title: Behavioral, emotional, and situational context of purging episodes in anorexia nervosa.
abstract: OBJECTIVE
  The current study examined behavioral, emotional, and situational factors involved in purging among women with anorexia nervosa (AN).
  
  
  METHODS
  Women with AN (n=118) completed a two-week ecological momentary assessment protocol involving daily reports of eating disorder behaviors, mood, and stressful events. Generalized estimating equations examined the likelihood and context of purging following eating episodes involving both overeating and loss of control (binge eating; BE); loss of control only (LOC); overeating only (OE); and neither loss of control nor overeating (non-pathological eating; NE).
  
  
  RESULTS
  Relative to NE, purging was more likely to occur following BE, LOC, and OE (Wald chi-square = 18.05; p < .001). BE was more strongly associated with subsequent purging than LOC but not OE; the latter two did not differ from one another. Negative affect predicted purging following NE (Wald chi-square = 7.71; p = .005).
  
  
  CONCLUSIONS
  Binge eating involving large amounts of food was the strongest predictor of purging in AN, which challenges the notion that loss of control is the most salient aspect of experiencing distress in bulimia nervosa and BE disorder. Parallel to findings from the BE literature, negative affect strongly predicted purging following NE. Further research should clarify the function and triggers of purging in AN.
authors: Department of Psychiatry and Behavioral Neuroscience, the University of Chicago, Chicago, Illinois.
authors: Andrea B
authors: AB
authors: Goldschmidt
authors: Erin C
authors: EC
authors: Accurso
authors: Deanna N
authors: DN
authors: Schreiber-Gregory
authors: Ross D
authors: RD
authors: Crosby
authors: Li
authors: L
authors: Cao
authors: Scott G
authors: SG
authors: Engel
authors: James E
authors: JE
authors: Mitchell
authors: Scott J
authors: SJ
authors: Crow
authors: Carol B
authors: CB
authors: Peterson
authors: Daniel
authors: D
authors: Le Grange
authors: Stephen A
authors: SA
authors: Wonderlich
mesh_terms: D000328:Adult; D000339:Affect; D000856:Anorexia Nervosa / Q000523:psychology*; D056912:Binge-Eating Disorder / Q000523:psychology; D052018:Bulimia Nervosa / Q000523:psychology; D004644:Emotions; D005247:Feeding Behavior / Q000523:psychology; D005260:Female; D006801:Humans; D006963:Hyperphagia / Q000523:psychology; D008016:Life Change Events
keywords: anorexia nervosa; binge eating; compensatory behaviors; ecological momentary assessment; loss of control; overeating; purging
references: Appetite. 2004 Oct;43(2):155-73
references: 15458802
references: Psychol Bull. 1991 Jul;110(1):86-108
references: 1891520
references: Aust N Z J Psychiatry. 1996 Dec;30(6):839-44
references: 9034475
references: Neuroscience. 2006;139(3):813-20
references: 16460879
references: J Consult Clin Psychol. 2007 Dec;75(6):901-13
references: 18085907
references: Int J Eat Disord. 2009 May;42(4):371-4
references: 19040266
references: Int J Eat Disord. 2009 Nov;42(7):590-4
references: 19598270
references: Int J Eat Disord. 2009 Dec;42(8):674-86
references: 19610126
references: Psychol Bull. 2011 Jul;137(4):660-81
references: 21574678
references: Eur Eat Disord Rev. 2012 Nov;20(6):451-60
references: 22696277
references: J Abnorm Psychol. 2013 Aug;122(3):672-83
references: 23647124
references: J Abnorm Psychol. 2013 Aug;122(3):709-19
references: 24016011
references: J Consult Clin Psychol. 2014 Feb;82(1):30-9
references: 24219182
references: Int J Eat Disord. 2015 Apr;48(3):305-11
references: 25195932
references: Physiol Behav. 2012 Jun 6;106(3):332-6
references: 22465312