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Background: Avoidant/restrictive food intake disorder (ARFID) is a feeding/eating disorder characterized by avoidance/restriction of food intake by volume and/or variety. The emergence of shape/weight-related eating disorder symptoms in the longitudinal course of ARFID is an important clinical phenomenon that is neither robustly documented nor well understood. We aimed to characterize the emergence of eating disorder symptoms among adults with an initial diagnosis of ARFID who ultimately developed other eating disorders., Method: Thirty-five participants (94% female; M age = 23.17 ± 5.84 years) with a history of ARFID and a later, separate eating disorder completed clinical interviews (i.e., Structured Clinical Interview for DSM-5 - Research Version and Longitudinal Interval Follow-Up Evaluation) assessing the period between ARFID and the later eating disorder. Participants used calendars to aid in recall of symptoms over time. Descriptive statistics characterized the presence, order of, and time to each symptom. Paired samples t-tests compared weeks to emergence between symptoms., Results: Most participants (71%) developed restricting eating disorders; the remainder (29%) developed binge-spectrum eating disorders. Cognitive symptoms (e.g., shape/weight concerns) tended to onset initially and were followed by behavioral symptoms. Shape/weight-related food avoidance presented first, objective binge eating, fasting, and excessive exercise occurred next, followed by subjective binge eating and purging., Conclusions: Diagnostic crossover from ARFID to another (typically restricting) eating disorder following the development of shape/weight concerns may represent the natural progression of a singular clinical phenomenon. Findings identify potential pathways from ARFID to the development of another eating disorder, highlighting possible clinical targets for preventing this outcome., (© 2024. The Author(s).)

Loss of control (LOC) is a hallmark feature of binge eating that is associated with significant distress and impairment. Despite the central role diurnal rhythms may play in the development and maintenance of LOC eating, diurnal patterns of LOC remain understudied and poorly characterised. We assessed the diurnal timing of LOC in a sample of females with bulimia nervosa and binge-eating disorder who participated in a study assessing the impact of bright light exposure on binge eating, hypothesising that higher ratings of LOC would be more likely to occur later in the day. Participants (N = 34) completed a 22-day protocol during which they provided LOC ratings six times daily. Kernel density estimates describing LOC ratings across times of day were compared using permutation tests of equality. Results demonstrated an evening shift in LOC, wherein higher LOC was more likely to occur later in the day and lower LOC was more likely to occur earlier in the day. This study is the first to clearly depict the phenomenon that the likelihood of experiencing higher LOC increases throughout the day, pointing to the potential role diurnal rhythms, such as disrupted appetitive rhythms or mood variations, may play in maintaining binge eating., (© 2023 The Authors. European Eating Disorders Review published by Eating Disorders Association and John Wiley & Sons Ltd.)

Objective: Circadian rhythm disruptions are associated with binge eating, can be causal of negative mood, and may be corrected with bright light exposure. A subtype of individuals with binge-spectrum eating disorders are characterized by combined high dietary restraint and negative affect. These individuals have higher eating disorder psychopathology and poorer treatment response. We aimed to test the targeted effects of morning bright light exposure on individuals with binge-spectrum eating disorders, hypothesizing significant reductions in binge eating for those characterized by high dietary restraint and negative affect., Methods: Participants (N = 34 females with binge-eating disorder and bulimia nervosa) used a morning bright light and normal light for 10 consecutive days each, in randomized order. They completed the Change in Eating Disorder Symptoms (CHEDS) scale at baseline, day 12 (when they switched lamps), and day 22. We conducted moderation analyses, clustering data by person, controlling for order, and examining the effect of light condition on binge eating according to baseline restraint and negative affect., Results: At high levels of combined dietary restraint and negative affect, participants experienced a reduction in binge eating and food preoccupation following exposure to morning bright light. There were no changes in restrictive eating, body preoccupation, body dissatisfaction, or body checking following exposure to morning bright light for these individuals., Discussion: These findings suggest that morning bright light may be a useful adjunct to empirically supported eating disorder treatments that target binge eating, especially for individuals characterized by the difficult to treat restraint/negative affect subtype., Public Significance: At high levels of combined dietary restraint and negative affect, participants with binge-spectrum eating disorders experienced a reduction in binge eating and food preoccupation following exposure to morning bright light. These findings suggest that morning bright light may be a useful adjunct to empirically supported eating disorder treatments that target binge eating, especially for individuals characterized by the difficult-to-treat restraint/negative affect subtype., (© 2023 Wiley Periodicals LLC.)

