Temporal associations between affective instability and dysregulated eating behavior in bulimia nervosa

Abstract

Prior research suggests that the construct of emotional instability may be salient to bulimia nervosa (BN), but no study to date has used ecological momentary assessment (EMA) to examine its temporal association with binge eating and purging. In the current study, 133 women with DSM-IV BN used portable digital devices to provide multiple daily negative affect (NA) and positive affect (PA) ratings and record eating disorder behaviors over 2 weeks. Two state-of-the art indices quantified affective instability: probability of acute change (PAC), which represents the likelihood of extreme affective increases, and mean squared successive difference (MSSD), which represents average change over successive recordings. For extreme affective change, results revealed that on bulimic behavior days, extreme NA increases were less likely after bulimic behaviors than before them, and extreme increases in PA were more likely after bulimic behaviors than during the same time period on non-bulimic behavior days. However, average NA instability (i.e., MSSD) was (a) greater on bulimic behavior days than non-bulimic behavior days, (b) greater after bulimic behaviors than during the same time period on non-bulimic behavior days, and (c) greater after bulimic behaviors than before them. Results lend support to the notion that bulimic behaviors are negatively reinforcing (i.e., via post-behavior acute affective changes), but also indicate that these behaviors may exacerbate overall affective dysregulation. These findings may improve understanding of BN maintenance and inform the development of novel interventions or refinement of existing treatments.

Delay Discounting of Reward and Impulsivity in Eating Disorders: From Anorexia Nervosa to Binge Eating Disorder

“…This is in line with other research that found that urgency, especially negative urgency, was associated with bingeing and purging behaviours, as well as subjective loss of control of food intake (Claes et al ., , Claes et al ., ; Fischer et al ., ; Racine et al ., ; Wolz et al ., ). Being that neuroimaging evidence has suggested that negative affect increases the rewarding value of food (Bohon & Stice, ) and that emotion dysregulation is associated with excess weight (Steward et al ., ), our results lend support to the notion that bingeing behaviours could mainly be negatively reinforcing (Berner et al ., ). Other researchers have found the tendency to act rashly when experiencing strong emotions (i.e.…”

Associations between physical activity and eating‐disorder psychopathology among individuals categorised with binge‐eating disorder and bulimia nervosa

“…Non‐compensatory PA may target certain psychopathology associated with BED and BN. For example, affective distress and dysregulation, body dissatisfaction, food cravings, and impulsivity are often associated with BED and BN. PA can improve affect immediately and reduce affective reactivity to stressors .…”

Associations of food addiction and nonsuicidal self‐injury among women with an eating disorder: A common strategy for regulating emotions?

“…Furthermore, FA has been associated with higher negative affect, lower self-esteem, and higher emotion dysregulation among individuals with an ED (Gearhardt et al, 2012;Pisetsky, Haynos, Lavender, Crow, & Peterson, 2017;Wolz, Granero, & Fernández-Aranda, 2017). Likewise, affective instability has been linked to dysregulated eating behaviours (i.e., bingeing and purging episodes) in women with BN (Berner et al, 2017;Wolz et al, 2016). FA has also been associated with impairments in executive functioning, namely, impulsivity: Individuals with FA in a sample of individuals with an ED diagnosis scored higher on measures of negative urgency and lack of perseverance, indicating impulsive characteristics within this ED population with FA (Granero et al, 2018;Pivarunas & Conner, 2015;Wolz et al, 2016).…”