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Binge-eating disorder (BED) is associated with overweight/obesity, physical inactivity, and disturbances in affective functioning. While research suggests that physical activity (PA) may have beneficial effects on BED symptoms, little is known about the daily correlates of PA. As a first step in understanding the processes linking PA and binge eating, this study examined associations between PA (i.e., self-reported time engaged in moderate-to-vigorous PA), affective functioning (i.e., positive and negative affect, body satisfaction, emotion regulation), and eating-related cognitions and behaviors (i.e., craving, overeating, loss of control eating) measured via ecological momentary assessment (EMA). Adults with BED (N = 91) completed a seven-day EMA protocol during which they completed repeated measures of these variables. Results indicated individuals who reported greater time engaged in PA over the EMA protocol evidenced higher positive affect and body satisfaction, and lower overeating (between-subjects effects). No significant within-subjects effects were observed. Findings demonstrate that individual differences in PA levels were related to more adaptive affective functioning and eating regulation in daily life. Results highlight the relevance of PA in BED, and the need for future studies to identify the timescale of these relationships using objective measurements of PA. [ABSTRACT FROM AUTHOR]

Objective: The network theory of mental disorders conceptualizes eating disorders (EDs) as networks of interacting symptoms. Network analysis studies in EDs mostly have examined transdiagnostic and/or mixed age samples. The aim of our study was to investigate similarities and differences of networks in adolescents and adults with anorexia nervosa (AN) or bulimia nervosa (BN). Method: Participants were 2,535 patients (n = 991 adults with AN, n = 821 adolescents with AN, n = 473 adults with BN, and n = 250 adolescents with BN) who completed the Eating Disorder Inventory‐2. Twenty‐seven items were selected. Cross‐sectional networks were estimated via Joint Graphical Lasso. Core symptoms were identified using strength centrality. Spearman correlations and network comparison tests (NCTs) were used to compare groups. Results: Across diagnoses and ages, feeling ineffective, desire to be thinner, worries that feelings will get out of control, guilt after overeating as well as doing things perfectly emerged as most central symptoms. There were moderate to high correlations between symptom profiles (0.62–0.97, mean: 0.78) as well as high correlations between network structures (0.83–0.93, mean: 0.87) and network strengths (0.73–0.95, mean: 0.85). Global strength significantly differed in two of the six NCTs, and 2.5–10% of edges differed between networks. Discussion: Considerable similarities in network structures and strengths across diagnoses and ages speak in favor of the transdiagnostic approach to EDs. Besides drive for thinness, ineffectiveness, emotion regulation difficulties, and perfectionism might be the most consistent factors in ED networks. These symptoms as well as their symptom connections should be especially focused in treatment regardless of age and diagnosis. [ABSTRACT FROM AUTHOR]

Low positive affect has been identified as an antecedent of binge‐eating episodes among individuals with binge‐eating disorder (BED), yet positive affect has received far less attention in eating disorders research than its counterpart, negative affect. In this article, we argue that the low levels of positive affect which occur with anhedonia (i.e., loss of interest or pleasure in activities) may contribute to the onset and maintenance of BED. We introduce a theoretical model in which anhedonia increases the risk for BED through its interrelationships with dysregulated eating and weight gain, and we describe potential direct (e.g., reward‐related processes) as well as indirect (e.g., influences on depressive symptoms and physical activity) pathways by which anhedonia may lead to adverse eating‐ and weight‐related outcomes. We also propose a momentary maintenance model in which low positive affect and positive affect dysregulation occurring with anhedonia maintain binge eating directly and indirectly through maladaptive health behaviors, such as decreased physical activity, less healthy eating, and fewer social interactions, which in turn maintain anhedonia. We draw upon outside literature to present evidence that aligns with the proposed risk and maintenance models and conclude by outlining avenues for future research—including methodological/measurement, theoretical, and clinical research directions. [ABSTRACT FROM AUTHOR]

