Emotional eating in anorexia nervosa and bulimia nervosa

A systematic review and meta-analysis of cross-sectional questionnaire studies of the relationship between negative and positive emotional eating and body mass index: Valence matters

Questionnaire measures of negative emotional eating (NEE) have been associated with elevated body mass index (BMI). Relatively fewer studies have examined positive emotional eating (PEE) and they report that PEE is associated with lower BMI or is not associated with BMI. To examine whether NEE and PEE are linked to BMI, we conducted a systematic review and meta-analysis of studies that used the Emotional Appetite Questionnaire (EMAQ) and the Salzburg Emotional Eating Scale (SEES), which assess change in eating associated with positive and negative emotions, and measured BMI in adults with a range of BMIs. A search of databases (CINAHL Medline, and PsycINFO), citations (Google Scholar) and dissertations (Proquest), and a preprint registry (Open Science Framework, OSF) was conducted independently by three screeners. Forty-three cross-sectional studies were eligible for inclusion. Correlations between BMI and NEE scales and PEE scales were extracted. Age and sex were examined as potential moderators. We found statistically significant (ps < .001) and small mean effect sizes with random-effects models. Higher EMAQ NEE (d = .152 [.11, .19], N = 18,576) and SEES NEE scales (sadness, d = .209 [.168, .250]; angry, d = .096 [.047, .144]; anxiety, d = .169 [.124, .211], N = 4141) were associated with higher BMI. The EMAQ PEE (d = -.073 [-.106, -.041], N = 18,806) and the SEES happy (d = -.157 [-.100, -.114], N = 4141) scales were associated with lower BMI. There was significant heterogeneity in effect sizes for PEE and NEE; however, there was no statistically significant moderation by age or sex. There was also no evidence for publication bias except for SEES sadness. This analysis is limited to cross-sectional questionnaire-based studies. NEE may be associated more strongly than PEE with emotional regulation difficulties and overeating of energy-dense foods which may be why it is associated with higher BMI.

Development and preliminary validation of the comprehensive emotional eating scale (CEES)

In emotional eating (EE), affective states influence desire to eat and/or eating behavior. Most research on EE focuses on over-/under-eating in response to negative emotions, the former of which is related to higher weight and binge-spectrum eating disorder (ED) symptoms while the latter has been implicated in low weight and restrictive-only ED. Individuals endorsing both forms of negative EE are more impaired than those reporting unidirectional negative EE. Less is known about the influence of positive emotions on eating, in part due to a lack of self-report measures of positive over- and under-eating as separate constructs. The current study presents the development, including item reduction and initial factorial validity (primary aims) and convergent validity (secondary aims) of the Comprehensive Emotional Eating Scale (CEES), a four-factor measure of positive and negative over- and under-eating. The initial 134-item pool for the CEES was based on a review of extant emotional eating scales and emotion words from the Positive and Negative Affect Schedule. The item pool was reduced and four factors identified using exploratory graphical analysis. The structure of the final set of 40 items was evaluated using confirmatory factor analysis. Convergent validity of the negative over- and under-eating scales was established using measures of body image-focused eating disorder and ARFID symptoms, and exploratory data on the correlates of positive over- and under eating were reported. The CEES showed preliminary evidence of factorial and convergent validity in a US-based convenience sample. It allows for classification on all four quadrants of emotional eating.

Comprehensive insights into emerging advances in the Neurobiology of anorexia

BACKGROUND

Anorexia is a complex eating disorder influenced by genetic, environmental, psychological, and socio-cultural factors. Research into its molecular mechanisms and neural circuits has deepened our understanding of its pathogenesis. Recent advances in neuroscience, molecular biology, and genetics have revealed key molecular and neural circuit mechanisms underlying anorexia.

AIM OF REVIEW

Clarify the peripheral and central molecular mechanisms regulating various types of anorexia, identify key cytokines and neural circuits, and propose new strategies for its treatment. Key scientific concepts of review: Anorexia animal models, including activity-induced, genetic mutation, and inflammation-induced types, are explored for their relevance to studying the disorder. Anorexic behavior is regulated by cytokines, hormones (like GDF15, GLP-1, and leptin), and neural circuits such as AgRP, serotonergic, dopaminergic, and glutamatergic pathways. Disruptions in these pathways, including GABAergic signaling in AgRP neurons and 5-HT2C and D2 receptors, contribute to anorexia. Potential therapies target neurotransmitter receptors, ghrelin receptors, and the GDF15-GFRAL pathway, offering insights for treating anorexia, immune responses, and obesity.

Expressive Suppression of Emotions in Bulimia Nervosa: An Electroencephalography Study

OBJECTIVE

Previous research has found dysfunctional emotion regulation in bulimia nervosa (BN), including self-reported greater habitual use of maladaptive strategies such as suppression than in healthy individuals. However, there is no evidence on the performance in the implementation of expressive suppression in BN. The aim of this study was to investigate brain activity (in terms of ERP) and self-reported ratings associated with expressive suppression of emotions elicited by positive and negative stimuli in women with BN.

METHOD

Event-related potentials (ERP) were recorded from 23 female individuals with BN and 26 matched healthy controls. Participants were shown emotional pictures under two conditions: using facial suppression or attentively viewing. High-density EEG was used to characterize the time course of emotion regulation.

RESULTS

ERP amplitudes varied significantly with valence, with positive (vs. neutral and negative) pictures eliciting larger ERP amplitudes. However, no significant differences in ERP were observed between the groups or conditions. The BN group reported lower self-efficacy in implementing suppression compared to the control group, the latter with a positive correlation between the perceived self-efficacy and the change in emotional arousal between conditions.

DISCUSSION

Our findings suggest that individuals with BN might have difficulties in monitoring the emotion regulation process compared to healthy individuals. This suggests that other processes (e.g., metacognitive difficulties, self-esteem) rather than a failure to implement suppression, might underlie these results. However, further research is needed to validate this interpretation. Implications and directions for future research are discussed.

Emotional Eating and Mental Health Among Lebanese University Students During COVID-19 Outbreak

Background and Aim: Emotional eating (EE) is the uncontrollable desire to eat in response to negative emotions such as anxiety, irritation, or depression. The 2019 coronavirus (COVID-19) pandemic and strict quarantine raised the likelihood of mental symptoms and, as a consequence, EE. The main objective of this study was to assess the extent of EE and mental health among Lebanese university students and to identify the main correlates of EE. Methods: A cross-sectional study was undertaken between March and April 2021. Overall, 356 Lebanese university students aged between 18 and 25 years completed an online questionnaire that assesses EE and mental state, as well as health and eating habits. Results: The total mean EE score was 33.82 (±8.52). The main predictors of EE among university students were a higher grade point average (GPA) (p=0.010), higher body mass index (BMI) (p < 0.001), consuming more fats (p=0.013), and eating more sweets and cookies (p=0.010). In addition, depression, anxiety, and stress were highly prevalent among Lebanese university students during the pandemic (43.8%, 51.7%, and 91.6%, respectively). Conclusion: This study provides evidence of the negative impact of the COVID-19 outbreak on emotional well-being and eating behaviors among Lebanese university students. Targeted nutrition education programs that address the cultural and economic realities of Lebanese students, as well as psychological counseling offered by the universities, would be of interest to improve the diet quality and emotional well-being of the students.

Emotional food craving across the eating disorder spectrum: an ecological momentary assessment study

PURPOSE

Emotional eating during negative emotions might underlie disordered eating behavior (i.e., binge eating and food restriction). Positive emotions, by contrast, seem to promote healthier eating behavior. Naturalistic research on the links between emotions and eating across individuals with binge-eating disorder (BED), bulimia nervosa (BN), binge-purge anorexia nervosa (AN-BP), and restrictive anorexia nervosa (AN-R) is, however, lacking.

METHODS

Individuals without eating disorders (comparison group, CG, n = 85), and patients with BED (n = 41), BN (n = 50), AN-BP (n = 26), and AN-R (n = 29) participated in an ecological momentary assessment study. Six daily notifications over eight days prompted ratings of momentary food craving and emotional states differing in valence and arousal.

RESULTS

Results supported specific emotion-food-craving patterns in each group. Compared to the CG, arousing negative emotions and higher cravings co-occurred in patients with BN. In patients with AN-BP (at trend level also in patients with AN-R) less arousing negative emotions and lower cravings co-occurred. In patients with AN, positive emotions and higher cravings co-occurred whereas in patients with BED less arousing positive emotions and lower cravings co-occurred.

