Food Addiction Is Associated with Irrational Beliefs via Trait Anxiety and Emotional Eating

Emotional eating, internet overuse, and alcohol intake among college students: a pilot study with virtual reality

Introduction

The term emotional eating (EE) describes the tendency to eat as an automatic response to negative emotions and has been linked to anxiety and depression, common symptoms among the university population. The EE tendencies have also been associated with excessive internet use and an increase in alcohol intake among young university students.

Methods

The aim of this study is to examine the relationship between the tendency towards EE and other health-compromising behaviors, such as excessive internet use or high alcohol intake. Additionally, it aims to investigate the association of these risky behaviors with the participants' performance level in a virtual reality (VR) task that assesses their executive functioning, and to assess impulsivity and levels of anxiety and depression.

Results

The results associate EE with excessive internet (r = 0.332; p < 0.01). use but not with alcohol consumption. Alcohol consumption was not associated with anxiety, depression, or impulsivity, but it was related to altered executive functions in the VR task: flexibility and working memory explained 24.5% of the variance. By contrast, EE and internet overuse were not related to executive function but were associated with impulsivity, depression, and anxiety. Impulsivity and depressive symptoms accounted for 45% of the variance in EE. Depression, trait anxiety and impulsivity explained 40.6% of the variance in internet overuse.

Discussion

The results reveal distinct patterns of psychological and neuropsychological alterations associated with alcohol consumption compared to emotional eating (EE) and excessive internet use. These findings underscore significant differences in the contributing factors between addictions and other substance-free addictive behaviors. For a deeper understanding of the various contributing factors to EE in college students, further research is recommended.

The role of irrational beliefs in the relationship between attention deficit hyperactivity disorder (ADHD) symptoms and disordered eating in two general student samples

Attention deficit hyperactivity disorder (ADHD) symptoms are associated with disordered eating and negative mood. The purpose of this study was to examine whether irrational beliefs mediate this relationship along with previously reported mediators such as depression and impulsivity. Irrational beliefs trigger negative automatic thoughts which are believed, in cognitive behavior therapies, to be a source of psychopathology. Challenges brought about by symptoms of ADHD may lead to habitual emotion-eliciting thought patterns which, in turn, could lead to negative mood and disordered eating. Undergraduate students (N = 127) completed online questionnaires assessing ADHD symptoms and disordered eating and several potential mediators including irrational beliefs, depression, impulsivity, interoceptive accuracy, and reward responsiveness. The results, which were replicated in a second study (N = 254), indicated that irrational beliefs and depression mediated the relationship between ADHD symptoms and disordered eating. In the second study, impulsivity due to negative urgency was also a mediator. These findings support the theory that the symptoms of ADHD lead to enhancement of irrational beliefs, depression, and negative urgency which are linked to disordered eating.

Factors increasing the risk for food addiction in Ecuadorian students

Background

Food addiction (FA) is a construct that has gained interest in recent years, but its relevance in the Ecuadorian population has not yet been explored. The aims of this study were to explore the differences in the psychological profile (including FA) between university students from Ecuador and to identify the underlying structure of the relationships of the FA severity level through a mediational model.

Methods

The sample consisted of 972 university students, women and men (mean age: 20.1 years old, SD = 2.6), recruited from four Ecuadorian regions. The assessment tools included a unidimensional scale of FA, eating-related measures, emotion regulation state, impulsivity, and psychopathology state. Path analysis modeled the direct and indirect effects explaining the FA severity level.

Results

The results indicated that higher psychopathological levels were associated with FA. Similarly, no differences in FA were observed between the Ecuadorian regions. The path analysis suggested that older age, female sex, and higher difficulties in emotional regulation, impulsivity, negative mood, and anxiety trigger disordered eating; subsequently, more impaired eating behavior impacted the FA level.

Conclusion

FA is a complex clinical entity that includes multiple components related to eating disorders (EDs) and other mental health problems. The results of this study provide empirical knowledge for designing evidence-based prevention and treatment strategies.

