Binge eating as escape from self-awareness

Feasibility and acceptability of a theory-based online tool for reducing stress-induced eating

Stress-induced eating is associated with various health risks like obesity and cardiovascular disease, exacerbated by the overconsumption of unhealthy foods. This study sought to investigate replacement coping strategies for stress-induced eating that participants can seek to implement using behaviour change techniques like implementation intentions. The study adopted a feasibility and acceptability design, with 258 participants (88.37% female) aged 17-75 years old who self-reported stress-induced eating. Participants were asked to identify cues for their stress-induced eating and evaluate the acceptability of eight potential replacement coping strategies. After selecting their preferred strategy, participants formed implementation intentions, linking the strategy with their previously identified cues. There were six themes of cues for stress-induced eating as identified by participants, including a range of external and internal stressors. Themes regarding the acceptability of the replacement coping strategies were organised based on constructs from integrated social cognition theories. Participant responses reflected cognitive and affective attitudes, and control and normative beliefs behind engagement in coping behaviour; further, automatic and volitional processes were described by participants as playing a role in whether a coping strategy was deemed as useful. Plans formulated by participants commonly detailed specific situations and strategies to utilise, though few described start times or durations of their plan. Action planning was found to significantly increase following formation of implementation intentions, and participants' descriptions supported the feasibility and acceptability of utilising implementation intentions to adopt alternative coping strategies to stress-induced eating. Future research should conduct a randomised controlled trial to assess the efficacy of the implementation intentions intervention in promoting uptake of replacement coping strategies to reduce stress-induced eating.

Proof-of-concept testing of a brief virtual ACT workshop for emotional eating

BACKGROUND

Emotional eating, or eating in response to negative emotions, is a commonly reported short-term emotion regulation strategy but has been shown to be ineffective in the long term. Most emotional eating interventions based on Acceptance and Commitment Therapy (ACT) have been delivered in the context of weight loss trials, highlighting a need for ACT-based emotional eating interventions in weight-neutral contexts.

AIMS

This proof-of-concept study aimed to test the acceptability and efficacy potential of a brief virtual ACT workshop for emotional eating in a small sample of adults identifying as emotional eaters.

METHODS

Twenty-six adult emotional eaters completed an ACT workshop delivered in two 1.5-h sessions over two weeks. The workshop targeted awareness and acceptance of emotions and eating urges, and valued actions around eating.

RESULTS

The acceptability of the workshop was demonstrated by high participant satisfaction. Significant improvements on all outcome measures were found and maintained up to 3 months follow-up.

CONCLUSIONS

These proof-of-concept findings suggest that a brief virtual ACT workshop may improve emotional eating and associated ACT processes. Results from this study can inform a future randomized controlled trial to test the efficacy of the workshop and the role of theoretical processes of change.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT04457804.

LEVEL OF EVIDENCE

Level IV, evidence obtained from multiple time series with the intervention.

Examining Indirect and Direct Effects of Risk and Resilience on the Relation Between Perceived Discrimination and Eating Disorder Symptoms in Ethnic Minority American Women

Direct relationships between perceived discrimination and eating pathology in ethnic minorities are well-documented. However, theoretical work examining unique risk and resilience factors that strengthen or weaken the relation between these constructs in ethnic minorities is lacking. The current study aims to address this gap by incorporating stress-process and tripartite frameworks to examine social and personal resources as they relate to perceived discrimination and eating pathology. In a sample of Black, Asian, and Latine women (N = 296, M age = 30.82), social support did not mediate the relationship between perceived discrimination and eating pathology. A significant interaction effect was observed for thin-ideal internalization strengthening the relation between perceived discrimination and negative emotional eating. Thin-ideal internalization moderated the relation between perceived discrimination and negative emotional eating in Latine Women, and disordered eating in Black Women. Overall, findings suggest ethnic minority Women have both personal and social resources that may influence the strength of effect on the relation between perceived discrimination on eating pathology.

Effect of emotional priming on eating willingness of women with restrictive diet

Background

There is controversy regarding whether negative or positive emotions have a greater impact on the eating behavior of restrictive dieters. Moreover, it is unclear whether unconscious emotional processing can predict the eating behavior of restrictive dieters. This study investigated the effects of conscious and unconscious emotional processing on the dietary behavior of women with restrictive diet.

Methods

Female student participants (N = 600) completed the Dutch Eating Behavior Questionnaire to screen 60 each of successful, unsuccessful restrictive and unrestricted eaters. They were randomly and equally divided into two groups for supra-threshold and subliminal emotional priming and carried out a behavioral task to index eating intentions.

Results

The restrictive dieters increase their willingness to eat when they are in a positive mood, even if they are not consciously aware of their happiness. Furthermore, the unsuccessful restrictive dieters are more intense.

Conclusion

This study presents empirical evidence on the impact of positive emotions on the eating intention of restrictive dieters and the cognitive characteristics of unsuccessful restrictive dieters. Additionally, it offers guidance for unsuccessful restrictive dieters to personalize their treatment goals.

Prediction of adolescent weight status by machine learning: a population-based study

BACKGROUND

Adolescent weight problems have become a growing public health concern, making early prediction of non-normal weight status crucial for effective prevention. However, few temporal prediction tools for adolescent four weight status have been developed. This study aimed to predict the short- and long-term weight status of Hong Kong adolescents and assess the importance of predictors.

METHODS

A population-based retrospective cohort study of adolescents was conducted using data from a territory-wide voluntary annual health assessment service provided by the Department of Health in Hong Kong. Using diet habits, physical activity, psychological well-being, and demographics, we generated six prediction models for successive weight status (normal, overweight, obese and underweight) using multiclass Decision Tree, Random Forest, k-Nearest Neighbor, eXtreme gradient boosting, support vector machine, logistic regression. Model performance was evaluated by multiple standard classifier metrics and the overall accuracy. Predictors' importance was assessed using Shapley values.

RESULTS

442,898 Primary 4 (P4, Grade 4 in the US) and 344,186 in Primary 6 (P6, Grade 6 in the US) students, with followed up until their Secondary 6 (Grade 12 in the US) during the academic years 1995/96 to 2014/15 were included. The XG Boosts model consistently outperformed all other model in predicting the long-term weight status at S6 from P4 or P6. It achieved an overall accuracy of 0.72 or 0.74, a micro-averaging AUC of 0.92 or 0.93, and a macro-averaging AUC of 0.83 or 0.86, respectively. XG Boost also demonstrated accurate predictions for each predicted weight status, surpassing the AUC values obtained by other models. Weight, height, sex, age, frequency and hours of aerobic exercise were consistently the most important predictors for both cohorts.

CONCLUSIONS

The machine learning approaches accurately predict adolescent weight status in both short- and long-term. The developed multiclass model that utilizing easy-assessed variables enables accurate long-term prediction on weight status, which can be used by adolescents and parents for self-prediction when applied in health care system. The interpretable models may help to provide the early and individualized interventions suggestions for adolescents with weight problems particularly.

Risk factors for momentary loss of control and subsequent abandonment of self-devised dietary restraint plans in adults with weight-loss goals: a behaviour sequence analysis approach

OBJECTIVE

The current study aims to improve understanding of events leading to lapses of dietary restraint, and to identify pathways to perseverance or abandonment of weight loss efforts in response to lapses. In addition, Behaviour Sequence Analysis (BSA) was also evaluated as an analytical tool in dietary behaviour.

DESIGN

A sample of 176 adults who were engaging in self-imposed dietary restraint for weight loss were recruited to participate.

MAIN OUTCOME MEASURES

Participants were instructed to provide a detailed written timeline of an episode where they lapsed in their dietary restraint plan. They were instructed to report their preceding behaviours and internal states, and social and environmental contexts, leading up to and after their lapse in dietary restraint.

RESULTS

Lapses in dietary restraint were precipitated by negative internal states in the presence of cues for highly palatable foods. In addition, abandonment of weight loss efforts after lapsing was preceded by dichotomous thinking, whereas perseverance was preceded by a more neutral, flexible interpretation of the lapse in self-control.

CONCLUSION

BSA has identified that neutral evaluation of inevitable lapses in dietary restraint are predictive of continuation with weight loss efforts, highlighting the importance of individual tolerance of lapses in self-regulation.

