Examining negative urgency as a predictor of eating disorder maintenance in purging syndromes.

OBJECTIVES: Negative urgency is associated with short-term maintenance of binge eating and purging in unselected samples. The current study used an eating disorder sample to test the hypothesis that negative urgency maintains bulimia nervosa (BN) and purging disorder (PD) at long-term follow-up. It was also hypothesized that baseline differences in negative urgency between BN and PD would remain at follow-up. METHODS: Secondary analyses were conducted on a sample of women who engaged in recurrent self-induced vomiting (n = 68; 52.9% BN; 47.1% PD). Women completed diagnostic interviews and questionnaires at baseline and at a mean (SD) of 5.95 (1.58) years follow-up (range = 2.51-9.62; retention rate = 75%). RESULTS: Negative urgency did not predict eating disorder diagnostic status, recovery status, or global eating pathology at follow-up (p's = .06-.83). There were no significant differences in negative urgency across women with BN and PD at follow-up (p = .16). However, post hoc analyses indicated that negative urgency was not stable across time (ICC = .102). Increases in negative urgency from baseline to follow-up were associated with greater global eating pathology at follow-up (p = .002). CONCLUSION: Results suggest negative urgency does not predict long-term eating disorder maintenance. Negative urgency may not be a stable personality trait but rather an indicator of overall poor emotion regulation. Future research should confirm that changes in negative urgency predict chronic eating pathology over long durations of follow-up in women who have increasing negative urgency across time.

Elevated fullness and bloating as correlates of eating pathology: Implications for screening.

A minority of individuals with eating disorders report being asked about their eating by health care professionals; delayed detection of eating disorders may contribute to poorer outcomes. The current study investigated common meal-related gastrointestinal symptoms (i.e., elevated fullness and bloating) as correlates of eating pathology that may be more readily disclosed to health professionals and indicate the need to assess for eating pathology. The current study also tested the hypothesis that elevated fullness and bloating are more strongly linked to eating pathology among those with higher body dissatisfaction. 281 university students (70.1% female, 84.3% white) completed gastrointestinal symptom and eating pathology assessments. Elevated fullness and bloating were each associated with increased purging, restrictive eating behaviors, and likelihood of having an eating disorder. Elevated fullness and bloating were more strongly linked to purging and probable eating disorder diagnosis with higher, relative to lower, body dissatisfaction. However, body dissatisfaction did not moderate the relationship between gastrointestinal symptoms and restrictive eating behaviors. Results indicate that elevated fullness and bloating are correlates of eating pathology. Healthcare professionals should consider and/or assess for eating pathology when elevated fullness and bloating are reported; further assessment of body dissatisfaction may be helpful in identifying purging behaviors.

Trauma and Alcohol Use Among Transgender and Gender Diverse Women: An Examination of the Stress-Buffering Hypothesis of Social Support.

Transgender and gender diverse (TGD) women (i.e., individuals who were assigned male at birth and identify as women or trans women) experience trauma at disproportionate rates compared to cisgender populations. While trauma is associated with increased alcohol use among TGD women, research regarding factors that are protective of this association is scant. The stress-buffering hypothesis of social support suggests that perceived social support, defined as the judgment that social network members will be helpful when individuals experience stress, may buffer and reduce the association between trauma symptoms and alcohol use. However, this relationship has not been examined among TGD women. We examined whether perceived social support moderates the association between trauma and alcohol use among 89 TGD women. Exploratory multiple regression analyses provided support for this hypothesis, insofar as trauma symptoms were related to alcohol use by individuals with low, relative to high levels of perceived social support. Exploratory analyses demonstrated that this finding was driven by perceived social support from friends and family. Our results are the first to suggest that social support reduces alcohol use among TGD women and add to the literature on their trauma and alcohol use.

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.

Emotion dysregulation as a correlate of food and alcohol disturbance in undergraduate students.

Disordered eating behaviors (e.g., binge eating, food restriction, self-induced vomiting, and laxative use) as well as alcohol use and related issues are prevalent in undergraduate students and are often comorbid with one another. Recently, the unique combination of these behaviors, termed food and alcohol disturbance (FAD), has received empirical attention. FAD involves compensatory behaviors performed in preparation for, or in response to, alcohol use in order to counteract calories consumed from alcohol and/or to increase intoxication. Research on FAD is sparse; in particular, there is a lack of consensus regarding potential gender differences in FAD and a lack of knowledge concerning psychological correlates of these behaviors. Emotion dysregulation is a transdiagnostic correlate of psychopathology, including disordered eating and alcohol use, and therefore may relate to FAD. The present study used a cross-sectional design to examine associations between emotion dysregulation and FAD, as well as gender differences in this relationship, in a sample of male and female undergraduate students (N = 417; 51.8% female). There were no gender differences in FAD, and the associations between emotion dysregulation and FAD did not vary among men and women. FAD was positively associated with emotion dysregulation at the bivariate level, but emotion dysregulation was not uniquely associated with FAD after accounting for disordered eating, alcohol use and problems, and body mass index. Future research should extend the current findings by examining temporal associations between emotions, emotion dysregulation, and FAD.

Emotion dysregulation across the spectrum of pathological eating: Comparisons among women with binge eating, overeating, and loss of control eating.

Emotion regulation difficulties influence the etiology and maintenance of binge eating and eating disorders, but differential associations between emotion dysregulation and objective binge eating (OBE) components have not been examined. We compared emotion dysregulation dimensions in women with OBEs (n = 27), overeating only (n = 25), loss of control (LOC) only (n = 32), or no pathological eating (n = 137). Women with OBEs had significantly more difficulty with overall emotion dysregulation, access to strategies, and impulse control when upset than other groups. Women with OBEs and women with overeating did not differ on poor emotional clarity, whereas women with OBEs and women with LOC did not differ on non-acceptance of emotions. The combination of overeating and LOC eating is associated with the greatest emotion dysregulation, but certain emotion regulation facets may differentially relate to overeating and LOC. Identifying emotion-related treatment targets for core eating disorder symptoms is important.

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.