Affective processes underlying restrictive eating in atypical anorexia nervosa: Comparisons to anorexia nervosa and bulimia nervosa using ecological momentary assessment.

OBJECTIVE: Certain symptom and risk/maintenance factor similarities between individuals with atypical anorexia nervosa (AN) and 'typical' AN have been documented, but few studies have investigated how atypical AN compares to bulimia nervosa (BN). Further, the role of affective mechanisms in maintaining restrictive eating in atypical AN has not been examined. The current study investigated whether atypical AN resembles AN and/or BN on affect-related processes using questionnaires and ecological momentary assessment (EMA). METHOD: Women with atypical AN (n = 24), AN-restrictive subtype, (n = 27), AN-binge eating/purging subtype (n = 34), and BN (n = 58) completed questionnaires measuring depressive symptoms and emotion regulation difficulties. They also completed a 14-day EMA protocol during which they reported negative and positive affect and skipped meals five times/day (signal-contingent surveys) and restrictive eating after meals/snacks (event-contingent surveys). RESULTS: Diagnostic groups generally did not differ on questionnaire measures nor affective patterns surrounding restrictive eating behaviors. Momentary changes in affect did not predict or follow restriction at meals/snacks, though higher momentary negative affect ratings predicted skipped meals, and higher positive affect was reported after skipped meals. Greater average negative affect and lower average positive affect predicted both restrictive eating behaviors. DISCUSSION: Across diagnoses, reductions in food intake do not appear to be influenced by momentary changes in affect, though skipping meals may serve an emotion regulation function. Atypical AN seems to resemble AN and BN on affective processes underlying restrictive eating, raising further questions regarding the unique diagnosis of atypical AN. PUBLIC SIGNIFICANCE: Though atypical anorexia appears to strongly resemble anorexia nervosa, it is less clear how this disorder relates to bulimia nervosa. It is further unknown whether affective-related processes underlie restrictive eating in atypical anorexia nervosa, and how these processes compare to those in anorexia nervosa and bulimia nervosa. Results suggest that atypical anorexia does not differ from anorexia nervosa or bulimia nervosa on emotion-related measures, nor in affective patterns surrounding restrictive eating behaviors.

Acting impulsively when "upset": Examining associations among negative urgency, undifferentiated negative affect, and impulsivity using momentary and experimental methods.

INTRODUCTION: Negative urgency is a personality pathway toward impulsive behavior that increases risk for transdiagnostic psychopathology. Limited research supports the core tenant of urgency theory, that is, that individuals with high trait negative urgency act more impulsive when experiencing increased negative emotion. We hypothesized that it may not be negative emotion intensity, but difficulty in differentiating among negative emotions, that prompts impulsive behavior among individuals with elevated negative urgency. METHODS: We tested this hypothesis in 200 undergraduates using both ecological momentary assessment (measured momentary undifferentiated negative affect and impulsivity) and experimental methods (manipulated emotion differentiation and measured behavioral impulsivity). RESULTS: Momentary undifferentiated negative affect predicted impulsivity in the specific domains of work/school and exercise, but interactions between momentary undifferentiated negative affect and negative urgency were not supported. Manipulated emotion differentiation did not impact behavioral impulsivity regardless of negative urgency scores. CONCLUSION: Inconsistent with theory, the impulsive behavior of individuals with negative urgency may not be conditional on elevated or undifferentiated negative affect.

A mechanistic staging model of reward processing alterations in individuals with binge-type eating disorders.

