Negative affect, interpersonal perception, and binge eating behavior: An experience sampling study

Social support and overeating in young women: The role of altering functional network connectivity patterns and negative emotions

Research suggests that social support has a protective effect on emotional health and emotionally induced overeating. Women are especially more sensitive to benefits from social support when facing eating problems. Although it has been demonstrated that social support can affect the neural processes of emotion regulation and reward perception, it is unclear how social support alters synergistic patterns in large-scale brain networks associated with negative emotions and overeating. We used a large sample of young women aged 17-22 years (N = 360) to examine how social support influences the synchrony of five intrinsic networks (executive control network [ECN], default mode network, salience network [SN], basal ganglia network, and precuneus network [PN]) and how these networks influence negative affect and overeating. Additionally, we explored these analyses in another sample of males (N = 136). After statistically controlling for differences in age and head movement, we observed significant associations of higher levels of social support with increased intra- and inter-network functional synchrony, particularly for ECN-centered network connectivity. Subsequent chain-mediated analyses showed that social support predicted overeating through the ECN-SN and ECN-PN network connectivity and negative emotions. However, these results were not found in men. These findings suggest that social support influences the synergistic patterns within and between intrinsic networks related to inhibitory control, emotion salience, self-referential thinking, and reward sensitivity. Furthermore, they reveal that social support and its neural markers may play a key role in young women's emotional health and eating behavior.

Binge-eating adolescent treatment (BEAT) - findings from a pilot study on effects and acceptance of a blended treatment program for youth with loss of control eating

BACKGROUND

Loss of Control Eating (LOC) is the most prevalent form of eating disorder pathology in youth, but research on evidence-based treatment in this group remains scarce. We assessed for the first time the effects and acceptance of a blended treatment program for youth between 14 and 24 years with LOC (Binge-eating Adolescent Treatment, BEAT).

METHODS

Twenty-four youths (mean age 19.1 years) participated in an active treatment of nine-weeks including three face-to-face workshops and six weekly email-guided self-help sessions, followed by four email guided follow-up sessions, one, three, six and 12 months after the active treatment. All patients completed a two-weeks waiting-time period before treatment begin (within-subject waitlist control design).

RESULTS

The number of weekly LOC episodes substantially decreased during both the waiting-time (effect size d = 0.45) and the active treatment (d = 1.01) period and remained stable during the subsequent 12-months follow-up (d = 0.20). The proportion of patients with full-threshold binge-eating disorder (BED) diagnoses decreased and transformed into LOC during the study course, while the abstainer rate of LOC increased. Values for depressive symptoms (d = 1.5), eating disorder pathology (d = 1.29) and appearance-based rejection sensitivity (d = 0.68) all improved on average from pretreatment to posttreatment and remained stable or further improved during follow-up (d between 0.11 and 0.85). Body weight in contrast remained constant within the same period. Treatment satisfaction among completers was high, but so was the dropout rate of 45.8% at the end of the 12-months follow-up.

CONCLUSIONS

This first blended treatment study BEAT might be well suited to decrease core symptoms of LOC, depressive symptoms and appearance-based rejection sensitivity. More research is needed to establish readily accessible interventions targeted more profoundly at age-salient maintaining factors such as appearance-based rejection sensitivity, while at the same time keeping dropout rates at a low level.

TRIAL REGISTRATION

The trial was registered at the German Clinical Trials Register (ID: DRKS00014580; registration date: 21/06/2018).

The influence of stress on the neural underpinnings of disinhibited eating: a systematic review and future directions for research

Disinhibited eating involves overconsumption and loss of control over food intake, and underpins many health conditions, including obesity and binge-eating related disorders. Stress has been implicated in the development and maintenance of disinhibited eating behaviours, but the mechanisms underlying this relationship are unclear. In this systematic review, we examined how the impact of stress on the neurobiological substrates of food-related reward sensitivity, interoception and cognitive control explains its role in disinhibited eating behaviours. We synthesised the findings of functional magnetic resonance imaging studies including acute and/or chronic stress exposures in participants with disinhibited eating. A systematic search of existing literature conducted in alignment with the PRISMA guidelines identified seven studies investigating neural impacts of stress in people with disinhibited eating. Five studies used food-cue reactivity tasks, one study used a social evaluation task, and one used an instrumental learning task to probe reward, interoception and control circuitry. Acute stress was associated with deactivation of regions in the prefrontal cortex implicated in cognitive control and the hippocampus. However, there were mixed findings regarding differences in reward-related circuitry. In the study using a social task, acute stress associated with deactivation of prefrontal cognitive control regions in response to negative social evaluation. In contrast, chronic stress was associated with both deactivation of reward and prefrontal regions when viewing palatable food-cues. Given the small number of identified publications and notable heterogeneity in study designs, we propose several recommendations to strengthen future research in this emerging field.