Prospective association of screen time with binge-eating disorder among adolescents in the United States: The mediating role of depression

OBJECTIVE

Screen time has been reported to be associated with binge-eating disorder (BED) among adolescents in the US; however, potential mediators remain unclear. This study aimed to evaluate depression symptoms as a mediator of the prospective association between screen time and BED.

METHOD

We utilized data from 9465 children (aged 9-11 years at baseline) from the Adolescent Brain Cognitive Development (ABCD) study (2016-2021). A generalized structural equation model was used to examine the prospective association between average daily screen time at baseline and BED at year 2, adjusting for baseline BED diagnosis, and other potential covariates (e.g., age, sex, and income). Mediation was examined using bias-corrected (BC) 95% confidence intervals for the indirect effect of baseline screen time on year 2 BED through depression symptoms (change from baseline to year 1).

RESULTS

One hundred and one participants (42.7% male, 49.4% racial/ethnic minority) met the criteria for BED in year 2. Participants were 9.9 years of age on average at baseline, 51.3% identified as male, and 43.1% identified as a racial/ethnic minority. Adjusting for covariates, screen time was prospectively associated with BED (OR = 1.09, 95% CI [1.03, 1.14], p = .005). Depression symptoms (B = .19, BC 95% CI [0.10, 0.28]) partially mediated (9.2%) the prospective association between screen time and BED.

DISCUSSION

Among US adolescents, higher baseline screen time was prospectively associated with BED diagnosis at year 2, and this relationship was partially mediated by increased depression symptoms. Preventive approaches targeting high screen use may have utility for reducing BED risk among adolescents.

PUBLIC SIGNIFICANCE

Among U.S. adolescents, higher screen time was prospectively associated with the incidence of BED. This association was partially mediated by the change in depressive symptoms. Preventive approaches targeting high screen use may have utility for reducing BED risk among adolescents.

The role of habit in maintaining binge/purge behaviors: An ecological momentary assessment study

OBJECTIVE

Individuals with eating disorders transdiagnostically engage in binge eating (BE) and/or purging, despite life-threatening consequences. Little is known about factors that contribute to the persistence of these behaviors. This study explored whether habitual control over binge/purge (B/P) spectrum behaviors contributes to symptom persistence and whether negative reinforcement via reductions in negative affect is less influential in maintaining B/P behaviors that are under habitual control and are persistent.

METHOD

Women with BE and/or purging (N = 81) completed self-report measures assessing habit strength of BE and purging. Then, they completed a 14-day ecological momentary assessment (EMA) protocol during which they completed measures of negative affect, BE, and purging multiple times per day.

RESULTS

Habitual control over purging was associated with a greater frequency of purging during the EMA period. However, habitual control over BE was not associated with the severity of loss of control eating or the frequency of BE episodes. Habitual control did not moderate temporal relations between negative affect and B/P behaviors during the EMA period. However, exploratory analyses revealed that individuals with a longer duration of BE and greater habitual control over BE showed a less pronounced reduction in negative affect following BE.

DISCUSSION

Overall, these findings suggest that purging may be maintained by habitual stimulus-response learning. In addition, they support the possibility that reduction in negative affect may play a less prominent role in maintaining BE that is habitual and persistent.

PUBLIC SIGNIFICANCE

This study investigated whether habit contributes to the persistence of symptoms in women with binge/purge spectrum behaviors and whether negative reinforcement via reductions in negative affect is less influential in maintaining binge/purge behaviors that are under habitual control. The findings suggest that purging may be maintained through habit. This supports the potential utility of habit reversal interventions to decrease habitual purging.

Black Young Adult Superwomen in the Face of Gendered Racial Microaggressions: Contextualizing Challenges With Acceptance and Avoidance and Emotional Eating

BACKGROUND

Black young adult women (ages 18-35) are at disproportionate risk for obesity and emotional eating. Emotional eating interventions target psychological flexibility, such as reducing experiential avoidance and increasing acceptance of food-related thoughts. Yet Black women face gendered racism, and some endorse roles that reduce psychological flexibility, such as the superwoman schema role. Culturally centered stress and coping has often been overlooked, leading to an incomplete understanding of processes that engender emotional eating and the implications for appropriate and effective interventions for Black young adult women.

PURPOSE

We investigated direct and indirect pathways of associations between stress from gendered racial microaggressions to emotional eating through the endorsement of superwoman schema and two aspects of psychological flexibility.

METHODS

Black young adult women (N = 504; Mage = 24.72; 75.2% African American; 98.4% cisgender) participated in an online survey wherein they reported demographics, stress from gendered racial microaggressions, superwoman schema, experiential avoidance, acceptance of food-related thoughts, and emotional eating. Path analysis was conducted to examine direct and indirect effects.

RESULTS

Results provided evidence for indirect associations between more stress from gendered racial microaggressions and more emotional eating. More stress was associated with greater endorsement of the superwoman schema which was associated with more experiential avoidance and less acceptance of food-related thoughts, which were each associated with more emotional eating.

CONCLUSIONS

Endorsement of superwoman schema and concomitant avoidance and less acceptance may be one way that gendered racial stress propels emotional eating. Future research could test intervention components that disrupt this path.

Emotional dysregulation moderates the relation between perceived stress and emotional eating in adolescent military dependents

OBJECTIVE

Adolescent children of US service members (i.e., military-dependent youth) face unique stressors that increase risk for various forms of disinhibited eating, including emotional eating. Difficulties with adaptively responding to stress and aversive emotions may play an important role in emotional eating. This study examined emotion dysregulation as a potential moderator of the association between perceived stress and emotional eating in adolescent military dependents.

METHOD

Participants were military-dependent youth (N = 163, 57.7% female, Mage = 14.5 ± 1.6, MBMI-z = 1.9 ± 0.4) at risk for adult binge-eating disorder and high weight enrolled in a randomized controlled prevention trial. Prior to intervention, participants completed questionnaires assessing perceived stress and emotional eating. Parents completed a questionnaire assessing their adolescent's emotion dysregulation. Moderation analyses were conducted using the PROCESS macro in SPSS and adjusted for theoretically relevant sociodemographic covariates.

RESULTS

The interaction between adolescent perceived stress and emotion dysregulation (parent-reported about the adolescent) in relation to adolescent emotional eating was found to be significant, such that higher emotion dysregulation magnified the association between perceived stress and emotional eating (p = .010). Examination of simple slopes indicated that associations between perceived stress and emotional eating were strongest for youth with above-average emotion dysregulation, and non-significant for youth with average or below-average emotion dysregulation.

DISCUSSION

Findings suggest that greater emotion dysregulation may increase risk for emotional eating in response to stress among military-dependent youth at risk for binge-eating disorder or high weight. Improving emotion regulation skills may be a useful target for eating disorder prevention among youth who are at risk for emotional eating.

PUBLIC SIGNIFICANCE

Prior research has shown that adolescent military dependents are at increased risk for eating disorders and high weight. The current study found that emotion dysregulation moderated the relationship between perceived stress and emotional eating among military-dependent youth. There may be clinical utility in intervening on emotion regulation for adolescent dependents at particular risk for emotional eating and subsequent eating disorders.

Effects of Covid-19-related anxiety on overeating and weight gain in a diverse college sample

The outbreak of the Covid-19 pandemic has been linked with caloric overeating and weight gain. We employed a mediation analysis to determine whether pandemic-associated overeating was a direct effect of Covid-19-related anxiety (affect regulation theory) or mediated by a coping mechanism of escape eating (escape theory). A diverse pool of college students participated in a repeated cross-sectional study during three separate waves: May 2021 (wave 1, n = 349), December 2021 (wave 2, n = 253), and March 2022 (wave 3, n = 132). The results revealed a significant indirect effect of Covid-19-related anxiety on high-caloric overeating mediated by escape eating, but no direct path between Covid-19-related anxiety and caloric overeating. Analysis of racial/ethnic status uncovered significantly greater Covid-weight gain in Hispanic participants compared with White, Black, and Asian participants. Our results suggest that Covid-19 weight gain is a byproduct of a mediated escape mechanism differentially affecting racial/ethnic groups.

The effect of perceived stress on binge eating behavior among Chinese university students: a moderated mediation model

Introduction

Previous studies have demonstrated a strong link between perceived stress and binge eating behavior, but the psychological mechanisms underlying such phenomenon are not fully understood. The present study further addressed this issue in a life history framework, focusing on life history strategy and distress tolerance.