Altered reward processing is thought to characterize binge-type eating disorders, but the exact nature of these alterations is unclear. A more fine-grained understanding of whether specific aspects of reward processing contribute to the development or maintenance of binge eating may point to new therapeutic targets and personalized treatments. The incentive sensitization theory of addiction proposes that repeated use of a substance increases the desire to approach a reward ('wanting') but not pleasure when consuming the reward ('liking'), suggesting that reward processes driving addiction change over time. We hypothesize that the same may be true for binge eating. Further, consistent with the maladaptive scaling hypothesis, reward processing may be heightened for multiple reinforcers in at-risk individuals but become tuned toward food once binge eating is initiated. In this article, we propose a mechanistic staging model of reward processing in binge-type eating disorders that synthesizes existing data and posits that alterations of reward processing depend on illness stage and reward type. We outline translational methods for testing key hypotheses and discuss clinical implications. Considering reward processing alterations in relation to illness stage has the potential to improve treatment outcomes by ensuring that the mechanisms targeted are personalized to the individual patient. PUBLIC SIGNIFICANCE: Individuals with binge-type eating disorders experience alterations in their desire for, and pleasure from, food. We believe that the exact nature of these alterations in reward processing change over the course of illness-from the at-risk state to an established illness. If true, treatments for binge-type eating disorders that target reward processing should be personalized to the illness stage of the patient.

Exploring latent profiles of disordered eating using an indicator of dietary restriction in an undergraduate sample of men and women.

OBJECTIVE: Latent class or latent profile analysis (LPA) studies in patients with eating disorders consistently identify a low-weight, restrictive eating subgroup that does not endorse weight/shape concerns. To date, similar studies in samples unselected for disordered eating symptoms have not identified a high restriction-low weight/shape concerns group, which may be due to a lack of inclusion of measures of dietary restriction. METHOD: We conducted an LPA using data from 1623 college students (54% female) recruited across three different studies. The Eating Pathology Symptoms Inventory Body Dissatisfaction, Cognitive Restraint, Restricting, and Binge Eating subscales were used as indicators, and body mass index, gender, and dataset were covaried. Purging, excessive exercise, emotion dysregulation, and harmful alcohol use were compared across resulting clusters. RESULTS: Fit indices supported a 10-class solution, including five disordered eating groups (largest to smallest): "Elevated General Disordered Eating", "Body Dissatisfied Binge Eating," "Most Severe General Disordered Eating," "Non-Body Dissatisfied Binge Eating," and "Non-Body Dissatisfied Restriction." The "Non-Body Dissatisfied Restriction" group scored as low on other measures of traditional eating pathology and harmful alcohol use as non-disordered eating groups but scored as high on a measure of emotion dysregulation as other disordered eating groups. DISCUSSION: This study is the first to identify a latent restrictive eating group that does not endorse traditional disordered eating cognitions in an unselected sample of undergraduate students. Results underscore the importance of using measures of disordered eating behaviors without implied motivation to capture overlooked problematic eating patterns in the population that are distinct from our "traditional" understanding of disordered eating. PUBLIC SIGNIFICANCE: We identified a group of individuals with high levels of restrictive eating but low body dissatisfaction and intent to diet in an unselected adult sample of men and women. Results underscore the need to investigate restrictive eating outside of the traditional lens of body shape concerns. Findings also suggest that individuals with nontraditional eating difficulties may struggle with emotion dysregulation, putting them at risk of poor psychological and relational outcomes.

Reconsidering the role of interpersonal stress in eating pathology: Sensitivity to rejection might be more important than actual experiences of peer stress.

Rejection sensitivity (i.e., the tendency to anxiously expect, readily perceive, and overreact to real or perceived rejection) is theorized to play a role in the onset and maintenance of disordered eating. Although rejection sensitivity has repeatedly been associated with eating pathology in clinical and community samples, the pathways through which this psychological trait influences eating pathology have been not fully established. The current study investigated peer-related stress, which can be influenced by rejection sensitivity and is associated with eating pathology, as a mechanism linking these constructs. In two samples of women - 189 first-year undergraduate students and 77 community women with binge eating - we examined whether rejection sensitivity was indirectly associated with binge eating and weight/shape concerns via ostracism and peer victimization, both cross-sectionally and longitudinally. Our hypotheses were not supported: there were no indirect associations between rejection sensitivity and eating pathology via interpersonal stress in either sample. However, we did find that rejection sensitivity was directly associated with weight/shape concerns in both samples and with binge eating in the clinical sample in cross-sectional (but not longitudinal) analyses. Our findings suggest that the association between rejection sensitivity and disordered eating is not dependent on actual experiences of interpersonal stress. That is, simply anticipating or perceiving rejection may be sufficient to play a role in eating pathology. As such, interventions targeting rejection sensitivity may be helpful in the treatment of eating pathology.