Tonight, I'm disordered eating: The effects of food delivery app use, loneliness, and mood on daily body dissatisfaction and disordered eating urges

With the recent proliferation of food delivery applications ('apps'; FDAs), accessing a meal is more convenient and immediate than ever. However, these apps may foster dysregulated eating behaviours, including maladaptive eating to cope with negative emotional states. Using ecological momentary assessment (EMA), the current study assessed whether FDA use at baseline predicted levels of EMA-assessed disordered eating urges and body dissatisfaction, whether negative mood and loneliness impacted disordered eating urges and body dissatisfaction at the state level, and whether the latter relationships were moderated by FDA usage frequency. Participants (N = 483; 78.7% women; 20.1% men; 1.2% other) completed a baseline questionnaire and were characterised as current FDA users (49.3%) or non-users (50.7%). Participants then completed a smartphone-facilitated investigation into their experiences of loneliness, negative mood, body dissatisfaction, and disordered eating urges, six times per day for 7-days. Across the entire sample, current FDA users at baseline reported greater EMA-assessed urges to overeat. At the state level, loneliness and negative mood predicted greater body dissatisfaction, with the latter also predicting greater urges for restrictive eating and overeating. Among current FDA users at baseline, at the state level, loneliness predicted greater body dissatisfaction, and negative mood predicted greater body dissatisfaction and urges for overeating. No moderating effects were observed for baseline FDA usage frequency. These results elucidate FDA use and daily experiences of loneliness and negative mood as factors elevating eating disorder (ED)-related risk. Further extensions of this research with nuanced measures of state FDA use are required.

Examining predictors of binge eating behaviors among racially and ethnically diverse college men

Objective: College men may be at risk for binge eating (BE) but are underrepresented in research. This study aimed to examine if body weight/shape concerns, perceived stress, and psychological distress significantly contributed to the likelihood of BE over the past 28 days. Participants: A racially/ethnically diverse sample (N = 873) of college men. Method: An anonymous online survey was administered. Logistic regression analysis was conducted to examine the hypothesized associations for the entire sample, and exploratory analyses were conducted within each racial/ethnic group. Results: The model explained approximately 25% of the variance in BE, with body weight/shape concerns as the only significant predictor in the overall sample and for the White, Black, and Asian subsamples; none of the variables were significant among Latino men. Conclusions: Body weight/shape concerns predict BE among diverse college men. The findings have implications for future research, as well as for prevention and intervention for college men.

Binge Eating Disorder Is a Social Justice Issue: A Cross-Sectional Mixed-Methods Study of Binge Eating Disorder Experts' Opinions

BACKGROUND

Binge eating disorder is an autonomous DSM-V diagnosis characterized by discrete rapid consumption of objectively large amounts of food without compensation, associated with loss of control and distress. Environmental factors that contribute to binge eating disorder continue to evolve. This mixed-methods cross-sectional study assessed whether there is consensus among experts in the field about environmental factors that influence adult binge eating disorder pathology.

METHODS

Fourteen expert binge eating disorder researchers, clinicians, and healthcare administrators were identified internationally based on federal funding, PubMed-indexed publications, active practice in the field, leadership in relevant societies, and/or clinical and popular press distinction. Semi-structured interviews were recorded anonymously and analyzed by ≥2 investigators using reflexive thematic analysis and quantification.

RESULTS

Identified themes included: (1) systemic issues and systems of oppression (100%); (2) marginalized and under-represented populations (100%); (3) economic precarity and food/nutrition insecurity/scarcity (93%); (4) stigmatization and its psychological impacts (93%); (5) trauma and adversity (79%); (6) interpersonal factors (64%); (7) social messaging and social media (50%); (8) predatory food industry practices (29%); and (9) research/clinical gaps and directives (100%).