The relationship between coronavirus anxiety level and emotional eating in individuals with metabolic syndrome

This study used a descriptive, cross-sectional and relational screening model. The full sampling method was used in this study. The study was completed with 105 individuals with MetS attending the outpatient nutrition clinic and 109 non-MetS individuals without MetS diagnosis, who also attended the outpatient nutrition clinic. The data included anthropometric measurements, biochemical findings, blood pressure, a survey form, the Coronavirus Anxiety Scale (CAS), and the Emotional Eating Scale (EES). The coronavirus anxiety scale scores of individuals with MetS were found to be statistically significantly higher than those of the non-MetS group (p <0.05). The difference in the emotional eating scale scores between the MetS and non-MetS groups was not significant (p <0.05). Individuals with MetS had higher coronavirus anxiety levels than those without MetS; however, there was no difference between participants with and without MetS in terms of emotional eating behavior.

Associations among alexithymia, disordered eating, and depressive symptoms in treatment-seeking adolescent military dependents at risk for adult binge-eating disorder and obesity

PURPOSE

Evidence suggests that difficulties identifying and describing one's feelings, core components of alexithymia, are associated with attitudinal and behavioral symptoms of disordered eating; depressive symptoms also may underlie these associations. Specifically, research indicates that alexithymia is positively related to depressive symptoms, which in turn may promote both disordered-eating attitudes and certain disinhibited-eating behaviors (e.g., emotional eating). Findings also suggest that military-dependent youth with high weight may exhibit elevated depressive symptoms and disordered eating. As such, understanding associations among alexithymia, depressive symptoms, and disordered eating is particularly relevant for this vulnerable population.

METHODS

We examined 149 adolescent military dependents (14.4 ± 1.6y; 55.0% female; 20.0% non-Hispanic Black; BMIz: 1.9 ± 0.4) at high risk for binge-eating disorder and obesity in adulthood. Participants completed questionnaires assessing two components of alexithymia (difficulty identifying feelings [DIF] and difficulty describing feelings [DDF]), depressive symptoms, emotional eating, and trait anxiety; disordered-eating attitudes were assessed via semi-structured interview.

RESULTS

A series of regression-based models examined indirect relationships of DIF and DDF with disordered-eating attitudes and emotional eating through depressive symptoms. Bootstrapped 95% confidence intervals revealed a significant indirect path from each of the alexithymia components to disordered-eating attitudes via depressive symptoms; indirect paths to emotional eating were non-significant.

CONCLUSION

Results support the salience of depressive symptoms in the relationship between alexithymia and disordered-eating attitudes. Future research should utilize prospective designs and explore direct and indirect associations of alexithymia with other disordered-eating behaviors.

LEVEL OF EVIDENCE

Level III, evidence obtained from a well-designed cohort study.

Healthcare-related correlates of preoperative psychological distress among a mixed surgical and cancer-specific sample

OBJECTIVE

Preoperative distress is commonly experienced by surgical patients and is associated with adverse health-related outcomes. Research suggests preoperative distress may be elevated among cancer surgery patients relative to other surgical groups and there appears to be greater recognition of the adverse impacts of distress for these patients. This study examined associations between preoperative distress and postoperative healthcare-related correlates (e.g., length of stay, re-hospitalization) among a large, mixed surgical sample, and separately among cancer surgery patients with active cancer.

METHODS

We analyzed secondary data from the Vascular Events In Non-cardiac Surgery Patients Cohort Evaluation (VISION) study - Mental Health Supplement (N = 997; n = 370 active cancer/cancer surgery). The Kessler 6-item Psychological Distress Scale assessed preoperative distress on the day of surgery. Multivariable regressions examined associations between distress and healthcare-related correlates. For significant relationships, we examined associations between anxiety and depressive subscales of distress with the correlates of interest.