CONCLUSION

The found emotion-craving associations may underlie group-specific (dys-)functional eating behaviors, i.e., binge eating and food restriction during negative emotions in patients with BN and AN, and normalized appetitive responses during positive emotions in patients with BED and AN. Therapeutic efforts could target arousing negative emotions in patients with BN, and less arousing negative emotions in patients with AN. Positive emotions could be used in a salutogenetic approach in patients with BED and AN.

The relation between questionnaire-measured self-reported emotional eating and disordered eating behaviors: A meta-analysis of nearly three decades of research

Extensive research exists on the association between self-reported emotional eating (EE) and disordered eating (DE) behaviors. Heterogeneity exists by type (e.g., unidimensional vs. multidimensional) and valence (e.g., negative vs. positive) of self-reported EE, and no previous meta-analyses have examined the association between self-reported EE and DE behaviors. A total of 67 studies (N = 26,289; 43 reporting relations in one model, and 24 reporting relations in more than one model) met inclusion criteria; ranges for age and publication date were 18.0-61.8 years old and 1995 to 2022. Five models quantified relations between DE behaviors and 1) broad negative EE, 2) EE in response to depression, 3) EE in response to anger and anxiety, 4) EE in response to boredom, and 5) EE in response to positive emotions. Using random-effects models, pooled Cohen's d effect sizes suggested small, positive relations between DE behaviors and self-reported broad negative EE (d = 0.40, p < 0.001), EE-depression (d = 0.41, p < 0.001), EE-anger/anxiety (d = 0.35, p < 0.001), and EE-boredom (d = 0.38, p < 0.001). A significant, but very small, positive relation was observed between DE behaviors and self-reported EE-positive (d = 0.08, p = 0.01). Subgroup analyses suggested a medium, positive relation between self-reported broad negative EE and binge eating (d = 0.53, p < 0.001) and a small, positive relation between self-reported broad negative EE and dietary restraint (d = 0.20, p < 0.001). Significant heterogeneity was identified across all models except for the EE-boredom and DE behaviors model. Higher BMI, but not age, clinical status, or type of DE behavior strengthened the positive relation between self-reported broad negative EE and DE behaviors. Findings support previous research suggesting that negative and positive EE are distinct constructs, with negatively valenced EE being more closely associated with DE behaviors, especially binge eating.

Loss of control in binge-eating disorder: Fear and resignation

OBJECTIVE

Binge-eating disorder involves overeating while feeling a loss of control (LOC). Emotions around LOC appear to vary; some patients fear LOC whereas others feel powerless or "resigned" to LOC. This study examined differences in psychopathology among treatment-seeking patients with binge-eating disorder categorized with fear of LOC, resignation to LOC, and no fear/resignation of LOC.

METHOD

Doctoral research clinicians administered diagnostic and semistructured interviews to characterize psychopathology and establish a diagnosis of binge-eating disorder in participants (N = 382). The interview assessed fear of LOC in the past month. Further queries assessed whether, in the absence of fear of LOC, patients were resigned to LOC or had no fear/resignation.

RESULTS

Patients with fear of LOC and resigned to LOC endorsed significantly greater global eating-disorder psychopathology than patients with no fear/resignation. Patients with fear of LOC reported greater distress about binge eating and greater depression than those with no fear/resignation. Patients resigned to LOC reported significantly more frequent binge-eating episodes than those with fear of LOC and no fear/resignation. Black individuals and men were more likely to report no fear/resignation than other demographic groups.

DISCUSSION

This study describes a novel clinical aspect of binge-eating disorder: resignation to LOC. Findings highlight the importance of including anticipatory cognitive-affective experiences in treatment formulations and planning. Future research should examine co-occurrence of these experiences and their association with impairment. Future research should also examine how fear of LOC and resignation to LOC change during treatment and whether they predict or moderate treatment outcomes.

PUBLIC SIGNIFICANCE

Adults with binge-eating disorder have anticipatory cognitive-affective experiences about loss of control (LOC) over eating (i.e., fear of LOC, resigned to LOC, no fear nor resignation of LOC). Individuals who experience fear of LOC and those who are resigned to LOC had more severe psychopathology than those without fear/resignation. Binge-eating disorder has the highest prevalence of the eating disorders; thus, findings have high public significance in guiding clinicians' treatment planning.

Eating when depressed, anxious, bored, or happy: An examination in treatment-seeking adults with overweight/obesity

Emotions that differ in valence are uniquely associated with eating. In our previous study with an online sample of adults with overweight/obesity, eating in response to depression was the type of emotional eating most closely associated with negative psychosocial correlates (Braden et al., 2018). The current study extended this research by examining associations between emotional eating types (eating in response to depression, anxiety, boredom, happiness) and psychological correlates among treatment-seeking adults. The present study was a secondary analysis of adults (N = 63; 96.8% female) with overweight/obesity and self-identified emotional eating who completed a baseline assessment for a behavioral weight loss intervention. Emotional eating in response to depression (EE-depression), anxiety/anger (EE-anxiety/anger), and boredom (EE-boredom) were assessed with the revised Emotional Eating Scale (EES-R), and positive emotional eating (EE-positive) was assessed with the positive emotions subscale of the Emotional Appetite Questionnaire (EMAQ). The Eating Disorder Examination Questionnaire (EDE-Q), Binge Eating Scale (BES), Difficulties in Emotion Regulation Scale (DERS), and Patient Health Questionnaire-9 (PHQ-9; depressive symptoms) were also administered. Frequencies showed the most endorsed emotional eating type was EE-depression (44.4%; n = 28). Four multiple regression analyses examined associations between emotional eating (EE-depression, EE-anxiety/anger, EE-boredom, and EE-positive) and dependent variables (EDE-Q, BES, DERS, and PHQ-9). Results showed that depression was the emotional eating type most closely related to disordered eating, binge eating, and depressive symptoms. Eating in response to anxiety was closely related to emotion regulation difficulties. Positive emotional eating was related to less depressive symptoms. Exploratory analyses showed that lower levels of positive emotional eating were related to higher depressive symptoms among adults with greater emotion regulation difficulties. Researchers and clinicians may consider tailoring weight loss treatment based on unique emotions that trigger eating.

Eating disorder psychopathology and resilience in Iranian college students: A network analysis

OBJECTIVE

Eating disorder (ED) psychopathology is common among Iranian college students. Resilience (i.e., the ability to bounce back and adapt in the face of adverse and stressful conditions) has been found to be a protective factor against ED psychopathology in the West. However, no research to date has examined resilience as a protective factor against ED psychopathology in Iran. The current study used network analysis to examine an ED and resilience network in an Iranian sample.

METHOD

Participants were Iranian college students (N = 478) who completed the Farsi-Eating Disorder Examination-Questionnaire and Farsi-Brief Resilience Scale. We estimated a network of ED symptoms and resilience processes and identified central and bridge symptoms.

RESULTS

Central ED and resilience nodes were discomfort in seeing one's own body, feeling guilty about eating due to shape/weight, and thinking about shape and weight making it difficult to concentrate. Having a hard time making it through stressful events bridged with binge eating and fear of losing control over eating.

CONCLUSION

Processes related to managing stress and binge eating appear to maintain the association between ED symptoms and resilience processes.

A systematic review of the relationship between alexithymia and emotional eating in adults

Elucidating psychological characteristics associated with emotional eating may further inform interventions for this behaviour related to eating psychopathology. The present systematic review aimed to examine the relationship between alexithymia and self-reported emotional eating in adults, and provide a narrative synthesis of the existing literature. Using the PRISMA method for systematic reviews, six databases (MEDLINE, PsycInfo, PsycArticles, PubMed, SCOPUS, and Web of Science) were searched for peer-reviewed, quantitative research published between January 1994 and 20^th July 2021, when the searches were conducted. Eligible articles investigated the association between alexithymia, as measured by the Toronto Alexithymia Scale (Bagby, Parker, & Taylor, 1994), and emotional eating, as measured by any validated self-report instrument. Nine cross-sectional articles were reviewed, and risk of bias was assessed using the Appraisal Tool for Cross-Sectional Studies (Downes, Brennan, Williams, & Dean, 2016). A narrative synthesis of articles suggests positive associations between alexithymia and self-reported emotional eating. Five measures of emotional eating were used across articles, with limited but consistent evidence for the relationship between alexithymia and emotional eating as measured by the Dutch Eating Behaviour Questionnaire (Van strien et al., 1986). Further research is required to add evidence to the nature of the relationship between alexithymia and emotional eating, and to explore mechanisms that might underpin any relationships. Understanding the association between alexithymia and emotional eating may support strategies and interventions for those seeking help for emotional eating and related eating behaviours.