CONCLUSIONS

Overall, experts call for policy changes around systemic factors that abet binge eating and for greater public education about who can have binge eating disorder. There is also a call to take and account for the narratives and life experiences of individuals with binge eating disorder to better inform our current understanding of the diagnosis and the environmental factors that impact it.

Detecting Mental Health Behaviors Using Mobile Interactions: Exploratory Study Focusing on Binge Eating

BACKGROUND

Binge eating is a subjective loss of control while eating, which leads to the consumption of large amounts of food. It can cause significant emotional distress and is often accompanied by purging behaviors (eg, meal skipping, overexercising, or vomiting).

OBJECTIVE

The aim of this study was to explore the potential of mobile sensing to detect indicators of binge-eating episodes, with a view toward informing the design of future context-aware mobile interventions.

METHODS

This study was conducted in 2 stages. The first involved the development of the DeMMI (Detecting Mental health behaviors using Mobile Interactions) app. As part of this, we conducted a consultation session to explore whether the types of sensor data we were proposing to capture were useful and appropriate, as well as to gather feedback on some specific app features relating to self-reporting. The second stage involved conducting a 6-week period of data collection with 10 participants experiencing binge eating (logging both their mood and episodes of binge eating) and 10 comparison participants (logging only mood). An optional interview was conducted after the study, which discussed their experience using the app, and 8 participants (n=3, 38% binge eating and n=5, 63% comparisons) consented.

RESULTS

The findings showed unique differences in the types of sensor data that were triangulated with the individuals' episodes (with nearby Bluetooth devices, screen and app use features, mobility features, and mood scores showing relevance). Participants had a largely positive opinion about the app, its unobtrusive role, and its ease of use. Interacting with the app increased participants' awareness of and reflection on their mood and phone usage patterns. Moreover, they expressed no privacy concerns as these were alleviated by the study information sheet.

CONCLUSIONS

This study contributes a series of recommendations for future studies wishing to scale our approach and for the design of bespoke mobile interventions to support this population.

Correlates of interpersonal emotion regulation problems in Loss of Control eating (LOC) in youth: study protocol of the combined online and App based questionnaire, laboratory and randomized controlled online intervention i-BEAT trial

BACKGROUND

Binge Eating Disorder (BED) represents a common eating disorder associated with marked health impairments. A subclinical variant, loss of control eating (LOC) is prevalent in youth. LOC is associated with similar mental distress as full-blown BED, increases the risk to develop a BED and promotes continuous weight gain. The etiology of LOC is not yet fully understood and specialized treatment for youth is scarce.

METHODS

The i-BEAT study includes a cross-sectional and longitudinal online questionnaire study (N = 600), an App based daily-life approach and a laboratory virtual reality study in N = 60 youths (14-24 years) with and without LOC as well as a controlled randomized online treatment trial to investigate the feasibility, acceptance and efficacy of a CBT and an interpersonal emotion regulation module for youth (N = 120). The primary outcomes include self-reported as well as measured (heart rate variability, gaze behavior, reaction times in stop signal task) associations between emotion regulation problems (such as dealing with RS), psychological impairment and binge eating in a healthy control group and youth with LOC. Secondary outcomes encompass general eating disorder pathology, social anxiety, body mass index, hyperscanning behavior and therapists' rating of patients' condition pre and post treatment. Epigenetic correlates of RS are assessed in healthy controls and youth with LOC and explored before and after treatment.

DISCUSSION

The expected findings will specify the role of interpersonal emotion regulation problems such as coping with the experience of social exclusion and rejection sensitivity (RS) in LOC and clarify, whether including a training to cope with RS adds to the efficacy of a cognitive behavioral treatment (CBT).

TRIAL REGISTRATION

German Clinical Trial Register: DRKS00023706. Registered 27 November 2020, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023706.

A new integrative model for the co-occurrence of non-suicidal self-injury behaviours and eating disorder symptoms

OBJECTIVE

The high co-occurrence of non-suicidal self-injury (NSSI) behaviours and eating disorder (ED) symptoms suggests these conditions share common aetiological processes. We assessed a new integrative model of shared factors for NSSI and ED symptoms, where affect dysregulation, impulsivity, self-esteem, and body dissatisfaction mediated the relationship between insecure attachment and maladaptive schemas and NSSI and ED symptoms. A further aim of the study was to assess whether the model behaved similarly across a clinical eating disorder (ED) and a community sample.