RESULTS

Among the full surgical sample, after adjustment, preoperative distress was associated with a greater length of stay (b = 0.01, 95% CI [0.00-0.02], R² = 0.15, f² = 0.18) and increased odds of re-hospitalization (AOR = 1.07, 95%CI [1.01-1.13]). Results were comparable among cancer surgery patients (length of stay: b = 0.02, re-hospitalization: AOR = 1.11). Post-hoc analyses revealed associations between anxiety symptoms and re-hospitalization (AOR range: 1.13-1.26) and between depressive symptoms and length of hospital stay (b range: 0.02-0.04, R² range: 0.07-0.15, f² range: 0.07-0.18).

CONCLUSIONS

Findings suggest preoperative distress may be associated with greater postoperative healthcare needs. Results support the importance of screening for distress in the perioperative period.

Eating-to-Cope Motives and Uncontrolled Eating as Mediators Between Negative Emotional States and Food Addiction Among Argentinean Young Adults

Negative emotional states (NES; i.e., depression, anxiety and stress) are likely contributors to the development of food addiction (FA). The association between NES and FA symptoms may be mediated by altered eating behaviors or by eating-to-cope motives. This study examined, in a sample of Argentinean young adults, the association between NES and FA symptoms via eating-to-cope motives and three patterns of eating behaviors. We also examined whether the model was invariant across college status. The transition from high school to college is usually associated with increased exposure to stress, which promotes the probability of engaging in altered eating behaviors. A sample of 499 Argentinean young adults (mean age = 24.9 ± 3.51 years) completed a survey that assessed FA symptoms, eating behaviors (i.e., uncontrolled, emotional, and restrained eating), eating-to-cope motives and NES. A path analysis tested the indirect association between NES and FA symptoms via uncontrolled, emotional or restrained eating, or by eating-to-cope. Stress and depression symptoms were indirectly associated with FA symptoms via uncontrolled eating and eating-to-cope motives. The model was invariant across college status. The findings suggest that NES are associated with FA symptoms by increasing uncontrolled eating and eating-to-cope motives. Young adults exhibiting greater depressive or stress symptoms, higher eating-to-cope, or higher uncontrolled eating may be at risk for FA. Future research should examine the significance of this pattern by tailoring interventions to these characteristics.

Emotional Eating and Perfectionism as Predictors of Symptoms of Binge Eating Disorder: The Role of Perfectionism as a Mediator between Emotional Eating and Body Mass Index

(1) Background: Perfectionism has been linked to eating disorders and might be a risk factor for the appearance of eating pathologies. The aims of this study are (a) to verify the relationship between perfectionism, emotional eating (EE), binge eating (BE), and body mass index (BMI); (b) to identify the variables that predict BE symptoms and BMI; (c) to study the role of perfectionism as a mediator between EE and BMI. (2) Methods: 312 adult participants answered a cross-sectional survey that included the Multidimensional Perfectionism Scale, the Emotional Eater Questionnaire (EEQ), the Binge Eating Scale (BES), and a sociodemographic questionnaire including BMI. (3) Results: The results suggest a direct correlation between EE, BE, and BMI, showing that EE is a powerful predictor of BE symptoms and BMI. Furthermore, two dimensions of perfectionism have a mediator role between EE and BMI, specifically doubts and actions and concern over mistakes: the presence of these two components of perfectionism reverses the relationship between EE and BMI. (4) Conclusions: These results have significant implications for the understanding of the two different (pathological) eating patterns: intake restriction and overeating and should be considered in intervention programs.

Food Addiction and Emotional Eating Behaviors Co-Occurring with Problematic Smartphone Use in Adolescents?

