Loss of control eating exhibits an evening diurnal shift among females with bulimia nervosa and binge-eating disorder.

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.

Responses to bright light exposure in individuals with binge-spectrum eating disorders characterized by high dietary restraint and negative affect.

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.

Characterizing naturalistic meal timing, energy intake, and macronutrient intake among individuals with loss of control eating.

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.

Disconnect between sympathetically-induced hunger suppression and consumption among highly restrained eaters following stress.

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.

A biobehavioral circadian model of restrictive eating and binge eating.

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.

Practice makes perfect: Commentary on Burnette et al. (2021).

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.

Eating Disorder Examination-Questionnaire and Clinical Impairment Assessment norms for intersectional identities using an MTurk sample.

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.

Sleep/waketime preference and delayed diurnal eating rhythms are associated through light exposure timing and modified by sleep efficiency.

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.

Development and validation of a questionnaire assessing weighing tendencies: the Approach/Avoidance of Weighing Questionnaire (AAWQ).

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.

Motivation to change predicts naturalistic changes in binge eating and purging, but not fasting or driven exercise among individuals with eating disorders.

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.

Development and validation of a scale for the tendency to exercise in response to mood, eating, and body image cues: the Reactive Exercise Scale (RES).

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.

Examining heart rate variability as an indicator of top-down inhibitory control over emotions and eating behaviors among individuals with and without binge eating.

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.

Identifying duration criteria for eating-disorder remission and recovery through intensive modeling of longitudinal data.

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.

A summary of reporting guidelines and evaluation domains for using single-case experimental designs and recommendations for the study of eating disorders.

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.

Experiential avoidance, eating expectancies, and binge eating: A preliminary test of an adaption of the Acquired Preparedness model of eating disorder risk.

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.

Nonmedical prescription stimulant use for suppressing appetite and controlling body weight is uniquely associated with more severe eating disorder symptomatology.

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).

The Role of Anonymity in Determining the Self-Reported Use of Cocaine and Nonmedical Prescription Stimulant Use Among College Students.

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.

Individual differences in negative affect and weekly variability in binge eating frequency.

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.

Bidirectional associations between binge eating and restriction in anorexia nervosa. An ecological momentary assessment study.

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.

Course of avoidant/restrictive food intake disorder: Emergence of overvaluation of shape/weight.

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; Mage = 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.