Methods

Firstly, we investigated the mediation role of life history strategy on the relationship between perceived stress and binge eating behavior. Secondly, we examined the moderation role of distress tolerance on the effect of perceived stress on life history strategy, as well as on the direct effect of perceived stress on binge eating behavior. We analyzed data from 1342 Chinese university students.

Results

Results indicated that life history strategy mediates the relationship between perceived stress and binge eating behavior; distress tolerance has significant moderating effects on the direct effect of perceived stress on binge eating behavior and their indirect effect via life history strategy.

Discussion

Therefore, distress tolerance skills training and life history-based interventions might be potentially effective ways to reduce binge eating behavior triggered by perceived stress.

The effect of childhood depression trajectories on sugar-sweetened beverage habit trajectories in adolescence: Exploring sleep problems as a mediator

Although depression has been linked to the habit of consuming sugar-sweetened beverages (SSBs), little is known about their long-term relationships and the mediating role of sleep problems. This study examines the associations between childhood depressive symptoms trajectories and adolescent SSB-habit trajectories and whether these associations were mediated by sleep problems. Data came from 1560 adolescents participating in a longitudinal study across grades 1 through 12 in northern Taiwan. Group-based trajectory modeling was used to identify development of childhood depressive symptoms and an SSB habit in adolescence. Multinomial logistic regression was conducted to examine the influence of childhood depressive symptoms and adolescent SSB habit. Mediation analysis was conducted to test whether sleep problems mediated the associations examined. Four distinct trajectories of childhood depressive symptoms were identified: low-stable (30.79%), moderate-stable (42.32%), increasing (12.29%), and high-stable (11.60%). Three distinct trajectories of SSB habit in adolescence were identified: low-stable (44.32%), increasing (15.02%), and high-stable (40.65%). Children who had moderate-stable (aOR = 1.35; CI: 1.04-1.77), high-stable (aOR = 2.01; CI: 1.28-3.15), or increasing (aOR = 1.97; CI: 1.26-3.06) trajectories of depressive symptoms relative to those in the low-stable group were significantly more likely to belong to the high-stable trajectory of SSBs than to the low-stable SSBs group. The Z-mediation test showed that sleep problems significantly mediated the associations between trajectories of childhood depressive symptoms and trajectories of SSBs during adolescence (all p < 0.05). Childhood depressive symptoms conferred risks for adolescent SSB habits; and the effects were seen, in part, through increasing sleep problems.

Body dissatisfaction, negative affect, and engagement in healthy behaviors: The conditional effect of future-self continuity

The relationship between body dissatisfaction and negative affect is complex, with some research suggesting that this combination motivates individuals to engage in more health-related behaviors; while other studies find it increases unhealthy behavior. To bridge this gap, it may be the case that to the extent these individuals have continuity between their present and future selves, the more likely they are able to make positive health-related choices with this future self in mind. We examined individuals (n = 344; 51.74% men) aged between 18 and 72 years (M = 39.66, SD = 11.49) who endorsed high negative affect along with body dissatisfaction but either had high or low levels of future self-continuity. We found individuals experiencing body dissatisfaction and negative affect reported higher engagement in healthy behaviors only if they had a strong connection to their future self, index of moderated mediation = 0.07 (95% CI = 0.02, 0.13). These findings support targeting future-self continuity in therapeutic regimens to bolster engagement in healthy behaviors among individuals with body dissatisfaction and high negative affect.

The Relationship between Occupational Fatigue and Well-Being: The Moderating Effect of Unhealthy Eating Behaviour

Tech giants are large, well-known internet and technology companies. Employees of such companies are generally expected to work fast and for long periods of time, causing them to experience high occupational fatigue. The relationship between occupational fatigue and well-being is complex. Furthermore, in the context of the workplace, unhealthy eating behaviour may be used as a mechanism to cope with fatigue and stress. This study explored the relationship between occupational fatigue, well-being and unhealthy eating behaviour within this specific professional population. Study 1 used qualitative research methods, in which in-depth interviews were conducted with staff working at 13 tech giants in Shenzhen, China (N = 50). The findings revealed that work-related stress and occupational fatigue are common among employees working for tech giants. Additionally, factors such as unhealthy eating behaviour, workload, working hours and workplace interpersonal relationships were found to influence occupational well-being. Study 2 involved a cross-sessional survey of 237 employees of tech giants. The results indicated that occupational fatigue negatively impacts occupational well-being and that unhealthy eating behaviours play a moderating role between occupational fatigue and occupational well-being. These findings highlight the significance of adopting appropriate measures to improve the situation and cope with the effects of occupational fatigue by managing unhealthy eating behaviours.

The relationship between difficulties in the regulation of positive and negative emotions and binge-eating symptoms in young adults

It is well-established that binge-eating (BE) is linked to emotion regulation (ER) difficulties. However, research to date has focused almost exclusively on difficulties regulating negative emotions, with little attention to the relationship between positive emotion dysregulation and BE. Further, research is inconclusive regarding which specific facets of ER difficulties are most strongly associated with BE behaviour. Therefore, the current study examined whether difficulties regulating both negative as well as positive emotions explained unique variance in BE among young adults. The study also aimed to identify which particular dimensions of negative and positive ER difficulties were most strongly related to BE symptoms. Participants (N = 449) ages 18-25 completed self-report measures of difficulties regulating positive and negative emotions, BE symptoms, and psychological distress. Hierarchical regression analyses showed that BE was related to difficulties regulating both positive emotions and negative emotions, after controlling for psychological distress and BMI. Lack of emotional clarity and lack of access to ER strategies when faced with strong negative emotions were the facets of negative ER difficulties most strongly associated with BE. Impulsivity when experiencing strong positive emotions was the facet of positive ER difficulties most strongly associated with BE. These findings support the ER model of BE and suggest that difficulties regulating both positive and negative emotions contribute to BE among young adults.

Examining trait-like factors as predictors of state-level responses to food intake in women with bulimia nervosa, purging disorder, and controls

OBJECTIVE

Theories suggest that elevated negative affect and weight/shape concerns explain both who is affected by bulimic symptoms as well as when bulimic symptoms occur, suggesting that individual differences predict within-subject differences. However, few studies have tested this theoretical premise.

METHOD

In the present study, participants (N = 119) diagnosed with bulimia nervosa (N = 57), purging disorder (N = 31), and non-eating disorder controls (N = 31) completed measures of negative affect and weight/shape concerns and later made momentary affect and weight/shape concerns ratings before and after an ad lib meal.

RESULTS

State negative affect and weight/shape concerns increased post-meal. No moderating effect of trait negative affect was observed for state affect. In contrast, between-subject differences in weight/shape concerns moderated within-subject increases in state weight/shape concerns. Diagnostic group did not account for this effect.

DISCUSSION

Findings point to viable treatment targets for disordered eating. Targeting elevated weight/shape concerns early in interventions could facilitate reductions in purging after food intake for bulimia nervosa and purging disorder.

PUBLIC SIGNIFICANCE

In the present study, individual differences in weight/shape concerns at baseline predicted greater increases in state weight/shape concerns following eating. These effects were maintained when considering possible differences related to presence and type of eating disorder. Results suggest that targeting weight/shape concerns earlier in treatment may be important for reducing maladaptive responses to eating across eating disorders.

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.

Traversing mental health disorders during pregnancy: Lebanese women's experiences of antepartum depression and anxiety

INTRODUCTION

Over the past few years, Lebanon-a developing country-has faced a plethora of economic and political challenges, with more than half of the general population presenting depressive and anxiety symptoms. However, when it comes to maternal mental health during pregnancy, the last examination in Lebanon dates far back to 2005. Our study's aim was to help delineate the factors associated with Lebanese women's mental health disorders during pregnancy, namely antepartum depression and anxiety.

METHODS

We launched a cross-sectional study among Lebanese pregnant women (age ≥ 18 years) between June and July 2021, during the COVID-19 lockdown (N = 433).