Addiction in adolescence is increasing and has a significant impact on physical and mental health. Notably, addictions can be comorbid and affect each other. Despite the recent growing interest in food addiction (FA) and problematic smartphone use (PSU), few studies have investigated their association in adolescents. We investigated the relationship between FA and PSU in adolescents and the effects of eating behaviors. A total of 209 adolescents (44.5% male; mean age = 12.86 ± 0.7 years) participated in the current school-based community study. We found a positive correlation between the dimensional Yale Food Addiction Scale for Children 2.0 (dYFAS-C2.0) and the Smartphone Overdependence Scale after adjusting for age, sex, body mass index, and socioeconomic status. The high-risk PSU group accounted for 17.2% of participants. Furthermore, this group showed 2.3 times higher dYFAS-C2.0 scores than the general group. Emotional overeating and satiety responsiveness were correlated with PSU. A comprehensive evaluation of addiction symptoms is needed for proper intervention, especially in adolescents with symptoms of abnormal eating behaviors.

Anxiety and Food Addiction in Men and Women: Results From the Longitudinal LIFE-Adult-Study

BACKGROUND

Anxiety is a widespread phenomenon, and it is connected to disordered eating and obesity. We want to analyze the connection between anxiety and food addiction (FA) over two points in time to better understand the directionality of the association. Since there are gender differences with regard to anxiety and eating, we are also interested in differences between men and women.

METHODS

We used data from the population-based LIFE-Adult-Study (N = 1,474) at time 1 (baseline) and time 2 (first follow-up) to analyze the connections between anxiety (GAD-7) and FA (YFAS) using a multiple group latent cross-lagged panel model with female and male participants as groups. We controlled for age, marital status, socioeconomic status and social support.

RESULTS

Anxiety (women: β = 0.50, p ≤ 0.001; men: β = 0.59, p ≤ 0.001) as well as FA (women: β = 0.37, p ≤ 0.001; men: β = 0.58, p ≤ 0.001) exhibited stability over time for both genders. We found a significant association between anxiety at time 1 and FA at time 2 for women (β = 0.25, p ≤ 0.001) but not for men (β = 0.04, p = 0.10), and significant associations between FA at time 1 and anxiety at time 2 for women (β = 0.23, p ≤ 0.001) as well as men (β = 0.21, p ≤ 0.001).

CONCLUSION

Food addiction longitudinally affects anxiety, independent of gender and other sociodemographic variables. In addition, anxiety affects subsequent FA as well, but only in women. Interventions that address FA could reduce anxiety in men and women, while interventions that mitigate anxiety could help prevent FA in women.

A cross-sectional study on the correlates of food addiction symptoms in adolescents seeking treatment for obesity: eating attitudes and gender differences

BACKGROUND AND OBJECTIVES

Multidisciplinary approach including psychiatric support, have come to the fore in the treatment of obesity. Food addiction and disordered eating behaviors are among major psychiatric problems that have important effects on both clinical manifestation and response to treatment. This study aimed to investigate correlates of food addiction among adolescents who are seeking treatment for obesity.

METHOD

This study included 126 adolescents between 11 and 18 years of age, 48 patients in the "study group" who are seeking treatment for obesity (BMI for age greater than 95th percentile) and 78 adolescents (BMI for age under 85th percentile) in the "control group" who were reached via online survey. All participants were requested to complete self-report based measurement tools of Yale Food Addiction Scale (YFAS) and Eating Attitude Test-40 (EAT-40).

RESULTS

47.9% adolescents (n = 23) in the study group met food addiction diagnosis according to diagnostic evaluation of YFAS; which was significantly higher than 5.1% (n = 4) adolescents in the control group (p < 0.001). EAT-40 total scores and the scores in subscales of "anxiety of gaining weight," "dieting," and "thin body preoccupation" were significantly higher in the study group. Gender differences were observed when food addiction symptoms were correlated with eating attitudes among the study group.

CONCLUSIONS

Comparing to the controls, food addiction and disordered eating behaviors were more common in adolescents seeking treatment for obesity. Gender differences in the correlates of food addiction symptoms imply that different approaches might be needed for psychological interventions.

