2 (AQQII); Positive and Negative Affect Scale (PANAS-SF), Depression, Anxiety, and Stress Scale 21 (DAS21); Multidimensional Assessment of Interoceptive Awareness (MAIA); and the Self-as-Context (SAC) scale. A stepwise backwards linear regression and mediation analysis were performed, as well as a cluster analysis of the non-linear ANN upper hidden layer output.

Results: Higher levels of alexithymia were associated with increased psychological inflexibility, lower positive affect scores, and lower interoception for the subscales of “not distracting” and “attention regulation.” SAC mediated the relation between emotional regulation and total alexithymia. The ANNs accounted for more of the variance than the linear regressions, and were able to identify complex and varied patterns within the participant subgroupings.

Conclusion: The findings were discussed within the context of developing a SAC processed-based therapeutic model for alexithymia, where it is suggested that alexithymia is a complex and multi-faceted condition, which requires a similarly complex, and process-based approach to accurately diagnose and treat this condition.

Emotional eating, binge eating, physical inactivity, and vespertine chronotype are negative predictors of dietary practices during COVID-19 social isolation: A cross-sectional study

Objectives

Coronavirus disease 2019 (COVID-19) emerged and rapidly spread worldwide. Several countries have imposed lockdown and isolation in attempt to mitigate viral spread. However, social isolation has a negative effect on psychological aspects, increasing stress, fear, anxiety, anger and emotional disturbance, as well as affecting sleep pattern and the practice of physical activity. Negative emotions and lifestyle changes trigger overeating, consequently affecting dietary practices. The aim of this study was to verify the prevalence of lifestyle factors (i.e., sleep time/quality and practice of physical exercise), eating behavior dimensions, chronotype, and association with dietary practices (planning, domestic organization, food choice, ways of eating) in home confinement during the COVID-19 pandemic in São Paulo, Brazil.

Methods

This cross-sectional study was conducted between April 27 and May 25, 2020. An anonymous online questionnaire (Microsoft Forms) was used for data collection by the snowball method. We verified dietary practices (outcome), eating behavior, physical exercise practice, sleep quality and duration, and chronotype (exposure variables). Sex, age, educational and social status were assessed as covariates and confounders. We evaluated 724 adults (585 women and 139 men). Mean age was 32.6 y (±11.3) for women and 33.5 y (±10.5) for men.

Results

Emotional eating (EE) and binge eating (BE) were positively correlated (r = 0.66; P <0.001). Dietary practices were negatively correlated with BE (r = –0.41; P <0.001), EE (r = –0.33; P <0.001) and body mass index (r = –0.24; P <0.001). Linear regression demonstrated that EE (β = –0.1351; t = –2.841; P = 0.005; η_p² = 0.013), BE (β = –0.2580; t = –5.612; P < 0.001; η_p² = 0.050), no practice of physical exercise at home (β = –0.4271; t = –5.933; P < 0.001; η_p² = 0.055), being vespertine (β = –0.3435; t = 2.076; P = 0.038; η_p² = 0.019), and age (β = –0.082; t = –2.210; P = 0.027; η_p² = 0.008) are negative predictors of dietary practices. Finally, cognitive restraint (β = 0.1407; t = 3.858; P < 0.001; η_p² = 0.024), better sleep quality (β = 0.1768; t = 2.506; P = 0.012; η_p² = 0.010), receiving 4–10 wages per month (according to a minimum wage in Brazil that corresponds to US $ 183.01) (β = 0.2568; t = 2.573; P = 0.10; η_p² = 0.027) and 10 – 20 wages per month (β = 0.4490; t = 3.726; P < 0.001; η_p² = 0.027) are positive predictors of dietary practices.

Conclusion

Eating behavior, physical exercise, sleep, and social factors can be important predictors for dietary practices during COVID-19 social confinement. Longitudinal studies in Brazil are needed to confirm these findings.

Gender Differences in Empathy During Adolescence: Does Emotional Self-Awareness Matter?