Binge eating demonstrates an evening diurnal shift among individuals with eating disorders. Disruptions to diurnal appetitive rhythms may be somewhat chronic and set the stage for additional disruptions to prompt binge eating. Despite known diurnal shifts in binge eating and related constructs (e.g., mood) and detailed characterizations of binge-eating episodes, no findings to date describe the naturalistic diurnal timing and composition of energy and nutrient intake on days with and without loss of control eating. We aimed to characterize eating behaviors (i.e., meal timing, energy intake, and macronutrient composition) across seven days in individuals with binge-spectrum eating disorders, assessing differences between eating episodes and days with and without loss of control eating. Undergraduate students (N = 51; 76.5% female) who endorsed past 28-day loss of control eating completed a 7-day naturalistic ecological momentary assessment protocol. Participants completed daily food diaries and reported instances of loss of control eating across the 7-day period. Results indicated that episodes of loss of control were more likely to occur later in the day, but overall meal timing did not differ across days with and without loss of control. Similarly, greater caloric consumption was more likely for episodes with loss of control, but overall caloric consumption did not differ between days with and without loss of control. Analysis of nutritional content demonstrated differences between both episodes and days with and without loss of control for carbohydrates and total fats, but not for protein. Findings provide support for the hypothesized role disruptions in diurnal appetitive rhythms play in maintaining binge eating via consistent irregularities, underscoring the importance of examining treatment adjuncts that intervene on the regulation of meal timing to enhance eating disorder treatment outcomes., Competing Interests: Declaration of competing interest None, (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Despite emphasis on findings suggesting restrained eaters increase food consumption under stress, unrestrained eaters' reduction in intake is more robust. Early proposals asserted unrestrained eaters significantly reduced intake after certain threats due to the hunger-inhibiting effects of autonomic influences, presuming unrestrained eaters are more responsive to these effects and restrained eaters rely less on physiological cues for eating. However, scant empirical evidence has substantiated these claims. This study examined whether a sequence exists whereby stress elicits autonomic activation, autonomic activation impacts hunger, and hunger then impacts eating, with dietary restraint altering the hunger-intake link. It was hypothesized that sympathetic nervous system activation would be greatest when ongoing safety from stress was uncertain, sympathetic activation would be linked to reduced hunger, and lower hunger would be associated with attenuated intake. Restraint, conceptualized via Hagan et al.'s (2017) latent restraint factors, was hypothesized to reduce the association between hunger and intake. Female participants (n = 147) were randomized to a stress + certain safety, stress + uncertain safety, or control condition. Sympathetic nervous system activity was recorded prior to a bogus taste test, which quantified ad libitum consumption of highly-palatable snack foods post-stress. Only the stress + uncertain safety condition exhibited greater sympathetic nervous system activity than the control condition. A significant index of moderated serial mediation emerged for Preoccupation with Dieting and Weight-Focused Restraint in the stress + uncertain safety condition. Though sympathetic activation decreased hunger similarly regardless of dietary restraint, only less restrained individuals significantly decreased intake. More restrained individuals ate more despite experiencing lower hunger. The disconnect between hunger and intake in more restrained eaters suggests that focus on enhancing attunement to hunger may yield greater benefit than enhancing restraint. 281 words., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Fear of being evaluated negatively by others is a risk factor for the development of disordered eating. Specifically, trait level fear of negative evaluation (FNE) predicts disordered eating severity above other social anxiety traits. However, it remains unclear how state levels of this fear may impact eating behavior. The current study aimed to examine this risk factor in the context of state-level eating behavior. We hypothesized that: (a) elevated levels of state FNE would enhance the relationship between restraint and restriction and (b) we sought to explore the predictive nature of high trait FNE on restriction. Study procedures for N = 64 undergraduate students included assessment of dietary restraint, fear of negative evaluation, and hypothetical meal choice in the context of several proposed social and non-social settings. Results indicated that higher state FNE was related to more restrictive food choice across settings, and levels of trait FNE were not related to food choices. State FNE did not enhance the relationship between restraint and restriction. This project sought to examine the degree to which fear of negative evaluation impacts the relationship between dietary restraint and restriction, testing a unique risk factor for the development of eating psychopathology., Competing Interests: Declaration of competing interest, (Copyright © 2022. Published by Elsevier Ltd.)

Purpose: Earlier work on engaging in physical exercise when experiencing negative affect demonstrated robust associations with eating disorder (ED) behaviors and attitudes; however, measurement of the behavior was primitive, relying on one yes/no question that cannot capture much variability. We report on the development of a self-report measure, the Reactive Exercise Scale (RES), that disentangles the tendency to engage in exercise in response to negative mood cues from the tendency to engage in exercise in response to eating and body image cues, which themselves may be associated with negative mood. The measure also assesses exercising in response to positive mood cues., Methods: Exploratory factor analysis (EFA) guided item and factor selection. Confirmatory factor analysis (CFA) in an independent sample tested a 3-factor solution-exercising in response to negative mood cues, eating and body image cues, and positive mood cues. Correlations with exercise attitudes, eating disorder and body image attitudes, mood, and personality were used to evaluate construct validity., Results: Results supported the 3-factor structure and indicated that exercising in response to negative mood cues may not uniquely relate to most aspects of ED psychopathology when accounting for eating and body image cues, which themselves are associated with negative mood., Conclusion: The RES captures the tendency to exercise in response to negative mood, positive mood, and eating and body image cues. Together, these constructs allow researchers to examine the unique relations of negative mood cued exercise with ED constructs, while accounting for appearance-related motives for which exercise may also be used., Level of Evidence: Level III: evidence obtained from well-designed cohort or case-control analytic studies., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Objective: There are limited data to guide the interpretation of scores on measures of eating-disorder psychopathology among underrepresented individuals. We aimed to provide norms for the Eating Disorder Examination-Questionnaire (EDE-Q) and Clinical Impairment Assessment (CIA) across racial/ethnic, gender, and sexual identities, and sexual orientations and their intersections by recruiting a diverse sample of Amazon MTurk workers (MTurkers; N = 1782)., Method: We created a comprehensive, quantitative assessment of racial/ethnic identification, gender identification, sex assigned at birth, current sexual identification, and sexual orientation called the Demographic Assessment of Racial, Sexual, and Gender Identities (DARSGI). We calculated normative data for each demographic category response option., Results: Our sample was comprised of 68% underrepresented racial/ethnic identities, 42% underrepresented gender identities, 13% underrepresented sexes, and 49% underrepresented sexual orientations. We reported means and standard deviations for each demographic category response option and, where possible, mean estimates by percentile across intersectional groups. EDE-Q Global Score for a subset of identities and intersections in the current study were higher than previously reported norms for those identities/intersections., Discussion: This is the most thorough reporting of norms for the EDE-Q and CIA among racial/ethnic, sexual, and gender identities, and sexual orientations and the first reporting on multiple intersections, filling some of the gaps for commonly used measures of eating-disorder psychopathology. These norms may be used to contextualize eating-disorder psychopathology reported by underrepresented individuals. The data from the current study may help inform research on the prevention and treatment of eating-disorder psychopathology in underrepresented groups., Public Significance: We provide the most thorough reporting on racial/ethnic, sexual, and gender identities, and sexual orientations for the Eating Disorder Examination - Questionnaire and Clinical Impairment Assessment, and the first reporting on intersections, which fills some of the gaps for commonly used measures of eating-disorder psychopathology. These norms help inform research on the prevention and treatment of eating-disorder psychopathology in underrepresented groups., (© 2022 Wiley Periodicals LLC.)