The role of self-compassion in the relationship between rejection and unhealthy eating: An ecological momentary assessment study.

Available studies suggest that experiencing interpersonal rejection heightens negative affect and, in turn, triggers unhealthy eating behaviors. Elucidating individual differences that attenuate the negative consequences of rejection could inform interventions targeting unhealthy eating. This study examined the buffering role of self-compassion in the relationship between rejection experiences and unhealthy eating behaviors, defined as snacking on junk food and overeating. Two-hundred undergraduate students (50% women) completed ecological momentary assessments measuring rejection experiences, emotions, and unhealthy eating seven times a day for 10 consecutive days. Self-compassion was measured after the 10-day assessment period. Reports of rejection were low (2.6%) in our university sample. Multilevel mediation analyses examined whether the relationship between experiencing rejection and subsequent unhealthy eating was mediated by negative affect. Multilevel moderated mediation analyses further considered whether relationships between rejection and negative affect and between negative affect and unhealthy eating were moderated by self-compassion. Experiencing rejection predicted more unhealthy eating behaviors at the next time point, and this relationship was fully explained by increases in negative affect. Participants with high levels of self-compassion experienced less intense negative affect after rejection and reported less unhealthy eating behaviors when feeling negative emotions, compared to their counterparts with lower levels of self-compassion. The indirect effect of rejection on unhealthy eating was moderated by self-compassion, and there was no statistically significant relationship between rejection and unhealthy eating behaviors among highly self-compassionate participants. Findings suggest that cultivating self-compassion may help attenuate the negative impact of rejection experiences on emotions and unhealthy eating behaviors.

The roles of negative emotion intensity, negative emotion differentiation, and self-compassion in loss of control eating.

OBJECTIVE: Negative affect intensity is robustly related to binge eating, but the relationship between negative emotion differentiation (i.e., the ability to differentiate negatively-valenced emotions) and binge eating is unclear. Further, little is known about factors that might reduce emotion intensity and/or enhance emotion differentiation, thereby reducing binge eating. Self-compassion is consistently linked to less binge eating, which may be due to decreased negative affect and/or an enhanced ability to differentiate emotions. The current study examined the roles of negative emotion intensity, negative emotion differentiation, and self-compassion in binge eating using ecological momentary assessment. METHOD: Participants were 201 university students (52.2% female) who completed questionnaires assessing affect seven times a day, and engagement in loss of control (LOC) eating episodes at the end of each day, for 10 days. The average of sadness, fear, guilt, and hostility subscales represented negative emotion intensity; intraclass correlations across negative affect subscales defined negative emotion differentiation. Both daily (i.e., within-person) and trait (i.e., between-person) emotion variables were examined as predictors. RESULTS: Between-person negative emotion intensity, but not negative emotion differentiation, significantly predicted LOC eating occurrence. Self-compassion had a significant effect on LOC eating frequency, and this relationship was partially mediated via negative emotion intensity, but not via negative emotion differentiation. DISCUSSION: Lower levels of negative emotion intensity partially account for the relationship between greater self-compassion and less frequent LOC eating. These findings highlight the importance of cultivating self-compassion to down-regulate negative emotions and to reduce LOC eating. PUBLIC SIGNIFICANCE STATEMENT: Our findings suggest that university students who approach their limitations compassionately experience fewer negative emotions in daily life and engage in less loss of control eating. Lower levels of negative affect partially explain this relationship between self-compassion and loss of control eating. These results highlight the importance of cultivating an understanding and a compassionate attitude toward oneself for reducing eating pathology.

