title: The role of affect in the maintenance of anorexia nervosa: evidence from a naturalistic assessment of momentary behaviors and emotion.
abstract: The current study examines the relationship of affect and eating disorder behavior in anorexia nervosa (AN) using ecological momentary assessment. Participants were 118 adult females recruited at three sites from eating disorder treatment centers and community advertisements. All participants met full Diagnostic and statistical manual of mental disorders (4th ed.) criteria or subthreshold criteria for AN. Participants were provided handheld computers and asked to report positive affect, negative affect, loss of control (LOC) eating, purging, exercise, drinking fluids to curb appetite, and weighing one's self multiple times per day as well as dietary restriction once daily over a 2-week interval. Mixed-effects models were used to examine the extent to which affective states predict dietary restriction. In addition, we used two analytic approaches to compare affect before and after other eating disorder behaviors. We found that higher daily ratings of negative affect were associated with a greater likelihood of dietary restriction on subsequent days. When examining the single rating immediately before and after behaviors, we found that negative affect increased significantly after LOC eating, purging, the combination of LOC and eating/purging, and weighing of one's self. Using this same analytic approach, we also found negative affect to decrease significantly after the consumption of fluids to curb appetite and exercise. When examining the covariation of AN behaviors and negative affect assessed multiple times in the hours and minutes before the behaviors, we found negative affect significantly increased before LOC eating, purging, the combination of LOC eating/and purging, and weighing behavior. Negative affect also significantly decreased after the occurrence of these behaviors. These findings are consistent with the idea that that negative affect is potentially a critical maintenance mechanism of some AN symptoms, but that the analytic approach used to examine affect and behavior may have significant implications on the interpretation of findings.
authors.affiliation: Neuropsychiatric Research Institute.
authors.forename: Scott G
authors.initials: SG
authors.lastname: Engel
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Wonderlich
authors.forename: Ross D
authors.initials: RD
authors.lastname: Crosby
authors.forename: James E
authors.initials: JE
authors.lastname: Mitchell
authors.forename: Scott
authors.initials: S
authors.lastname: Crow
authors.forename: Carol B
authors.initials: CB
authors.lastname: Peterson
authors.forename: Daniel
authors.initials: D
authors.lastname: Le Grange
authors.forename: Heather K
authors.initials: HK
authors.lastname: Simonich
authors.forename: Li
authors.initials: L
authors.lastname: Cao
authors.forename: Jason M
authors.initials: JM
authors.lastname: Lavender
authors.forename: Kathryn H
authors.initials: KH
authors.lastname: Gordon
mesh_terms: D000293:Adolescent; D000328:Adult; D000339:Affect; D000856:Anorexia Nervosa / Q000523:psychology*; D004038:Diet, Reducing / Q000523:psychology; D015444:Exercise / Q000523:psychology; D005247:Feeding Behavior / Q000523:psychology*; D005260:Female; D006801:Humans; D007389:Internal-External Control; D008875:Middle Aged; D055815:Young Adult
references.citation: Clin Psychol Rev. 2003 Feb;23(1):57-74
references.pmid: 12559994
references.citation: Psychol Med. 2010 Nov;40(11):1887-97
references.pmid: 20102669
references.citation: Int J Eat Disord. 2000 Jul;28(1):8-19
references.pmid: 10800009
references.citation: Int J Eat Disord. 2009 May;42(4):318-25
references.pmid: 19115372
references.citation: Int J Eat Disord. 2007 Sep;40(6):521-30
references.pmid: 17573697
references.citation: Stat Med. 1992 Oct-Nov;11(14-15):1825-39
references.pmid: 1480876
references.citation: Compr Psychiatry. 2007 Mar-Apr;48(2):124-31
references.pmid: 17292702
references.citation: Br J Clin Psychol. 2011 Sep;50(3):310-25
references.pmid: 21810109
references.citation: Eat Behav. 2009 Aug;10(3):184-91
references.pmid: 19665102
references.citation: Clin Psychol Psychother. 2009 Jul-Aug;16(4):348-56
references.pmid: 19517577
references.citation: Int J Eat Disord. 2003 Nov;34(3):349-60
references.pmid: 12949927
references.citation: Behav Res Ther. 2009 Oct;47(10):897-900
references.pmid: 19631931
references.citation: J Psychiatry Neurosci. 2010 Jul;35(4):267-74
references.pmid: 20598239
references.citation: Psychopharmacol Bull. 1997;33(3):381-90
references.pmid: 9550882
references.citation: J Consult Clin Psychol. 2007 Aug;75(4):629-38
references.pmid: 17663616
references.citation: Am J Psychiatry. 2001 Apr;158(4):632-4
references.pmid: 11282700
references.citation: Psychol Bull. 2002 Sep;128(5):825-48
references.pmid: 12206196
references.citation: J Pers Soc Psychol. 1988 Jun;54(6):1063-70
references.pmid: 3397865
references.citation: Psychol Bull. 2011 Jul;137(4):660-681
references.pmid: 21574678
references.citation: Am J Psychiatry. 2004 Dec;161(12):2215-21
references.pmid: 15569892
references.citation: Int J Eat Disord. 2011 Sep;44(6):531-9
references.pmid: 20957704
references.citation: Int J Eat Disord. 2010 Jul;43(5):398-404
references.pmid: 19670226
references.citation: Psychiatry Res. 2012 May 15;197(1-2):103-11
references.pmid: 22401969
references.citation: Br J Clin Psychol. 2006 Sep;45(Pt 3):343-66
references.pmid: 17147101
references.citation: Nat Rev Neurosci. 2009 Aug;10(8):573-84
references.pmid: 19603056
references.citation: Psychol Bull. 1991 Jul;110(1):86-108
references.pmid: 1891520
references.citation: Compr Psychiatry. 2012 Jul;53(5):496-501
references.pmid: 22036318
references.citation: Int J Eat Disord. 2007 Apr;40(3):271-6
references.pmid: 17177212
references.citation: Int J Eat Disord. 2011 Jul;44(5):421-7
references.pmid: 20721894
references.citation: Behav Res Ther. 2011 Oct;49(10):714-7
references.pmid: 21764036
references.citation: Int J Eat Disord. 2008 Dec;41(8):748-54
references.pmid: 18528869
references.citation: Biol Psychiatry. 2007 Feb 1;61(3):348-58
references.pmid: 16815322
references.citation: Int J Eat Disord. 2005 Dec;38(4):335-9
references.pmid: 16261606