Patients' Experience of Attending a Binge Eating Group Program - Qualitative Evaluation of a Pilot Study

We developed a group program for patients with binge eating disorders (BED), comprising cognitive therapy, affect consciousness, and therapeutic writing. We wished to investigate how therapeutic writing and affect consciousness were experienced by the patients when integrated in a cognitive behavioral therapy (CBT) program. To our knowledge, such an intervention has not been tried in patients with BED. Aim: To explore patients’ experience of attending a binge eating group program comprising therapeutic writing, affect consciousness, and CBT. Research question: How do patients evaluate their experience of attending an integrative binge eating group program? Method: A qualitative design using an evaluative focus group interview with participants (four women and two men) who had completed the pilot program. Results: Three themes emerged: Enhanced self-awareness about the meaning of feelings; A more generous attitude towards oneself; and On the path to a better grip on the eating difficulties. Discussion: We interpreted the three themes in light of transition processes. The program was described as an essential part of the healing process and seems valuable for enabling new approaches leading to therapeutic changes when suffering from BED.

Decoding the Role of Gut-Microbiome in the Food Addiction Paradigm

Eating behaviour is characterised by a solid balance between homeostatic and hedonic regulatory mechanisms at the central level and highly influenced by peripheral signals. Among these signals, those generated by the gut microbiota have achieved relevance in recent years. Despite this complex regulation, under certain circumstances eating behaviour can be deregulated becoming addictive. Although there is still an ongoing debate about the food addiction concept, studies agree that patients with eating addictive behaviour present similar symptoms to those experienced by drug addicts, by affecting central areas involved in the control of motivated behaviour. In this context, this review tries to summarise the main data regarding the role of the gut microbiome in eating behaviour and how a gut dysbiosis can be responsible for a maladaptive behaviour such as “food addiction”.

Food addiction and psychiatric comorbidities: a review of current evidence

BACKGROUND

Food addiction (FA) is characterised by the consumption of appetible foods and by addictive psychological and behavioural symptoms such as cravings, tolerance, limited control of substance intake and withdrawal symptoms. Despite previous research on FA has been hindered by the lack of a formal definition for this condition, recent global trends have stirred the interest of the scientific community towards a proper classification and construct of FA. More specifically, recent studies have pointed towards shared defective neurobiological mechanisms as well as frequent comorbidities between FA, eating disorders, mood disorders, anxiety disorders and substance-related and addictive disorders.

OBJECTIVE

In this review, we will provide an overview of the complex symptomatology of food addiction evaluating its relationship with mood disorders, anxiety disorders, eating disorders and substance-related and addictive disorders.

METHODS

We wrote a systematic review and followed a PRISMA methods.

RESULTS

Patients with FA and substance use disorders show similar risk factors, neurobiological and hormonal correlates, personality traits and symptom profiles. The presence of FA appears to be directly proportional to the burden of symptoms of affective disorder. The comorbidity between FA and other eating disorders is associated with worse clinical conditions and symptoms.

CONCLUSION

FA should be considered a sort of transnosological construct existing in different psychopathological domains that have similarities with substance-related, affective, and eating disorders. Furthermore, FA seems to be likely an important factor related to several psychopathological dimensions, but further studies are needed to clarify this view.

LEVEL OF EVIDENCE

Level V, review article.

Foods, Nutrients and Dietary Patterns in Relation to Irrational Beliefs and Related Psychological Disorders: The ATTICA Epidemiological Study