Eating disorders and the nine symptoms of borderline personality disorder: A systematic review and series of meta-analyses.

OBJECTIVE: Eating disorders and borderline personality disorder have high rates of comorbidity. However, the extent to which individual BPD symptoms are elevated in patients with EDs is largely unknown. Meta-analyses examined: (1) which of the nine BPD symptoms are especially elevated in individuals with versus without EDs, (2) whether particular ED subtypes have elevated levels of certain BPD symptoms, and (3) which BPD symptoms remain unstudied/understudied in relation to EDs. METHODS: We performed nine separate meta-analyses (one for each BPD symptom) to compare levels of symptoms in patients with EDs versus healthy controls. A total of 122 studies (range = 4-34 studies across symptoms) were included. RESULTS: Affective instability was the BPD symptom most elevated, while anger was the BPD symptom least elevated, in patients with EDs compared to controls. When comparing effect sizes across ED subtypes, anorexia nervosa binge-eating/purging subtype had the largest effect sizes for the greatest number of BPD symptoms, while effect sizes for AN restrictive subtype were not significantly larger than those of other EDs for any BPD symptom. The least studied BPD symptoms were identity disturbance and interpersonal difficulties. DISCUSSION: These meta-analyses suggest that certain symptoms of BPD play a more prominent role in the comorbidity between BPD and EDs than others. Targeting affective instability when treating cases of comorbid ED and BPD may be especially likely to ameliorate the negative outcomes related to this comorbidity. Future research should further investigate identity disturbance and interpersonal difficulties in the context of EDs. PUBLIC SIGNIFICANCE: Having an eating disorder and borderline personality disorder is a common comorbidity associated with a severe clinical presentation. BPD is characterized by nine distinct symptoms. This research examined levels of individual BPD symptoms in patients with versus without EDs. Findings can guide researchers and clinicians towards studying and treating symptoms that may be most relevant for BPD-ED comorbidity and in turn, improve outcomes for these patients.

OBJETIVO: Los trastornos de la conducta alimentaria (TCA) y el trastorno límite de la personalidad (TLP) tienen altas tasas de comorbilidad. Sin embargo, se desconoce en gran medida hasta qué punto los síntomas individuales del TLP están elevados en pacientes con TCA. Este metaanálisis examinó: (1) cuál de los nueve síntomas de TLP está especialmente elevado en individuos con TCA versus sin TCA, (2) si los subtipos particulares de TCA tienen niveles elevados de ciertos síntomas de TLP, y (3) qué síntomas de TLP permanecen sin estudiar/poco estudiados en relación con los TCA. MÉTODOS: Se realizaron nueve metanálisis separados (uno para cada síntoma de TLP) para comparar los niveles de síntomas en pacientes con TCA versus controles sanos. Se incluyeron un total de 122 estudios (rango = 4-34 estudios entre los síntomas). RESULTADOS: La inestabilidad afectiva fue el síntoma de TLP más elevado, mientras que el enojo fue el síntoma de TLP menos elevado, en pacientes con TCA en comparación con los controles. Al comparar los tamaños del efecto entre los subtipos de TCA, la anorexia nervosa (AN) subtipo atracón/purgación tuvo los tamaños de efecto más grandes para el mayor número de síntomas de TLP, mientras que los tamaños del efecto para la AN subtipo restrictivo no fueron significativamente mayores que los de otros TCA para cualquier síntoma de TLP. Los síntomas de TLP menos estudiados fueron alteración de la identidad y dificultades interpersonales. DISCUSIÓN: Estos metanálisis sugieren que ciertos síntomas de TLP juegan un papel más prominente que otros en la comorbilidad entre el TLP y los TCA. Enfocarse en la inestabilidad afectiva al tratar casos de TCA y TLP comórbidos puede ser especialmente probable que mejore los resultados negativos relacionados con esta comorbilidad. Los estudios de investigación futuros deben investigar más a fondo la alteración de la identidad y las dificultades interpersonales en el contexto de los TCA.