Caloric consumption occurs in rhythms, typically during daytime, waking hours, marked by peaks at mealtimes. These rhythms are disrupted in individuals with eating disorders; mealtime peaks are blunted and delayed relative to sleep/waketimes. Individuals with eating disorders also tend to experience an overall phase delay in appetite; they lack hunger earlier in the day and experience atypically high hunger later in the day, the latter of which may culminate in binge-eating episodes. This disruptive appetitive behavior-early in the day restrictive eating and later in the day binge eating-may be partially accounted for by circadian disruptions, which play a role in coordinating appetitive rhythms. Moreover, restrictive eating and binge eating themselves may further disrupt circadian synchronization, as meal timing serves as one of many external signals to the central circadian pacemaker. Here, we introduce the biobehavioral circadian model of restrictive eating and binge eating, which posits a central role for circadian disruption in the development and maintenance of restrictive eating and binge eating, highlighting modifiable pathways unacknowledged in existing explanatory models. Evidence supporting this model would implicate the need for biobehavioral circadian regulation interventions to augment existing eating disorder treatments for individuals experiencing circadian rhythm disruption. PUBLIC SIGNIFICANCE: Existing treatments for eating disorders that involve binge eating and restrictive eating mandate a regular pattern of eating; this is largely responsible for early behavioral change. This intervention may work partly by regulating circadian rhythm and diurnal appetitive disruptions. Supplementing existing treatments with additional elements specifically designed to regulate circadian rhythm and diurnal appetitive rhythms may increase the effectiveness of treatments, which presently do not benefit all who receive them., (© 2022 Wiley Periodicals LLC.)

Frequent weighing to assess shape and weight is common in eating disorders, as is going to great lengths to avoid knowledge of weight. However, few tools exist to measure these different weighing tendencies. This study reports on the development of a self-report measure of weighing tendencies using exploratory and confirmatory factor analysis (EFA; CFA). An EFA using 10 items identified 2 factors and indicated all items should be retained. Two CFAs in two independent samples indicated that a 2-factor, 6-item version fit reasonably well. The factors indicate the tendency to approach weighing and to avoid weighing. Additional evidence of convergent and discriminant validity is presented, covering a number of eating behaviors and relevant behavioral constructs. Findings suggest that individuals characterized by approach weighing tendencies may weight-check to reduce the anxiety and distress of not knowing their weights, and those characterized by avoidance may reduce the anxiety and distress of knowing their weights by avoiding weight-related information. This may have important clinical implications, as the feared stimulus for one group is uncertainty about their weights, whereas for the other, it is awareness of their weights, suggesting different treatment targets. Overall, the AAWQ appears to be a promising tool that may aid in examining weighing tendencies, in turn having the potential to aid in eating disorder cognitive-behavioral clinical case formulation and treatment planning.

We examined the naturalistic relations between motivation to change and change in four specific eating disorder (ED) behaviors-binge eating (BE), purging, fasting, and driven exercise-in a community-based sample of individuals with EDs over two consecutive 6-week periods. We conducted cross-lagged generalized estimating equations using the transtheoretical model's four stages of change to predict changes in the ED behaviors 6 weeks later. Individuals reported lower pre-contemplation for behaviors typically associated with more distress (e.g., BE, purging) than they did for behaviors associated with less distress (e.g., fasting and driven exercise). Action predicted decreases in BE and purging frequencies but not fasting or driven exercise frequencies. Naturalistic relations between ED behavior severity/frequency and motivation to change these features can be detected over 6-week intervals; that is, attempts at change in individuals' natural environments can be successful over relatively brief periods of time, especially when individuals experience the motivation to change these features. The process of motivation to change ED behaviors is not linear, and our study highlights the movement between stages of change among individuals with EDs. Future research is needed to examine how much of the observed changes are sustained.

Delayed eating rhythms, relative to the sleep/wake period, commonly manifest as a lack of hunger in the morning (morning anorexia) and elevated hunger in the late evening (evening hyperphagia). These intake patterns are associated with adverse mental and physical health outcomes. We aimed to evaluate whether the timing of light exposure, an important environmental signal for circadian synchronization, explains the link between sleep/waketime preferences and delayed diurnal appetite. We also aimed to test whether disruptions in sleep quality, reflecting suboptimal circadian synchronization, identify individuals for whom sleep/waketime preference is associated with delayed diurnal appetite. Participants (N = 150) completed a measure of their sleep/waketime preferences and wore a device to capture their sleep efficiency and naturalistic light exposure for 48 consecutive hours. The timing of light exposure mediated the link between sleep/waketime preferences and evening hyperphagia, but not morning anorexia, such that a later peak in light exposure mitigated some of the risk for evening hyperphagia that was associated with later sleep/waketime preferences. Sleep efficiency moderated the association between sleep/waketime preference and morning anorexia, but not evening hyperphagia. Earlier sleep/waketime preference was associated with less morning anorexia among individuals with high sleep efficiency, but morning anorexia was consistently elevated among individuals with poor sleep efficiency. These results on the relation between sleep/waketime preference and two aspects of delayed diurnal appetite suggest that morning anorexia depends on sleep efficiency and evening hyperphagia may be influenced by the timing of daily light exposure. Future research should assess over longer periods, covering weekdays and weekends, and incorporate momentary reports of meals/snacks and appetite., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Underrepresented identities have been overlooked in the development of measures assessing eating disorders; therefore, limited normative data exist for these identities. To address this, Burnette et al. sought to provide Eating Disorder Examination-Questionnaire and Eating Attitudes Test-26 norms for transgender adults using Amazon's MTurk. However, they were unable to achieve this goal due to what they perceived as high rates of invalid responses. Instead, they provided recommendations for conducting MTurk research. However, little or no evidence supports the validity of several recommendations, partly because their study was not designed to derive or validate recommendations. By their own admission, their strategies failed to address what they identified as the central problem. We express concern about Burnette et al.'s recommendations because (a) the recommendations are built on assumptions about the problem that may not be true; and (b) the recommendations are not provided within the context of limitations of self-report/online data collection writ large. We detail these concerns and propose that strategies for mitigating inattentive/invalid responding be subjected to validation prior to being recommended to prevent the implementation of procedures that result in the exclusion of the target population, individuals who we historically, and perhaps still, unjustly exclude from research., (© 2021 Wiley Periodicals LLC.)