Empathy refers to the capacity to experience emotions similar to those observed or imagined in another person, with the full knowledge that the other person is the source of these emotions. Awareness of one's own emotional states is a prerequisite for self-other differentiation to develop. This study investigated gender differences in empathy during adolescence and tested whether emotional self-awareness explained these differences. Two-hundred-eleven adolescents (108 girls and 103 boys) between 14 and 19 years completed the Interpersonal Reactivity Index (IRI) and the Toronto Alexithymia Scale (TAS-20) to assess empathy and emotional self-awareness, respectively. Overall, girls obtained higher scores than boys on IRI subscales like emotional concern, personal distress, and fantasy. Regarding emotional self-awareness, we found gender differences in TAS-20 scores, with girls reporting greater difficulty identifying feelings and less externally oriented thinking than boys. Difficulty identifying feelings explained the greatest personal distress experienced by girls. Lower externally oriented thinking accounted for girls' greater emotional concern and fantasy. These findings offer an insight into the role of emotional self-awareness-which is essential for self-other differentiation-as an account for gender differences in empathic abilities during adolescence. In girls, difficulty identifying feelings can impair the ability to differentiate between ones' and others' emotions, leading them to experience self-focused and aversive responses when confronted with others' suffering. Conversely, in boys, externally oriented thinking can mitigate personal distress when faced with others' discomfort.

Emotional Eating in Adults: The Role of Sociodemographics, Lifestyle Behaviors, and Self-Regulation-Findings from a U.S. National Study

Background: Emotional eating, the tendency to overeat in response to negative emotions, has been linked to weight gain. However, scant evidence exists examining the prevalence and correlates of emotional eating among large samples of adults in the United States (U.S.). Hence, we examine the relationship among individual and socioeconomic factors, health behaviors, and self-regulation with emotional eating patterns among U.S. adults. Methods: Cross-sectional analysis of 5863 Family Health Habits Survey participants. Multivariable, ordered, logistic regression was employed to examine the relationship between the frequency of the desire to eat when emotionally upset (never, rarely, sometimes, often, and very often) and the independent variables. Results: Analysis reveals that 20.5% of the sample tended to emotionally eat often or very often. Being female, non-Hispanic White, and of younger age were all related to a higher likelihood of emotional eating. Additionally, inability to delay gratification (impatience) was related to an 18% increased likelihood (95% confidence interval (CI) 1.05–1.33) for emotional eating. Finally, emotional eating was significantly related to more frequent fast-food consumption. Conclusions: Program planners might need to develop targeted interventions aimed at enhancing emotional regulation skills while addressing these less healthful behaviors (e.g., fast-food intake) with the goal of obesity and chronic disease prevention.

The Mediating Effects of Fear of COVID-19 and Depression on the Association Between Intolerance of Uncertainty and Emotional Eating During the COVID-19 Pandemic in Turkey

The COVID-19 pandemic has greatly affected the mental health of individuals due to severe changes in their normal life routines. These changes might give rise to stress-induced factors and result in developing maladaptive behaviors. Therefore, the present study tested an explorative sequential mediation model regarding the COVID-19 pandemic as a global natural experiment and hypothesized that fear and depression would be serial mediators of the relationship between intolerance of uncertainty and emotional eating. An online cross-sectional survey with convenience sampling was adopted. A total of 362 participants were recruited from Turkey, and each completed a battery of demographic questions and psychometric scales. The standardized instruments used to test the model’s constructs were the Intolerance of Uncertainty Scale, Fear of COVID-19 Scale, Hospital Anxiety and Depression Scale, and Three-Factor Eating Questionnaire-R21. The model was tested using a bootstrapping method utilizing IBM AMOS 24 software. Results showed that emotional eating was positively associated with intolerance of uncertainty, fear of COVID-19, and depression. Moreover, fear of COVID-19 had positive correlation with intolerance of uncertainty and depression. Significant negative association was also found between age and intolerance of uncertainty. In addition, females significantly reported higher levels of emotional eating and fear of COVID-19 than males. The study’s hypothesized sequential mediation model was further supported. It is concluded that depression most likely developed by fear was triggered by intolerance of uncertainty during the COVID-19 pandemic and leading to emotional eating. The study is significant because it advances theories of emotional eating with an investigation examining some of its underlying mechanisms. Also, it is one of a few research studies highlighting to what extent the COVID-19 pandemic-related cognitions and emotions are associated with maladaptive behaviors in the case of emotional eating.

Application of three different coaching strategies through a virtual coach for people with emotional eating: a vignette study

BACKGROUND

Around 13% of the world's population suffers from obesity. More than 40% of people with obesity display emotional eating behaviour (eating in response to negative emotions or distress). It is an alternate to more effective coping strategies for negative emotions. Our study explored the opportunities for helping adults with emotional overeating using a virtual coach, aiming to identify preferences for tailored coaching strategies applicable in a personal virtual coach environment. Three different coaching strategies were tested: a validating, a focus-on-change, and a dialectical one - the latter being a synthesis of the first two strategies.

