A naturalistic examination of the temporal patterns of affect and eating disorder behaviors in anorexia nervosa

Abstract

Objective Evidence supports the presence of significant variability in the timing of affective experiences and eating disorder (ED) behaviors across ED populations. This study examined the naturalistic timing of affective states and ED behaviors in anorexia nervosa (AN). Methods Women (N = 118) with full or subthreshold DSM-IV AN completed two weeks of ecological momentary assessment (EMA) involving self-reports of affect and ED behaviors. Patterns of positive affect, negative affect, and tension/anxiety across hours of the day and days of the week were examined using linear mixed models. Variation in ED behavior occurrence (i.e., binge eating, vomiting, exercise, meal skipping, and self-weighing) across hours of the day and days of the week was examined using general estimating equations. Results Results revealed significant variation in tension/anxiety across hours of the day; there were no significant associations between time of day and negative or positive affect. All affective variables significantly varied across days of the week, with both negative affect and tension/anxiety highest in the middle of the week and lowest on the weekends. The ED behaviors all significantly varied across hours of the day, with binge eating and vomiting most common in later hours, exercise and self-weighing most common in earlier hours, and meal skipping most common at times corresponding to breakfast and lunch. ED behaviors did not significantly vary across days of the week. Conclusion The significant patterns of variation in the timing of affective experiences and ED behaviors may have utility in informing theories and interventions for AN.

Diet and behavioral habits related to oral health in eating disorder patients: a matched case-control study

“…Meal skipping is common in ED patients and has previously been reported on [24,25]. In this study, number of daily or weekly meals did not differ significantly between ED-good condition and controls.…”

Negative affect and binge eating: Reconciling differences between two analytic approaches in ecological momentary assessment research

“…It should be noted that the datasets used for study 1‐AN and study 2‐BN have been utilized in several other studies. For example, the AN dataset has been used in a variety of papers examining specific aspects of the emotion‐behavior relationship in AN (Engel et al, ; Haynos, Berg, & Cao, ; Lavender, Utzinger, and Crosby, ). Similarly, the BN data set has been utilized in several studies, which again have examined emotion‐behavior patterns (e.g., Berg et al, ; Crosby et al, ; Smyth et al, ).…”

Momentary emotion identification in female adolescents with and without anorexia nervosa

“…Most notably, the sample size is small compared to other EMA studies on eating disorders (Engel et al, 2016, 2013; Lavender et al, 2016). However, sufficient measurements were recorded to carry out LMM analysis, but the results need to be considered as exploratory.…”

“…Variations in time of tension and anxiety, which are suspected to correlate with emotion identification on a trait level (Eizaguirre et al, 2004; Gilboa-Schechtman et al, 2006), have been observed in individuals with AN (Lavender et al, 2016). A study on emotion identification in borderline personality disorder (BPD) identified a strong association of current levels of aversive tension and the ability to label specific emotions (Wolff et al, 2007).…”