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.

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.

The roles of negative affect and emotion differentiation in the experience of 'feeling fat' among undergraduate students: An ecological momentary assessment study.

'Feeling fat' is the somatic experience of being overweight not fully explained by objective body mass. According to the body displacement hypothesis, 'feeling fat' occurs when diffuse negative emotions are projected onto the body in lieu of adaptive emotion regulation. Emotion differentiation, the ability to experience and label discrete emotions, is an important skill for adaptively addressing emotion that may reduce 'feeling fat.' We hypothesized that individuals with better negative emotion differentiation would be less likely to report 'feeling fat' when experiencing high negative emotion. We collected ecological momentary assessment data from 198 undergraduate students (52.24% female). Multilevel modeling revealed that both within-person increases in negative emotions and the tendency to experience greater negative emotion were associated with greater 'feeling fat.' Of the specific types of negative emotion, guilt and sadness predicted 'feeling fat.' Contrary to hypotheses, individuals with better emotion differentiation were more likely to report 'feeling fat' after experiencing elevated negative affect. These findings contradict the primary clinical conceptualization of 'feeling fat,' suggesting that factors beyond displacement of negative emotions onto the body may be responsible for 'feeling fat'. Results in a sample with pronounced shape/weight concern may better support the traditional clinical understanding of 'feeling fat.'

Daily instability in body dissatisfaction in individuals with and without eating disorders.

Body dissatisfaction (BD) includes negative thoughts and feelings about one's body shape. Although typically assessed as a trait, BD has been found to fluctuate within a day. The present study examined whether daily instability in BD differs according to trait BD, eating disorder (ED) diagnosis, and engagement in maladaptive exercise. Participants with EDs (n = 166) and controls (n = 44) completed a self-report measure of trait BD and reported BD and engagement in maladaptive exercise five times daily for 14 days as part of an ecological momentary assessment protocol. BD instability was calculated as adjusted mean squared successive difference. On average across assessments, participants with EDs reported a 16% change in their BD ratings between consecutive assessments, which was significantly higher than the 12% change in controls. Trait BD was significantly inversely associated with BD instability in individuals with EDs, but not in controls. BD instability did not differ across ED diagnoses or between days with versus without maladaptive exercise. Findings suggest that BD is a dynamic state that varies within a day, especially in participants with EDs. Further research is needed to clarify whether this heightened instability in BD is a clinically relevant factor underlying ED symptoms.

Gender differences in compulsive exercise facets and their associations with eating disorder symptoms.

Compulsive exercise (CE) is a core symptom of eating disorders (EDs) that is common in undergraduate men and women. Importantly, CE is a multidimensional construct, and certain facets of CE (i.e., exercise to control weight or to avoid negative affect associated with missed exercise) are more strongly associated with ED symptoms in undergraduate women than others. However, less is known about how CE facets relate to ED symptoms in men. This study examined: 1) gender differences in levels of CE facets, assessed using the Compulsive Exercise Test (CET); 2) whether specific CE facets independently relate to ED symptoms; and 3) whether gender moderates these relationships. Five hundred and ninety-one university students (58.5 % men) completed the CET and Eating Pathology Symptoms Inventory. Women reported significantly greater weight control exercise, exercise for mood improvement, lack of exercise enjoyment, body dissatisfaction, and purging than men, while men reported more muscle building than women. CE motivated by avoidance of negative emotions and performed in a rule-driven manner and weight control CE were associated with the greatest number of ED symptoms. Further, rigid exercise routines were associated with greater muscle building. Women with greater weight control CE experienced more body dissatisfaction, and women with more CE motivated by avoidance of negative emotions experienced more restriction, compared to men. Overall, specific CE facets relate to ED symptoms in men and women. Findings highlight the importance of interventions designed to target unhealthy exercise motivations and of cultivating healthy attitudes towards exercise across genders.

Protection versus risk? The relative roles of compassionate and uncompassionate self-responding for eating disorder behaviors.

Research demonstrates the protective role of self-compassion for eating disorder symptoms. However, studies investigating self-compassion most often use the Self-Compassion Scale, which aggregates the distinct but related constructs of compassionate and uncompassionate self-responding. This study examined differential associations of compassionate and uncompassionate self-responding with positive and negative affect and with a range of eating disorder behaviors (i.e., binge eating, purging, dietary restriction, and excessive exercise). Participants were 547 undergraduate students (59% women, Mage = 20.49, SDage = 1.83) who completed measures of self-compassion, trait affect, and eating disorder behaviors. Compassionate and uncompassionate self-responding were moderately negatively correlated (rs = -0.41 and -0.33, among women and men, respectively). Compassionate self-responding was more strongly related to positive affect, and uncompassionate self-responding was more strongly related to negative affect. Among women, uncompassionate self-responding was related to all eating disorder behaviors controlling for compassionate self-responding, whereas compassionate self-responding was not uniquely related to any eating disorder behavior. Among men, a similar pattern emerged, except that only compassionate self-responding related uniquely to excessive exercise. Results are consistent with studies showing that the presence of uncompassionate self-responding might outweigh the absence of compassionate self-responding in explaining psychopathology. Findings highlight the potential importance of primarily targeting uncompassionate self-responding in eating disorder interventions.