A cotwin control study of associations between financial hardship and binge eating phenotypes during COVID-19

BACKGROUND

COVID-19 was associated with significant financial hardship and increased binge eating (BE). However, it is largely unknown whether financial stressors contributed to BE during the pandemic. We used a longitudinal, cotwin control design that controls for genetic/environmental confounds by comparing twins in the same family to examine whether financial hardship during COVID-19 was associated with BE.

METHODS

Female twins (N = 158; Mage  = 22.13) from the Michigan State University Twin Registry rated financial stressors (e.g., inability to afford necessities) daily for 49 consecutive days during COVID-19. We first examined whether financial hardship was associated with BE phenotypes across the full sample. We then examined whether cotwins who differed on financial hardship also differed in BE.

RESULTS

Participants who experienced greater mean financial hardship across the study had significantly greater dimensional BE symptoms, and participants who experienced greater financial hardship on a given day reported significantly more emotional eating that day. These results were replicated in cotwin control analyses. Twins who experienced more financial hardship than their cotwin across the study reported greater dimensional BE symptoms than their cotwin, and participants who experienced more financial hardship than their cotwin on a given day reported greater emotional eating that day. Results were identical when restricting analyses to monozygotic twins, suggesting associations were not due to genetic confounds.

CONCLUSIONS

Results suggest that BE-related symptoms may be elevated in women who experienced financial hardship during COVID-19 independent of potential genetic/environmental confounds. However, additional research in larger samples is needed.

PUBLIC SIGNIFICANCE

Little is known regarding how financial difficulties during the COVID-19 pandemic may have contributed to increased binge eating (BE). We found preliminary evidence that financial hardship during COVID-19 may be associated with greater rates of BE-related symptoms even when comparing twins from the same family. While additional research is needed, results suggest that people who experienced financial hardship during COVID-19 may be at increased risk for BE.

Connecting a health-focused self-concept with orthorexia nervosa symptoms via fear of losing control over eating unhealthy food and disgust for unhealthy food

PURPOSE

Orthorexia nervosa (ON) involves a maladaptive preoccupation with healthy eating through strict dietary rules that negatively affect physical and mental health. Recent evidence suggests that ON symptoms may stem, in part, from having a health-focused self-concept (i.e., overvaluing the importance of health for self-definition and self-worth). Herein, fear of losing control over eating unhealthy foods and disgust for unhealthy foods were examined as potential mediators of the association between health-focused self-concept and ON symptoms.

METHODS

The parallel mediation model was tested using a community sample of people who believe they are currently following a healthy eating diet plan and/or believe they are leading a healthy eating lifestyle (N = 442). Participants were recruited from Amazon's Mechanical Turk and completed a questionnaire battery that included the Health-Focused Self-Concept Scale, questionnaires assessing fear of losing control over eating unhealthy food and disgust with unhealthy food, and the Orthorexia Nervosa Inventory.

RESULTS

As expected, a health-focused self-concept was indirectly and positively associated with ON symptoms via fear and disgust.

CONCLUSION

The findings conceptually replicate and extend prior research on anorexia nervosa supporting the transdiagnostic utility of a focused self-concept, fear of losing control, and disgust across eating disorders.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Eating disorder psychopathology and negative affect in Iranian college students: a network analysis

BACKGROUND

ED psychopathology is becoming more prevalent in Iran. Negative affect has been found to be an important risk factor in eating disorder (ED) onset in research conducted in Western countries, and is also emerging as a potential vulnerability factor to ED psychopathology in Iran. Network theory offers a novel framework to understand the association between negative affect and ED psychopathology in Iran. The primary aim of the current study was to use network analysis to identify bridge symptoms (i.e., symptoms that activate or weaken symptoms in another cluster) across a negative affect and ED psychopathology network among Iranian college students. We also aimed to identify core symptoms (i.e., nodes that demonstrate the strongest connections to other nodes).

METHOD

Participants were Iranian college students (n = 637; 60.3% women) who completed the Farsi-eating disorder examination-questionnaire and Farsi-negative affect. We estimated a network of ED symptoms and negative affective states and identified bridge and central symptoms.

RESULTS

Hostility and shame emerged as central bridge symptoms across the negative affect and ED psychopathology clusters. The most central nodes were strong desire to lose weight, definite fear of losing control over eating, and binge eating episodes.

CONCLUSION

The negative affective states of hostility and shame may increase vulnerability to ED psychopathology among Iranian college students. Findings have important implications for ED prevention programs that should be examined in future research.

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

BACKGROUND

While negative affect (NA) typically increases risk for binge eating, the ultimate impact of NA may depend on a person's ability to regulate their emotions. In this daily, longitudinal study, we examined whether emotion regulation (ER) modified the strength of NA-dysregulated eating associations.

METHODS

Women (N = 311) from the Michigan State University Twin Registry first reported dimensional binge eating symptoms and broad ER difficulties (e.g., limited emotional awareness, difficulty controlling emotional impulses). Participants then rated use of adaptive (cognitive reappraisal, social sharing, situation modification, and acceptance) and maladaptive (rumination, expressive suppression, and self-criticism) ER strategies, emotional eating (EE), objective binge eating (OBE), and NA once daily for 49 consecutive days.

RESULTS

There were several main effects of ER on binge-eating pathology in both between-person (i.e., comparing women who differed on average) and within-person (i.e., examining fluctuations in variables day-to-day) analyses. Between-person, greater broad ER difficulties, greater maladaptive strategy use, and lower adaptive strategy use were all associated with greater binge-eating pathology. Within-person, greater maladaptive strategy use was associated with greater odds of OBE on that day and on the following day. However, neither broad ER difficulties nor use of specific strategies moderated associations between NA and dysregulated eating in between- or within-person analyses.

CONCLUSIONS

While ER is independently associated with risk for dysregulated eating, it may not fully mitigate the impact of NA. Additional strategies (e.g., decreasing environmental stressors and increasing social support) may be needed to minimize NA and its impact on dysregulated eating.

PUBLIC SIGNIFICANCE

Negative affect (NA; e.g., sadness, guilt) increases dysregulated eating risk. Because NA is sometimes unavoidable, we examined whether emotion regulation (ER; i.e., how a person responds to their emotions) might impact whether NA leads to dysregulated eating. Although more effective ER was associated with less dysregulated eating overall, ER did not impact the association between NA and dysregulated eating. Other approaches may therefore be needed to mitigate NA-dysregulated eating associations.

Taking a closer look at mindful eating: incremental validity and importance of subfacets

PURPOSE

Mindful eating (ME) seems a promising approach to clarify the underlying mechanisms of mindfulness-based interventions for eating and weight-related issues. The current study aimed to investigate the incremental validity of this eating-specific approach beyond a generic conception of mindfulness and explore preliminary indication which subfacets of the multidimensional construct ME might be of particular importance in order to study them more precisely and tailor mindfulness-based interventions for eating and weight-related issues more properly.

METHODS

Self-report data (N = 292) were collected online. Hierarchical regression analyses were used to explore the incremental validity of ME beyond generic mindfulness, predicting maladaptive eating (emotional and uncontrolled eating) and consumption of energy-dense food. Multiple regressions were used to examine the impact of the seven different ME subfacets on the very same outcomes.

RESULTS

Findings demonstrated the incremental validity of ME on all outcomes. Generic mindfulness no longer predicted emotional eating, uncontrolled eating, or the consumption of energy-dense food when entering ME. The subfacet 'non-reactive stance' predicted all three outcomes significantly. For emotional and uncontrolled eating, the subfacets 'accepting and non-attached attitude toward one's own eating experience', 'eating in response to awareness of fullness', and the 'awareness of eating triggers and motives' additionally showed a significant influence.

CONCLUSION

ME seems a valuable approach in clarifying how mindfulness might impact eating and weight-related issues. Beyond that, it might be beneficial for upcoming interventions to strengthen specific ME subfacets, depending on the focused outcomes.

LEVEL OF EVIDENCE

Level V, descriptive cross-sectional study.

Examining a mediation model of body image-related cognitive fusion, intuitive eating, and eating disorder symptom severity in a clinical sample

PURPOSE

This study sought to explore the associations between Intuitive Eating (IE), eating disorder (ED) symptom severity, and body image-related cognitive fusion within a clinical sample. IE was also examined as a possible mediator in the relationship between body image-related fusion and ED symptoms.