METHOD

123 females with a lifetime ED diagnosis and 531 female individuals from the community completed an online survey, which included measures assessing the variables of interest. A cross-sectional single time point analysis was used.

RESULTS

Invariance testing indicated that the model was structurally non-invariant (different across groups). The proposed integrative model was a good fit for the ED group, but for the community sample only a revised model reached an acceptable fit. Both attachment and maladaptive schemas, included early in the model, were implicated in the pathways leading to ED and NSSI symptoms in the ED and community groups. In the community group, impulsivity, a mediator, was a shared predictor for NSSI and bulimic symptoms. No other mediating variables were shared by NSSI and ED symptoms in the two groups. Overall, the proposed model explained slightly more variance for the ED group relative to the community group in drive for thinness (R² = .57 vs .51) and NSSI (R² = .29 vs .24) but less variance in bulimic symptoms (R² = .33 vs .39).

CONCLUSION

We conclude that the current model provides only limited support for explaining the comorbidity between NSSI and ED symptoms. It is vital to consider both common (e.g., attachment and maladaptive schemas) and specific factors (e.g., impulsivity) to better understand the pathways that lead to the co-occurrence of NSSI and ED symptoms. A new integrative model assessed whether emotion dysregulation, impulsivity, self-esteem, and body dissatisfaction were mediators in the relationship between insecure attachment and maladaptive beliefs about the world and the self and subsequent eating disorder and self-harm symptoms. A further aim was to assess whether the proposed model differed between a clinical eating disorder and a community sample. All participants were female and included 123 patients with a lifetime eating disorder and 531 individuals from the community. Participating individuals completed an online survey at one timepoint, which included measures assessing the variables of interest. The findings of the current study indicated that the proposed model was a good match for the clinical eating disorder sample, but for the community sample only a revised model yielded acceptable statistical fit. Both insecure attachment and maladaptive beliefs about the world and the self, included early in the model, were indirectly related to eating disorder and self-harm symptoms for both the eating disorder and the community groups. Impulsivity, a mediator, was the only shared predictor for self-harm, and bulimic symptoms in the community group. We conclude that the current model provides only limited support for explaining the comorbidity between self-harming behaviours and disordered eating symptoms.

Association patterns of cannabis abuse and dependence with risk of problematic non-substance-related dysregulated and addictive behaviors

Co-occurrence of drug misuse with other dysregulated behaviors is common. This study was aimed at exploring the associations between the risk of presenting a clinically relevant condition involving non-substance-related addictive or dysregulated behaviors (as measured by the MultiCAGE CAD-4 screening), and cannabis abuse/dependence (CAST/SDS) scores, and the role of gender therein. Participants were recruited using stratified probabilistic sampling at the University of Granada. Mann-Whitney’s U tests were used to compare male and female students in SDS and CAST scores. Associations between gender and MultiCAGE scores were estimated using the γ ordinal correlation index, and tested with χ². For each MultiCAGE dimension, a Poisson-family mixed-effects model was built with either SDS or CAST as the main input variable, while controlling for nicotine and alcohol dependence, and relevant sociodemographic variables. Incidence rate ratios (IRR) were computed for SDS/CAST effects, and the significance threshold was family-wise Bonferroni-corrected. Gender differences were significant for cannabis dependence/abuse and all MultiCAGE scores for non-substance-related conditions, with males showing higher risk scores for excessive gambling, excessive internet use, excessive video gaming, and hypersexuality, and females presenting higher scores in dysregulated eating and compulsive buying. Cannabis dependence and abuse were significantly associated with a higher risk of problematic video gaming. These associations were mostly driven by males. Importantly, although risk of problematic video gaming was specifically associated with cannabis abuse/dependence, there was only a weak non-significant association between problematic video gaming and alcohol use scores. Risk of alcohol use problems, in turn, was strongly associated with all other non-substance-related problems (problematic gambling, excessive Internet use, dysregulated eating, compulsive buying, and hypersexuality). These differential associations can cast light on the etiological similarities and dissimilarities between problematic substance use and putative addictive behaviors not involving drugs.

