title: A naturalistic examination of negative affect and disorder-related rumination in anorexia nervosa.
abstract: In anorexia nervosa (AN), volitional inhibition of rewarding behaviors, such as eating, involves a conflict between the desire to suppress appetite and the inherent motive to consume. This conflict is thought to have costs that carry over into daily life, e.g., triggering negative affect and/or recurring ruminations, which may ultimately impact long term outcome. Hence, increasing research effort is being dedicated to understand the link between emotional and ruminative processes in the etiology and maintenance of AN. We investigated whether affective states influence disorder-related rumination in AN applying "ecological momentary assessment", a method which allows the experimenter to gain insight into psychological processes in the natural environment and assess data in real time. Participants (AN = 37, healthy controls = 33) were given a smartphone for 14 days. A ringtone signaled at six random time-points each day to fill in a questionnaire, which gauged disorder-typical thoughts about food and weight as well as affective state. Analyses, applying hierarchical linear models confirmed that AN patients spend more time thinking about food, body shape and weight than controls (p < 0.001). Additionally, the results support the hypothesis that momentary negative affect (but not baseline depression (p = 0.56) or anxiety symptoms (p = 0.60) are positively associated with a higher amount of disorder-related rumination in patients (p < 0.001). Our findings are in line with theories which claim that ruminative thinking induces a vulnerability to negative stimuli which, in turn, fosters heightened negative affect. Thus, therapeutic interventions could be improved by implementing modules that specifically target disorder-related rumination.
authors.affiliation: Translational Developmental Neuroscience Section, Eating Disorder Services and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, University Hospital C. G. Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
authors.forename: Maria
authors.initials: M
authors.lastname: Seidel
authors.affiliation: Translational Developmental Neuroscience Section, Eating Disorder Services and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, University Hospital C. G. Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
authors.forename: Juliane
authors.initials: J
authors.lastname: Petermann
authors.affiliation: International School of Management and Technical University of Dortmund, Dortmund, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Diestel
authors.affiliation: Translational Developmental Neuroscience Section, Eating Disorder Services and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, University Hospital C. G. Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
authors.forename: Franziska
authors.initials: F
authors.lastname: Ritschel
authors.affiliation: Translational Developmental Neuroscience Section, Eating Disorder Services and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, University Hospital C. G. Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
authors.forename: Ilka
authors.initials: I
authors.lastname: Boehm
authors.affiliation: Translational Developmental Neuroscience Section, Eating Disorder Services and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, University Hospital C. G. Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: King
authors.affiliation: Translational Developmental Neuroscience Section, Eating Disorder Services and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, University Hospital C. G. Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Geisler
authors.affiliation: Translational Developmental Neuroscience Section, Eating Disorder Services and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, University Hospital C. G. Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
authors.forename: Fabio
authors.initials: F
authors.lastname: Bernardoni
authors.affiliation: Translational Developmental Neuroscience Section, Eating Disorder Services and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, University Hospital C. G. Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
authors.forename: Veit
authors.initials: V
authors.lastname: Roessner
authors.affiliation: Department of Psychology, Technische Universität Dresden, Dresden, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Goschke
authors.affiliation: Translational Developmental Neuroscience Section, Eating Disorder Services and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, University Hospital C. G. Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany. transden.lab@uniklinikum-dresden.de.
authors.forename: Stefan
authors.initials: S
authors.lastname: Ehrlich
mesh_terms: D000293:Adolescent; D000328:Adult; D000339:Affect / Q000502:physiology*; D000856:Anorexia Nervosa / Q000503:physiopathology*; D002648:Child; D000072860:Ecological Momentary Assessment; D005260:Female; D006801:Humans; D013850:Thinking / Q000502:physiology*; D055815:Young Adult
keywords: Anorexia nervosa; Ecological momentary assessment; Negative affect; Rumination