Evaluating the role of negative affect and negative interpretation biases in emotional eating behavior

OBJECTIVE

The study of emotional eating, or (over)eating in response to emotions, may inform transdiagnostic interventions for eating pathology. Prior work has focused on the role of negative affect in promoting emotional eating. The present study sought to extend this work through examining the role of cognitive biases.

METHOD

Women who self-reported (n = 50) and did not self-report (n = 40) emotional eating completed self-report questionnaires of negative affect and negative interpretation biases, an implicit measure of cognitive bias, and a behavioral assay of emotional eating involving an ad lib test meal following a stress induction task.

RESULTS

The emotional eating group endorsed elevated trait negative affect, explicit shame biases, and implicit negative biases compared to controls. In addition, state negative affect increased after the stress induction task, and the emotional eating group endorsed greater state negative affect before and after the task and consumed more food following the stress induction. Only explicit cognitive shame biases demonstrated significant indirect effects in the association between group and food consumption. Specifically, elevated explicit shame biases were positively associated with amount of food consumed for the emotional eating group.

DISCUSSION

Future research should examine whether interventions that target cognitive biases related to shame reduce emotional eating.

PUBLIC SIGNIFICANCE

Individuals with emotional eating consumed more food than controls following a stress induction. Explicit shame cognitive biases were positively associated with amount of food consumed for the emotional eating group. Shame cogntiive biases may be fruitful targets for reducing emotional eating.

Evaluating the predictive validity of purging disorder by comparison to bulimia nervosa at long-term follow-up

OBJECTIVE

The current study sought to examine the predictive validity of the purging disorder diagnosis at long-term follow-up by comparing naturalistic outcomes with bulimia nervosa.

METHOD

Women with purging disorder (N = 84) or bulimia nervosa (N = 133) who had completed comprehensive baseline assessments as part of one of three studies between 2000 and 2012 were sought for follow-up assessment. Nearly all (94.5%) responded to recruitment materials and 150 (69% of sought sample; 83.3% non-Hispanic white; 33.40 [7.63] years old) participated at an average of 10.59 (3.71) years follow-up. Participants completed the Eating Disorder Examination, the Structured Clinical Interview for DSM-IV, and a questionnaire battery. Diagnostic groups were compared on eating disorder (illness status, recovery status, and eating pathology) and related outcomes. Group differences in predictors of outcome were explored.

RESULTS

There were no significant differences in eating disorder presence (p = .70), recovery status (p = .87), and level of eating pathology (p = .17) between diagnostic groups at follow-up. Post hoc equivalence tests indicated group differences were smaller than a medium effect size (p's ≤ .005). Groups differed in diagnosis at follow-up (p = .002); diagnostic stability was more likely than cross-over to bulimia nervosa for women with baseline purging disorder (p = .004).

DISCUSSION

Although purging disorder and bulimia nervosa do not differ in long-term outcomes, the relative stability in clinical presentation suggests baseline group differences in clinical presentation may be useful in augmenting treatments for purging disorder.

PUBLIC SIGNIFICANCE STATEMENT

While purging disorder is classified as an "other specified" eating disorder, individuals who experience this disorder have comparable negative long-term outcomes as those with bulimia nervosa. This highlights the importance of screening for and treating purging disorder as a full-threshold eating disorder.

Reducing anticipated non-suicidal self-injury by improving body esteem in individuals with weight suppression: A proof of concept study

OBJECTIVE

Research suggests that weight suppression (WS) is linked to non-suicidal self-injury (NSSI) and that drive for thinness and depression may explain this association. We conducted a proof-of-concept study using a randomized control trial design to determine if improving body esteem and reducing depressive symptoms reduced NSSI in individuals with WS.

METHOD

Weight suppressed participants (N = 60) who engaged in NSSI were recruited from the community and randomly assigned to an on-line intervention or control condition. The on-line intervention was adapted from a cognitive-dissonance intervention originally designed to reduce thin-ideal internalization in females to an intervention to reduce internalization of unhealthy body ideals in both genders. Participants' weight/shape concerns, depressive symptoms, and NSSI were assessed at pre- and post-intervention, or at baseline and 2-week follow-up for controls.

RESULTS

Compared to controls, participants in the treatment condition reported greater decreases in likelihood of future NSSI [Cohen's d (95% CI) = -0.38 (-0.90-0.15)], weight/shape concerns [-1.19 (-1.75 to -0.62)], depressive symptoms [-1.00 (-1.56 to -0.45)], and significant improvements in appearance [1.27 (0.70-1.84)] and weight esteem [1.38 (0.80-1.96)].

DISCUSSION

Future work could test this intervention in a larger trial with an active alternative treatment condition.

Self-report measures of loss of control over eating: Psychometric properties in clinical and non-clinical samples

OBJECTIVE

Research evidence supports the clinical significance of subjective feelings of loss of control over eating; however, limited attention has been given to how this construct is assessed. Two measures have been developed in recent years (i.e., Eating Loss of Control Scale [ELOC] and Loss of Control over Eating Scale [LOCES]), but further validation in clinical and non-clinical samples is needed.

METHOD

The current study evaluated the psychometric properties, including factor structure, criterion validity, and measurement invariance of the ELOC and LOCES across two groups: (a) a clinical sample of individuals with eating disorders (n = 106) and (b) a non-clinical sample of college students (n = 321).

RESULTS

Confirmatory factor analyses indicated that the 16-item version of the ELOC and 7-item brief version of the LOCES provided good fit to the data in both samples. These measures were highly correlated (r = .83-.87) and associated with binge-eating and related psychopathology. The ELOC demonstrated partial invariance between men and women and between the clinical and non-clinical samples. The LOCES-brief demonstrated full invariance between men and women and partial invariance between the clinical and non-clinical samples.

DISCUSSION

Findings suggest that the 16-item ELOC and 7-item LOCES are reliable measures of severity of loss of control eating in clinical and non-clinical samples. Given the brevity of the LOCES-brief and evidence for measurement invariance across sex, it is recommended over the ELOC in heterogeneous samples. Future research is needed to confirm the validity of these measures across individuals with and without eating disorders.

Consequences of Making Weight: A Review of Eating Disorder Symptoms and Diagnoses in the United States Military

Eating disorders are serious psychiatric illnesses associated with health problems. Such problems may compromise military performance, highlighting the need to establish the level of eating pathology that exists in military samples. This article qualitatively reviews prevalence estimates of eating disorder symptoms and diagnoses in military samples, providing nonmilitary estimates for context. Findings suggest that eating disorder symptoms are prevalent in cadets and active duty service members, especially when using self-report measures. The increased salience of weight in the military and increased exposure to trauma may influence risk for eating disorders. Alternatively, individuals at risk for eating disorders may self-select into the military. Overall, this review suggests that eating disorder symptoms are common in military samples and that further research is warranted.