METHODS

A qualitative study used vignettes reflecting the two most relevant situations for people with emotional eating: 1. experiencing negative emotions, with ensuing food cravings; and 2. after losing control to emotional eating, with ensuing feelings of low self-esteem. Applied design: 2 situations × 3 coaching strategies.

PARTICIPANTS

71 adult women (Mage 44.4/years, range 19-70, SD = 12.86) with high scores on the DEBQ-emotional eating scale (Memo 3.65, range 1.69-4.92, SD = .69) with mean BMI 30.1 (range 18-46, SD = 6.53). They were recruited via dieticians' practices, were randomly assigned to the conditions and asked how they would face and react to the presented coaching strategies. Data were transcribed and a thematic analysis was conducted.

RESULTS

Qualitative results showed that participants valued both the validating coaching strategy and the focus-on-change strategy, but indicated that a combination of validation and focus-on-change provides both mental support and practical advice. Data showed that participants differed in their level of awareness of the role that emotions play in their overeating and the need for emotion-regulation skills.

CONCLUSION

The design of the virtual coach should be based on dialectical coaching strategies as preferred by participants with emotional eating behaviour. It should be tailored to the different stages of awareness of their emotions and individual emotion-regulation skills.

Emotional eating during COVID-19 in the United Kingdom: Exploring the roles of alexithymia and emotion dysregulation

Emotional eating, generally defined as (over)-eating in response to negative emotions, has been associated with poor physical and psychological outcomes. During a time of heightened negative affect, it is important to understand the impact of the COVID-19 pandemic and associated lockdown measures on eating behaviours, and further elucidate the ways in which emotional eating is related to emotion dysregulation and impaired abilities to identify emotions (i.e. alexithymia). The aims of this study were to explore perceived changes in eating behaviours in relation to self-reported negative affect during the pandemic and to examine direct and indirect effects of alexithymia on emotional eating. An online questionnaire measured these constructs in the general population of the United Kingdom (n = 136). Findings demonstrated that those who reported changes to their eating behaviours during the pandemic also reported greater levels of depression during the same time frame. Mediation analyses revealed that difficulties identifying and describing feelings both predicted emotional eating indirectly via emotion dysregulation. Findings contribute to the understanding of the mechanisms underpinning the relationship between alexithymia and emotional eating and describe changes to eating behaviours during COVID-19. We discuss how these findings should be applied, and recommendations for future research.

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One quarter of participants reported eating more than usual during COVID-19.

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One third of participants reported eating less healthfully than usual.

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Difficulty identifying feelings influences emotional eating via emotion dysregulation.

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Difficulty describing feelings influences emotional eating via emotion dysregulation.

Emotion regulation difficulties interact with negative, not positive, emotional eating to strengthen relationships with disordered eating: An exploratory study

Disordered eating includes core eating disorder symptoms present in diverse populations. The extant literature has focused on associations between negative emotional eating and disordered eating to the exclusion of positive emotional eating. Emotion regulation may help explain relationships between emotional eating and disordered eating. Emotion regulation difficulties was examined as a moderator of relationships between negative and positive emotional eating and disordered eating including dietary restraint, eating, weight, and shape concerns, and global scores of disordered eating, a general index of disordered eating. A cross-sectional study was employed using a university student population in the United States. Participants completed surveys assessing negative (Dutch Eating Behavior Questionnaire; Emotional Appetite Questionnaire) and positive (Emotional Appetite Questionnaire) emotional eating, emotion regulation (Difficulties in Emotion Regulation Scale), and disordered eating (Eating Disorder Examination Questionnaire). Moderation analyses were calculated with emotion regulation difficulties as the moderator of relationships between negative and positive emotional eating and disordered eating. Across two separate measures of negative emotional eating, higher negative emotional eating was associated with higher weight concerns and global scores of disordered eating when emotion regulation difficulties was average and increased (+1 SD above average). Higher positive emotional eating was associated with lower dietary restraint and global scores of disordered eating when emotion regulation difficulties was decreased (-1 SD below average). Emotion regulation difficulties strengthened relationships between negative, not positive, emotional eating and disordered eating. Research and clinical implications for the contribution of emotional eating and emotion regulation on disordered eating were discussed.