How COVID-19 lockdown measures could impact patients with bulimia nervosa: Exploratory results from an ongoing experience sampling method study

OBJECTIVE

The impact of COVID-19 lockdown measures on patients with an eating disorder remains unclear, but preliminary results indicate that some patients could be more vulnerable to experience an increase in eating disorder pathology than others. To provide possible directions for future research, this report explored the impact of the Belgian COVID-19 lockdown measures on patients with bulimia nervosa (BN).

METHODS

The data of 15 female patients with BN from an ongoing experience sampling method study were analyzed. Mixed effects models compared surroundings, social context, negative affect (NA), positive affect (PA) and binge eating before and after the implementation of the lockdown measures.

RESULTS

After the implementation of the lockdown measures, significant changes in surroundings and social context were found as well as an increase in NA and decrease in PA. Patients who experienced a higher binge eating frequency during the lockdown also experienced a stronger change in NA and PA.

CONCLUSIONS

Future research should also look at changes in surroundings, social context, affect and how these interact with factors such as personality traits and coping styles when investigating why some patients are more susceptible to the negative effects of lockdown measures than others.

Compliance With Mobile Ecological Momentary Assessment of Self-Reported Health-Related Behaviors and Psychological Constructs in Adults: Systematic Review and Meta-analysis

Background

Mobile ecological momentary assessment (mEMA) permits real-time capture of self-reported participant behaviors and perceptual experiences. Reporting of mEMA protocols and compliance has been identified as problematic within systematic reviews of children, youth, and specific clinical populations of adults.

Objective

This study aimed to describe the use of mEMA for self-reported behaviors and psychological constructs, mEMA protocol and compliance reporting, and associations between key components of mEMA protocols and compliance in studies of nonclinical and clinical samples of adults.

Methods

In total, 9 electronic databases were searched (2006-2016) for observational studies reporting compliance to mEMA for health-related data from adults (>18 years) in nonclinical and clinical settings. Screening and data extraction were undertaken by independent reviewers, with discrepancies resolved by consensus. Narrative synthesis described participants, mEMA target, protocol, and compliance. Random effects meta-analysis explored factors associated with cohort compliance (monitoring duration, daily prompt frequency or schedule, device type, training, incentives, and burden score). Random effects analysis of variance (P≤.05) assessed differences between nonclinical and clinical data sets.

Results

Of the 168 eligible studies, 97/105 (57.7%) reported compliance in unique data sets (nonclinical=64/105 [61%], clinical=41/105 [39%]). The most common self-reported mEMA target was affect (primary target: 31/105, 29.5% data sets; secondary target: 50/105, 47.6% data sets). The median duration of the mEMA protocol was 7 days (nonclinical=7, clinical=12). Most protocols used a single time-based (random or interval) prompt type (69/105, 65.7%); median prompt frequency was 5 per day. The median number of items per prompt was similar for nonclinical (8) and clinical data sets (10). More than half of the data sets reported mEMA training (84/105, 80%) and provision of participant incentives (66/105, 62.9%). Less than half of the data sets reported number of prompts delivered (22/105, 21%), answered (43/105, 41%), criterion for valid mEMA data (37/105, 35.2%), or response latency (38/105, 36.2%). Meta-analysis (nonclinical=41, clinical=27) estimated an overall compliance of 81.9% (95% CI 79.1-84.4), with no significant difference between nonclinical and clinical data sets or estimates before or after data exclusions. Compliance was associated with prompts per day and items per prompt for nonclinical data sets. Although widespread heterogeneity existed across analysis (I²>90%), no compelling relationship was identified between key features of mEMA protocols representing burden and mEMA compliance.

Conclusions

In this 10-year sample of studies using the mEMA of self-reported health-related behaviors and psychological constructs in adult nonclinical and clinical populations, mEMA was applied across contexts and health conditions and to collect a range of health-related data. There was inconsistent reporting of compliance and key features within protocols, which limited the ability to confidently identify components of mEMA schedules likely to have a specific impact on compliance.

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

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.