METHODS

This study includes cross-sectional analyses with data from 100 adult females and 75 adolescent females seeking residential treatment for an ED. Self-reported demographic information, ED symptoms, IE behaviors, and body image-related cognitive fusion were collected from participants within the first week of treatment following admission to the same residential ED treatment facility.

RESULTS

ED symptom severity was significantly negatively associated with three of the four domains of IE; unconditional permission to eat, reliance on hunger and satiety cues, and body-food choice congruence. A significant mediational effect of IE on the relationship between body image-related fusion and ED symptoms through IE behaviors was observed (β = 11.3, SE = 0.003, p < 0.001). This effect was only observed for the unconditional permission to eat (β = 0.13, p = 0.003) and reliance on hunger and satiety cues (β = 0.10, p = 0.005) domains of IE when the domains were subsequently analyzed individually.

CONCLUSION

Unconditional permission to eat and reliance on hunger and satiety cues appear to be particularly influential domains of IE in the relationship between body image-related fusion and ED symptom severity. It is possible that changes in these IE domains may be mechanisms through which body image-related fusion influences ED symptoms. Future longitudinal research is needed to better understand the relationship between body image-related cognitive fusion and IE and the potential for targeting these constructs specifically in the context of ED treatment.

LEVEL OF EVIDENCE

Level V, cross-sectional analysis from descriptive study.

Investigation of Loneliness and Social Support in Patients with Eating Disorders: A Case-Control Study

Loneliness and, to a lesser degree, social support are considered under-researched topics in the literature on eating disorders (ED). This study attempted to expand the relevant body of research by examining loneliness in combination with social support in ED patients and in healthy controls (HC). Binge-eating problems, emotional eating, resilience, anxiety, and depression symptoms were also assessed. Thirty-two patients with ED and twenty-nine HC completed the following measures: UCLA Loneliness Scale, Social Support Questionnaire—Short Form, Binge Eating Scale, Emotional Eating Scale, Connor–Davidson Resilience Scale, Hospital Anxiety and Depression Scale, and the Eating Disorder Examination Questionnaire. Eating-disorder patients showed higher levels of loneliness and lower levels of social support—both in terms of perceived availability and satisfaction—than HC. Anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) subgroups did not differ significantly on either of these variables. In ED patients, loneliness was only correlated with Social Support Satisfaction (negatively) and depressive symptomatology (positively). Patients with ED appear to be lonelier and less satisfied with their social support compared to HC. We found similar levels of loneliness and social support between AN, BN, and BED sufferers. Decreased social support satisfaction and elevated symptoms of depression could account for ED patients’ high levels of loneliness.

The Florence Emotional Eating Drive (FEED): a validation study of a self-report questionnaire for emotional eating

PURPOSE

Emotional eating is a trans-diagnostic dimension in eating disorders and is present in many other conditions that could affect eating attitudes. At present, there is no instrument that measures emotional eating evaluating both the intensity and the frequency of emotion-induced desire to eat. The aim of the study was the validation of the Florence Emotional Eating Drive (FEED).

METHODS

A sample of healthy volunteers was initially enrolled to explore internal consistency and test-retest reliability. The Emotional Eating Scale (EES), Eating Disorders Evaluation-Questionnaire (EDE-Q), Binge Eating Scale (BES) and Symptom Checklist-90 (SCL-90-R), together with the final version of FEED, were administered to a clinical sample composed by patients with eating disorders, obesity, and type 2 diabetes, to explore the underlying structure of the questionnaire and verify its validity.

RESULTS

FEED showed excellent internal consistency (Cronbach's alpha = 0.96) and test-retest reliability (r = 0.93). FEED scores were higher in patients with BN and BED than in AN patients, negatively correlated with age and positively with BES and EES. Multiple regression analysis showed that FEED, but not EES, was independently associated with SCL-90-R and EDE-Q scores.

CONCLUSION

FEED internal consistency and test-retest reliability were excellent. The addition of specific questions on the frequency of behaviours led to a better component structure and robustness compared to EES. A tool that reliably and specifically assesses eating behaviours driven by emotional states may be extremely useful in clinical settings.

LEVEL OF EVIDENCE

Level V, cross-sectional study.

Stress-induced alterations in HPA-axis reactivity and mesolimbic reward activation in individuals with emotional eating

BACKGROUND

Emotional eating has emerged as a contributing factor to overeating, potentially leading to obesity or disordered eating behaviors. However, the underlying biological mechanisms related to emotional eating remain unclear. The present study examined emotional, hormonal, and neural alterations elicited by an acute laboratory stressor in individuals with and without emotional eating.

METHODS

Emotional (n = 13) and non-emotional eaters (n = 15) completed two main study visits, one week apart: one visit included a Stress version and the other a No-stress version of the Maastricht Acute Stress Task (MAST). Immediately pre- and post-MAST, blood was drawn for serum cortisol and participants rated their anxiety level. After the MAST, participants completed a Food Incentive Delay (FID) task during functional magnetic resonance imaging (fMRI), followed by an ad libitum snack period.

RESULTS

Emotional eaters exhibited elevated anxiety (p = 0.037) and cortisol (p = 0.001) in response to the Stress MAST. There were no changes in anxiety or cortisol among non-emotional eaters in response to the Stress MAST or in either group in response to the No-stress MAST. In response to the Stress MAST, emotional eaters exhibited reduced activation during anticipation of food reward in mesolimbic reward regions (caudate: p = 0.014, nucleus accumbens: p = 0.022, putamen: p = 0.013), compared to non-emotional eaters. Groups did not differ in snack consumption.

CONCLUSIONS

These data indicate disrupted neuroendocrine and neural responsivity to psychosocial stress amongst otherwise-healthy emotional eaters, who demonstrated hyperactive HPA-axis response coupled with hypoactivation in reward circuitry. Differential responsivity to stress may represent a risk factor in the development of maladaptive eating behaviors.

Feel Good, Eat Better: The Role of Self-Compassion and Body Esteem in Mothers' Healthy Eating Behaviours

Mothers’ eating behaviours are important to ensure the health and well-being of themselves and their families. Recent research has pointed to self-compassion, defined as extending kindness to oneself in times of perceived inadequacy or general suffering, as a trait associated with healthy forms of eating, such as intuitive eating, and reduced maladaptive forms of eating, such as emotional eating. However, little is known about the psychological mechanism through which self-compassion relates to healthy eating behaviours. This study examined 100 mothers’ levels of self-compassion, body esteem and eating behaviours. Structural equation modelling revealed that self-compassion was positively associated with diet quality and intuitive eating, while being negatively associated with emotional eating. Moreover, these links occurred, in part, due to higher body esteem. This points to a mechanism through which self-compassion may positively contribute to mothers’ healthy eating behaviours. The implications for eating outcomes and women’s health are discussed.

The moderating effects of mindfulness facets on psychological distress and emotional eating behaviour

BACKGROUND

Emotional eating is an impulsive mood-regulation strategy that often follows psychological distress. Mindfulness is associated with less impulsive behaviour. Mindful eating involves a considered awareness of hunger and satiety, and conscious, non-automatic, food choices. This study examines the moderating role of mindfulness on the relationship between distress and emotional eating.

PARTICIPANTS AND PROCEDURE

Participants (N = 392) completed self-report measures on distress, mindfulness and emotional eating, after which moderation analysis was carried out.

RESULTS

Mindfulness was negatively associated with emotional eating, but only when distress was low. The most important facets of mindfulness for this were being able to describe one's emotional state and a non-judgemental response to that state.

CONCLUSIONS

These results support previous findings that mindfulness reduces the impact distress has on emotional eating. Future research could explore interventions that enable individuals to describe their emotional state in the moment to reduce preoccupation with food during times of distress.

Bad mood food? Increased versus decreased food cue reactivity in anorexia nervosa and bulimia nervosa during negative emotions

OBJECTIVE

Emotion regulation difficulties in anorexia nervosa (AN) and bulimia nervosa (BN) might underlie bingeing and purging in BN, extreme fasting in AN, or combinations of these symptoms in binge-purge type AN. In this study, we tested for decreased food cue reactivity in response to negative emotions in AN, and the opposite pattern for BN. Furthermore, we explored subgroup differences (restrictive vs. binge-purging AN; history of AN in BN).

METHOD

Patients with AN (n = 41), BN (n = 39), and matched controls (n = 70) completed an emotional eating questionnaire. In a laboratory experiment, we induced negative emotions and measured food cue reactivity (pleasantness, desire to eat (DTE), and corrugator muscle activity).

