Ecological momentary assessment of stressful events and negative affect in bulimia nervosa.
OBJECTIVE
Negative affect precedes binge eating and purging in bulimia nervosa (BN), but little is known about factors that precipitate negative affect in relation to these behaviors. We aimed to assess the temporal relation among stressful events, negative affect, and bulimic events in the natural environment using ecological momentary assessment.


METHODS
A total of 133 women with current BN recorded their mood, eating behavior, and the occurrence of stressful events every day for 2 weeks. Multilevel structural equation mediation models evaluated the relations among Time 1 stress measures (i.e., interpersonal stressors, work/environment stressors, general daily hassles, and stress appraisal), Time 2 negative affect, and Time 2 binge eating and purging, controlling for Time 1 negative affect.


RESULTS
Increases in negative affect from Time 1 to Time 2 significantly mediated the relations between Time 1 interpersonal stressors, work/environment stressors, general daily hassles, and stress appraisal and Time 2 binge eating and purging. When modeled simultaneously, confidence intervals for interpersonal stressors, general daily hassles, and stress appraisal did not overlap, suggesting that each had a distinct impact on negative affect in relation to binge eating and purging.


CONCLUSIONS
Our findings indicate that stress precedes the occurrence of bulimic behaviors and that increases in negative affect following stressful events mediate this relation. Results suggest that stress and subsequent negative affect may function as maintenance factors for bulimic behaviors and should be targeted in treatment.
Department of Psychiatry and Behavioral Neuroscience, The University of Chicago.
Andrea B
AB
Goldschmidt
Department of Clinical Research, Neuropsychiatric Research Institute.
Stephen A
SA
Wonderlich
Department of Clinical Research, Neuropsychiatric Research Institute.
Ross D
RD
Crosby
Department of Clinical Research, Neuropsychiatric Research Institute.
Scott G
SG
Engel
Department of Clinical Research, Neuropsychiatric Research Institute.
Jason M
JM
Lavender
Department of Psychiatry, University of Minnesota Medical School.
Carol B
CB
Peterson
Department of Psychiatry, University of Minnesota Medical School.
Scott J
SJ
Crow
Department of Clinical Research, Neuropsychiatric Research Institute.
Li
L
Cao
Department of Clinical Research, Neuropsychiatric Research Institute.
James E
JE
Mitchell
D000293:Adolescent; D000328:Adult; D000339:Affect; D002032:Bulimia / Q000523:psychology*; D052018:Bulimia Nervosa / Q000523:psychology*; D005247:Feeding Behavior / Q000523:psychology; D005260:Female; D006801:Humans; D008016:Life Change Events; D013315:Stress, Psychological / Q000523:psychology*; D055815:Young Adult