Affect Dysregulation in Context: Implications and Future Directions of Experience Sampling Research on Affect Regulation Models of Loss of Control Eating

Abstract

Loss of control eating is a core, transdiagnostic eating disorder symptom associated with psychological distress, functional impairment, and reduced quality of life. However, the factors that contribute to persistent loss of control eating despite negative consequences are not fully understood. Understanding the mechanisms that maintain loss of control eating is crucial to advance treatments that interrupt these processes. Affect regulation models of loss of control eating hypothesize that negative emotions trigger loss of control eating, and that loss of control eating is negatively reinforced because it temporarily decreases negative affect. Several variations on this basic affect regulation model have been proposed, including theories suggesting that negative affect decreases during loss of control eating rather than afterwards (escape theory), and that loss of control eating replaces one negative emotion with another that is less aversive (trade-off theory). Experience sampling designs that measure negative affect and eating behavior multiple times per day are optimally suited to examining the nuanced predictions of these affect regulation models in people's everyday lives. This paper critically reviews experience sampling studies examining associations between negative affect and loss of control eating, and discusses the implications for different affect regulation models of loss of control eating. The review concludes by proposing an expanded affect-focused model of loss of control eating that incorporates trait-level individual differences and momentary biological and environmental variables to guide future research. Clinical implications and recommendations are discussed.

A daily diary study of emotion regulation as a moderator of negative affect‐binge eating associations

“…While NA is an established risk factor for dysregulated eating (Haedt‐Matt & Keel, 2011; Mikhail, 2021), less is known about factors that may buffer against the impact of NA. Negative emotions are not always avoidable, and it is important to identify resiliency factors that may prevent dysregulated eating even when NA is high.…”

“…Indeed, emotional eating (EE), or eating in response to NA, is a strong correlate and predictor of clinical binge eating (BE) (Ricca et al, 2009(Ricca et al, , 2012Stice et al, 2002). Associations between NA and dysregulated eating are observed not only at the between-person level, but also in within-person studies that track changes in NA and BE/EE over time (Haedt-Matt & Keel, 2011;Mikhail, 2021). In other words, not only are people with higher average NA more likely to experience BE/EE, but day-to-day or hour-tohour changes in NA may also amplify the risk for BE/EE.…”

Heart Rate Variability and Laboratory-Based Loss-of-Control Eating in Children and Adolescents

“…Although past studies have observed a maladaptive stress response in adolescents with frequent LOC-eating prior to an episode of LOC-eating [ 27 , 28 ], our findings appear indicative of a healthful pre-meal stress response among youth with infrequent recent LOC-eating. This pattern of pre-meal stress responses may help to explain why prior studies have failed to detect a link among self-reported pre-meal negative affective states and LOC-eating in youth [ 6 , 11 , 12 , 13 , 54 ], despite consistent evidence for this relationship in adults with eating disorders [ 55 , 56 , 57 ]. Additionally, our findings are consistent with affective models of LOC-eating that are predicated on the notion that eating is used as a method to manage stressful circumstances, e.g., [ 8 , 9 , 10 ], thus potentially rendering a healthy stress response at early stages of disordered eating onset.…”

Practical Considerations for Using the Eating Disorder Examination Interview with Adolescents

“…Additional limitations include the lack of specific consideration for certain factors that could influence ratings (eg, food insecurity); lack of items assessing muscularity-oriented behaviors and attitudes (of particular relevance for boys) and ARFID diagnostic criteria; and potentially variable psychometric performance of the measure across various subgroups of youth. Notably, numerous other measures/modalities are available for assessing ED symptomatology (eg, other interviews, 220–223 self-report questionnaires, 221 , 224 , 225 ecological momentary assessment protocols 226–228 ). As such, it is vital to consider the benefits and limitations of the various options in the context of one’s clinical or research aims, as well as in relation to the sociodemographic characteristics and identities of the person or persons who will be assessed.…”