Examining relationships among thin-ideal internalization, eating pathology, and motivational reactions to high- and low-calorie food.

Motivational responses to food stimuli are relevant for eating disorders (EDs). Research examining reactions to food in EDs has been mixed, with some studies reporting enhanced appetitive responses, and others observing defensive responses, to food. Thin-ideal internalization, a socio-cognitive factor implicated in EDs, may relate to these mixed findings, as individuals with eating pathology may experience food as a threat to internalized ideals of thinness, despite its inherently appetitive qualities. In the present study, physiological reflexes measuring defensive (startle blink reflex) and appetitive (postauricular reflex) responding as well as self-report ratings were recorded while 88 women with and without eating pathology viewed images of high- and low-calorie food. Greater global eating pathology, but not thin-ideal internalization, was associated with negative self-report valence ratings and lower craving ratings of high-calorie food. In contrast, greater thin-ideal internalization and eating pathology both related to more positive self-report valence ratings of low-calorie food, with thin-ideal internalization accounting for some of the shared variance between low-calorie food ratings and eating pathology. Overall, thin-ideal internalization may represent a higher-order factor that may contribute to the relationship between conscious reactions to food and disordered eating.

Impact of the COVID-19 pandemic on the psychological health of individuals with mental health conditions: A mixed methods study.

OBJECTIVES: This study explored how the coronavirus disease 2019 (COVID-19) pandemic has affected individuals with mental health conditions. METHODS: Participants were 477 adults (82% female) who reported a past-year mental health condition. They completed an online survey that included an open-ended question. Mixed methods analysis was conducted. RESULTS: While all mental health conditions were moderately impacted by the COVID-19 pandemic, self-reported impact on anxiety disorder and obsessive-compulsive disorder symptoms was greater than for all other mental health symptoms. Thematic analysis revealed five themes: (1) the contribution of the pandemic to worsening mental health; (2) life interruptions due to the pandemic; (3) increased loneliness/isolation; (4) upsides of the pandemic; and (5) normalization of the anxieties previously experienced by those with mental health conditions. CONCLUSION: Individuals with pre-existing mental health conditions reported a worsening of symptoms during the COVID-19 pandemic. Governments and organizations must focus on supporting and increasing access to treatment for this population.

Hunger games: Associations between core eating disorder symptoms and responses to rejection by peers during competition.

OBJECTIVE: Individuals with eating disorder (ED) symptoms are sensitive to social threat and report maladaptive interpersonal styles that may contribute to and exacerbate negative evaluation from others. Research in this area has relied primarily on self-report. The current study examined associations between behavioral responses to social threat and core ED symptoms using a behavioral paradigm. Based on previous findings that individuals with binge-eating report being more reactive and confrontational, whereas individuals with dietary restriction tend to be more submissive and avoidant of conflict, we hypothesized that binge eating would be associated with a greater tendency to retaliate against rejection perpetrators, whereas dietary restriction would be associated with a lower tendency to retaliate when rejected. METHOD: Undergraduate women (N = 132) completed a self-report measure of ED symptoms and participated in an online "Survivor"-type game in which they voted to either accept or reject computerized coplayers, while also receiving acceptance or rejection feedback from others. RESULTS: Neither ED symptom was associated with how often participants retaliated against coplayers who rejected them. However, dietary restriction was related to more rejection votes overall (i.e., the tendency to reject others regardless of how others voted). DISCUSSION: Findings suggest that individuals with dietary restriction may rely on a maladaptive defensive strategy aimed at pre-empting rejection, or alternatively, have difficulty shifting from habitual self-isolating behavior that results from over-involvement with restricting symptoms. Interventions targeting hypersensitivity to social threat or interpersonal flexibility may help reduce interpersonal stress and mitigate its impact on restricting symptoms.

The effects of puberty on associations between mood/personality factors and disordered eating symptoms in girls.

