The role of habit in maintaining binge/purge behaviors: An ecological momentary assessment study

Abstract

ObjectiveIndividuals with eating disorders transdiagnostically engage in binge eating (BE) and/or purging, despite life‐threatening consequences. Little is known about factors that contribute to the persistence of these behaviors. This study explored whether habitual control over binge/purge (B/P) spectrum behaviors contributes to symptom persistence and whether negative reinforcement via reductions in negative affect is less influential in maintaining B/P behaviors that are under habitual control and are persistent.MethodWomen with BE and/or purging (N = 81) completed self‐report measures assessing habit strength of BE and purging. Then, they completed a 14‐day ecological momentary assessment (EMA) protocol during which they completed measures of negative affect, BE, and purging multiple times per day.ResultsHabitual control over purging was associated with a greater frequency of purging during the EMA period. However, habitual control over BE was not associated with the severity of loss of control eating or the frequency of BE episodes. Habitual control did not moderate temporal relations between negative affect and B/P behaviors during the EMA period. However, exploratory analyses revealed that individuals with a longer duration of BE and greater habitual control over BE showed a less pronounced reduction in negative affect following BE.DiscussionOverall, these findings suggest that purging may be maintained by habitual stimulus–response learning. In addition, they support the possibility that reduction in negative affect may play a less prominent role in maintaining BE that is habitual and persistent.Public significanceThis study investigated whether habit contributes to the persistence of symptoms in women with binge/purge spectrum behaviors and whether negative reinforcement via reductions in negative affect is less influential in maintaining binge/purge behaviors that are under habitual control. The findings suggest that purging may be maintained through habit. This supports the potential utility of habit reversal interventions to decrease habitual purging.

A transdiagnostic and translational framework for delineating the neuronal mechanisms of compulsive exercise in anorexia nervosa

“…With respect to feeding, individuals with AN report food restriction as a habit that they "do without thinking" (Coniglio et al, 2017;Davis et al, 2020) and binge-eating and purging may both be acts that form a cycle of repetitive and rigid behaviors (Dougherty et al, 2023). Notably, increased reliance on habitual processes in AN is not only shown in feeding-related symptoms, but also demonstrated across other modalities like excessive handwashing (Gupta et al, 1987), suggesting patients with AN broadly tend to rely on habitual control over their behavior, which may lead to compulsive tendencies (Seidel et al, 2022).…”