Emotional eating in healthy individuals and patients with an eating disorder: evidence from psychometric, experimental and naturalistic studies

Emotional eating has traditionally been defined as (over)eating in response to negative emotions. Such overeating can impact general health because of excess energy intake and mental health, due to the risks of developing binge eating. Yet, there is still significant controversy on the validity of the emotional eating concept and several theories compete in explaining its mechanisms. The present paper examines the emotional eating construct by reviewing and integrating recent evidence from psychometric, experimental and naturalistic research. Several psychometric questionnaires are available and some suggest that emotions differ fundamentally in how they affect eating (i.e. overeating, undereating). However, the general validity of such questionnaires in predicting actual food intake in experimental studies is questioned and other eating styles such as restrained eating seem to be better predictors of increased food intake under negative emotions. Also, naturalistic studies, involving the repeated assessment of momentary emotions and eating behaviour in daily life, are split between studies supporting and studies contradicting emotional eating in healthy individuals. Individuals with clinical forms of overeating (i.e. binge eating) consistently show positive relationships between negative emotions and eating in daily life. We will conclude with a summary of the controversies around the emotional eating construct and provide recommendations for future research and treatment development.

Personalized models of psychopathology as contextualized dynamic processes: An example from individuals with borderline personality disorder

OBJECTIVE

Psychopathology research has relied on discrete diagnoses, which neglects the unique manifestations of each individual's pathology. Borderline personality disorder combines interpersonal, affective, and behavioral regulation impairments making it particularly ill-suited to a "one size fits all" diagnosis. Clinical assessment and case formulation involve understanding and developing a personalized model for each patient's contextualized dynamic processes, and research would benefit from a similar focus on the individual.

METHOD

We use group iterative multiple model estimation, which estimates a model for each individual and identifies general or shared features across individuals, in both a mixed-diagnosis sample (N = 78) and a subsample with a single diagnosis (n = 24).

RESULTS

We found that individuals vary widely in their dynamic processes in affective and interpersonal domains both within and across diagnoses. However, there was some evidence that dynamic patterns relate to transdiagnostic baseline measures. We conclude with descriptions of 2 person-specific models as an example of the heterogeneity of dynamic processes.

CONCLUSIONS

The idiographic models presented here join a growing literature showing that the individuals differ dramatically in the total patterning of these processes, even as key processes are shared across individuals. We argue that these processes are best estimated in the context of person-specific models, and that so doing may advance our understanding of the contextualized dynamic processes that could identify maintenance mechanisms and treatment targets. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

An examination of the interpersonal model of binge eating over the course of treatment

The current study examined the interpersonal model of binge eating, which posits that interpersonal problems lead to negative affect, which results in binge eating, over the course of two psychotherapy treatments (interpersonal psychotherapy and cognitive behavioural therapy) in 162 adults with binge-eating disorder. A series of longitudinal simple mediation analyses preliminarily showed that treatment addresses the mechanisms of the interpersonal model of binge eating as theoretically proposed in predicting reductions in binge eating, the primary dependent variable, and the secondary dependent variables including global eating disorder psychopathology, shape concern, and weight concern, but not reductions in restraint or eating concern. Moderated mediation analyses did not fully support treatment differences, as changes in the mechanisms of the interpersonal model occurred in both treatments and suggest both treatments addressed negative affect and interpersonal precipitants of eating disorder symptomatology. Future research should replicate this study using variables that do not overlap in time to investigate causation of the model, and more generally, further examine theoretical treatment models and treatment mediators as this research could help improve efficacy of treatment for binge-eating disorder.

Borderline personality disorder and eating disorders: a trans-diagnostic approach to unravelling diagnostic complexity

OBJECTIVES

This opinion paper considers co-morbid borderline personality disorder (BPD) and eating disorders and proposes that a trans-diagnostic approach looking at presenting problems and treatment approaches may be of value.

CONCLUSIONS

Trans-diagnostic elements can be identified across the two syndromes. Trans-diagnostic elements appear to include some shared aetiological factors as well as some shared syndromal components. The shared syndromal components include problems with affect, interpersonal problems, problems with self-concept and impulsivity. The pathoplastic effects of culture, attitudes to fatness and the neurobiology of starvation and/or restriction of intake are crucial to integrate into the understanding of co-morbidity of these two disorders. Trans-diagnostic approaches to treatment lead to trans-diagnostic improvements across the two disorders.