RESULTS

In total, 87.8% of the participants experienced depression (mild to severe), where severe depression was observed in 7.9%. In addition, 70.3% had a significant level of anxiety. Increased pregnancy-specific hassles (beta = 0.93), being Muslim compared to Christians (beta = 3.19), being afraid of an existing aggressor (beta = 8.75), urinary tract infections (beta = 2.02), and higher gestational age (beta = 0.07) were significantly associated with higher depression, whereas higher physical activity index (beta =  - 0.09) and increased disordered eating attitudes during pregnancy (beta =  - 0.27) were significantly associated with less depression, all accounting for 60.4% of the model's variance. Additionally, increased pregnancy-specific hassles (beta = 0.54), being Muslim compared to Christians (beta = 2.42), urinary tract infections (beta = 1.72), and having been emotionally or physically abused (beta = 1.19) were significantly associated with higher levels of anxiety and could predict 49% of the total variance.

CONCLUSION

Our study has suggested the existence of factors that have additive effects in potentiating the risk for depression and anxiety among Lebanese pregnant women, namely cultural beliefs, pregnancy-related distress, medical complications during pregnancy, and a history of abuse. Therefore, it would be judicious to implement screening programs targeting pregnant women at risk for antepartum depression and anxiety. In addition, high rates of prenatal depression and anxiety were detected among our sample, supporting that recognizing and treating maternal mental health disorders should be prioritized during antenatal care in Lebanon.

"I enjoy the good foods, all of which are not good for me." The categorization and moralization of food

Intuitive eating emphasizes eating in response to physiological cues of hunger and satiety and is associated with multiple positive health outcomes. Unconditional permission to eat (UPE), a domain of intuitive eating, encourages removing food classifications and permission to eat all foods. However, the categorization of food is described as a method to simplify decision making and moralization of foods can help prioritize food items in consumption. Thus, we were interested in understanding how foods are labeled and applied, the moralization of foods, and how individuals with low UPE labeled and moralize foods. Using Prolific Academic, we recruited 49 adults 18 years and older living in the United States to complete an online survey and interview. The survey assessed intuitive eating (IES-2) and the interview explored what and how participants eat and their thoughts and feelings about their body. Participants frequently used multiple labels when talking about foods. Healthy and unhealthy were common and offered a rationale for consumption, emotions were used to label foods, and taste and cost were important to food choice. Participants frequently moralized foods, although three participants explicitly stated they choose not to moralize foods. Individuals reporting low UPE described the importance of restriction and were following strict dietary recommendations. While labeling foods has been proposed to simplify decision-making, the use of labels is highly nuanced and thus understanding the connections between how foods are labeled and behaviors may be highly complex. We suggest future research explore how the categorization and moralization of food are associated with health behaviors and outcomes, how differing definitions of "healthy/unhealthy" foods are associated with behaviors, and the impacts of food insecurity and chronic disease management on food categorization and moralization.

Frequency of Impulsive-Compulsive Behavior and Associated Psychological Factors in Parkinson's Disease: Lack of Control or Too Much of It?

Background and Objectives: Impulse Control Disorders (ICDs) including pathological gambling, hypersexuality, compulsive eating, compulsive buying, and other related behaviors are well-known distinct non-motor symptoms in Parkinson's Disease (PD). Some large-scale studies present a prevalence of at least 10%, however, there are other reports providing much higher rates. The majority of the conducted studies investigating ICDs focus mainly on pharmacological factors, however, from a psychological perspective, there is yet enough room for investigation. In order to address the above issues, we designed a two-part study. Materials and Methods: First, we aimed to identify the incidence of ICD and related behaviors in a cohort of 892 Greek PD patients. Second, we administered a comprehensive battery of psychometric tools to assess psychological factors such as personality dimensions, quality of life, defenses, coherence, and resilience as well as to screen general cognitive capacity in PD patients with ICD manifestations. Results: With regard to the first part, we identified ICD manifestations in 12.4% of the patients. Preliminary findings from the second part indicate elevated activity, rather than impulsivity, as well as interrelations between several variables, including measures of activity, coping mechanisms, and quality of life. Conclusions: We present a working hypothesis for the contribution of high activity channeled to specific behavioral patterns through specific coping mechanisms, concerning the emergence of ICDs and related behaviors in PD, and further stress the importance of compulsivity rather than impulsivity in this process.

Back to the future: Progressing memory research in eating disorders

OBJECTIVE

Human behaviors, thoughts, and emotions are guided by memories of the past. Thus, there can be little doubt that memory plays a fundamental role in the behaviors (e.g., binging), thoughts (e.g., body-image concerns), and emotions (e.g., guilt) that characterize eating disorders (EDs). Although a growing body of research has begun to investigate the role of memory in EDs, this literature is limited in numerous ways and has yet to be integrated into an overarching framework.

METHODS

In the present article, we provide an operational framework for characterizing different domains of memory, briefly review existing ED memory research within this framework, and highlight crucial gaps in the literature.

RESULTS

We distinguish between three domains of memory-episodic, procedural, and working-which differ based on functional attributes and underlying neural systems. Most recent ED memory research has focused on procedural memory broadly defined (e.g., reinforcement learning), and findings within all three memory domains are highly mixed. Further, few studies have attempted to assess these different domains simultaneously, though most behavior is achieved through coordination and competition between memory systems. We, therefore, offer recommendations for how to move ED research forward within each domain of memory and how to study the interactions between memory systems, using illustrative examples from other areas of basic and clinical research.

DISCUSSION

A stronger and more integrated understanding of the mechanisms that connect memory of past experiences to present ED behavior may yield more comprehensive theoretical models of EDs that guide novel treatment approaches.

PUBLIC SIGNIFICANCE

Memories of previous eating-related experiences may contribute to the onset and maintenance of eating disorders (EDs). However, research on the role of memory in EDs is limited, and distinct domains of ED memory research are rarely connected. We, therefore, offer a framework for organizing, progressing, and integrating ED memory research, to provide a better foundation for improving ED treatment and intervention going forward.

Food Addiction and Grazing-The Role of Difficulties in Emotion Regulation and Negative Urgency in University Students

University students are a vulnerable population to the development of disordered eating, such as food addiction (FA) and grazing. FA is an emerging concept characterized by an intense desire to eat hyper-palatable foods. Grazing is characterized by the repetitive and unplanned ingestion of food throughout a period of time. Both FA and grazing have been associated with increased scores of negative urgency (NU) and difficulties in emotion regulation (ER). This study aims to evaluate the frequency of FA and grazing in a university population and to test the direct, total, and indirect effects-via FA-of ER and NU on repetitive eating and compulsive grazing. A total of 338 participants responded to a set of psychological measures assessing these variables. Thirty-six (10.7%) participants met the criteria for FA diagnosis and 184 (54.4%) presented grazing. Confirmatory factor analysis showed acceptable fit indexes for the model tested (χ2(1695) = 3167.575; p < 0.001; CFI = 0.955; NFI = 0.908; TLI = 0.953; SRMR = 0.085; RMSEA = 0.051; CI 90% (0.048; 0.053); P[RMSEA ≤ 0.05] = 0.318) and suggested that FA partially mediated the effect of difficulties in ER and NU on grazing, specifically on compulsive grazing. The results indicate that individuals with difficulties in ER and impulse control under negative emotions are more likely to engage in grazing if food addiction scores are higher. These results highlight the importance of assessing these variables, particularly in at-risk populations such as university students.

Psychometric properties of persian version of escapism scale among Iranian adolescents

The aim of this study was to assess the psychometric properties of the Persian version of the Escapism Scale among Iranian adolescents aged 14-18. Between January 2021 and August 2021, cross-sectional study was conducted using a convenience sampling method to select 566 participants (340 girls and 226 boys) to investigate the relationship between physical activity and mental health in adolescents. The participants completed several questionnaires, including the Escapism Scale, Erikson Psychosocial Stage Inventory (EPSI), Satisfaction with Life Scale (SWLS), Hope Scale (AHS), Smartphone Addiction Scale-Short Version (SAS-SV), and General Self-efficacy (GSE). Construct validity, reliability using Cronbach's alpha, and concurrent validity were used to evaluate the Escapism Scale's validity and reliability. Results of the Confirmatory Factor Analysis (CFA) indicated that a two-factor model provided a good fit for the data: sbX2 = 179.99 (p < 0.01); SRMR = 0.07; RMR = 0.56, CFI = 0.91; NFI = 0.89; IFI = 0.91; NFI = 0.89; GFI = 0.93; AGFI = 0.90, RMSEA = 0.076). The Cronbach's alpha coefficient for escapism was 0.73. The study found a significant positive relationship between escapism and smartphone addiction (r = 0.19). Additionally, a significant negative relationship was observed between escapism and hope (r=-0.31), satisfaction with life (r=-0.34), and general self-efficacy (r=-0.33). Furthermore, a significant relationship was found between escapism and gender. Lastly, the study found a significant relationship between escapism and identity confusion (r = 0.164, P < 0.01) and identity coherence (P < 0.01, r = 29). In conclusion, the Escapism Scale is a valid and reliable tool for assessing escapism and psychological evaluations in Iranian adolescents. These results may inform future research and suggest re-testing in clinical populations.