The integrative cognitive-affective therapy (ICAT) momentary maintenance model proposes a number of situational factors that precipitate eating disorder (ED) behaviors and cognitions. The current study examines momentary situational triggers in relation to a broad range of ED symptoms in a diagnostically heterogeneous sample of individuals with ED psychopathology. In the current study, 30 women with binge eating pathology completed a 14-day ecological momentary assessment (EMA) protocol during which they responded to five random signals throughout the day. During signaled assessments, participants completed measures of self-criticism, interpersonal problems, self-regulation of binge eating, appearance concerns, and cognitive and behavioral ED symptoms. Multilevel models were used to examine prospective associations between hypothesized ICAT maintenance factors and ED symptoms. Within-subjects self-criticism prospectively predicted vomiting, restriction, preoccupation with thoughts of food, and urges to eat. Within-subjects interpersonal problems prospectively predicted vomiting, and within-subjects appearance concerns prospectively predicted preoccupation with thoughts of food. There were no significant predictors of binge eating. These results provide some support for hypothesized momentary situational triggers of ED symptoms in the momentary maintenance model of ICAT using naturalistic, momentary assessment. Specifically, it may be particularly useful for interventions such as ICAT to address momentary self-criticism when targeting a range of ED symptoms. [ABSTRACT FROM AUTHOR]

Objective: Affect regulation, eating expectancies, and attention toward food‐related cues are interrelated constructs that have been implicated in the maintenance of binge eating. While these processes show considerable temporal variability, the momentary associations between these domains have not been elucidated. This study examined a model that posited momentary fluctuations in affect, eating expectancies, and attention bias (AB) would interact to predict subsequent binge eating. Method: Forty women who endorsed recurrent binge eating completed a 10‐day ecological momentary assessment protocol with ambulatory measures of AB (i.e., dot‐probe task with palatable food and neutral cues) and self‐report assessments of positive and negative affect, eating expectancies (i.e., the belief that eating would improve one's mood), and binge‐eating symptoms. Results: Generalized linear mixed models indicated higher momentary AB toward palatable food was associated with increased risk of subsequent binge eating, and a two‐way interaction showed that moments of higher eating expectancies and negative affect were associated with increased likelihood of subsequent binge eating. Also, a three‐way interaction emerged, in that the association between eating expectancies and subsequent binge eating was strongest at lower levels of positive affect and higher AB. Discussion: Together, findings partially supported hypotheses and demonstrate meaningful within‐person fluctuations in AB that precede binge eating. Further, results demonstrate that the momentary influence of eating expectancies on binge eating depends on both affective state and attentional processes. [ABSTRACT FROM AUTHOR]

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

While previous literature suggests that emotion dysregulation is a salient factor contributing to the onset and maintenance of eating disorders (EDs), less is known about how maladaptive, cognitively oriented regulation strategies such as rumination and thought suppression may be uniquely related to ED symptoms in men and women. The present study sought to examine the independent associations of ruminative brooding and thought suppression with ED symptoms, after controlling for negative affect intensity, and assess whether these associations differ by gender. Participants were 263 undergraduates who completed a series of questionnaires, including measures of ED symptoms (Eating Disorder Diagnostic Scale), ruminative brooding (Ruminative Response Scale), and thought suppression (White Bear Suppression Inventory). Generalized linear models examined main effects of ruminative brooding and thought suppression and their interactions with gender on ED symptoms, controlling for negative affect intensity. Higher ruminative brooding was associated with higher binge eating among women. Thought suppression was associated with higher vomiting and fasting frequency in both genders, with a stronger association between suppression and fasting in men compared to women. Together results demonstrate the unique contributions of cognitive perseveration and avoidance in ED symptomatology; specifically, ruminative brooding may be a salient factor contributing to binge eating in women, while high levels of thought suppression among males may contribute to fasting. Findings highlight the potential importance of examining and differentially targeting specific facets of cognitive emotion regulation in men and women engaging in ED behaviors. [ABSTRACT FROM AUTHOR]

There is growing recognition that impulsivity may serve as an underlying risk factor for binge eating. In addition, the association of impulsivity with binge eating may be moderated by other affective and cognitive risk factors. This study examined independent and interactive associations of negative affect, dietary restraint, and facets of impulsivity with binge eating. A diverse sample of 566 undergraduate women completed online questionnaires of study variables. Results revealed a three-way interaction of negative affect, dietary restraint, and attentional impulsivity in relation to binge eating. Women who were high on each of these three variables reported the greatest levels of binge eating. In addition, a two-way interaction was found for negative affect and nonplanning impulsivity in relation to binge eating, such that nonplanning impulsivity strengthened the association between negative affect and binge eating. Attentional and nonplanning facets of impulsivity may function as an underlying trait-level risk factor interacts with affective and/or cognitive risk (e.g., negative affect, dietary restraint) factors to predict elevated binge eating. [ABSTRACT FROM AUTHOR]