Dietary restraint refers to the intention to restrict caloric intake, whereas dietary restriction refers to the actual intentional and sustained restriction of caloric intake for weight-control purposes. Findings regarding the relation between dietary restraint and restriction to date are inconsistent. Our study sought to clarify this complex relationship using a novel laboratory task. Participants (N = 103; 56.3% female) completed a Paced Visual Serial Addition Task (PVSAT). Participants were provided a choice between ending each of eight PVSAT rounds at any time and drinking a high-calorie Kool-Aid® mixture or correctly completing 10 consecutive computations to access to a zero-calorie mixture for each round. We measured participants' dietary restraint using the Three-Factor Eating Questionnaire - Restraint Subscale and measured persistence and dietary restriction using the PVSAT. Results indicated a positive association between persistence and restriction. Female participants demonstrated higher eating disorder psychopathology, dietary restraint, and dietary restriction compared to male participants. Restraint was positively associated with restriction the more individuals persisted, indicating that persistence is a potentially important modifier of the relation between dietary restraint and restriction. Our findings highlight the complexity of the relation between dietary restraint and restriction; that is, measures of dietary restraint alone may not reliably predict short-term dietary restriction during laboratory consumption tasks; however, other factors, such as persistence, may play critical roles., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

The acquired preparedness model (APM) posits that the relationship between impulsivity and substance use is mediated by drug effect expectancies. Though the APM has been utilized to explain college student cannabis use, a comprehensive model conceptualizing impulsivity as a multidimensional construct has not been examined. Guided by the APM, the current study examined facets of impulsivity as simultaneous predictors of cannabis use through positive and negative expectancies. College students ( N = 478) completed an online survey assessing frequency of past-month cannabis use, facets of impulsivity, and cannabis expectancies. Using a bootstrapped path analysis, five facets of impulsivity were modeled as predictors of past-month cannabis use via positive and negative expectancies. A zero-inflated Poisson distribution was used, wherein dichotomous past-month cannabis use was examined independently of frequency. There was a significant indirect effect of sensation seeking on both increased likelihood and frequency of use through strong positive expectancies. Additionally, both negative and positive urgency were associated with a decreased likelihood of use through stronger negative expectancies, while lack of premeditation was associated with an increased likelihood of use through weaker negative expectancies. These results underscore the importance of examining impulsivity as a multi-dimensional construct in the understanding of college student cannabis use behavior.

Objective: Guilt increases prior to objective binge-eating episodes (OBE) and decreases following OBE, suggesting that OBE may function to regulate negative affective states. Rapid eating, a common feature of OBE, may be an observable indication of difficulty regulating eating. Heart rate variability (HRV), a measure of parasympathetic activity, is an indicator of top-down inhibitory control and indicates emotion regulation attempts. We aimed to test the effect of guilt on consumption rate and change in HRV among individuals with (+) and without (-) OBE., Method: Participants (N = 86) underwent a mood induction (randomized to either a neutral mood or a guilt condition) and were then provided with 32 ounces (0.95 L) of Boost® meal replacement shake (960 kcal) and instructed to consume until they felt satisfied. Guilt was measured at baseline, prior to consumption, and following consumption. HRV was measured throughout., Results: Participants in the guilt condition reported higher guilt prior to consumption than individuals in the neutral mood condition, primarily driven by individuals with low HRV. Guilt decreased following consumption among individuals with low HRV in the guilt condition. The OBE+ individuals did not consume more or at an overall faster rate than OBE- individuals. Guilt prior to consumption did not lead to faster initial rates among OBE+ individuals; although, OBE+ individuals who experienced an increase in HRV from prior to during consumption demonstrated faster initial rates and greater changes in rate over time., Discussion: When experiencing negative emotions, individuals with OBE may experience increases in parasympathetic functioning while eating, reinforcing OBE as a facilitator of emotion regulation., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Online, anonymous data collection is common and increasingly available to researchers studying eating disorders (ED), particularly since the development of online crowdsourcing platforms. Crowdsourcing for participant recruitment may also be one effective strategy to address ED research disruptions caused by the COVID-19 pandemic. We aimed to: (a) develop a rigorous method for assessing self-reported athropometrics; (b) determine if individuals with EDs self-select into MTurk studies assessing eating behaviors; and (c) characterize ED-related psychopathology in an MTurk sample. We recruited 400 US adults to complete an MTurk study assessing ED features. Results did not indicate the presence of a self-selection bias among individuals with EDs; however, 40% of the sample met criteria for a current ED diagnosis, with all diagnoses represented except ARFID, and 18.1% reported currently being in ED treatment. The sample was characterized by higher scores on measures of ED psychopathology compared to extant non-clinical norms. Approximately 66% of the overall sample and 73% of participants with EDs indicated that they have participated in more MTurk studies since the COVID-19 pandemic began. Finally, we identified an alternative approach to assessing self-reported height and weight that appears to reduce error, which we strongly recommend researchers conducting online surveys use. Our findings suggest that individuals with EDs appear to be overrepresented on MTurk and highlight the utility of crowdsourcing using MTurk as an ED data collection alternative during and after the COVID-19 pandemic., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Negative affect increases in the hours prior to binge eating (BE), suggesting individuals may use BE to attempt to alleviate experiences of aversive self-awareness, such as shame and guilt. Guilt involves feeling bad about ones behavior and may elicit reparative actions; shame involves feeling bad about oneself and is generally associated with maladaptive behavior. Distinguishing how shame and guilt differentially relate to specific eating disorder (ED) behaviors may inform our understanding of emotional antecedents of ED behaviors and lead to refined treatment and prevention targets. We aimed to distinguish shame and guilt as they relate to BE and self-induced vomiting (SIV). We hypothesized that: (a) shame-proneness and state shame would be uniquely associated with BE, as BE may be used to escape from experiences of shame, and (b) guilt-proneness and state guilt would be positively associated with SIV among individuals who binge eat, as SIV may be used as a reparative action for BE. Participants (N = 347) completed self-report measures assessing guilt, shame, and ED behaviors. Shame-proneness and state shame were uniquely associated with BE and the urge to binge eat, while guilt-proneness and state guilt were not. Contrary to our hypothesis, guilt-proneness and state guilt were not associated with SIV among those who binge eat or endorsed urges to binge eat. These findings suggest that shame and guilt are differentially related to ED behaviors and identify shame specifically as an emotion that may elicit BE. Future research is needed to identify temporal relations between shame and ED behaviors., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objective: Outcome states, such as remission and recovery, include specific duration criteria for which individuals must be asymptomatic. Ideally, duration criteria provide predictive validity to outcome states by reducing symptom-return risk. However, available research is insufficient for deriving specific recommendations for remission or recovery duration criteria for eating disorders., Method: We intensively modeled the relation between duration criteria length and rates of remission, recovery, and subsequent symptom return in longitudinal data from a treatment-seeking sample of women with anorexia nervosa (AN) and bulimia nervosa (BN). We hypothesized that the length of the duration criterion would be inversely associated with both rates of remission and recovery and with subsequent rates of symptom return., Results: Generalized estimating equations supported our hypotheses for all investigated eating-disorder features except for symptom return when using the Psychiatric Status Rating for AN., Discussion: We recommend that 6 months be used for remission definitions applied to binge eating, purging, and BN symptom composite measures, whereas no duration criteria be used for low weight and AN symptom composites. We further recommend that 6 months be used for recovery definitions applied to BN symptom composites and AN symptom composites, whereas 18 months be used for individual symptoms of binge eating, purging, and low weight. The adoption of these duration criteria into comprehensive definitions of remission and recovery will increase their predictive validity, which in turn, maximizes their utility., (© 2020 Wiley Periodicals, Inc.)