OBJECTIVE: Negative and positive urgency, anxiety, and depressive symptoms are significant factors of disordered eating (DE) symptoms in early adolescence through young adulthood. However, it is unclear how puberty-a critical developmental milestone that is associated with increased risk for DE symptoms-affects the relationship between these factors and DE symptoms, given that the role of pubertal status has rarely been considered in relation to these associations. Thus, the present study examined whether puberty moderates associations between mood/personality factors and DE in pre-adolescent and adolescent girls. METHOD: Participants included 981 girls (aged 8-16 years) from the Michigan State University Twin Registry. Mood/personality factors, pubertal status, and DE were assessed with self-report questionnaires. RESULTS: Puberty significantly moderated associations between several factors (negative urgency, positive urgency, trait anxiety, depressive symptoms) and the cognitive symptoms of DE (e.g., shape/weight concerns, body dissatisfaction). Associations between mood/personality factors and cognitive DE were stronger in girls with more advanced pubertal status. By contrast, no significant moderation effects were detected for mood/personality-dysregulated eating (e.g., binge eating, emotional eating) associations. DISCUSSION: Findings identify pubertal development as an important moderator of mood/personality-DE symptom associations, especially for cognitive DE symptoms that are known to predict the later onset of clinical pathology.

Extending the scope of the interpersonal psychotherapy model of eating disorders: Integrating the role of 'feeling fat'.

The interpersonal psychotherapy model of eating disorders (IPT-ED) argues that interpersonal problems result in negative affect, and that an inability to cope with this negative affect triggers ED symptoms. Relatedly, it is theorized that 'feeling fat' (i.e., the somatic experience of being overweight not entirely explained by one's body mass) results from shifting negative affect onto one's body, which can then be controlled via ED symptoms. Research has yet to identify why negative affect caused by interpersonal problems may trigger ED symptoms as opposed to other maladaptive behaviours. Integrating 'feeling fat' into the IPT-ED may help to explain this relationship. This study examined whether interpersonal problems positively related to ED symptoms via negative affect and 'feeling fat' in 190 undergraduate women (mean age [SD] = 19.05 [1.23]; mean BMI [SD] = 21.76 [3.17]; 72.8% Caucasian). Using both cross-sectional and longitudinal path analyses, we tested the indirect effects of ostracism and peer victimization on binge eating and restricting via negative affect and 'feeling fat' using serial indirect effects analyses. Cross-sectional path analysis revealed significant indirect effects of ostracism on both binge eating and restricting sequentially via negative affect and 'feeling fat', such that ostracism related to negative affect, which related to 'feeling fat', which was ultimately associated with disordered eating behaviours. Longitudinal path analysis replicated the significant indirect effects of ostracism on binge eating sequentially via negative affect and 'feeling fat'. Results suggest that individuals may displace negative feelings that result from ostracism onto their body, triggering 'feelings of fatness' and prompting ED symptoms. Future research should examine 'feeling fat' within the IPT-ED in a sample of individuals with EDs to determine its clinical utility beyond an undergraduate sample.

Emotion dysregulation moderates the relationship between alcohol use and eating pathology among heavy-drinking college men.

OBJECTIVES: There is limited research examining the relationship between alcohol use and eating pathology in men or factors that may moderate this association. The current study investigated the relationship between alcohol use and eating pathology, and examined emotion dysregulation as a moderator of this association, among heavy-drinking college men. METHOD: Men mandated to receive an alcohol intervention (N = 88; average age = 19 years) completed questionnaires related to alcohol use, emotion dysregulation, and eating pathology. RESULTS: Results demonstrated positive relationships between alcohol use and some eating pathology, and a significant interaction between alcohol use and emotion dysregulation. However, results were contrary to hypotheses, such that there was a positive relationship between alcohol use and eating pathology at low levels of emotion dysregulation. CONCLUSION: Future studies should continue to examine the overall presentation of eating pathology in men and investigate factors that may impact the relationship between alcohol use and eating pathology.