RESULTS

AN reported emotional undereating, while BN reported emotional overeating. In the laboratory task, BN showed increased DTE and an appetitive corrugator response during negative emotions, selectively towards high-calorie foods. AN showed generalized reduced cue reactivity to high-calorie food regardless of emotional state. This pattern appears to be characteristic of restrictive AN, while cue reactivity of both BN subgroups pointed towards emotional overeating.

CONCLUSIONS

The emotional over- versus undereating framework might help to explain bingeing and restricting along the anorectic-bulimic disorder spectrum, which calls for novel transdiagnostic theories and subgroup-specific treatments.

'Quarantine 15': Pre-registered findings on stress and concern about weight gain before/during COVID-19 in relation to caregivers' eating pathology

The coronavirus disease (COVID-19) has dramatically altered daily activities including eating and physical activity behaviors, which in turn may be related to eating pathology. Those who care for children (henceforth caregivers) may face the brunt of these changes, but little research has examined the consequences of COVID-19 on eating pathology in caregivers. A community sample of caregivers (N = 140) completed a cross-sectional online survey assessing demographics, stress and concern about weight gain before/during COVID-19, disordered eating (Eating Disorder Examination Questionnaire-Short Form), and emotional eating (Emotional Eating Scale-Revised). Significant positive relationships emerged between stress and concern about weight gain before/during COVID-19 and disordered eating, emotional eating-depression, emotional eating-anger/anxiety, and emotional eating-boredom. Stress and concern about weight gain during, but not before, COVID-19 positively predicted variance in disordered eating and emotional eating. Stress was associated with lower emotional eating-boredom when concern about weight gain during COVID-19 was low. Stress was associated with lower emotional eating-depression when concern about weight gain before COVID-19 was low, but when high, stress was associated with higher emotional eating-depression. Stress and concern about weight gain before/during COVID-19 may be relevant to worsened disordered eating and emotional eating in caregivers, a neglected population in the literature. Targeting concern about weight gain may weaken the relationship between stress and emotional eating-depression and emotional eating-boredom among caregivers in the context of the COVID-19 pandemic.

Emotional eating across different eating disorders and the role of body mass, restriction, and binge eating

OBJECTIVE

Different subtypes of eating disorders (ED) show dysfunctional eating behaviors such as overeating and/or restriction in response to emotions. Yet, systematic comparisons of all major EDs on emotional eating patterns are lacking. Furthermore, emotional eating correlates with body mass index (BMI), which also differs between EDs and thus confounds this comparison.

METHOD

Interview-diagnosed female ED patients (n = 204) with restrictive (AN-R) or binge-purge anorexia nervosa (AN-BP), bulimia nervosa (BN), or binge-eating disorder (BED) completed a questionnaire assessing "negative emotional eating" (sadness, anger, anxiety) and "happiness eating." ED groups were compared to BMI-matched healthy controls (HCs; n = 172 ranging from underweight to obesity) to exclude BMI as a confound.

RESULTS

Within HCs, higher BMI was associated with higher negative emotional eating and lower happiness eating. AN-R reported the lowest degree of negative emotional eating relative to other EDs and BMI-matched HCs, and the highest degree of happiness eating relative to other EDs. The BN and BED groups showed higher negative emotional eating compared to BMI-matched HCs. Patients with AN-BP occupied an intermediate position between AN-R and BN/BED and reported less happiness eating compared to BMI-matched HCs.

DISCUSSION

Negative emotional and happiness eating patterns differ across EDs. BMI-independent emotional eating patterns distinguish ED subgroups and might be related to the occurrence of binge eating versus restriction. Hence, different types of emotional eating can represent fruitful targets for tailored psychotherapeutic interventions. While BN and BED might be treated with similar approaches, AN-BP and AN-R would need specific treatment modules.

Emotional eating among Lebanese adults: scale validation, prevalence and correlates

OBJECTIVES

The present study aimed at developing an Arabic version of the Emotional Eating Scale (EES) and examining its reliability and validity among a sample of the Lebanese population. The secondary objective was to evaluate the correlation between emotional eating and body dissatisfaction along with depression and/or self-esteem among a representative sample of the Lebanese population.

METHODS

This cross-sectional study was conducted between January and May 2018. The sample was drawn proportionately from all Lebanese Mohafazat.

RESULTS

All items could be extracted from the list, except items 17 and 19. The EES items converged over a solution of four factors that had an Eigenvalue over 1, explaining a total of 67.06% of the variance (KMO = 0.939; Bartlett's test of sphericity p < 0.001; α_Cronbach = 0.952). A higher body dissatisfaction was significantly associated with higher emotional eating (β = 0.31) and lower self-esteem (β =  - 0.054); however, no significant association was found with depression. Self-esteem and depression were not found to be significantly associated with emotional eating. When introducing depression and self-esteem as mediator factors for body dissatisfaction and emotional eating, body dissatisfaction did not remain significantly associated with emotional eating.

CONCLUSION

In this study, the Emotional Eating Scale was validated in Arabic among the Lebanese adult population, making this scale usable in further Lebanese research. Moreover, our results showed that body dissatisfaction was positively correlated with emotional eating and self-esteem, but not with depression. A positive association between body dissatisfaction and emotional eating was also demonstrated. This research offers new perspectives for the evaluation of emotional eating among the Lebanese adult population.

LEVEL OF EVIDENCE

Level V Cross-sectional descriptive study.

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.

Emotion regulation difficulties interact with negative, not positive, emotional eating to strengthen relationships with disordered eating: An exploratory study

Disordered eating includes core eating disorder symptoms present in diverse populations. The extant literature has focused on associations between negative emotional eating and disordered eating to the exclusion of positive emotional eating. Emotion regulation may help explain relationships between emotional eating and disordered eating. Emotion regulation difficulties was examined as a moderator of relationships between negative and positive emotional eating and disordered eating including dietary restraint, eating, weight, and shape concerns, and global scores of disordered eating, a general index of disordered eating. A cross-sectional study was employed using a university student population in the United States. Participants completed surveys assessing negative (Dutch Eating Behavior Questionnaire; Emotional Appetite Questionnaire) and positive (Emotional Appetite Questionnaire) emotional eating, emotion regulation (Difficulties in Emotion Regulation Scale), and disordered eating (Eating Disorder Examination Questionnaire). Moderation analyses were calculated with emotion regulation difficulties as the moderator of relationships between negative and positive emotional eating and disordered eating. Across two separate measures of negative emotional eating, higher negative emotional eating was associated with higher weight concerns and global scores of disordered eating when emotion regulation difficulties was average and increased (+1 SD above average). Higher positive emotional eating was associated with lower dietary restraint and global scores of disordered eating when emotion regulation difficulties was decreased (-1 SD below average). Emotion regulation difficulties strengthened relationships between negative, not positive, emotional eating and disordered eating. Research and clinical implications for the contribution of emotional eating and emotion regulation on disordered eating were discussed.

Getting a deeper understanding of mindfulness in the context of eating behavior: Development and validation of the Mindful Eating Inventory

PURPOSE

Current research supports the effectiveness of mindfulness-based interventions for maladaptive eating behaviors associated with obesity and eating disorders. To investigate potential underlying mechanisms at work, reliable and valid instruments that allow for an exhaustive assessment of the context-specific construct Mindful Eating (ME) are needed. Therefore, the current work aimed to develop a comprehensive inventory reflecting a wide range of ME attitudes and behaviors: The Mindful Eating Inventory (MEI).

METHODS & RESULTS

Study 1 describes the item pool development for an initial version of the MEI comprising various steps (compilation of items, expert ratings, focus groups and think aloud protocols by laypersons). Within Study 2, the factor structure of this initial version was explored in an online sample of N = 828 participants and the item pool was shortened via a sequential process based on statistical and content-related considerations. Exploratory factor analyses yielded a seven-factor structure. This structure could be confirmed within Study 3 on an independent online sample of N = 612 participants using confirmatory factor analysis. Criterion validity was supported by hypotheses-confirming correlations with eating-specific and global health-relevant outcomes.

CONCLUSION

Our findings demonstrate that the MEI is a valid and reliable (in terms of internal consistency and retest-reliability) tool, which allows for a comprehensive assessment of various ME attitudes and behaviors within one parsimonious inventory. It further enabled us to propose a so far missing, initial scientific operational definition of this eating-specific construct, that may help to advance future research and clinical application by clarifying mechanisms of action.