Nonmedical prescription stimulant use (NPS) is increasing, particularly among college students. College students typically engage in NPS for cognitive enhancement, recreational, and appetite/weight-related purposes; however, little research has used these motives to identify specific risk for, or consequences of, NPS. Moreover, there may be unique risk factors for motive-specific NPS that have yet to be explored, such as relevant personality traits (i.e., distress tolerance, impulsivity, and perfectionism) that are associated with NPS in general. Therefore, this study aimed to examine whether NPS users and nonusers could be differentiated via facets of impulsivity, perfectionism, and distress tolerance, and whether users could be further differentiated by reported motive for use based on these traits. Midwestern university undergraduate students (N = 668) who were enrolled in a psychology research pool completed an online survey assessing demographics, NPS and motives, and measures of distress tolerance, impulsivity, and perfectionism. Participants were primarily female (78%) and aged 18-54 (M = 20.10, SD = 3.19) years. Univariate and multivariate analysis of variance tests revealed associations between lifetime NPS and higher impulsivity, higher perfectionism, and lower distress tolerance. Further tests revealed NPS for appetite/weight-related purposes was associated with lower distress tolerance, while NPS for recreational purposes was associated with higher impulsivity. These findings contribute novel information regarding NPS motives and personality constructs. This information may aid in comprehensive identification of high-risk individuals for NPS and inform the development of specialized prevention and intervention efforts., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objective: To evaluate how subjective control over intake is influenced by objective aspects of consumption, negative affect, and recent binge eating., Method: 105 participants with or without current binge eating (BE) consumed a meal replacement shake following a 12-hour overnight fast in a 2 × 2 design: participants were instructed to either consume the entire shake (no control) or decide on their own how much to consume (affirmative control). They were allotted either 5 (fast) or 15 (slow) minutes to complete the task. Participants reported on subjective control and negative affect following consumption., Results: Compared to the slow condition, participants in the fast condition reported higher negative affect after eating. Individuals without a history of BE reported lower subjective control in the no control compared to the affirmative control condition; however, this pattern was reversed among those with BE, such that individuals reported higher subjective control following consumption in the no control condition. In addition, subjective control was positively associated with negative affect in the no control condition whereas it was negatively associated with negative affect in the affirmative control condition., Discussion: Eating rate influences affect, and subjective control over eating may be the result of an interaction of objective control with affect. Thus, distress may drive perceptions of control. This should be directly tested in future studies and has implications for how we understand BE., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

The insights and activities that regularly occur in clinical settings are an underutilized wellspring of potential scientific advances. Single-case experimental designs (SCEDs) include a collection of methods for testing hypotheses in one individual (or a small number of individuals) at a time that are particularly well suited to clinical settings. Their strengths include their potential for maximizing both internal and external validity by way of tight experimental control over threats to internal validity and flexibility in application and inclusion criteria. Despite these advantages, the eating disorder field has not made use of SCEDs to a similar extent as other research areas, providing an opportunity for expansion. Recent advances in organizing SCED standards have resulted in the publication of two sets of reporting guidelines relevant to eating disorders research. These guidelines are integrated and summarized alongside descriptions of domains for evaluating their methodological rigor. Example research questions of potential interest to the eating disorder field are illustrated with SCEDs, and several issues to consider when using SCEDs in eating disorders research are described. It is recommended that researchers aiming to use SCEDs refer to this paper and the resources cited herein when designing and reporting their work. Finally, it is hoped that individuals with access to clinical samples use this paper as a source of inspiration for testing their unique clinical insights., (© 2018 Wiley Periodicals, Inc.)

This study investigated learned expectancies of eating outcomes as a mechanism through which maladaptive avoidant strategies relate to eating psychopathology. Participants included 244 undergraduate students at a Midwestern university. The participants completed a battery of measures online. Preacher and Hayes's (2008) bootstrapping method of mediation and structural equation modeling were used to analyze the relationships among experiential avoidance, eating expectancies, and binge eating and to test how experiential avoidance fits within the Acquired Preparedness model of eating disorder risk that highlights the role of negative urgency. Results revealed that experiential avoidance was positively related to negative affect eating expectancies and to binge eating. Negative affect eating expectancies mediated the relationship between experiential avoidance and binge eating. Further, experiential avoidance more adequately explained binge eating in the Acquired Preparedness model of eating disorder risk than did negative urgency. The findings from this study suggest an alternative understanding of the pathways through which dispositional and psychosocial characteristics of undergraduate students may impact eating disorder symptomatology., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

There are few assessments that gather valid, highly detailed data on short-term (i.e., weekly) symptom frequency/severity retrospectively. In particular, methodologies that provide valid data for research investigating symptom changes are typically prospective, expensive, and burdensome. The purpose of this study was to evaluate a new interactive and graphical assessment tool for gathering detailed information about eating-related symptom frequency/severity retrospectively over a 3-month period. A mixed eating disorder sample ( N = 113) recruited from the community provided symptom data once weekly for 12 weeks and completed the Interactive, Graphical Assessment Tool (IGAT) assessing eating disorder symptoms on three occasions to determine the test-retest and concurrent validity of the IGAT. The IGAT performed marginally better than other measures for retrospective symptom frequency assessment in the eating disorders and did so at a greater level of detail than other available tools. Future research should evaluate the IGAT with other behaviors of interest.