Effect of body-related information on food attentional bias in women with body weight dissatisfaction

Women with body weight dissatisfaction (BWD) have long-term negative assessments of their body weight, which are often associated with poor eating behavior. In this study, we investigated the effect of body-related information on the food cue processing and attention of women with BWD. Sixty-eight women were recruited and assigned to either a BWD (NPSS-F > 2) (n = 32) or a no body weight dissatisfaction (NBWD) group (NPSS-F < 1) (n = 36). We measured attentional bias to food cues (high- and low-calorie) with a food probe task after exposure to body-related information and recorded eye tracking data. Body-related images were presented prior to a pair of stimulus images (food-neutral or neutral-neutral). Body-related information and food type were repeated measure factors in our study. Our results showed that the first fixation duration bias for high-calorie foods was significantly longer than for low-calorie foods after exposure to overweight cues in the BWD group. Compared with the NBWD group, the BWD group showed longer first fixation duration bias for high-calorie foods after exposure to overweight cues. The direction for high-calorie foods was significantly more often than that for low-calorie foods in the BWD group after exposure to body-related information. Our findings suggest that compared to women with NBWD, women with BWD may be more susceptible to body-related information, resulting in increased attention to high-calorie foods.

Reconceptualizing emotion regulation and coping strategy usage in eating disorders research: The utility of a regulatory flexibility framework

Emotion regulation and coping strategies are often conceptualized in eating disorder (ED) research as inherently adaptive or maladaptive, and successful regulation is often defined as greater overall use of adaptive strategies. However, recent empirical work outside of the field of EDs challenges this categorical conceptualization of strategies, demonstrating that adaptiveness is determined by the ability to flexibly implement and adjust strategies based on contextual demands (i.e., regulatory flexibility). Despite evidence that emotion regulation and coping strategies are best conceptualized in terms of flexibility in the broader literature, few ED studies have adopted this model. We review the current conceptual framework of emotion regulation and coping strategies used in ED research and present regulatory flexibility as an alternative approach to conceptualizing these strategies. The lack of research on regulatory flexibility among individuals with EDs limits our understanding of the role of emotion regulation and coping difficulties in ED risk and maintenance. Adopting a regulatory flexibility model of strategies in EDs may extend knowledge of the role of emotion regulation difficulties in the development and maintenance of EDs. We highlight the potential utility of investigating regulatory flexibility and present recommendations for future research on regulatory flexibility in EDs. PUBLIC SIGNIFICANCE STATEMENT: Research on emotion regulation and coping strategy usage in eating disorders often view regulatory strategies as inherently adaptive or maladaptive. However, recent studies support defining strategies in terms of flexibility. Adopting a regulatory flexibility model of strategies in eating disorders research may advance knowledge of the role of emotion regulation difficulties in the development and maintenance of eating disorders, ultimately enhancing prevention and treatment efforts.

Incidence and prevalence of eating disorders among active duty US military-dependent youth from 2016 to 2021

OBJECTIVE

The offspring of US military service members may be at increased risk for eating disorders. However, no epidemiological studies to date have evaluated eating disorder incidence rates and prevalence estimates among military-dependent youth.

METHOD

This retrospective cohort study examined eating disorder diagnoses in the military healthcare system (MHS) from 2016 through 2021. Active duty and national guard military-dependent youth, aged 10-17 years, who received care in the MHS via TRICARE Prime insurance, were identified by one or more ICD-10 codes indicative of an eating disorder diagnosis (anorexia nervosa, bulimia nervosa, binge-eating disorder, and other-specified eating disorders).

RESULTS

During the 6-year surveillance period, 2534 dependents received incident diagnoses of eating disorders, with a crude overall incidence rate of 1.75 cases per 10,000 person-years. The most common diagnosis was other-specified eating disorder, followed by anorexia nervosa, bulimia nervosa, and binge-eating disorder. The crude annual incidence rate of all eating disorder diagnoses increased by nearly 65% from 2016 to 2021. Rates for all diagnoses were highest in 2020 and 2021. Period prevalence estimates were .08% for any eating disorder diagnosis, .01% for anorexia nervosa, .004% for bulimia nervosa, .004% for binge-eating disorder, and .06% for other-specified eating disorders.

DISCUSSION

The observed increase in eating disorder diagnoses during the surveillance period appeared to be driven by female dependents. More military dependents experienced a new-onset diagnosis during the COVID-19 pandemic compared to previous years. These findings highlight the need for eating disorder screening, identification, and treatment for dependents within the MHS.

PUBLIC SIGNIFICANCE STATEMENT

Children of US military service members may be at increased risk for eating disorders. Results indicate new-onset eating disorder cases increased 65% from 2016 to 2021, primarily among girls compared to boys. The most diagnosed and fastest growing diagnosis was other-specified eating disorder. Rates of anorexia nervosa increased following the COVID-19 pandemic. Findings highlight the need for eating disorder screening, identification, and treatment within the military healthcare system.

Characteristics of Malaysian 16-year-old girls who reported regular binge eating episodes and the associated risk factors: a descriptive study

OBJECTIVES

Adolescents may suffer from binge eating (BE), that refers to consuming a large amount of food in a short period of time and accompanied by feelings of loss of control (LOC) over eating. This study compared the prevalence of BE between 16-year-old Malaysian girls from two types of public schools, Malay-English-medium and Chinese-Malay-English-medium schools. Additionally, this study identified associated risk factors of those who presented regular BE episodes, including LOC eating, anxiety, body mass index (BMI), body dissatisfaction (BD) and eating disorders (EDs) psychopathology.

METHODS

398 participants completed self-reports assessing BE symptoms, LOC eating, state anxiety, trait anxiety, EDs psychopathology, and BD. They also reported heights and weights. Descriptive statistics, t-tests, chi-square tests, and Z-test for independent proportions were conducted.

RESULTS

There was no significant difference in either the prevalence of BE or EDs psychopathology between participants from the two types of schools. 71 (17.8 %) participants reported moderate-to-severe symptoms of BE, and 46 (11.6 %) reported moderate-to-severe levels of LOC eating. Those who reported moderate-to-severe symptoms of BE reported significantly higher levels of LOC eating, BD, drive to be thinner, BMI, state anxiety, and EDs psychopathology, compared to those who reported none-to-minimal BE.

CONCLUSIONS

BE and LOC eating appeared to be relatively common among secondary school girls in Malaysia. The relatively high prevalence of BE amongst adolescents in our sample highlighted the importance of early identification of signs for BE as preventive measures from developing EDs psychopathology among children and adolescents. We propose that attitudes towards eating and body image-related concerns should be included in school screenings aimed at preventing psychological problems in minors.

School absenteeism and impairment associated with weight bullying

INTRODUCTION

Many children experience weight-based bullying (WB), when individuals are treated poorly or demeaned because of weight. WB has negative mental and physical health consequences. The current study examined how children's experiences of different forms of WB (verbal, social, physical, cyber) were associated with impaired functioning in school, social life, and family life.

METHODS

Data were collected in Spring 2021. Participants (N = 224) were parents of a school-aged child and lived in the United States. Sixty percent of parents were mothers and 72% of parents self-identified as White. They completed surveys regarding weight, eating, and bullying.

RESULTS

Social and cyber WB were associated with clinically significant impairment for both children and parents. Children who experienced social and physical WB were more likely to skip school, whereas physical and cyber WB were associated with skipping a particular class. All forms of bullying were associated with skipping gym class. Social and cyber WB were associated with isolating. Cyber WB was associated with all disordered eating behaviors. In addition, physical WB was associated with binge eating, social WB was associated with purging, and verbal WB was associated with secretive eating.

