Affect regulation and purging: An ecological momentary assessment study in purging disorder.

Abstract

Research suggests that affect may play an important role in the propensity to purge among women with Purging Disorder (PD). However, prior work has been constrained to cross-sectional or laboratory designs which impact temporal interpretations and ecological validity. This study examined the role of negative affect (NA) and positive affect (PA) in triggering and maintaining purging in PD using ecological momentary assessment. Women with PD (N=24) made multiple daily ratings of affect and behavior for two weeks. Multilevel models examined associations between affect and purging at different levels of analysis, including a novel analytic approach to address the specificity of changes in affect relative to purging behavior by comparing trajectories of change on purge versus non-purge days. For trajectories of affect over time, NA increased before purging and decreased following purging on purge days; however, only the decrease in NA following purging was significantly different from the trajectory of NA on non-purge days. Conversely, PA failed to increase before purging on purge days compared to a matched time-point on non-purge days. These findings suggest unique roles of PA in triggering and NA in maintaining purging in PD and support models in which purging functions to regulate affect. For comparisons of ratings before and after purging, NA increased and PA decreased after purging, highlighting how different analytic strategies produce different findings requiring integration into affect regulation models. These data provide insight into why women with PD purge after consuming normal amounts of food, a crucial first step for developing effective interventions.

Emotional Response Inhibition: A Shared Neurocognitive Deficit in Eating Disorder Symptoms and Nonsuicidal Self-Injury

“…Consistent with this notion, the most commonly reported function of NSSI and ED behaviors is to reduce negative affect [19][20][21][22][23][24][25]. Ecological momentary assessment corroborates the idea that direct and indirect self-injury are both motivated by a desire to alleviate unpleasant emotional states, as increased negative affect proximally predicts episodes of NSSI, dysregulated eating, and compensatory behaviors [26][27][28][29][30][31][32].Much like emotion dysregulation, impulsivity is implicated in various psychiatric disorders and self-injurious behaviors. This multifaceted construct encompasses several subfactors, including impulsive personality traits and impulsive behavior, or motor impulsivity.…”

Incremental validity of the episode size criterion in binge‐eating definitions: An examination in women with purging syndromes

“…The first group reflects those with BN, for whom binge eating episodes are a known trigger of purging. The second group may comprise individuals with PD whose purging behavior is triggered by the act of eating in the presence of shape concerns or other triggers, such as changes in positive and negative affect rather than “pathological overeating” or feelings of LOC. Importantly, regardless of our approach to recruitment, if PD and BN merely represented the same disorder of LOC eating and compensatory behavior residing on different ends of an irrelevant continuum of eating episode size, one would not expect this interaction.…”

“…Data were drawn from women with BN purging subtype ( n = 141) and PD ( n = 102) who participated in one of four studies examining psychological and/or biological correlates of eating pathology in BN and PD . Recruitment methods across studies were identical and involved mass e‐mails to college women, posters and paid advertisements in the community.…”

“…ICC for purging frequency, available for three of the parent studies, [35][36][37] was excellent at 0.99. Interrater reliability for diagnosis in the parent studies from which these data come was excellent (Kappa range: 0.91-1.00 [35][36][37] and 100% agreement 34 ). In addition to using the EDE to operationalize the key variables of LOC eating frequency and eating episode size, the EDE total score was used as a measure of eating disorder severity, Cronbach's alpha 5 0.84.…”

“…Data were drawn from women with BN purging subtype (n 5 141) and PD (n 5 102) who participated in one of four studies examining psychological and/or biological correlates of eating pathology in BN and PD. [34][35][36][37] Recruitment methods across studies were identical and involved mass e-mails to college women, posters and paid advertisements in the community. For inclusion in the present study, participants met criteria either for DSM-5 BN or research criteria for PD, 38 which is differentiated from BN by the absence of recurrent OBEs (e.g., episodes > 1000 kcal).…”