Objective: Nonmedical prescription stimulant use (NPS; i.e., use without a prescription or in ways other than prescribed) to suppress appetite or control weight appears to be associated with eating disorder (ED) symptomatology among college students. However, it remains unknown if this relationship is motive-specific and uniquely related to ED symptomatology. This research examined whether engaging in NPS specifically for appetite/weight-related purposes is associated with ED symptomatology and a unique indicator of more severe symptomatology., Method: A nonclinical sample of college students (N = 668; 79% female) reported eating disorder symptoms via the Eating Pathology Symptoms Inventory and Eating Disorder Examination-Questionnaire, and lifetime history of NPS and corresponding motives., Results: Binge eating, body dissatisfaction, negative attitudes towards obesity, restricting, purging, and cognitive restraint were reported more frequently by students who endorsed NPS for weight/appetite-related purposes than by those who used for other purposes or denied lifetime NPS. Additionally, NPS for appetite/weight-related purposes was uniquely associated with ED symptomatology after adjusting for gender, lifetime NPS, and past-month binge eating and purging., Discussion: Engaging in NPS for appetite/weight-related purposes is a unique indicator of ED symptomatology, highlighting the need to query for this behavior among individuals with an ED. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:813-816)., (© 2016 Wiley Periodicals, Inc.)

Background: Nonmedical prescription stimulant use (NPSU) is commonly reported by college students and is on the rise. It is possible that increases in NPSU rates may stem from a lack of stigmatization regarding use, given recent evidence that students do not hold strong negative perceptions related to NPSU., Objectives: This study aimed to assess NPSU and cocaine use using a conventional method and a method that assures anonymity. As anonymous data collection has typically found higher prevalence rates for stigmatized behaviors compared to conventional techniques, it was expected that cocaine rates would differ between techniques, while NPSU rates would not., Methods: At a Midwestern university during the Fall 2012 and Spring 2013 terms, groups of college student participants were randomly assigned either to a condition in which the data collection method guaranteed their anonymity (n = 204) or to a condition using a more conventional data collection technique that did not guarantee anonymity (n = 236). Participants responded to self-report measures assessing stimulant use, perception of anonymity of the methods, and demographics., Results: When anonymity was guaranteed, male participants were significantly more likely to report cocaine use. However, no differences in NPSU rates were noted for either sex, regardless of anonymity., Conclusions: These results suggest that NPSU may not have the same perceived negative social consequences as other more stigmatized stimulant drugs, with young men in particular giving little weight to the potential consequences of NPSU.

This study examined the unique contribution of individual eating disorder symptoms and related features to overall eating disorder-related impairment. Participants (N=113) from the community with eating disorders completed assessments including the Clinical Impairment Assessment (CIA) and the Eating Disorder Examination Questionnaire. A multiple linear regression analysis indicated that 58.6% of variance in the CIA was accounted for by binge eating frequency, weight and shape concerns, and depression. These findings indicate that certain eating disorder symptoms uniquely account for impairment and that depression is a substantial contributor. It is possible that purging, restrictive eating, and body mass index did not significantly contribute to impairment because these features are consistent with many individuals' weight and shape goals. The results imply that eating disorder-related impairment may be more a result of cognitive features and binge eating rather than body weight and compensatory behaviors., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

This study examined the association between restrictive eating behaviors and binge eating in anorexia nervosa (AN) using data collected in the natural environment. Women (N = 118) with DSM-IV full or subthreshold AN reported eating disorder behaviors, including binge eating episodes, going ≥ 8 waking hours without eating, and skipping meals, during 2 weeks of ecological momentary assessment (EMA). Time-lagged generalized estimating equations tested the following hypotheses: 1) dietary restriction would predict binge eating while controlling for binge eating the previous day; 2) binge eating would predict restriction the subsequent day while controlling for restriction the previous day. After controlling for relevant covariates, the hypotheses were not supported; however, there appeared to be a cumulative effect of repeatedly going 8 consecutive hours without eating (i.e. fasting) on the risk of binge eating among individuals who recently engaged in binge eating. In addition, skipping meals was associated with a lower risk of same day binge eating. The relationship between binge eating and dietary restriction appears to be complex and may vary by type of restrictive eating behavior. Future research should aim to further clarify the nature of the interaction of binge eating and restrictive eating among individuals with AN in order to effectively eliminate these behaviors in treatment., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Objective: To examine the relationship of neuroticism and negative affect (NA) lability with weekly binge eating fluctuations between binge eating disorder (BED) and bulimia nervosa (BN)., Method: Individuals with BED (n = 30) and BN (n = 54) from the community completed self-report measures at baseline and prospectively for 12 consecutive weeks. Weekly data were analyzed by using (mean) squared successive deviation to account for fluctuations in NA and binge eating from week to week., Results: Generalized estimating equations revealed the presence of a two-way interaction between neuroticism and NA lability predicting binge eating fluctuations (Wald χ(2) = 8.25; df = 1; p = .004), indicating that higher NA lability was only related to larger fluctuations in the frequency of binge eating episodes when present in individuals who were also high on neuroticism. An interaction was also detected between eating disorder diagnosis and NA lability, but this was accounted for by differences in average NA between the diagnoses., Discussion: This study highlights the relevance of two traits and their interaction in understanding individual differences in binge eating fluctuations. Additionally, findings indicate that diagnostic differences in average NA may impact binge eating fluctuations and NA lability., (Copyright © 2013 Wiley Periodicals, Inc.)

Emotions are implicated in the etiology and maintenance of binge eating (BE). It is largely unknown whether BE is more strongly tied to emotions for certain individuals. This study investigated whether beliefs about the function of eating moderate the relationship between positive and negative affect and the frequency of BE. A mixed eating disorder sample (n=105) prospectively reported their weekly BE frequency and positive and negative affect for 12 weeks after completing the Eating Expectancy Inventory. Results indicated that holding the expectancy that eating helps to relieve negative affect prospectively predicts higher frequencies of BE, and holding the expectancy that eating is pleasurable and useful as a reward predicts lower frequencies. Further, increases in negative affect were associated with increases in BE, and increases in positive affect were associated with decreases in BE. Neither of the hypothesized relationships between affect and BE was moderated by expectancies. However, an interaction between negative and positive affect was found, indicating that only the combination of high positive and low negative affect is specifically related to reduced BE. Holding specific expectancies about the function of eating and fluctuations in both positive and negative affect appear to be associated with BE among individuals with eating disorders. Cognitive interventions should target eating-related expectancies that may maintain BE behavior., (© 2013.)