Identifying stress-related eating in behavioural research: A review

Stress is a commonly reported precipitant of overeating. Understanding the relationship between stress and food intake is important, particularly in view of the increasing prevalence of obesity. The purpose of this review is to examine how stress-related eating has been defined and measured in the literature to date. There are no established diagnostic criteria or gold standards for quantification of stress-related eating. Questionnaires relying on the accuracy of self-report are the mainstay of identifying people who tend to eat in response to stress and emotions. There is a paucity of clinical research linking objective measurements of stress and appetite with self-reported eating behaviour. Limitations of the methodological approaches used and the heterogeneity between studies leave significant knowledge gaps in our understanding of the mechanism of stress related eating, and how best to identify it. These issues are discussed, and areas for further research are explored.

Emotional eating in patients attending a specialist obesity treatment service

OBJECTIVE

The prevalence of emotional eating (EE) has increased in the general population over past decades. There is limited information on how common EE is among people seeking obesity treatment. We aimed to estimate the proportion of people with EE, and strength of associations between a predefined set of factors and EE in people referred for obesity treatment.

METHODS

Cross-sectional study recruiting 387 adults from a hospital obesity service. "Emotional eating" was defined as Emotional Eating Scale (EES) score ≥25. Strength of associations were estimated by boot-strapped quantile regression analysis. Results are presented as quantile difference (QD) of EES scores at the 25th, 50th or 75th quantile, and 95% confidence intervals (95%CI).

RESULTS

The study population consisted of 71% women, with a median age of 52 years (interquartile range [IQR]: 42, 61), and a median body mass index of 42 kg/m² (IQR: 37, 49). 187 participants were managed with lifestyle modification alone, 103 with the addition of obesity pharmacotherapy, 79 with bariatric surgery, and 18 with both bariatric surgery and medications. EE was reported by an estimated 58% (95%CI: 53, 63) of participants. Factors with the largest and most consistent magnitude of association with EES differences include age, sex, use of glucagon-like peptide-1 (GLP-1) agonists, history of sleeve gastrectomy and recent bariatric surgery.

CONCLUSION

Emotional eating affected more than half of people referred for obesity treatment. Age, sex, use of GLP-1 agonists, history of sleeve gastrectomy and recent bariatric surgery had the strongest associations with EE. These findings allow hypothesis generation about the underlying physiological mechanisms behind emotional eating for investigation in future research.

Patterns of negative emotional eating among Chinese young adults: A latent class analysis

There is ample evidence suggesting that negative emotional eating is closely related to disordered eating behaviors. However, most previous studies on the topic focused only on emotional over-eating, but neglected emotional under-eating. Moreover, previous studies also mainly used variable-oriented methods by reducing negative emotional eating to a single dimension, which limits our understanding of individual differences in negative emotional eating. In this study, we used a person-oriented approach, latent class analysis (LCA), to examine the negative emotional eating patterns and to characterize these patterns in a sample of 1,068 Chinese young adults (52.6% females, aged 17-24 years). Negative emotional eating was measured by the Emotional Over-Eating and Emotional Under-Eating subscales of the Adult Eating Behavior Questionnaire. Four patterns, namely, "non-emotional eating" (38.9%), "emotional over- and under-eating" (15.4%), "emotional over-eating" (14.7%), and "emotional under-eating" (31.0%), were identified. Sex and BMI were found to be statistically significant predictors for negative emotional eating patterns. The identified four patterns showed significant differences in eating disorder symptoms and psychological distress. Particularly, participants in emotional over- and under-eating exhibited the highest level of eating disorder symptoms and psychological distress. Overall, this study identified four distinct negative emotional eating patterns, among which, the emotional over- and under-eating was the most problematic. Future studies regarding negative emotional eating and its impact on mental health may benefit from focusing not only on individuals with emotional over-eating, but also on those showing a mixed pattern of negative emotional eating.

Neural Responses to Infant Emotions and Emotional Self-Awareness in Mothers and Fathers during Pregnancy

Neuroscientific research has largely investigated the neurobiological correlates of maternal and (to a much lesser extent) paternal responsiveness in the post-partum period. In contrast, much less is known about the neural processing of infant emotions during pregnancy. Twenty mothers and 19 fathers were recruited independently during the third trimester of pregnancy. High-density electroencephalography (hdEEG) was recorded while expectant parents passively viewed images representing distressed, ambiguous, happy, and neutral faces of unknown infants. Correlational analyses were performed to detect a link between neural responses to infant facial expressions and emotional self-awareness. In response to infant emotions, mothers and fathers showed similar cerebral activity in regions involved in high-order socio-affective processes. Mothers and fathers also showed different brain activity in premotor regions implicated in high-order motor control, in occipital regions involved in visuo-spatial information processing and visual mental imagery, as well as in inferior parietal regions involved in attention allocation. Low emotional self-awareness negatively correlated with activity in parietal regions subserving empathy in mothers, while it positively correlated with activity in temporal and occipital areas implicated in mentalizing and visual mental imagery in fathers. This study may enlarge knowledge on the neural response to infant emotions during pregnancy.

