The current study examines the relationship of affect and eating disorder behavior in anorexia nervosa (AN) using ecological momentary assessment. Participants were 118 adult females recruited at three sites from eating disorder treatment centers and community advertisements. All participants met full DSM-IV criteria or sub-threshold criteria for AN. Participants were provided handheld computers and asked to report positive affect, negative affect, loss of control (LOC) eating, purging, exercise, drinking fluids to curb appetite, and weighing one's self multiple times per day as well as dietary restriction once daily over a two-week interval. Mixed-effects models were used to examine the extent to which affective states predict dietary restriction. Additionally, we used two analytic approaches to compare affect prior to and after other eating disorder behaviors. We found that higher daily ratings of negative affect were associated with a greater likelihood of dietary restriction on subsequent days. When examining the single rating immediately before and after behaviors, we found that negative affect increased significantly following LOC eating, purging, the combination of LOC and eating/purging, and weighing of one's self. Using this same analytic approach we also found negative affect to decrease significantly following the consumption of fluids to curb appetite and exercise. When examining the covariation of AN behaviors and negative affect assessed multiple times in the hours and minutes before the behaviors, we found negative affect significantly increased prior to LOC eating, purging, the combination of LOC eating/and purging, and weighing behavior. Negative affect also significantly decreased following the occurrence of these behaviors. These findings are consistent with the idea that that negative affect is potentially a critical maintenance mechanism of some AN symptoms, but that the analytic approach used to examine affect and behavior may have significant implications on the interpretation of findings.
CBT for BN delivered via telemedicine was both acceptable to participants and roughly equivalent in outcome to therapy delivered in person.
Bulimia nervosa and non-suicidal self-injury (NSSI) co-occur at high rates, and both have been conceptualized as maladaptive emotion regulation strategies. Treatments focusing on emotion regulation have been designed for both problem behaviors, yet, there exists very little research examining the temporal emotional states surrounding acts of NSSI. Using ecological momentary assessment (EMA) methodology, the current study examined the temporal association between positive and negative emotional states prior to and consequent to acts of NSSI within a subset of bulimia nervosa patients. Results indicate significant increases in negative affect, and decreases in positive affect, prior to an NSSI act. Post-NSSI, positive affect significantly increased while negative affect remained unchanged. The findings offer partial support for an emotion regulation paradigm to understanding NSSI within bulimic populations and implications for treatment are discussed. Keywordsnon-suicidal self-injury; emotion regulation; EMA; deliberate self-harm; bulimia; eating disorder Non-suicidal self-injury (NSSI; the deliberate damage of one's body tissue without suicidal intent, Muehlenkamp, 2005) is a troubling behavior that many clinicians are encountering, yet struggle to understand (White-Kress, 2003;Zila & Kiselica, 2001). Prevalence rates among non-clinical samples of adolescents and young adults range from 4% (Klonsky & Muehlenkamp, 2007) to 38% (Whitlock, Eckenrode, & Silverman, 2006;Lloyd-Richardson et al 2007), whereas prevalence rates among inpatient adolescents have been reported at 30 to 68% (Makikyro et al., 2004;Nixon, Cloutier, & Aggarwal, 2002). Of particular interest are findings that rates of NSSI tend to be quite high among a subset of persons with select psychiatric disorders including borderline personality disorder (Zanarini, Frankenburg, Ridolfi, & Jager-Hyman, 2006), and eating disorders; especially bulimia nervosa (BN; Anderson, Carter, & McIntosh, 2002;Claes, Vandereycken, & Vertommen, 2001;Favaro & Santonastaso, 1999;Wonderlich, Myers, Norton, & Crosby, 2002).Correspondence regarding this article should be addressed to: Jennifer J Muehlenkamp, PhD, Department of Psychology, 319 Harvard St stop 8380, University of North Dakota, Grand Forks, ND 58202; E-mail: jennifer.muehlenkamp@und.edu; Phone: 701-777-4496, Fax: 701-777-3454. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptBehav Res Ther. Author manuscript; available in PMC 2010 January 1. & Telch, 1998; Kjelsas, Borsting, & Gudde, 2004;Smyth, Wonderlich, & Heron, 2007;Telch & ...
Objective-Negative affect has been purported to play an important role in the etiology and maintenance of bulimic behaviors. The objective of this study was to identify daily mood patterns in the natural environment exhibited by individuals with bulimia nervosa and to examine the relationship between these patterns and bulimic behaviors.Method-One hundred thirty-three women aged 18-55 meeting DSM-IV criteria for bulimia nervosa were recruited through clinical referrals and community advertisements. Ecological momentary assessment was used to collect multiple ratings of negative affect, binge eating and purging each day for a two-week period using palmtop computers. Latent growth mixture modeling was used to identify daily mood patterns.Results-Nine distinct daily mood patterns were identified. The highest rates of binge eating and purging episodes occurred on days characterized by stable high negative affect or increasing negative affect over the course of the day.Conclusions-These findings support the conclusion that negative mood states are intimately tied to bulimic behaviors and may in fact precipitate such behavior. Keywords bulimia nervosa; ecological momentary assessment; latent growth mixture model A number of sources of information converge to suggest that negative affect is an antecedent to binge eating and purging. Several theoretical models contend that negative affect plays an important role in the etiology and maintenance of bulimic behaviors. Heatherton and Baumeister (1991) proposed that binge eating serves as a mechanism to "escape from selfawareness," thereby allowing an individual with bulimia nervosa (BN) to reduce the subjective experience of negative affect. Masking theory (Polivy & Herman, 1999) contends that BN patients avoid dealing with the actual source of their negative affect by engaging in binge eating, which provides a more acceptable source to which they can attribute negative affect.Corresponding Author: Ross D. Crosby, Ph.D., Director of Biomedical Statistics, Neuropsychiatric Research Institute, 120 Eighth St. South, Box 1415, Fargo, ND 58107. Tel: (701) Fax: (701) 293-3226, E-mail: rcrosby@nrifargo.com. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptBehav Res Ther. Author manuscript; available in PMC 2010 March 1. Regardless of the specific model to which one adheres, increasing empirical evidence suggests that negative affect plays a role in the etiology and maintenance of eating disorders. For example, there is neurobiological support for the notion that patients with anorexia nervosa (...
Paralleling the increasing use of bariatric surgery is an increasing desire for body contouring surgery. Most patients desire body contouring surgery after bariatric surgery. However, third party payors usually do not reimburse for such procedures.
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