We explored the differences in dietary habits and dietary patterns between individuals characterized by irrational beliefs with no or low anxiety and depressive symptoms and individuals characterized by irrational beliefs with high anxiety and depressive symptomatology. Within the context of the ATTICA cohort study (2002–2012), 853 participants without evidence of cardiovascular disease (453 men (45 ± 13 years) and 400 women (44 ± 18 years)) underwent mental health assessment through the irrational beliefs inventory (IBI), the Zung self-rating depression scale (ZDRS) and the state–trait anxiety inventory (STAI). Demographic characteristics, a thorough medical history, dietary behaviour and other lifestyle behaviours were also evaluated and analysed using factor analysis. Five main factors related to dietary patterns were extracted for the high-IBI/low-STAI group of participants (explaining the 63% of the total variation in consumption), whereas four factors were extracted for the high-IBI/high-STAI participants, the high-IBI/low-ZDRS participants and the high-IBI/high-ZDRS participants, explaining 53%, 54% and 54% of the total variation, respectively. A Western-type dietary pattern was the most dominant factor for individuals reporting irrational beliefs and anxiety or depressive symptomatology. The high refined carbohydrates and fats dietary pattern was the most dominant factor for individuals with irrational beliefs but without psychopathology. Linear regression analysis showed that irrational beliefs, in combination with anxiety or depression, age, sex and BMI, were important predictors of adherence to the Mediterranean diet. Dietary habits interact with irrational beliefs and, in association with the consequent psychological disorders, are associated with overall diet, and presumably may affect the health status of individuals.

Separating the Signal from the Noise: How Psychiatric Diagnoses Can Help Discern Food Addiction from Dietary Restraint

Converging evidence from both animal and human studies have implicated hedonic eating as a driver of both binge eating and obesity. The construct of food addiction has been used to capture pathological eating across clinical and non-clinical populations. There is an ongoing debate regarding the value of a food addiction "diagnosis" among those with eating disorders such as anorexia nervosa binge/purge-type, bulimia nervosa, and binge eating disorder. Much of the food addiction research in eating disorder populations has failed to account for dietary restraint, which can increase addiction-like eating behaviors and may even lead to false positives. Some have argued that the concept of food addiction does more harm than good by encouraging restrictive approaches to eating. Others have shown that a better understanding of the food addiction model can reduce stigma associated with obesity. What is lacking in the literature is a description of a more comprehensive approach to the assessment of food addiction. This should include consideration of dietary restraint, and the presence of symptoms of other psychiatric disorders (substance use, posttraumatic stress, depressive, anxiety, attention deficit hyperactivity) to guide treatments including nutrition interventions. The purpose of this review is to help clinicians identify the symptoms of food addiction (true positives, or "the signal") from the more classic eating pathology (true negatives, or "restraint") that can potentially elevate food addiction scores (false positives, or "the noise"). Three clinical vignettes are presented, designed to aid with the assessment process, case conceptualization, and treatment strategies. The review summarizes logical steps that clinicians can take to contextualize elevated food addiction scores, even when the use of validated research instruments is not practical.

Are Adherence to the Mediterranean Diet, Emotional Eating, Alcohol Intake, and Anxiety Related in University Students in Spain?

Research has suggested that university students are at risk from certain unhealthy habits, such as poor diet or alcohol abuse. At the same time, anxiety levels appear to be higher among university students, which may lead to high levels of emotional eating. The aim of this study was to analyze the degree of adherence to the Mediterranean diet (AMD), emotional eating, alcohol intake, and anxiety among Spanish university students, and the interrelationship of these variables. A total of 252 university students filled out the Mediterranean Diet Quality Index (KIDMED) questionnaire for Mediterranean diet adherence, an Alcohol Use Disorders Identification Test, a State-Trait Anxiety Inventory and the Emotional Eater Questionnaire. We analyzed descriptive data, a t-test and analysis of variance (ANOVA) for differences, a Pearson correlation, and multiple regression tests. Results showed low levels of AMD among university students (15.5%) and considerable levels of emotional eating (29%) and anxiety (23.6%). However, levels of alcohol dependence were low (2.4%). State-anxiety was a predictor of the emotional eater score and its subscales, and sex also was predictive of subscale guilt and the total score. However, AMD was predicted only by trait-anxiety. These models accounted for between 1.9% and 19%. The results suggest the need for the implementation of educational programs to promote healthy habits among university students at risk.