Objective: The purpose of this study was to compare the type and frequency of restrictive eating behaviors across the two subtypes of anorexia nervosa (AN; restricting [ANr] and binge eating/purging [ANbp]) using ecological momentary assessment (EMA) and to determine whether subtype differences in restrictive eating behaviors were attributable to severity of the disorder or the frequency of binge eating., Method: Participants (N = 118) were women at least 18 years of age with full (n = 59) or subthreshold (n = 59) AN who participated in a two week (EMA) protocol., Results: General estimating equations revealed that individuals with ANbp generally reported more frequent restrictive eating behaviors than individuals with ANr. These differences were mostly accounted for by greater severity of eating psychopathology, indicating that the presence and frequency of restrictive eating behaviors in AN may be nonweight-based markers of severity. Binge eating frequency did not account for these findings., Discussion: The present findings are especially interesting in light of the weight-based severity rating in the DSM-5., (Copyright © 2013 Wiley Periodicals, Inc.)

This study examined the unique associations between eating disorder symptoms and two emotion-related constructs (affective lability and anxiousness) assessed via distinct methodologies in anorexia nervosa (AN). Women (N = 116) with full or subthreshold AN completed baseline emotion and eating disorder assessments, followed by two weeks of ecological momentary assessment (EMA). Hierarchical regressions were used to examine unique contributions of baseline and EMA measures of affective lability and anxiousness in accounting for variance in baseline eating disorder symptoms and EMA dietary restriction, controlling for age, body mass index, depression, and AN diagnostic subtype. Only EMA affective lability was uniquely associated with baseline eating disorder symptoms and EMA dietary restriction. Anxiousness was uniquely associated with baseline eating disorder symptoms regardless of assessment method; neither of the anxiousness measures was uniquely associated with EMA dietary restriction. Affective lability and anxiousness account for variance in global eating disorder symptomatology; AN treatments targeting these emotion-related constructs may prove useful., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Background: College students continue to report nonmedical prescription stimulant use to enhance alertness and concentration. Despite increasing prevalence of this behavior, techniques for preventing or treating it are lacking. An intervention that focuses on challenging positive consequence-oriented beliefs about prescription stimulants may be efficacious in preventing use., Methods: The current study examined the efficacy of a randomized controlled expectancy challenge intervention to prevent nonmedical prescription stimulant use among 96 at-risk, stimulant-naïve college students (i.e., low grade point average, Greek involvement, binge drinking, cannabis use). Forty-seven participants completed a brief expectancy challenge intervention aimed at modifying positive expectancies for prescription stimulants, to consequently deter initiation of use. The remaining participants received no intervention., Results: The expectancy challenge successfully modified expectancies related to prescription stimulant effects. Nevertheless, this intervention group and a control group showed comparable rates of nonmedical prescription use at 6-month follow-up. However, negative expectancies were significant predictors of reduced odds of future use., Conclusions: A challenge session appears to modify stimulant-related expectancies, which are related to nonmedical prescription stimulant use. Nevertheless, a more potent challenge or booster sessions might be essential for longer-term changes., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

The role of anxiety has been emphasized in etiological/maintenance models of anorexia nervosa. This study identified daily patterns of anxiety in anorexia nervosa and examined the likelihood of the occurrence of eating disorder behaviors in each trajectory, the daily temporal distribution of eating disorder behaviors in each trajectory, and the extent to which the tendency to exhibit particular anxiety trajectories was associated with baseline diagnostic and trait-level personality variables. Women with full or subthreshold anorexia nervosa (N = 118) completed a 2-week ecological momentary assessment (EMA) protocol during which they reported on a variety of behavioral and affective variables, including anxiety and eating disorder behaviors. Using latent growth mixture modeling to classify EMA days (N = 1,526) based on anxiety ratings, we identified 7 distinct daily anxiety trajectories. Overall differences between trajectories were found for rates of binge eating, self-induced vomiting, body checking, skipping meals, and dietary restriction. Furthermore, distinct daily temporal distributions of eating disorder behaviors were found across the trajectories, with peaks in the probability of behaviors frequently coinciding with high levels of anxiety. Finally, traits of personality pathology (affective lability, self-harm, social avoidance, and oppositionality) and the presence of a co-occurring mood disorder were found to be associated with the tendency to experience particular daily anxiety trajectories (e.g., stable high anxiety). Findings support the presence of within-person variability in daily anxiety patterns in anorexia nervosa and also provide evidence for an association between these anxiety patterns and eating disorder behaviors., (PsycINFO Database Record (c) 2013 APA, all rights reserved.)

The purpose of this study was to test the impact of two variables on post-binge eating negative emotion in a combined sample of women with anorexia nervosa (AN; n = 47) and bulimia nervosa (BN; n = 121). Participants completed two weeks of an ecological momentary assessment protocol during which they provided multiple daily ratings of overall negative affect and guilt and reported eating disorder behaviors including binge eating and self-induced vomiting. The results indicate that both overall negative affect and guilt exhibited a statistically significantly decrease in the hour immediately following binge eating episodes. The decrease in guilt, but not overall negative affect, was moderated by eating disorder diagnosis and the tendency to engage in self-induced vomiting. Specifically, individuals with BN reported a greater reduction in guilt than those with AN, and individuals who did not typically engage in self-induced vomiting reported more decreases in guilt than those who typically engaged in self-induced vomiting. This study extends the existing literature on the relationship between negative affect and eating disorder behaviors, suggesting guilt as a potentially relevant facet of negative affect in the maintenance of binge eating. In addition, the findings indicate that two individual differences, eating disorder diagnosis and self-induced vomiting, may influence the trajectory of guilt following binge eating episodes., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Objectives: To describe the longitudinal course of three core eating disorder symptoms-low body weight, binge eating, and purging-in women with anorexia nervosa (AN) and bulimia nervosa (BN) using a novel statistical approach., Method: Treatment-seeking women with AN (n = 136) or BN (n = 110) completed the Eating Disorders Longitudinal Interval Follow-Up Evaluation interview every 6 months, yielding weekly eating disorder symptom data for a 5-year period. Semiparametric mixture modeling was used to identify longitudinal trajectories for the three core symptoms., Results: Four individual trajectories were identified for each eating disorder symptom. The number and general shape of the individual trajectories was similar across symptoms, with each model including trajectories depicting stable absence and stable presence of symptoms as well as one or more trajectories depicting the declining presence of symptoms. Unique trajectories were found for low body weight (fluctuating presence) and purging (increasing presence). Conjunction analyses yielded the following joint trajectories: low body weight and binge eating, low body weight and purging, and binge eating and purging., Discussion: The course of individual eating disorder symptoms among patients with AN and BN is highly variable. Future research identifying clinical predictors of trajectory membership may inform treatment and nosological research., (Copyright © 2010 Wiley Periodicals, Inc.)