Restraint and binge eating are cognitive and behavioral processes that are particularly important in the context of obesity. While extensive research has focused on negative affect (NA) in relation to binge eating, it is unclear whether affective valence (i.e., positive versus negative) and stability (i.e., state versus trait) differentially predict binge eating and restraint among individuals with obesity. Distinguishing between valence and stability helps elucidate under which affective contexts, and among which individuals, restraint and binge eating are likely to occur. Therefore, the present study examined relationships between trait and state levels of NA and positive affect (PA), binge eating, and restraint intention among 50 adults with obesity (BMI ≥ 30). Participants completed baseline assessments followed by a two-week ecological momentary assessment (EMA) protocol. Structural equation modeling assessed a trait model of person-level measures of affect in relation to overall levels of binge eating and restraint intention, while general estimating equations (GEEs) assessed state models examining relationships between momentary affect and subsequent binge eating and restraint. The trait model indicated higher overall NA was related to more binge eating episodes, but was unrelated to overall restraint intention. Higher overall PA was related to higher overall restraint intention, but was unrelated to binge eating. State models indicated momentary NA was associated with a greater likelihood of subsequent binge eating and lower restraint intention. Momentary PA was unrelated to subsequent binge eating or restraint intention. Together, findings demonstrate important distinctions between the valence and stability of affect in relationship to binge eating and restraint intention among individuals with obesity. While NA is a more salient predictor of binge eating than PA, both overall PA and momentary NA are predictors of restraint intention. [ABSTRACT FROM AUTHOR]

Emotional reactivity is theorized to contribute to both eating disorders (ED) and nonsuicidal self-injury (NSSI). Although EDs and NSSI frequently co-occur, no study has examined emotional reactivity in individuals with both conditions. This study examined the following hypotheses in a large clinical sample ( N = 648): (1) patients with co-occurring ED and NSSI would report higher emotional reactivity and more severe clinical characteristics; (2) among those with EDs, patients with bulimia nervosa (BN) would be more likely to report NSSI and evidence higher emotional reactivity compared to those with anorexia nervosa (AN); and (3) higher emotional reactivity would be associated with worse treatment outcomes. Data were collected at admission and discharge from inpatient, partial hospitalization, and intensive outpatient treatment programs for EDs or NSSI. The NSSI-only and co-occurring groups reported significantly higher emotional reactivity than the ED-only group. Among those with EDs, individuals with BN reported higher emotional reactivity and were more likely to engage in NSSI compared to those with AN. Emotional reactivity was inconsistently related to treatment outcomes among the co-occurring and ED-only groups. In sum, results highlight the importance of emotional reactivity in clinical presentations, particularly when NSSI is present. [ABSTRACT FROM AUTHOR]

Objective The DSM-5 includes severity specifiers (i.e., mild, moderate, severe, extreme) for anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED), which are determined by weight status (AN) and frequencies of binge-eating episodes (BED) or inappropriate compensatory behaviors (BN). Given limited data regarding the validity of eating disorder (ED) severity specifiers, this study examined the concurrent and predictive validity of severity specifiers in AN, BN, and BED. Method Adults with AN ( n = 109), BN ( n = 76), and BED ( n = 216) were identified from previous datasets. Concurrent validity was assessed by measures of ED psychopathology, depression, anxiety, quality of life, and physical health. Predictive validity was assessed by ED symptoms at the end of the treatment in BN and BED. Results Severity categories did not differ in baseline validators, though the mild AN group evidenced greater ED symptoms compared to the severe group. In BN, greater severity was related to greater end of treatment binge-eating and compensatory behaviors, and lower likelihood of abstinence; however, in BED, greater severity was related to lower ED symptoms at the end of the treatment. Discussion Results demonstrated limited support for the validity of DSM-5 severity specifiers. Future research is warranted to explore additional validators and possible alternative indicators of severity in EDs. [ABSTRACT FROM AUTHOR]