'Feeling fat,' eating pathology, and eating pathology-related impairment in young men and women.

'Feeling fat' has received little empirical attention despite clinical recognition as an eating disorder maintenance factor. This experience also occurs in non-clinical populations and may relate to elements of subclinical eating pathology. The present study examined whether 'feeling fat' independently contributes to eating pathology and eating pathology-related impairment, over and above over-evaluation of weight and shape and dysphoria. University students (N = 990; 54.3% female) completed questionnaires measuring these constructs. Moderated multiple hierarchical regression analyses evaluated 'feeling fat''s unique contribution to eating pathology and impairment, and the moderating effects of gender and eating disorder symptom severity. 'Feeling fat' accounted for significant unique variance in eating pathology, but not eating pathology-related impairment, over and above over-evaluation of weight and shape and dysphoria. The relationship between 'feeling fat' and eating pathology-related impairment was stronger in women than in men. Symptom severity did not moderate the relationship between 'feeling fat' and either dependent variable. 'Feeling fat' distinctly relates to eating pathology in a sample of young adults, suggesting that 'feeling fat' deserves attention in individuals without eating disorders. Future research should longitudinally investigate the direction of the relationship between 'feeling fat' and eating pathology and examine mechanisms of gender differences in 'feeling fat.'

Understanding "feeling fat" and its underlying mechanisms: The importance of multimethod measurement.

"Feeling fat," the somatic sensation of being overweight that does not entirely correlate with one's actual weight, is recognized clinically as a maintenance factor in eating disorders. Occurring amidst Western internalized thin ideals and weight stigma, "feeling fat" is wide-reaching and also reported by those with subclinical and absent eating pathology. However, empirical study of "feeling fat" is limited. Regarding proposed mechanisms, "feeling fat" may (a) reflect the displacement of negative affect onto the body, (b) represent one element of a cognitive distortion related to the imagined consumption of fattening food, and/or (c) be a function of impaired interoceptive awareness. However, the relative and/or joint contributions of these mechanisms to "feeling fat" are unclear. Regarding measurement, retrospective assessment with single items has been the norm. Innovative measures of "feeling fat" will expand our understanding of this construct. Ecological momentary assessment can clarify the transitory nature of this experience, and physiological measures can allow for assessment of somatic elements of "feeling fat. Multi-method and implicit measurement strategies of 'feeling fat'" may clarify the mechanisms underlying this experience. Further research with improved measurement techniques may also benefit eating disorder treatment by highlighting new treatment foci (e.g., cognitive distortions, interoceptive awareness).

Convergence in maternal and child reports of impulsivity, depressive symptoms, and trait anxiety, and their predictive utility for binge-eating behaviors.

OBJECTIVE: Early detection of binge-eating (BE) behaviors and their risk factors is associated with better outcomes. A multi-informant approach for assessing BE psychopathology and risk factors has been emphasized to increase the probability and accuracy of early detection. Impulsivity (particularly negative and positive urgency), trait anxiety, and depressive symptoms are associated with BE behaviors. The present study examined maternal-child convergence of reports of child BE, impulsivity, trait anxiety, and depressive symptoms and examined the predictive power of maternal reports for child-reported BE behaviors. METHOD: Participants included 927 female twins (aged 8-16 years) and 468 mothers from the Michigan State University Twin Registry. Risk factors and BE were assessed with self-report questionnaires. RESULTS: Intraclass correlation coefficients showed fair-to-moderate inter-rater agreement (ICCs = .31-.41) between maternal and child reports of risk factors and low-to-fair agreement for BE (ICCs = .05-.29). Controlling for the effects of age, pubertal status, body mass index, and family relatedness, multilevel models showed that maternal reports of child impulsivity, anxiety, and depressive symptoms did not add predictive power above and beyond child reports. DISCUSSION: Results call into question the utility and practical implications of using maternal reports to supplement child reports for BE and its risk factors.