DISCUSSION

Victims of WB experience impairment in school, social life, and family life, absenteeism, and disordered eating. It is essential to develop approaches to address WB in its various forms to identify strategies for reducing and preventing WB across various levels of influence, including peer groups, schools, and families.

Social Networking Site Use and Emotional Eating Behaviors among Chinese Adolescents: The Effects of Negative Social Comparisons and Perspective-Taking

Emotional eating has emerged as a significant disordered eating and public health concern among adolescents. Despite the widespread prevalence of social networking site (SNS) use among this population, research investigating the influence of SNS use on adolescent eating behaviors remains limited. This study is to examine the impact of SNS use on emotional eating among Chinese adolescents, with a specific focus on exploring the mediating role of negative social comparisons and the moderating effect of perspective-taking. Data were obtained through an online survey involving 778 middle school students in China. The findings indicate that SNS use exerts a positive influence on adolescents' engagement in emotional eating, with this association being mediated by the presence of negative social comparisons. Perspective-taking demonstrated a protective role in the context of adolescents' utilization of social media platforms. For individuals characterized by high levels of perspective-taking, the effects of SNS use on negative social comparisons are mitigated, subsequently reducing its impact on emotional eating.

Shame facets as predictors of problematic eating behaviors: An ecological momentary assessment study

It is well-established that negative affect acts as predictor and maintenance factor of problematic eating behaviors. However, the relevance of different facets of negative affect is unclear. While guilt was consistently shown as having a relevant contribution in relation with problematic eating patterns, shame might play a similar role. The current study used an ecological momentary assessment design to assess associations between facets of shame and subsequent disturbed eating behaviors. The study included 57 females with high levels of eating disorders (ED) symptomatology who completed five surveys per day for 14 consecutive days. Participants completed measures of facets of shame (i.e., general shame, body shame, shame around eating), negative affect and problematic eating behaviors (i.e., binge eating, restriction, weighting, body checking, purging, taking laxative/diuretics and excessive exercise). Data were analyzed using multilevel models. In general, between-subjects facets of shame were associated with more disturbed eating behaviors, with shame explaining a significantly and clinically relevant percent of the variance of these problematic eating behaviors. At the within-subject level, facets of shame predicted subsequent binge eating, body checking and excessive exercise. These findings support the role of shame in ED symptomatology and the relevance of directly tackling shame in psychological treatments.

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.

Functions of disordered eating behaviors: a qualitative analysis of the lived experience and clinician perspectives

BACKGROUND

One method to improve treatment outcomes for individuals with eating disorders (EDs) may be understanding and targeting individuals' motives for engaging in DE behaviors-or the functions of DE behaviors. The goal of this study was to investigate and categorize the various functions of DE behaviors from the perspectives of adults who engage in DE behaviors and clinicians who treat EDs.

METHODS

Individuals who engage in DE behaviors (n = 16) and clinicians who treat EDs (n = 14) were interviewed, and a thematic analysis was conducted to determine key functions of DE behaviors.

RESULTS

Four main functions of DE behaviors were identified by the authors: (1) alleviating shape, weight, and eating concerns; (2) regulating emotions; (3) regulating one's self-concept; and (4) regulating interpersonal relationships/communicating with others.

CONCLUSIONS

Differences in participant responses, particularly regarding the relevance of alleviating shape and weight concerns as an DE behavior function, highlight the importance of individualized conceptualizations of DE behavior functions for any given client.

The effects of body dissatisfaction and depression levels on the dietary habits of university students in southern China during COVID-19

Introduction

The novel coronavirus disease of 2019 has impacted people's lives greatly. The spread of the pandemic has restricted many everyday social lives. Some studies have shown that strict risk control during the pandemic threatens people's mental health and eating habits. University students vulnerable to mental health problems may have more prominent mental health and eating disorders during the pandemic. This study aims to elucidate the relationship between body dissatisfaction, depression, body mass index, and emotional eating among university students in the context of the pandemic in southern China. It provides a theoretical basis for developing future approaches to improve depression and emotional eating among university students.

Methods

A total of 1,135 university students were recruited for the study. All participants completed anthropometric, body dissatisfaction, eating behavior, and depression level surveys.

Results

The study finds that female students have higher levels of body dissatisfaction, depression, and emotional eating than male students. University students in the high body dissatisfaction group had higher levels of depression. Depression level (β = 0.33, p < 0.01), body dissatisfaction (β = 0.22, p < 0.01), sex (β = 0.16, p < 0.01), and income (β = 0.06, p < 0.01) were significant predictors of emotional eating. Fundamentally, this study highlights the impact of body dissatisfaction on depression and emotional eating.

Discussion

The potential to improve depression and emotional eating among university students by improving their levels of body dissatisfaction was demonstrated.

The impact of work-family conflict on product preferences: The role of self-control

Despite the high incidence of work-family conflict, there has been a lack of research that investigates its impact on employee behavior, particularly concerning their consumption behavior, which has received inadequate attention. The present study draws on the strength model of self-control and investigates the influence of individuals' work-family conflict on their preferences for hedonic and utilitarian products via self-control, with frugality acting as a moderator of this relationship. This study gathered data from 502 full-time employees with families in China. Results from the moderated mediating model analysis conducted using the SPSS-PROCESS macro revealed that work-family conflict was positively associated with a preference for hedonic products and negatively associated with a preference for utilitarian products. Self-control was found to mediate the relationship between work-family conflict and product preferences, with a weaker mediating effect observed for individuals with higher levels of frugality in the case of utilitarian products. The findings of this study contribute to the literature on work-family conflict and have implications for organizations and merchants in understanding and addressing the impact of work-family conflict on employee consumption behavior. Specifically, this study provides insight into how organizations can better manage work-family conflict and how merchants can make more informed marketing decisions for hedonic and utilitarian products.

Weight and disordered eating among adolescents from low-income backgrounds

Disordered eating affects youth from varying socioeconomic backgrounds; however, representation of youth from low-income backgrounds within disordered eating research has been limited. The aim of the current study was to examine the association between adolescent weight and disordered eating among a sample of youth from a low-income background and to examine specific socioenvironmental factors that might moderate this association. Adolescents ages 12-17 (N = 73) from a low-income background and their parents/guardians completed self-report questionnaires. Adolescent height and weight were objectively measured to calculate BMI z-score. Adolescent weight was significantly positively associated with global disordered eating (95 % CI [0.26, 0.54]), after controlling for sex. Parental weight concern moderated the association between weight and global disordered eating, F(4, 68) = 18.44, p < .01, such that the relation between adolescent zBMI and disordered eating was no longer significant at low levels of parental weight concern. Structured family meals moderated the association between weight and global disordered eating, F(4, 68) = 11.99, p < .01, such that more frequent meals weakened the association between adolescent zBMI and disordered eating. Findings suggest that higher weight is associated with greater levels of disordered eating among adolescents from a low-income background. In addition, lower levels of parental weight concern and more frequent family meals significantly buffered the association between weight and disordered eating in this at-risk, yet understudied population. Both parental weight concern and family meals present as factors within the family environment that may serve as targets for intervention.

Integrating aspects of affect, reward, and cognition to develop more comprehensive models of binge-eating pathology

Reward-related processes are an increasing focus of eating disorders research. Although evidence suggests that numerous distinct reward processes may contribute to eating pathology (e.g., reward learning and delay discounting), existing etiological models of reward dysfunction tend to focus on only a limited number of reward processes, and frequently lack specificity when identifying the individual reward processes hypothesized to contribute to dysregulated eating behavior. Moreover, existing theories have been limited in their integration of reward-related processes with other demonstrated risk and maintenance factors for eating disorders (e.g., affect and cognition), potentially contributing to underdeveloped models of eating pathology. In this article, we highlight five distinct reward processes with theorized or demonstrated relevance to eating disorders involving binge-eating, followed by a review of two well-established risk/maintenance factors for binge-eating pathology. We then introduce two novel models of binge eating onset and maintenance that integrate these factors (i.e., the Affect, Reward, Cognition models), and discuss methods for testing each of the models in future research. Ultimately, we hope that the proposed models provide a springboard for the continued evolution of more precise and comprehensive theories of reward dysfunction in the eating disorders, as well as the development of novel intervention approaches. PUBLIC SIGNIFICANCE STATEMENT: Eating disorders are associated with abnormalities in multiple domains of reward functioning. However, models of reward dysfunction within the eating disorders have not been well-integrated with prominent models of affect and cognition. This article presents two novel models of onset and maintenance for binge-eating pathology, which attempt to integrate observed reward abnormalities with other affective and cognitive processes implicated in binge-type eating disorders.