Relative stability of alexithymia and openness to emotions in one psychiatric day hospital setting

Alexithymia (literally, difficulty finding words for emotions) and openness to emotions (OE: referring to the cognitive representation, communication, regulation, perception of internal and external bodily sensations, and social restriction of emotions) are strongly linked to psychopathology. The absolute and relative stability hypotheses were tested in order to determine whether significant changes occurred on these constructs after therapy, a condition where changes were expected for both constructs. Negative attitudes toward treatment (NTI) and perceived social support (PSS) were expected to significantly predict alexithymia and OE. Patients (N = 179) who participated in this longitudinal study filled in the Toronto Alexithymia Scale, the Dimensions of Openness to Emotions Scale, the NTI subscale, the Multidimensional Scale of Perceived Social Support, and the Social Desirability Scale. After treatment, we observed significant decrease of all alexithymia scores and significant increases of three OE scores, that is, cognitive representation, communication, and regulation of emotions. Regression analyses revealed that gender, age, NTI, and PSS were significant predictors of alexithymia and OE. NTI strongly predicted lower OE levels and higher alexithymia levels, whereas PSS had opposite predicting effects on these constructs. In conclusion, the significant changes, and the moderate to high correlational levels observed between before and after alexithymia and OE scores, strengthen the relative stability hypothesis for both constructs. In addition, PSS represents a protective factor and NTI a vulnerability indicator for therapists. Our aim is to optimize treatment by providing therapists treating emotion difficulties a more concrete array of variables that potentially either promote or subvert recovery.

The relation of alexithymia and attachment with type 1 diabetes management in adolescents: a gender-specific analysis

BACKGROUND

Several studies indicate the role of psychosocial factors in the management and control of chronic diseases in adolescents. In this regard, the roles of attachment and alexithymia in the management of type 1 diabetes in adolescents and related gender-specific patterns have rarely been the focus of empirical research. In this study we investigate the gender-specific relationship of alexithymia and attachment with self-care and blood glucose level in adolescents with type1 diabetes.

METHODS

This is a cross-sectional study conducted on adolescents aged 12-18 years, with type 1 diabetes. Participants were recruited from diabetes clinics and the Iranian Diabetes Society. Data were collected using the Farsi versions of the Toronto Alexithymia Scale (FTAS-20), the Inventory of Parent and Peer Attachment (IPPA) and the Summary of Diabetes Self-Care Activities Scale (SDSCA). Blood glucose levels were measured by determining HbA1c which were abstracted from medical records. Data were analyzed using SPSS21 software.

RESULTS

Participants were 150 adolescents (57% female), mean age 14.97 ± 2.30. Alexithymia (β = 0.10, P = 0.01), difficulty identifying feelings (β = 0.15, P = 0.03) and communication with mothers (β = - 0.08, P = 0.03) predicted HbA1c in girls, whereas no significant relationships were observed for HbA1c with alexithymia and attachment in boys. Factors that predicted self-care in girls were alexithymia (β = - 0.04, P = 0.02), difficulty identifying feelings (β = - 0.06, P = 0.04); in boys however in addition to these two factors predicting self-care [alexithymia (β = - 0.07, P = 0.01) and difficulty identifying feelings (β = - 0.11, P = 0.01)], we also found difficulty describing feelings (β = - 0.16, P = 0.02), communication with mother (β = 0.04, P = 0.04), alienation to mother (β = - 0.06, P = 0.03), to father (β = - 0.06, P = 0.01) and to peers (β = - 0.09, P = 0.03).

CONCLUSIONS

Our results suggest that, in a gender-specific pattern, alexithymia and attachment could affect self-care and blood glucose level in adolescents with type 1 diabetes; findings that can be used to facilitate more effective treatment strategies and interventions in this age group.

Factors affecting emotional eating and eating palatable food in adults

BACKGROUND/OBJECTIVES

The aim of this study was to determine the relationship among emotional eating behavior, tendency to eat palatable foods, and several risk factors.

SUBJECTS/METHODS

This study was carried out on 2,434 persons (1,736 women and 698 men) aged between 19 and 64 years. A questionnaire form was used as a data collection tool, which consisted of items for the socio-demographic characteristics, anthropometric measurements, Emotional Appetite Questionnaire (EMAQ), and the Palatable Eating Motives Scale (PEMS).