A 1-day acceptance and commitment therapy workshop leads to reductions in emotional eating in adults

PURPOSE

Emotional eating has been defined as the tendency to overeat in response to negative emotions and is a symptom of emotion dysregulation. Interventions for emotional eating have been developed based on acceptance and commitment therapy (ACT). However, these interventions only address emotional eating in the context of weight loss programs and are therefore not available in a weight neutral context.

METHODS

The present study aimed to test the feasibility and acceptability of a 1-day ACT workshop that taught skills to reduce emotional eating, without promoting weight loss. The workshop was delivered in a single day and aimed to reduce emotional eating by improving values clarification and commitment, acceptance, and mindfulness. Follow-ups were conducted at 2 weeks and 3 months post-intervention.

RESULTS

Results suggest feasibility and acceptability of the 1-day workshop; participants described appreciating the brevity of the program and its applicability to their everyday lives. Improvements in emotional eating were found at 2 weeks (t(31) = 5.80, p < 0.001) and 3 months (t(29) = 6.96, p < 0.001). A repeated measures MANOVA revealed a significant main effect of time (F(14, 96) = 4.98, p < 0.001, partial η² = 0.421), with follow-up ANOVAs indicating that this effect held for all variables.

CONCLUSION

The results from this study can be used to inform a larger-scale randomized controlled trial to determine the efficacy of the program in a larger sample and eventually disseminate it in other real-world settings.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03744780.

LEVEL OF EVIDENCE

Level IV, evidence obtained from multiple time series with the intervention.

Patterns of negative emotional eating among Chinese young adults: A latent class analysis

There is ample evidence suggesting that negative emotional eating is closely related to disordered eating behaviors. However, most previous studies on the topic focused only on emotional over-eating, but neglected emotional under-eating. Moreover, previous studies also mainly used variable-oriented methods by reducing negative emotional eating to a single dimension, which limits our understanding of individual differences in negative emotional eating. In this study, we used a person-oriented approach, latent class analysis (LCA), to examine the negative emotional eating patterns and to characterize these patterns in a sample of 1,068 Chinese young adults (52.6% females, aged 17-24 years). Negative emotional eating was measured by the Emotional Over-Eating and Emotional Under-Eating subscales of the Adult Eating Behavior Questionnaire. Four patterns, namely, "non-emotional eating" (38.9%), "emotional over- and under-eating" (15.4%), "emotional over-eating" (14.7%), and "emotional under-eating" (31.0%), were identified. Sex and BMI were found to be statistically significant predictors for negative emotional eating patterns. The identified four patterns showed significant differences in eating disorder symptoms and psychological distress. Particularly, participants in emotional over- and under-eating exhibited the highest level of eating disorder symptoms and psychological distress. Overall, this study identified four distinct negative emotional eating patterns, among which, the emotional over- and under-eating was the most problematic. Future studies regarding negative emotional eating and its impact on mental health may benefit from focusing not only on individuals with emotional over-eating, but also on those showing a mixed pattern of negative emotional eating.

A look at the intergenerational associations between self-compassion, body esteem, and emotional eating within dyads of mothers and their adult daughters

Research has demonstrated that mothers transmit body-related attitudes and eating behaviors to their daughters, but little is known about the role of self-compassion-treating oneself with kindness and being mindful about one's experiences-in this transmission. This research examined the intrapersonal and interpersonal associations between mothers' and daughters' self-compassion, body esteem (i.e., positive self-evaluations about one's appearance), and emotional eating (i.e., the tendency to eat in response to negative affect). Dyads (N = 191) of Canadian mothers (mean age: 57.37) and daughters (mean age: 28.76) completed self-report questionnaires. Dyadic, structural equation modeling and bootstrapping analyses were conducted to examine relationships among the study variables. Controlling for mothers' and daughters' body mass index, self-compassionate mothers and daughters reported higher body esteem. Additionally, daughters of self-compassionate mothers were more self-compassionate and had higher body esteem, which in turn predicted lower emotional eating. Adding to the literature on the intergenerational transmission of eating-related attitudes and behaviors, results suggest a relation between mother and daughter self-compassion, body esteem, and eating behaviors. Results also showed that attitudes toward oneself were related to eating behaviors. Mothers' self-compassion might provide a model for daughters, which in turn is associated with daughters' improved body esteem and eating behaviors.

Concept d’alimentation émotionnelle : mesure et données expérimentales

Le concept d’alimentation émotionnelle (emotional eating) peut se définir comme le fait de moduler la consommation alimentaire en réponse à un ressenti émotionnel plutôt qu’à celui de la faim ou de la satiété . Il postule l’existence d’une association étroite entre la régulation homéostasique de la prise alimentaire et de l’humeur, que l’affectivité ferait partie des traits psychologiques qui augmentent ou diminuent la consommation alimentaire et le contrôle du poids. Les mécanismes mis en cause sont les mêmes que ceux incriminés dans les abus de substances ou certaines addictions comportementales : la nourriture serait utilisée pour « s’automédiquer » d’un ressenti déplaisant. Actuellement, un recours à la prise alimentaire pour se réconforter d’un éprouvé négatif est de plus en plus mis en cause dans la surconsommation (overeating) et l’obésité , ainsi que dans les différents sous-types de troubles du comportement alimentaire . Si ces études suggèrent bien qu’adopter un comportement alimentaire « de réconfort » peut avoir des effets délétères pour la santé, on ne sait pas encore dans quelles mesures certaines ou toutes les émotions sont associées à des modifications importantes de la prise alimentaire, quel(s) rôle(s) de médiation peuvent avoir différentes stratégies de régulation émotionnelle ou comportementale. Pourtant, le recours à l’alimentation émotionnelle, au même titre que l’abus de substances, serait en augmentation ces 20 dernières années , et des associations entre un comportement alimentaire « de réconfort » avec des indicateurs de mal être ou de mauvaise santé mentale (ex. stress, burn-out, dépression), en plus de problèmes de poids, commencent à être rapportées. Mieux identifier si toutes ou certaines émotions favorisent l’émergence de l’alimentation émotionnelle, et quelles sont les personnes les plus vulnérables, permettrait de développer des stratégies thérapeutiques plus ciblées et donc potentiellement plus efficaces.

Étude psychométrique des facteurs émotionnels et motivationnels impliqués dans la prise alimentaire

Le concept d’alimentation émotionnelle se définit comme le fait de moduler la consommation alimentaire en réponse à un ressenti émotionnel plutôt qu’à celui de la faim ou de la satiété [1]. Il postule que l’affectivité ferait partie des traits psychologiques qui augmentent ou diminuent la consommation alimentaire et le contrôle du poids. Le recours à l’alimentation émotionnelle est de plus en plus mis en cause dans la surconsommation (overeating) et l’obésité [2], et les différents sous-types de troubles du comportement alimentaire [3]. Si des études suggèrent qu’adopter un comportement alimentaire « de réconfort » peut avoir des effets délétères, on ne sait pas encore dans quelle mesure certaines ou toutes les émotions sont associées à des modifications importantes de la prise alimentaire. L’objectif de l’étude était de mieux identifier si toutes ou certaines émotions favorisent l’émergence de l’alimentation émotionnelle, et quelles sont les personnes les plus vulnérables. Des étudiants (n = 149 ; âge = 21,5 ± 2,9 ; 81,9 % femmes) ont complété des évaluations de l’alimentation émotionnelle (EMAQ), l’alimentation intuitive (IES), l’addiction à l’alimentation (YFAS) ainsi que la personnalité affective (ANPS). Des corrélations bivariées (Spearman) et des régressions linéaires ont été menées. L’effet de la catégorie d’IMC a été analysé par des tests de Mann-Withney. On retrouve des associations significatives entre la personnalité affective et : la propension à moduler sa prise alimentaire (ex. : EMAQ-émotions négatives/ANPS-négatif Rho = –0,17, p = 0,04 ; IES-Total/ANPS-Tristesse Rho = –0,19, p = 0,03) et à présenter des symptômes d’addiction alimentaire (e.g. YFAS-Sevrage/ANPS-Tristesse Rho = 0,18, p = 0,04). L’alimentation émotionnelle et l’alimentation intuitive prédisent l’IMC (EMAQ-négatif/IMC : = 0,17, p = 0,04 ; IES-Total/IMC : = –0,17, p = 0,04). Le fait de moduler la consommation alimentaire indépendamment de la sensation de faim ou de la satiété (IES-signaux internes) est significativement plus marqué chez les étudiants en surpoids/obèses (p = 0,03). L’étude confirme l’importance de prendre en compte le recours à l’alimentation comme une stratégie potentiellement inadaptée de régulation émotionnelle et ses conséquences sur la santé.