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.

Loss of control eating in relation to blood pressure among adolescent girls with elevated anxiety at-risk for excess weight gain

Loss of control (LOC)-eating, excess weight, and anxiety are robustly linked, and are independently associated with markers of poorer cardiometabolic health, including hypertension. However, no study has examined whether frequency of LOC-eating episodes among youth with anxiety symptoms and elevated weight status may confer increased risk for hypertension. We examined the relationship between LOC-eating frequency and blood pressure among 39 adolescent girls (14.9 ± 1.8 years; body mass index [BMI] = 29.9 ± 5.6; 61.5 % White; 20.5 % African American/Black; 5 % Multiple Races; 2.5 % Asian; 12.8 % Hispanic/Latino; 30.8 % with reported LOC-eating) with elevated anxiety and above average BMI who enrolled in a clinical trial aimed at preventing excess weight gain. LOC-eating over the past three months was assessed via clinical interview, and blood pressure (systolic and diastolic) was measured with an automatic blood pressure monitor. Adjusting for age, fat mass, and height, LOC-eating episode frequency was significantly, positively associated with diastolic blood pressure (β = 0.38, p = 0.02), but not with systolic blood pressure (β = 0.13, p = 0.41). Replication studies, with larger sample sizes, participants of varying weight-strata, and prospective data are required to elucidate the relationship between LOC-eating and cardiovascular functioning in youth with elevated anxiety.

Inhibitory control towards angry stimuli in patients with binge eating disorder: a pilot study

BACKGROUND

Emotion regulation theories and the negative urgency concept assume that negative mood increases binge eating. Negative emotions are considered as a trigger for binge eating, while binge eating itself is regarded as an impulsive behavior and should thus be increased within the negative urgency concept. Anger might be a specific negative emotion triggering binge eating in patients with binge eating disorder (BED). We investigated how inhibitory control as one main factor of impulsivity is influenced by anger stimuli in patients with BED and two control groups.

METHODS

We compared patients with BED (N = 20) with normal-weight healthy control participants (NW-CG, N = 20) and BMI-matched overweight and obese control participants (BMI-CG, N = 18). We used the emotional Stop Signal task (eSST) to investigate inhibitory control, where we presented angry facial expressions in comparison with neutral facial expressions as emotional stimuli.

RESULTS

All participants showed decreased inhibitory control in the angry versus neutral condition, i.e., a faster Stop Signal Reaction Time and a lower percentage of correct reactions. However, no significant group differences emerged in terms of performance. Performance in the eSST did not correlate with negative urgency, disorder- or emotion-related characteristics.

CONCLUSIONS

The current pilot study does not deliver evidence for decreased inhibitory control towards angry stimuli in patients with BED, as we detected a general and not disorder-related effect in all participants that might represent the conjunction of inhibitory control and anger. A direct mood induction technique might have led to different results. Further research in healthy and clinical groups is needed.

Appetitive and Aversive Motivation in Dysregulated Behaviors: A Meta-Analysis

Appetitive and aversive motivation are prominent in theories of dysregulated behaviors. The authors conducted a meta-analysis of the association between individual differences in appetitive and aversive motivation and several dysregulated behaviors (i.e., alcohol use, marijuana use, tobacco use, binge eating, aggression, gambling, and nonsuicidal self-injury). Alcohol use (r = .17, k = 141), marijuana use (r = .13, k = 23), aggression (r = .22, k = 52), and gambling (r = .08, k = 55) were all significantly positively related to appetitive motivation. Binge eating (r = .28, k = 34) and self-injury (r = .17, k = 10) were significantly positively related to aversive motivation. Effect sizes were similar to the median effect size in personality research. Together, these results provide some evidence that some dysregulated behaviors are more correlated with approach motivation, whereas others are more correlated with aversive motivation, which may indicate distinct etiological pathways.

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.

Facets of impulsivity and reward in relation to binge-eating disorder course of illness among children: findings from the Adolescent Brain Cognitive Development study

BACKGROUND

The present study examined facets of impulsivity and reward sensitivity [as measured by the UPPS-P Impulsive Behavior Scale and Behavioral Activation and Behavioral Inhibition Scales (BIS/BAS)] as multivariable predictors of subsequent binge-eating disorder (BED) course of illness in middle childhood.

METHODS

The current sample included children aged 9-10 years (N = 9,438) who took part in the baseline and 1-year follow-up assessments of the Adolescent Brain Cognitive Development (ABCD) study. BED course was operationalized as those who never developed BED or subthreshold BED (SBED) ('control'), were diagnosed with BED/SBED at year 1 but not baseline ('developers'), were diagnosed with BED/SBED at baseline but not year 1 ('remitters'), or were diagnosed with BED/SBED at both times ('maintainers').

RESULTS

Higher baseline BIS/BAS reward responsivity scores were related to the greater likelihood of belonging to the maintainer group relative to the control and remitter groups (ORs1.12-1.19). Regarding covariates, higher baseline body mass index percentile and internalizing symptoms were related to the greater likelihood of BED development, remittance, and maintenance compared to the control group (ORs = 1.04-1.14); no variables were uniquely related to BED development. Exploratory analyses showed that the likelihood of belonging to the maintainer group compared to the control group was greatest at higher levels of negative urgency in combination with high reward responsivity.

CONCLUSIONS

Heightened reward responsivity may convey risk for poorer BED course in children, while emotional disorder symptomatology may act as a more general risk and maintenance factor for BED.

Autonomic indices and loss-of-control eating in adolescents: an ecological momentary assessment study

BACKGROUND

Loss-of-control (LOC) eating commonly develops during adolescence, and it predicts full-syndrome eating disorders and excess weight gain. Although negative emotions and emotion dysregulation are hypothesized to precede and predict LOC eating, they are rarely examined outside the self-report domain. Autonomic indices, including heart rate (HR) and heart rate variability (HRV), may provide information about stress and capacity for emotion regulation in response to stress.

METHODS

We studied whether autonomic indices predict LOC eating in real-time in adolescents with LOC eating and body mass index (BMI) ⩾70th percentile. Twenty-four adolescents aged 12-18 (67% female; BMI percentile mean ± standard deviation = 92.6 ± 9.4) who reported at least twice-monthly LOC episodes wore biosensors to monitor HR, HRV, and physical activity for 1 week. They reported their degree of LOC after all eating episodes on a visual analog scale (0-100) using a smartphone.

RESULTS

Adjusting for physical activity and time of day, higher HR and lower HRV predicted higher self-reported LOC after eating. Parsing between- and within-subjects effects, there was a significant, positive, within-subjects association between pre-meal HR and post-meal LOC rating. However, there was no significant within-subjects effect for HRV, nor were there between-subjects effects for either electrophysiologic variable.

CONCLUSIONS

Findings suggest that autonomic indices may either be a marker of risk for subsequent LOC eating or contribute to LOC eating. Linking physiological markers with behavior in the natural environment can improve knowledge of illness mechanisms and provide new avenues for intervention.

Mindfulness facets differentially relate to self-reported negative and positive emotional eating types in treatment-seeking adults with overweight/obesity

BACKGROUND

Mindfulness is a meaningful therapeutic target in the treatment of emotional eating in adults with overweight/obesity. Descriptive research mapping relations between mindfulness facets and emotional eating types in treatment-seeking adults with overweight/obesity is needed.

METHODS

Cross-sectional relations between mindfulness facets (i.e., acting with awareness, describe, non-judgment, non-reactive, and observe; Five Facet Mindfulness Questionnaire-Short Form) and emotional eating types (i.e., self-reported negative and positive emotional eating; Emotional Eating Scale-Revised, Emotional Appetite Questionnaire) were examined in a treatment-seeking sample of adults with overweight/obesity (N = 63).

