title: Aversive tension in female adolescents with Anorexia Nervosa: a controlled ecological momentary assessment using smartphones.
abstract: BACKGROUND
  Current models of Anorexia Nervosa (AN) emphasize the role of emotion regulation. Aversive tension, described as a state of intense arousal and negative valence, is considered to be a link between emotional events and disordered eating. Recent research focused only on adult patients, and mainly general emotion regulation traits were studied. However, the momentary occurrence of aversive tension, particularly in adolescents with AN, has not been previously studied.
  
  
  METHODS
  20 female adolescents with AN in outpatient treatment and 20 healthy adolescents aged 12 to 19 years participated in an ecological momentary assessment using their smartphones. Current states of aversive tension and events were assessed hourly for two consecutive weekdays. Mean and maximum values of aversive tension were compared. Multilevel analyses were computed to test the influence of time and reported events on aversive tension. The effect of reported events on subsequent changes of aversive tension in patients with AN were additionally tested in a multilevel model.
  
  
  RESULTS
  AN patients showed higher mean and maximum levels of aversive tension. In a multilevel model, reported food intake was associated with higher levels of aversive tension in the AN group, whereas reported school or sport-related events were not linked to specific states of aversive tension. After food intake, subsequent increases of aversive tension were diminished and decreases of aversive tension were induced in adolescents with AN.
  
  
  CONCLUSIONS
  Aversive tension may play a substantial role in the psychopathology of AN, particular in relation with food intake. Therefore, treatment should consider aversive tension as a possible intervening variable during refeeding. Our findings encourage further research on aversive tension and its link to disordered eating.
  
  
  BACKGROUND
  German register of clinical trials (DRKS): DRKS00005228 (Date of registration: September 2, 2013).
authors.affiliation: Department for Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany. david.kolar@unimedizin-mainz.de.
authors.forename: David R
authors.initials: DR
authors.lastname: Kolar
authors.affiliation: Department for Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Hammerle
authors.affiliation: Department for Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.|Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.
authors.forename: Ekkehart
authors.initials: E
authors.lastname: Jenetzky
authors.affiliation: Department for Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Huss
authors.affiliation: Department for Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.|Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany.
authors.forename: Arne
authors.initials: A
authors.lastname: Bürger
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care; D000856:Anorexia Nervosa / Q000523:psychology*; D001143:Arousal; D002648:Child; D004644:Emotions; D005260:Female; D005858:Germany; D006801:Humans; D000068997:Smartphone; D055815:Young Adult
keywords: Adolescence; Anorexia nervosa; Aversive tension; Eating disorder; Ecological momentary assessment; Emotion regulation; Smartphones