The Word Repeating Technique (WRT) is a cognitive defusion technique used in Acceptance and Commitment Therapy (ACT). In this exercise, a word or short phrase is quickly repeated aloud until the context required for the word to have literal meaning changes. This study compared the WRT to a procedure that requires words to retain their meaning [the Implicit Associations Task (IAT)]. If the WRT operates by inducing a loss of meaning in words, one would not expect similar effects from a task requiring literal processing of words. Participants (N = 160) completed either the WRT or IAT with or without a theoretically consistent rationale for performing the task, while an additional 40 participants were in a control condition. Both the WRT and IAT decreased discomfort and believability ratings from pre- to post-test for words that were targeted in the tasks, with the WRT resulting in a larger pre- to post-test decrease for discomfort ratings. Only the WRT decreased the discomfort of words not targeted in the task from pre- to post-test, while neither task decreased the believability of words that were not targeted in the tasks. Providing a rationale did not have an effect for either task. Although the strengths of the effects for the WRT were larger than those for the IAT, both tasks demonstrated effects in the same direction and neither demonstrated effects that were larger in magnitude than what was accounted for by regression to the mean., (2010 Elsevier Ltd. All rights reserved.)

Objective: To investigate whether the desire to lose weight moderates the association between objective binge eating episodes (OBEs) and eating and body image-related psychopathology in men., Method: Participants (N = 404) completed questionnaires assessing eating and body image psychopathology and were grouped based on the presence of OBEs and the desire to lose weight., Results: The desire to lose weight was found to moderate the relationships between the presence of OBEs and restraint, eating concerns, shape concerns, and weight concerns but not the presence of fasting, purging, driven exercise, or body image dissatisfaction. In fact, men who experienced OBEs engaged in similar rates of purging regardless of whether they desired to lose weight., Discussion: The results of this study suggest that disordered eating behaviors may be manifested differently in some men compared to what is typically observed in women, with over one-quarter of men who reported binge eating following this unusual pattern., (© 2009 by Wiley Periodicals, Inc.)

Normative data on the Eating Disorder Examination Questionnaire for samples of undergraduate men in the United States are presented. Participants were 404 undergraduate men aged 18-26 who completed the EDE-Q as part of two larger survey studies. Mean scores, standard deviations, and percentile ranks for the Global score and four subscale scores are provided. Data regarding the frequency of objective binge eating episodes and compensatory behaviors also are reported. Although the overall prevalence of full threshold eating disorders remains lower in men than in women, body dissatisfaction and disordered eating behaviors are fairly common among young men. These results will help researchers and clinicians interpret the EDE-Q scores of undergraduate men., (Copyright 2009 Elsevier Ltd. All rights reserved.)

This study tested whether exercising in response to negative affect moderates the association between obligatory exercise and eating and body image psychopathology. Participants (n=226) completed the Eating Disorders Examination-Questionnaire (EDE-Q), Obligatory Exercise Questionnaire (OEQ), and a question assessing whether they ever exercise in response to negative affect. In total, 132 (58.4%) participants endorsed exercising in response to negative affect. Multiple regression analyses revealed significant main effects of negative affect motivated exercise, OEQ total scores, and gender on all four EDE-Q subscales and significant interactions of negative affect motivated exercise and OEQ scores on the Eating Concern, Shape Concern, and Weight Concern scales but not the Restraint scale of the EDE-Q. Obligatory exercisers may not demonstrate elevated eating and body image concerns in the absence of negative affect motivated exercise, providing further support of the importance of the function of exercise.

Objective: The purpose of this study was to determine the prevalence and correlates of exercising in response to negative affect., Method: Participants (N = 177) completed questionnaires assessing affect before and after exercise, exercise quality and quantity, eating behaviors and attitudes, body image, and self-esteem., Results: Fifty-eight percent of participants endorsed ever exercising in response to negative affect. As a group, these individuals were more likely to report self-induced vomiting, binge eating, and fasting over the previous 4 weeks. They also showed poorer body image and self-esteem, and their exercise was more obligatory and impairing. Groups did not differ on body mass index or quantity of exercise., Discussion: Negative affect motivated exercise appears to be a common phenomenon that is associated with eating disordered behavior.

Context: Recent data suggest that purging disorder, a recently characterized form of eating disorder not otherwise specified, may be worthy of specific delineation in nosological schemes. However, more data are needed to determine how purging disorder differs from bulimia nervosa., Objective: To examine clinical features and subjective as well as objective physiological responses to a standardized test meal in purging disorder compared with bulimia nervosa and controls., Design: Study visit 1 included psychological assessments with structured clinical interviews and questionnaires. Study visit 2 included assessment of test-meal responses., Setting: Participants recruited from the community completed test-meal studies in a General Clinical Research Center., Participants: Women with DSM-IV bulimia nervosa-purging subtype (n = 37) and purging disorder (n = 20) and non-eating disorder controls (n = 33) with a body mass index (calculated as weight in kilograms divided by height in meters squared) between 18.5 and 26.5 who were free of psychotropic medications., Main Outcome Measures: Assessments of eating disorder severity, postprandial cholecystokinin response, and subjective responses to test meals., Results: Eating abnormalities were significantly elevated in participants with purging disorder and bulimia nervosa compared with controls but did not differ between eating disorder groups. Participants with purging disorder demonstrated significantly greater postprandial cholecystokinin release compared with participants with bulimia nervosa (t(76.44) = 2.51; P = .01) and did not differ significantly from controls (t(75.93) = 0.03; P = .98). Participants with purging disorder reported significantly greater postprandial fullness and gastrointestinal distress compared with participants with bulimia nervosa and controls., Conclusions: Purging disorder is a clinically significant disorder of eating that appears to be distinct from bulimia nervosa on subjective and physiological responses to a test meal. Findings support further consideration of purging disorder for inclusion in the classification of eating disorders. Future studies on the psychobiology of purging disorder are needed to understand the propensity to purge in the absence of binge eating.