Extending the Acquired Preparedness model of binge eating: Testing the indirect effects of high-risk personality traits on binge eating via positive and negative reinforcement expectancies.

According to the Acquired Preparedness (AP) model of binge eating, individuals high in negative urgency are more likely to develop the expectancy that eating alleviates negative affect, which in turn increases the likelihood of binge eating. Although both cross-sectional and longitudinal studies have provided strong support for the negative urgency version of the AP model, there are likely other personality traits and expectancies that may transact to increase risk for binge eating. We extended the AP model to examine how other high-risk personality traits related to reward and impulsivity might lead to binge eating via learned expectancies about eating. In a large sample of male and female college students (N = 998; 54.6% female), we tested the indirect effects of reward responsiveness, fun seeking, and sensation seeking on binge eating via expectancies related to positive and negative reinforcement from eating. Our results suggested an indirect effect of reward responsiveness on binge eating via the expectancy that eating is rewarding and an indirect effect of fun seeking on binge eating via the expectancies that eating is rewarding and eating alleviates boredom. In contrast, sensation seeking had neither direct nor indirect effects on binge eating. Findings suggest that there are multiple pathways from personality to binge eating that depend on differential learning experiences and should be considered in terms of prevention and treatment efforts.

Symptoms of anorexia nervosa and bulimia nervosa have differential relationships to borderline personality disorder symptoms.

Eating disorders (EDs) and borderline personality disorder (BPD) are highly comorbid. BPD is characterized by the presence of at least five of nine symptoms. Given the number/variety of emotional and interpersonal symptoms that comprise BPD, some BPD traits may relate to EDs, whereas others may not be associated. This study examined relationships between BPD symptoms and symptoms of bulimia nervosa (BN) and anorexia nervosa (AN), including whether the nine BPD symptoms differentially relate to BN versus AN. Participants were 208 adolescent psychiatric inpatients. BPD symptoms, measured via structured interview, correlated more strongly with self-reported BN than AN symptoms. BN and AN symptoms were greater among individuals who endorsed unstable relationships, affective instability, emptiness, identity disturbance, inappropriate anger, dissociation/paranoia, and suicidal behavior. BN, but not AN symptoms, were higher when impulsivity was endorsed. Avoiding abandonment was neither related to BN nor AN. Affective instability, impulsivity, and anger had substantially larger associations with BN compared to AN, while identity disturbance was more strongly related to AN than BN. Findings provide useful information for targeting specific BPD symptoms to help prevent and reduce co-occurring EDs and BPD and the negative consequences associated with this comorbidity.

Effort expenditure for rewards task modified for food: A novel behavioral measure of willingness to work for food.

OBJECTIVE: Binge eating and associated eating disorders are characterized by abnormalities in reward processing. One component of reward is willingness to expend effort to obtain a reinforcer. The Effort Expenditure for Rewards Task (EEfRT) is a widely used behavioral measure of willingness to work for money. We sought to modify the EEfRT to examine willingness to work for food reward and to preliminarily examine the association between binge eating and effort expenditure for food. METHOD: Participants were 63 females recruited to span the spectrum of binge-eating severity. The modified EEfRT required participants to make a series of choices between an easier, low-reward option (one portion of food) and a harder, high-reward option (between two to five portions of food). Each trial also varied on probability of winning. RESULTS: Participants self-reported engagement in the task, working hard at easy and hard tasks, and making choices based on reward probability and magnitude. As with the original EEfRT, probability, reward magnitude, and their interaction predicted the likelihood of choosing the hard task. Across two different measures, binge-eating symptoms interacted with reward magnitude, such that those with high binge eating used reward magnitude more to make trial choices than those with low binge eating. DISCUSSION: These data provide initial support for the validity of the EEfRT modified for food as a behavioral measure of willingness to work for food reward. The impact of binge eating on effort expenditure must be replicated in samples of patients with eating disorders.