RESULTS

A positive significant correlation was observed between the BMI groups and the negative emotions, negative situations, and negative total scores of EMAQ (P < 0.01). The regression results on negative subscales showed that a one unit increase in BMI resulted in a 0.293 unit increase in negative situations scores, a 0.626 unit increase in negative emotions scores, and a 0.919 unit increase in negative total EMAQ scores. When the BMI groups and PEMS subscale scores were examined, a significant relationship was found in the social motives, rewarding, and conformity subscales (P < 0.01). A one unit increase in BMI increased the coping motives scores by 0.077 units.

CONCLUSIONS

The emotional states have a significant effect on the eating behavior. On the other hand, an increase in eating attacks was observed, particularly in people who were under the effect of a negative emotion or situation. Nevertheless, there were some limitations of the study in terms of quantitative determination of the effects of this eating behavior depending on the BMI.

Emotion regulation difficulties and impaired working memory interact to predict boredom emotional eating

Emotional eating (EE), or eating in response to emotions, is related to depression, binge eating, and weight gain. Emotion regulation difficulties are a risk factor for EE. Working memory deficits may also be a risk factor for EE, as working memory is an important cognitive factor in emotion regulation. The current study is a secondary analysis that examined whether working memory moderated the relationship between emotion regulation and emotional eating. A college student sample completed measures of EE in response to depression, boredom, and anxiety/anger (Emotional Eating Scale), emotion regulation (Difficulties in Emotion Regulation Scale) and a working memory task (AOSPAN). Moderated regression analyses were conducted. Conditional moderation was observed, such that greater emotion regulation difficulties were associated with boredom EE, when working memory was one standard deviation (SD) below average. Moderation analyses were not significant when examining associations between working memory, emotion regulation difficulties, and depression and anxiety EE. Findings suggest that the correlates of boredom EE may be different than depression and anxiety/anger EE. Although the current study was cross-sectional, it is possible that individuals with poorer working memory and emotion regulation difficulties, especially in tandem, may be at increased risk for boredom EE.

The association between alexithymia and eating behavior in children and adolescents

OBJECTIVE

Alexithymia, or the difficulty identifying or describing one's own emotions, may be a risk factor for dysregulated eating and excess weight gain. However, the relationships between alexithymia and eating behaviors in community samples of non-clinical youth have not been well-characterized. We hypothesized that alexithymia would be positively associated with disordered and disinhibited eating in a community-based sample of boys and girls without an eating disorder.

METHOD

Two hundred children (8-17 years old) across the weight spectrum completed an interview to assess loss of control (LOC) eating and eating-related psychopathology, a laboratory test meal designed to induce disinhibited eating, and questionnaires to assess alexithymia, eating in the absence of hunger, and emotional eating. Linear and logistic regressions were conducted to examine the relationship between alexithymia and eating variables, with age, sex, race, and fat mass as covariates. Test meal analyses also adjusted for lean mass. Given the overlap between alexithymia and depression, all models were repeated with depressive symptoms as an additional covariate.

RESULTS

Alexithymia was associated with an increased likelihood of reporting LOC eating (p < .05). Moreover, alexithymia was positively associated with disordered eating attitudes, emotional eating, and eating in the absence of hunger (ps < .05). Greater alexithymia was associated with more carbohydrate and less fat intake at the test meal (ps < .05). After adjusting for depressive symptoms, alexithymia remained associated with eating in the absence of hunger and carbohydrate and fat intake (ps < .05).

DISCUSSION

In healthy children, alexithymia is associated with some facets of eating behavior and food intake. If supported prospectively, these preliminary findings suggest alexithymia may be a modifiable risk factor to reduce disordered eating and excess weight gain in youth.

Parenting quality in infancy and emotional eating in adolescence: Mediation through emotion suppression and alexithymia

This study assessed the association between parenting quality at age 15 and 28 months and emotional eating (EE) at age 12 and 16 years through serial mediation by suppression of emotions and alexithymia at 12 years. The sample included 129 children and their parents. Lower parental quality in infancy was related to more suppression of emotions, which in turn was related to more difficulty identifying emotions, and in turn to higher EE in adolescence. This serial mediation model was significant for EE at 12 years, and for EE at 16 years. If future studies reveal converging findings, this knowledge points to the need for programs preventing the development of EE in adolescence through increasing the quality of parenting in infancy.