Examining the Relationship Between Pain Intensity and Emotional Eating Among Latinos in a Federally Qualified Health Center: The Role of Anxiety Sensitivity

There is limited understanding of pain and its relationship to emotional eating among Latinos as well as knowledge about potential mechanisms that may underlie their association. We explored whether anxiety sensitivity (fear of the negative consequences of anxiety) explained the relation between pain intensity and emotional eating among a sample of Latinos. Participants were 79 (87.3% female; M_age = 42.04, SD = 12.01) predominately female Latino attendees of a Federally Qualified Health Center. As hypothesized, results indicated that pain intensity yielded a significant indirect effect through anxiety sensitivity for emotional eating. Alternative models wherein anxiety sensitivity served as the predictor and pain intensity as the indirect effect were also significant. Such novel data highlight the potential bi-directional relationship between pain intensity and anxiety sensitivity in terms of emotional eating. Overall, pain intensity and anxiety sensitivity may serve as mechanisms that underlie emotional eating among Latino adults.

The sex-specific association between autistic traits and eating behavior in childhood: An exploratory study in the general population

Children with Autism Spectrum Disorder (ASD) often exhibit problematic eating behaviors, an observation mostly based on male dominated, clinical ASD study samples. It is, however, important to evaluate both children with an ASD diagnosis and children with subclinical autistic traits as both often experience difficulties. Moreover, considering the suggestion of a possible girl-specific ASD phenotype, there is a need to determine whether autistic traits are related with problematic eating behaviors in girls as well. This study explores the sex-specific association between autism (both autistic traits and diagnosed ASD) and eating behavior in middle childhood in Generation R, a prospective population-based cohort from fetal life onwards. We collected parental reports of autistic traits at six years (Social Responsiveness Scale) and of eating behavior at ten years (Children's Eating Behaviour Questionnaire). In this cohort of 3559 children, autistic traits at six years were associated with more Picky Eating, Emotional Eating and Food Responsiveness in later childhood (e.g. adjusted B for Picky Eating = 0.07; 95% CI: 0.03, 0.11). Stratified analyses showed that in girls, autistic traits were associated with more Emotional Overeating and Emotional Undereating (e.g. adjusted B for Emotional Undereating = 0.12; 95% CI: 0.04, 0.20), while no associations were found for boys. Results comparing children with and without an ASD diagnosis in the cohort largely confirm these associations (e.g. in girls, adjusted B for Emotional Undereating = 0.72; 95% CI: 0.01, 1.42). Our results point to a sex-specific association between autism and eating behavior in middle childhood. Also, our study is the first study to show that autistic traits are associated with emotionally based eating problems in girls and possibly represent part of a girl-specific ASD phenotype.

Emotion dysregulation and body mass index: The explanatory role of emotional eating among adult smokers

There is limited understanding of the relationship between emotion dysregulation and weight gain among smokers, although available data suggest there are potential relationships that may be of clinical importance. The present study explored a potential mechanism in the relationship between emotion dysregulation and body mass index (BMI). Specifically, the current study examined the indirect effects of emotional eating on the association between emotion dysregulation and BMI among smokers. Participants included 136 (52.2% female; M_age = 42.25, SD = 11.24) adults who were treatment-seeking smokers. Primary analysis included one regression-based model, wherein emotion dysregulation served as the predictor, emotional eating as the intermediary variable, and BMI as the criterion variable. Covariates were age and gender. Results indicated that emotional dysregulation was significantly associated with BMI through emotional eating (a*b = 0.02, SE = 0.01, CI_95% = 0.002, 0.042). The current findings provide initial empirical evidence that greater reported levels of emotion dysregulation may be associated with greater reported levels of emotional eating, which in turn, may be related to higher BMI.

Binge eating-related concerns and depressive symptoms in young adulthood: Seven-year longitudinal associations and differences by race/ethnicity

OBJECTIVE

To examine longitudinal associations between binge eating-related concerns (i.e., cognitions associated with binge eating, such as embarrassment over amount eaten and fear of losing control over eating) and depressive symptoms among U.S. young adults and assess whether associations differ by race/ethnicity.

METHODS

This study used longitudinal data from Waves III (baseline; mean age = 21.77 years) and IV (follow-up; mean age = 28.76 years) of the National Longitudinal Study of Adolescent to Adult Health (N = 12,040). Linear regression models were run to examine associations between binge eating-related concerns at baseline and depressive symptoms at follow-up, adjusting for demographic covariates, baseline body mass index, and baseline depressive symptoms.

RESULTS

At baseline, 5.9% of participants reported embarrassment over amount eaten, 2.1% reported fear of losing control over eating, and 0.9% reported both binge eating-related concerns. In adjusted models, embarrassment over amount eaten (B = 0.81, p < .001), fear of losing control over eating (B = 1.57, p < .001), and endorsement of both binge eating-related concerns (B = 1.75, p < .001) at baseline were associated with higher depressive symptoms seven years later. The association between fear of losing control over eating and depressive symptoms differed by race/ethnicity (p = .001). Fear of losing control over eating was associated with higher depressive symptoms among non-Hispanic whites (B = 2.51, p < .001) and Asians/Pacific Islanders (B = 2.54, p = .009) but not among non-Hispanic blacks (B = -0.55, p = .48) or Hispanics/Latinos (B = -0.11, p = .92).

DISCUSSION

Binge eating-related concerns may contribute to depression risk among young adults, particularly among non-Hispanic whites and Asians/Pacific Islanders. Early identification of these cognitions and early intervention may help reduce depression risk in young adulthood.

Emotional eating and temperamental traits in Eating Disorders: A dimensional approach

Growing evidence shows that temperamental features and emotional dysregulation are linked to Eating Disorders (EDs). Aim of this study was to explore the possible relationship between temperament and emotional eating (EE) from a dimensional standpoint, and the association of specific temperamental dimensions with overeating triggered by specific emotions. We enrolled 253 women with Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder. Of those, 189 (74.7%), 73 (28.8%), and 80 (31.6%) reported binge eating, purging, or restrictive behaviors, respectively (the categories are not mutually exclusive). Participants completed the Emotional Eating Scale (EES), the Temperament and Character Inventory, the Eating Disorder Examination Questionnaire (EDE-Q) and the Symptom Checklist 90-Revised (SCL-90-R). Higher Persistence scores were found in the Restriction group, while the Binge group reported lower Persistence and higher Novelty Seeking scores. The Purge group showed lower Reward Dependence, Self Directedness and Cooperativeness scores. Patients with Purge also reported lower BMI and higher scores on EDE-Q restriction and eating concern subscales as well as higher scores for all SCL 90-R subscales. Patterns of association between temperamental traits and specific emotions were found in each group. Therefore, some temperamental features could be considered predictors of specific associations between emotions and the tendency to eat.

Eating when depressed, anxious, bored, or happy: Are emotional eating types associated with unique psychological and physical health correlates?

The majority of research on emotional eating has examined general emotional eating, to the exclusion of more distinct emotions such as boredom and positive emotions. The current study aimed to examine whether specific types of emotional eating (i.e., eating in response to depression (EE-D), anxiety/anger (EE-A), boredom (EE-B), and positive emotions (EE-P)) were related to a range of psychological (i.e., global psychological well-being, eating disorder symptoms, emotion regulation) and physical health variables. A sample of adults (n = 189) with overweight/obesity were recruited via Amazon Mechanical Turk. Participants self-reported height and weight and completed a battery of questionnaires. Correlational analyses showed that more frequent EE-D, EE-A, and EE-B were related to poorer psychological well-being, greater eating disorder symptoms, and more difficulties with emotion regulation. EE-P was not significantly related to outcome variables. In regression analyses, eating in response to depression (EE-D) was the type of emotional eating most closely related to psychological well-being, eating disorder symptoms, and emotion regulation difficulties. Exploratory analyses revealed associations between EE-D, EE-A, and EE-B and facets of emotion regulation and specific disordered eating symptoms. Findings suggest that unique patterns exist between specific types of emotional eating and psychological outcomes.