Impaired Conflict Monitoring to Food Cues in Women Who Binge Eat

Previous research demonstrated the associations between cognitive biases toward food cues and binge eating (BE) behavior. To determine the characteristics of conflict monitoring to food cues in women who binge eat and non-eating disordered controls, a flanker task featured high-caloric food and low-caloric food images was used to examine conflict monitoring with measures of accuracy and reaction time. Women who binge eat displayed longer reaction times (RTs) to incongruent trials (i.e., flanked by pictures from the different category) than to congruent trials (i.e., flanked by pictures from the same category), while controls showed no such difference. This finding demonstrated women who binge eat displayed a general flanker effect toward food-related stimuli compared to controls. Faster reaction times in response to high-caloric food images disturbed by low-caloric food images predicted lower self-reported motor impulsiveness in the women who binge eat, but not in controls. These data suggest a relative conflict monitoring deficit in women with BE pathology.

Power of Cognition: How Dysfunctional Cognitions and Schemas Influence Eating Behavior in Daily Life Among Individuals With Eating Disorders

Eating disorders (EDs) are characterized by marked cognitive distortions and maladaptive schemas. Cognitive models of EDs highlight the direct impact of cognitive dysfunctions on eating-related disturbances, insofar as specific cognitive contents such as thoughts about diet rules and food or loss of control may trigger disturbed eating behavior. Moreover, early maladaptive schemas that reflect perfectionist standards and relate to achievement and performance seem to be associated with disturbed eating, e.g., via their impact on situation-specific appraisals. However, so far, no study has investigated these assumptions. Hence, the present study sought to demonstrate whether and how cognitive content exerts an impact on eating behavior in daily life, and whether maladaptive core schemas impact the occurrence of binge eating via dysfunctional ED cognitions in eating-related contexts. N = 29 females with bulimia nervosa (BN), n = 31 females with binge eating disorder (BED) and n = 30 female controls without EDs (NC) participated in the study. All participants received a handheld computer for a 48-h period to capture antecedents of disturbed eating behavior in daily life. Event-sampling (meals, binge eating, purging, stressful situations) and signal-sampling (five times a day) methods were applied. EMA included a short questionnaire to assess dysfunctional cognitions and level of craving and to capture information about situational contexts. Early maladaptive schemas were assessed using a short version of the Young Schema Questionnaire at baseline. The main results showed specific patterns of dysfunctional eating-related cognitions for BED and BN. Binge eating was predicted by thoughts about loss of control (positively) and dietary restraint (negatively). For meal situations, no significant differences between the two ED groups emerged. All three domains exerted indirect effects on craving via thoughts about ‘eating/loss of control,’ whereas neither a direct nor an indirect effect emerged regarding thoughts about ‘dietary restraint.’ These results fit well with previous studies and support cognitive models of EDs; schema therapeutic approaches may be a valuable contribution to enhance treatment of EDs. Further studies should explore whether the findings from emerging adulthood can be generalized to younger age groups.

Socializing problems and low self-esteem enhance interpersonal models of eating disorders: Evidence from a clinical sample

OBJECTIVE

The present study evaluated the relative clinical validity of two interpersonal models of the maintenance of eating disorders, IPT-ED (Rieger et al., ) and the interpersonal model of binge eating (Wilfley, MacKenzie, Welch, Ayres, & Weissman, ; Wilfley, Pike, & Striegel-Moore, ). While both models propose an indirect relationship between interpersonal problems and eating disorder symptoms via negative affect, IPT-ED specifies negative social evaluation as the key interpersonal problem, and places greater emphasis on the role of low self-esteem as an intermediate variable between negative social evaluation and eating pathology.

METHOD

Treatment-seeking individuals (N = 306) with a diagnosed eating disorder completed measures of socializing problems, generic interpersonal problems, self-esteem, eating disorder symptoms, and negative affect (depression and anxiety). Structural equation models were run for both models.

RESULTS

Consistent with IPT-ED, a significant indirect pathway was found from socializing problems to eating disorder symptoms via low self-esteem and anxiety symptoms. There was also a direct pathway from low self-esteem to eating disorder symptoms. Using a socializing problems factor in the model resulted in a significantly better fit than a generic interpersonal problems factor. Inconsistent with both interpersonal models, the direct pathway from socializing problems to eating disorder symptoms was not supported.

DISCUSSION

Interpersonal models that included self-esteem and focused on socializing problems (rather than generic interpersonal problems) explained more variance in eating disorder symptoms. Future experimental, prospective, and treatment studies are required to strengthen the case that these pathways are causal.