Objective Evidence indicates that males account for a significant minority of patients with eating disorders (EDs). However, prior research has been limited by inclusion of small and predominantly non-clinical samples of males. This study aimed to (1) provide male clinical norms for widely used ED measures (Eating Disorder Examination Questionnaire [EDE-Q] and Eating Disorder Inventory-3 [EDI-3]) and (2) examine sex differences in overall ED psychopathology. Method Participants were 386 male and 1,487 female patients with an ED diagnosis aged 16 years and older who completed the EDE-Q and EDI-3 upon admission to a residential or partial hospital ED treatment program. Results Normative data were calculated for the EDE-Q (global and subscales) and the EDI-3 (drive for thinness, body dissatisfaction, and bulimia). Analyses of variance (ANOVAs) used to examine sex, ED diagnosis, and their interaction in relation to overall ED psychopathology revealed a consistent pattern of greater severity among females for ED psychopathology. Discussion This study provides clinical norms on the EDE-Q and the EDI-3 for males with clinically diagnosed EDs. It is unclear whether the greater severity observed in females reflects qualitative differences in ED presentation or true quantitative differences in ED severity. Additional research examining the underlying nature of these differences and utilizing male-specific ED measures with clinical samples is warranted. [ABSTRACT FROM AUTHOR]

Previous studies have suggested the positive influence of social support on the treatment and recovery of eating disorders (EDs). Yet, more research is needed on how objective and subjective social support differ between ED diagnostic groups using nationally representative data. Therefore, the current secondary data analysis examined associations between EDs and objective and subjective social support using data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) study. Participants completed measures of lifetime and past year diagnostic criteria for anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) and items assessing objective social support (i.e., number of close friends and close relatives) and subjective social support (i.e., perceptions of availability of support). Compared to those without EDs, those with AN, BN, and BED had poorer subjective social support—or lower perceptions of social support. However, there were fewer differences regarding objective social support. Individuals with BN reported a lower number of close relatives compared to those without EDs and those with AN, but there were no differences in the number of close friends between ED groups. Those who experienced remission from EDs had higher perceptions of social support compared to those with past year EDs. The findings show deficits in subjective social support across EDs but only lower objective social support in BN. This highlights the clinical utility of increasing perceptions of social support across EDs. The findings also show the importance of perceived social support in recovery from EDs. • We examined associations between objective and subjective social support and eating disorders (EDs). • Those with lifetime EDs had lower perceptions of social support. • Adults with lifetime bulimia nervosa had a lower number of close relatives. • Adults remitted from EDs had higher perceived social support compared to those with past year EDs. [ABSTRACT FROM AUTHOR]

Individuals with bulimia nervosa report elevated rates of childhood maltreatment, which appears to increase risk for co-occurring substance use problems and negatively impact clinical course. The current study sought to examine the mechanistic pathways by which specific forms of childhood maltreatment may give rise to substance use problems among individuals with bulimic-spectrum pathology. Women with bulimic-spectrum disorders (N = 204) completed measures of childhood trauma, emotion dysregulation, impulsivity, and substance use. Path analysis was used to examine emotion dysregulation and impulsivity as mediators of the relationship between distinct forms of childhood trauma (physical abuse, physical neglect, emotional abuse, emotional neglect, and sexual abuse) and the presence of problematic alcohol/drug use. In the full path model, significant pathways from childhood emotional abuse to emotion dysregulation, childhood emotional neglect to impulsivity, and emotion dysregulation to problematic substance use emerged. Further, emotion dysregulation significantly mediated the relationship between emotional abuse and substance use. Results indicate that emotion dysregulation may be an important mechanism linking a history of childhood emotional maltreatment to later eating and substance use problems, and therefore may be an important treatment target among individuals with co-occurring eating and substance use concerns. Childhood emotional abuse was related to greater emotion dysregulation. Childhood emotional neglect was related to greater impulsivity. Emotion dysregulation was related to greater problematic substance use. Emotional abuse may impact substance use through emotion dysregulation. Creating emotion dysregulation may improve substance and eating disorder symptoms. [ABSTRACT FROM AUTHOR]