The long and complex road in the search for treatment for mental disorders: An analysis of the process in five groups of patients

Seeking treatment for mental-health problems is a complex process, with different underlying motives in each stage. However, the entire process and these motives have hardly been investigated. This study aims to analyze the different stages of the help-seeking process and their underlying motives in five groups of patients with different mental disorders. In all, 156 patients seeking treatment in outpatient mental health clinics were individually interviewed: 71 had Obsessive-Compulsive Disorder (OCD), 21 had Agoraphobia (AGO), 18 had Major Depressive Disorder (MDD), 20 had Anorexia Nervosa (AN), and 22 had Cocaine Dependence (COC). The AGO and MDD patients delayed significantly less time in recognizing their mental health symptoms. Moreover, MDD patients disclosed their symptoms and searched for professional help faster than the other groups. The most relevant variables in the recognition of disorders were the loss of control over the symptoms, the interference produced by these symptoms, and their negative impact on the person's emotional state. The most frequent barriers to seeking treatment were related to minimizing the symptoms and fear of stigma. Finally, the most important motivator for seeking treatment was the awareness that minimizing the symptoms did not help to reduce them, lessen their interference, or make them disappear.

Binge eating and binge drinking among adolescents: The role of drinking and eating motives

This study aimed to investigate the motivations underlying binge eating and binge drinking in a sample of 302 adolescents. Our findings showed that binge eating was significantly correlated with gender, environmental, emotional, and social eating. Hierarchical multiple regression analysis indicated that emotional and environmental eating were significant positive predictors of binge eating, whereas binge drinking was significantly correlated with enhancement, social, and coping motives. Only enhancement motives were significant predictors of binge drinking. Our results support the argument that the reasons underlying binge eating and binge drinking in adolescents may be similar and may perform the same function.

Attitudes toward health and taste of food among women with bulimia nervosa and women of a non-clinical sample

Taste preferences and health concerns play important roles in determining eating attitudes, thus influencing food choices. Disordered eating attitudes are common among women, and can lead to the development and maintenance of eating disorders (ED). Attitudes toward health and taste of food among ED patients and its comparison with non-clinical women are not well known, and this knowledge could improve eating interventions. In this study, we compared taste preferences and health concerns in 27 women with diagnosis of bulimia nervosa (BN) and 216 women of a non-clinical sample. All participants completed the Health and Taste Attitude Scale (HTAS). Using analysis of covariance we compared the HTAS scores of the BN patients with those of the college students. Risk behaviors for ED (assessed by the Eating Attitudes Test) were identified in 54 (25%) of the non-clinical sample, all of whom were therefore excluded in comparison of BN patients. Non-clinical sample, compared to patients, scored higher on the HTAS Taste domain (p < 0.001) and its pleasure subscale (p < 0.001), whereas patients scored higher on the HTAS Health domain (p < 0.05) and its light product interest subscale (p < 0.05). Based on our data, eating attitudes of women of non-clinical sample are related to taste and pleasure, whereas women with BN are concerned with adopting a diet regarded as healthy, thus increasing their interest in "light" products. Therefore, the taste and health concerns must be considered in nutrition interventions for women in general, and prevention and treatment of ED as determinants of food choice.

Are loss of control while eating and overeating valid constructs? A critical review of the literature

BACKGROUND

Binge eating is a marker of weight gain and obesity, and a hallmark feature of eating disorders. Yet its component constructs - overeating and loss of control (LOC) while eating - are poorly understood and difficult to measure.

OBJECTIVE

The objective of this study is to critically review the human literature concerning the validity of LOC and overeating across the age and weight spectrum.

DATA SOURCES

English-language articles addressing the face, convergent, discriminant and predictive validity of LOC and overeating were included.

RESULTS

Loss of control and overeating appear to have adequate face validity. Emerging evidence supports the convergent and predictive validity of the LOC construct, given its unique cross-sectional and prospective associations with numerous anthropometric, psychosocial and eating behaviour-related factors. Overeating may be best conceptualized as a marker of excess weight status.

LIMITATIONS

Binge eating constructs, particularly in the context of subjectively large episodes, are challenging to measure reliably. Few studies addressed overeating in the absence of LOC, thereby limiting conclusions about the validity of the overeating construct independent of LOC. Additional studies addressing the discriminant validity of both constructs are warranted.

DISCUSSION

Suggestions for future weight-related research and for appropriately defining binge eating in the eating disorders diagnostic scheme are presented.

Validation and Factor Structure of the French-Language Version of the Emotional Appetite Questionnaire (EMAQ)

The concept of Emotional Eating (EE) is increasingly considered to be implicated in overeating and obesity, and in different subtypes of eating disorders. Among the self-report questionnaires assessing EE, the Emotional Appetite Questionnaire (EMAQ) includes recent advances in this area: it evaluates a broad range of emotions and situations both positive and negative, and the way they modulate food intake (decrease, stability, or increase). The main objective of our study was to further investigate the psychometric properties of the French version of the EMAQ in a large sample of students. Participants completed the EMAQ (n = 679), the DEBQ (Dutch Eating Behavior Questionnaire) (n = 75) and the CIDI-eating disorders screening (Composite International Diagnostic Interview) (n = 604). Factorial structure, reliability, and validity of the EMAQ were tested. Factorial analyses supported a two-factor (Positive and Negative) structure. The internal consistency indices were satisfactory and results suggest good test–retest reliability for the scale. Convergent and discriminant validity were confirmed from the significant correlations observed between the EMAQ scores and the DEBQ-EE subscale scores. Regarding associations with weight, whereas EMAQ negative scores were positively correlated with BMI, EMAQ positive scores were negatively correlated with BMI. Finally, EMAQ scores differed significantly depending on gender and risk for bulimia nervosa. This study supports the validity and the reliability of the EMAQ, which appears to be a promising instrument to better understand individual differences that could modulate food intake.

Negative emotions and emotional eating: the mediating role of experiential avoidance

PURPOSE

Emotional eating is a risk factor for eating pathology across the life- and weight-span. Research demonstrates that negative emotions are a precipitant of emotional eating, particularly among female college students. However, the underlying factors that explain this relationship are unclear. Experiential avoidance, a propensity toward being unwilling to remain in contact with aversive private experiences, may explain the association between negative emotions and emotional eating. The purpose of this study was to examine whether experiential avoidance would mediate the association between negative emotions and emotional eating.

METHODS

A sample of 132 women (17.4 % African American, 59.8 % White) completed measures of mood, experiential avoidance and emotional eating. Bias-corrected bootstrapping mediational analyses were conducted.

RESULTS

Experiential avoidance mediated the relationship between negative emotions and emotional eating b = -0.21, 95 % BC CI [-0.43, -0.07]. The indirect effect through experiential avoidance accounted for 9 % of the variance, which represents a medium effect (k ² = 0.09, 95 % BC CI [0.03, 0.18]).

CONCLUSIONS

Results suggest that experiential avoidance is important for understanding the relationship between negative emotions and emotional eating and may inform potential strategies for prevention and treatment.

Influence of Parental Expressed Emotions on Children's Emotional Eating via Children's Negative Urgency

We investigated whether parental expressed emotion (criticism and emotional overinvolvement) is related to children's emotional eating and whether this relationship is mediated by children's negative urgency. One hundred children, aged 8 to 13 years, either healthy or have binge-eating disorder and/or attention-deficit/hyperactivity disorder, completed the questionnaires, along with their parents. Parental criticism and, to a lesser extent, parental emotional overinvolvement were both positively related to children's emotional eating, and this relationship was mediated by children's negative urgency. Further exploratory analyses revealed that the mediating role of children's negative urgency in the relationship between parental criticism and children's emotional eating was pronounced in the clinical group of children with binge-eating disorder and attention-deficit/hyperactivity disorder but almost absent in the healthy control group. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.

The Development of a Novel Measure to Assess Motives for Compensatory Eating in Response to Exercise: The CEMQ

Compensatory eating in response to exercise may be an obstacle to achieving weight-loss and fitness goals. In this study we develop and conduct a preliminary examination of the psychometric properties of the Compensatory Eating Motives Questionnaire (CEMQ), a self-report questionnaire of motives for compensatory eating. Development and testing of the CEMQ was conducted in two student samples. Of respondents, 75% reported engaging in compensatory eating. Factor analysis yielded factors representing three domains of motives for compensatory eating: Eating for Reward, Eating for Recovery, and Eating for Relief. Internal consistency of the factors was adequate, and the factor structure was replicated. Correlations between the CEMQ subscales and trait questionnaires supported hypotheses for convergent and divergent validity. These results encourage further investigation of compensatory eating as a potential obstacle to weight loss, and support the continued assessment of the CEMQ as a tool to measure three conceptually distinct motives for compensatory eating.