RESULTS

Significant bivariate correlations revealed negative relations between mindfulness facets and emotional eating types. Multiple regressions revealed that higher describe (β = - 0.42, p = 0.004) mindfulness was associated with lower self-reported emotional eating-anger/anxiety; higher non-reactive (β = - 0.31, p = 0.01) and non-judgment (β = - 0.28, p = 0.02) mindfulness were associated with lower self-reported emotional eating-depression; and higher non-judgment (β = 0.26, p = 0.04) mindfulness was associated with higher self-reported emotional eating-positive.

CONCLUSIONS

Describe, non-judgment, and non-reactive mindfulness were uniquely and significantly associated with eating in response to negative and positive emotions. Results suggest the potential need for intervention programs to be sensitive to the multidimensional nature of mindfulness in the treatment of distinct types of emotional eating in adults with overweight/obesity.

LEVEL OF EVIDENCE

V, cross-sectional descriptive study.

Racial Discrimination is Associated with Binge-Eating Disorder in Early Adolescents: A Cross-Sectional Analysis

Background Racial and ethnic discrimination are known stressors and are associated with negative psychological and physical health outcomes. Previous studies have found relationships between racial/ethnic discrimination and binge-eating disorder (BED), though they have mainly focused on adult populations. The aim of this study was to determine associations between racial/ethnic discrimination and BED in a large, national cohort study of early adolescents. We further sought to explore associations between the racial/ethnic discrimination perpetrator (students, teachers, or other adults) and BED. Methods We analyzed cross-sectional data from the Adolescent Brain Cognitive Development Study (ABCD) (N = 11,075, 2018-2020). Logistic regression analyses examined associations between self-reported racial or ethnic discrimination and binge-eating behaviors and diagnosis. Racial/ethnic discrimination measures were assessed based on the Perceived Discrimination Scale, which measures experiences of discrimination based on race/ethnicity and frequency of ethnic discrimination by teachers, adults outside of school, and students. Binge-eating behaviors and diagnosis were based on the Kiddie Schedule for Affective Disorders and Schizophrenia (KSAD-5), adjusting for age, sex, race/ethnicity, household income, parental education, and site. Results In this racially diverse sample of adolescents (N = 11,075, mean age: 11 years), 4.7% of adolescents reported racial or ethnic discrimination and 1.1% met the criteria for BED at the one-year follow-up. In the adjusted models, racial/ethnic discrimination was associated with 3 times higher odds of having BED (OR 3.31, CI 1.66-7.74); when investigating associations between the racial/ethnic discrimination perpetrator (students, teachers, or other adults) and BED, experiencing ethnic discrimination by students and adults outside school were associated with significantly increased odds of BED diagnosis (OR 1.36, CI 1.10-1.68 & OR 1.42 CI 1.06-1.90, respectively); further, increased odds of binge eating behaviors was only significantly associated with ethnic discrimination perpetuated by students (OR 1.12, CI 1.02-1.23). Conclusions Children and adolescents who have experienced racial/ethnic discrimination, particularly when discrimination was perpetuated by other students, have higher odds of having binge-eating behaviors and diagnoses. Clinicians may consider screening for racial discrimination and providing anti-racist, trauma-informed care when evaluating and treating patients for BED.

Network analysis of eating disorder and depression symptoms among university students in the late stage of COVID-19 pandemic in China

Background

Eating disorders (EDs) and depression are common in university students, especially during the COVID-19 pandemic. The aim of this study was to elucidate characteristics of EDs and depression symptoms networks among Chinese university students in the later stage of the COVID-19 pandemic in China.

Methods

A total of 929 university students completed the SCOFF questionnaire measuring EDs and Patient Health Questionnaire with 9 items (PHQ-9) measuring depression in Guangzhou, China. The network model was applied to identify central symptoms, bridge symptoms, and important connections between SCOFF and PHQ-9 using R studio. The subgroup analyses of both genders in medical and non-medical students were further explored.

Results

In the networks of the whole sample, central symptoms included "Loss of control over eating" (EDs) and "Appetite changes" (depression). The bridge connections were between "Loss of control over eating" (EDs) and "Appetite changes" (depression), between "Deliberate vomiting" (EDs) and "Thoughts of death" (depression). "Appetite changes" (depression) and "Feeling of worthlessness" (depression) were central symptoms in both subgroups of medical and non-medical students. "Fatigue" (depression) was the central symptom in the female and medical students group. The edge between "Loss of control over eating" (EDs) and "Appetite changes" (depression) acted as a bridge in all subgroups.

Conclusion

Social network approaches offered promising ways of further understanding the association between EDs and depression among university students during the pandemic of COVID-19 in China. Investigations targeting central and bridge symptoms would help to develop effective treatments for both EDs and depression for this population.

The functions of binge eating scale (FBES): Development and preliminary psychometric validation

OBJECTIVE

Binge eating within binge-eating disorder (BED) is a behaviour widely understood as a response to dietary restraint and emotion dysregulation. However, qualitative literature suggests that a wider range of functions of binge eating exist, with associations between functions of binge eating and adverse childhood experiences highlighted across this research. The present study sought to develop a scale to measure a wide range of functions of binge eating within BED. A secondary aim was to examine the relationship between these functions and adverse childhood experiences (ACEs).

METHOD

The researchers developed an initial item pool for the Functions of Binge Eating Scale (FBES) and invited experts within the eating disorder (ED) field (n = 22) to review the items. The refined item pool was administered online to adults with self-reported binge eating symptoms (N = 882), along with related measures to establish scale validity.

RESULTS

Exploratory and confirmatory factor analyses produced an eight-factor structure (emotion regulation, hedonic hunger, compensatory eating, numbness/dissociation, emotion expression, self-punishment, control, self-protection). The scale demonstrated good internal reliability and adequate construct and predictive validity. Results also showed that functions theoretically related to childhood maltreatment were predicted by ACEs.

DISCUSSION

Findings extend our understanding of the range of functions of binge eating experienced in BED. Additionally, findings indicate that type of adverse childhood experience predicts functions of binge eating. Initial validation of the FBES suggests that functions of binge eating are wider than previously understood. Accordingly, clinicians are encouraged to explore and target more complex processes which might perpetuate binge-eating behaviour.

Sensory emotion regulation

Decades of evidence reveal intimate links between sensation and emotion. Yet, discussion of sensory experiences as tools that promote emotion regulation is largely absent from current theorizing on this topic. Here, we address this gap by integrating evidence from social-personality, clinical, cognitive-neuroscience, and animal research to highlight the role of sensation as a tool that can be harnessed to up- or downregulate emotion. Further, we review evidence implicating sensation as a rapid and relatively effortless emotion regulation modality and highlight future research directions. Notably, we emphasize the need to examine the duration of sensory emotion regulation effects, the moderating role of individual and cultural differences, and how sensory strategies interact with other strategies.

Negative affect and loss-of-control eating in relation to adiposity among non-Hispanic youth identifying as black or white

Negative affect and loss-of-control (LOC)-eating are consistently linked and prevalent among youth identifying as non-Hispanic Black (NHB) and non-Hispanic White (NHW), particularly those with high weight. Given health disparities in high weight and associated cardiometabolic health concerns among NHB youth, elucidating how the association of negative affect with adiposity may vary by racial/ethnic group, and whether that relationship is impacted by LOC-eating, is warranted. Social inequities and related stressors are associated with negative affect among NHB youth, which may place this group at increased risk for excess weight gain. Across multiple aggregated protocols, 651 youth (13.0 ± 2.7 y; 65.9 % girls, 40.7 % NHB; 1.0 ± 1.1 BMIz; 37.6 % LOC-eating) self-reported trait anxiety and depressive symptoms as facets of negative affect. LOC-eating was assessed by interview and adiposity was measured objectively. Cross-sectional moderated mediation models predicted adiposity from ethno-racial identification (NHB, NHW) through the pathway of anxiety or depressive symptoms and examined whether LOC-eating influenced the strength of the pathway, adjusting for SES, age, height, and sex. The association between ethno-racial identity and adiposity was partially mediated by both anxiety (95 % CI = [0.01, 0.05]) and depressive symptoms (95 % CI = [0.02, 0.08]), but the mediation was not moderated by LOC-eating for either anxiety (95 % CI = [-0.04, 0.003]) or depressive symptoms (95 % CI = [-0.07, 0.03]). Mechanisms underlying the link between negative affect and adiposity among NHB youth, such as stress from discrimination and stress-related inflammation, should be explored. These data highlight the need to study impacts of social inequities on psychosocial and health outcomes.