Behavioral Landscapes and Earth Mover's Distance: A New Approach for Studying Individual Differences in Density Distributions

Contemporary views of personality highlight intraindividual variability. We forward a general method for quantifying individual differences in behavioral tendencies based on Earth Mover's Distance. Using data from 150 individuals who reported on their and others' interpersonal behavior in 64,112 social interactions, we illustrate how this new approach can advance notions of personality as density distributions. Results provide independent confirmation and establish validity of existing representations of individual differences in interpersonal behavior, and identify new dimensions and profiles of personality and well-being. Benefits of the EMD method include freedom from assumptions about the shape and form of density distributions, generality of application to n-dimensional behavior captured in experience sampling studies, and natural integration of personality structure and dynamics.

Examination of the interpersonal model of loss of control eating in the laboratory

BACKGROUND

The interpersonal model of loss of control (LOC) eating proposes that interpersonal problems lead to negative affect, which in turn contributes to the onset and/or persistence of LOC eating. Despite preliminary support, there are no data examining the construct validity of the interpersonal model of LOC eating using temporally sensitive reports of social stress, distinct negative affective states, and laboratory energy intake.

METHOD

117 healthy adolescent girls (BMI: 75th-97th %ile) were recruited for a prevention trial targeting excess weight gain in adolescent girls who reported LOC eating. Prior to the intervention, participants completed questionnaires of recent social stress and consumed lunch from a multi-item laboratory test meal. Immediately before the test meal, participants completed a questionnaire of five negative affective states (anger, confusion, depression, fatigue, anxiety). Bootstrapping mediation models were conducted to evaluate pre-meal negative affect states as explanatory mediators of the association between recent social stress and palatable (desserts and snack-type) food intake. All analyses adjusted for age, race, pubertal stage, height, fat mass percentage, and lean mass.

RESULTS

Pre-meal state anxiety was a significant mediator for recent social stress and palatable food intake (ps<.05). By contrast, pre-meal state anger, confusion, depression, and fatigue did not mediate the relationship between social stress and palatable food intake (ps>.05).

DISCUSSION

Pre-meal anxiety appears to be the salient mood state for the interpersonal model among adolescent girls with LOC eating. Interventions that focus on improving both social functioning and anxiety may prove most effective at preventing and/or ameliorating disordered eating and obesity in these adolescents.

Seeing things differently: An experimental investigation of social cognition and interpersonal behavior in anorexia nervosa

OBJECTIVE

Interpersonal difficulties among individuals with anorexia nervosa (AN) may stem in part due to misperceiving social cues. The current study investigated social functioning by comparing interpersonal self-efficacy, perceptions of dominance/submission (i.e., agency) and coldness/warmth (i.e., communion), and hypothetical behavioral reactions among individuals with and without AN.

METHOD

Seventy-seven women (AN/Other Specified Feeding or Eating Disorder OSFED-AN n = 41, nonclinical comparison group n = 36) completed questionnaires assessing mood symptoms and interpersonal self-efficacy, followed by an experimental video-rating task in which they received critical feedback from job supervisors varying in degrees of agency and communion.

RESULTS

AN respondents perceived more coldness overall, even after adjusting for differences in depression and anxiety symptoms, and tended to respond with coldness even to videos that they perceived as being warm. However, perceptual accuracies for agency were similar across groups. Interpersonal self-efficacy moderated the relationship between diagnostic status and behavioral responses: among those who felt competent being cold-submissive, AN respondents selected cold-submissive responses more frequently than did the nonclinical comparison group.

DISCUSSION

Among those with AN symptoms, there may be a tendency toward social perceptual inaccuracies regarding communion and non-complementary cold behavioral responses. Results suggest that improving social perceptions may be a fruitful intervention target for enhancing interpersonal functioning among individuals with AN. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:499-506).

Ecological Momentary Assessment in Eating Disorder and Obesity Research: a Review of the Recent Literature

Our current understanding of the etiology and maintenance of eating disorders and obesity continues to be far from complete. Similarly, our understanding of determinants of both successful and unsuccessful weight loss surgery is also quite limited. While a number of research methodologies have been applied to these areas, one methodology that has recently seen a rise in popularity is the use of ecological momentary assessment (EMA). EMA allows one to study a variety of variables of interest in the natural environment. The study of eating disorders, obesity, and bariatric surgery has all been conducted using EMA recently. The current study is a review of these areas and summarizes the recent literature (past 3 years) in eating disorders, obesity, and bariatric surgery using EMA methodology.