Objective: The link between dysregulated positive affect and binge‐eating behavior in youth with obesity is poorly understood. In addition, it is unclear how putative associations differ across developmental periods of rapid biological and emotional change, such as puberty, and in racial and ethnic minority youth, who are more likely to be overweight but are underrepresented in the literature. Method: This study used a 2‐week ecological momentary assessment protocol to examine independent and interactive effects of positive affect intensity/instability, and pubertal stage on two components of binge‐eating behavior, loss of control eating (LOCE), and overeating. Results: Participants were 38 youth with overweight/obesity (ages 8–14 years; 78% African American/Hispanic). Positive affect instability was calculated using probability of acute change (PAC), representing the likelihood of extreme affective changes, and mean squared successive difference (MSSD), representing the average change in affect over successive recordings. There were no main effects of positive affect intensity on LOCE or overeating, but positive affect instability was negatively associated with overeating severity using both MSSD (p =.005) and PAC metrics (p =.001). However, moderation analyses including interactions with pubertal status revealed more extreme changes in positive affect (i.e., higher PAC) were related to greater overeating (p =.001) and LOCE severity (p =.043) in mid‐late pubertal youth but not in pre‐early pubertal youth. Discussion Pubertal status may influence the association between disruptions in positive affect and dysregulated eating in youth, and positive affect instability may be important to consider in order to understand the emotional correlates of binge eating in youth with overweight/obesity. [ABSTRACT FROM AUTHOR]

Objective: Although deficits in emotion regulation have been implicated in the maintenance of binge eating, few prospective studies have examined longitudinal associations between emotion regulation and eating disorder symptoms, which are needed to test these theoretical models.Method: Using a naturalistic design, the current study utilized longitudinal multilevel analyses to examine whether improvements in emotion regulation during treatment are associated with decreased binge eating frequency and eating disorder cognitions in a heterogeneous sample of adults with binge eating (N = 97). Analyses also accounted for between- and within-person differences in negative affect to inform specific targets for intervention.Results: Significant within-person associations between emotion regulation, negative affect, and eating disorder severity support hypotheses that emotion dysregulation and negative affect co-occur with eating disorder psychopathology. Only between-person differences in negative affect demonstrated associations with binge eating frequency over time.Discussion: Data suggest that momentary interventions targeting negative affect and emotion regulation skills may decrease eating disorder cognitions, but not binge eating frequency, among adults with binge eating. [ABSTRACT FROM AUTHOR]

Food and alcohol disturbance (FAD) proposes that individuals restrain or restrict food intake before, during, or after drinking in order to minimize weight gain and/or increase intoxication. Yet, research has yet to examine the potential functional associations between these behaviors within the FAD model. To examine the underlying tenets of FAD, this paper reports on two ecological momentary assessment (EMA) studies, which measuresd momentary restriction and alcohol use in women with binge eating. Study 1 included 30 women with at least one binge-eating episode at baseline whom completed 14 days of EMA recordings, and Study 2 included forty women with binge-eating symptoms whom completed ten days of EMA recordings. Study 1 analyses showed concurrent associations between meal skipping and avoiding eating to control weight with binge drinking. Study 2 analyses showed an association between fasting and total alcoholic drinks that was moderated by individual differences in overvaluation in shape and weight. That is, when women with higher overvaluation reported fasting since the last EMA signal, they consumed more alcoholic drinks; there was no association among women with lower overvaluation. These studies support the underlying conceptual model of FAD among women with binge eating. [ABSTRACT FROM AUTHOR]

Existing data suggest that deficits in social cognitive functioning are transdiagnostic phenomena that are observed across various forms of psychopathology. The goal of the present review was to provide an updated systematic review of the literature on social cognitive functioning across eating disorders (EDs), including anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Studies that assessed six areas of social cognition were included: theory of mind, social perception, social knowledge, attributional bias, emotion perception, and emotion processing. A systematic search identified 71 studies, the majority of which examined adult women with AN. Research typically focused on alexithymia, theory of mind, empathy, social processing, emotion recognition, or emotion processing. Results suggested some deficits in social cognition in EDs. AN had the most studies with some evidence for deficiencies in social cognition but a fair amount of variability. Research on BN and BED was limited and inconsistent, though there appear to be some deficits in social cognition. Together, the limited coverage across EDs and heterogeneous methodology preclude firm conclusions regarding general or ED-specific deficits, as well as understanding the role of social cognition in ED etiology and maintenance. Therefore, several key questions and future directions are outlined for research moving forward. • Studies of social cognition and eating disorder (ED) psychopathology were reviewed. • A systematic search identified 71 studies. • Results were inconsistent regarding social cognitive deficits across EDs. • Few studies have investigated bulimia nervosa or binge eating disorder. • We discuss limitations and future directions for research in this area. [ABSTRACT FROM AUTHOR]