Anhedonia, positive affect dysregulation, and risk and maintenance of binge‐eating disorder

Abstract

Low positive affect has been identified as an antecedent of binge‐eating episodes among individuals with binge‐eating disorder (BED), yet positive affect has received far less attention in eating disorders research than its counterpart, negative affect. In this article, we argue that the low levels of positive affect which occur with anhedonia (i.e., loss of interest or pleasure in activities) may contribute to the onset and maintenance of BED. We introduce a theoretical model in which anhedonia increases the risk for BED through its interrelationships with dysregulated eating and weight gain, and we describe potential direct (e.g., reward‐related processes) as well as indirect (e.g., influences on depressive symptoms and physical activity) pathways by which anhedonia may lead to adverse eating‐ and weight‐related outcomes. We also propose a momentary maintenance model in which low positive affect and positive affect dysregulation occurring with anhedonia maintain binge eating directly and indirectly through maladaptive health behaviors, such as decreased physical activity, less healthy eating, and fewer social interactions, which in turn maintain anhedonia. We draw upon outside literature to present evidence that aligns with the proposed risk and maintenance models and conclude by outlining avenues for future research—including methodological/measurement, theoretical, and clinical research directions.

The Effects of Anhedonia in Social Context

“…Individuals with depressive symptoms are more likely to feel lonely [33], spend time alone [34], or around individuals with similar levels of depression, or with one other person, rather than a group [35]. Fewer social interactions increase anhedonia and contribute to binge-eating in people with disordered eating [36]. Furthermore, difficulty describing feelings, social anxiety, and social avoidance characterize adolescent females with eating disorders [37].…”

“…For instance, socially anxious young adults use alcohol to increase positive affect during social situations [45]. Dysregulated positive affect also plays a role in both extremes of disordered eating, with social interactions contributing to this association [36,38] Although positive affect does not consistently predict social experiences [46], subjective social competence appears to be associated with positive affect in a reciprocal direction. This means that maintaining high positive affect could be challenging for people with mental health symptoms that compromise social skills, either subjectively or objectively.…”

Changes in affect from non-eating activity engagement as predictors of loss of control eating: an ecological momentary assessment study

“…More recently, low positive affect (PA) has also been recognized as a maintenance factor for LOCE [ 11 , 12 ]. Individuals with LOCE have been found to experience lower overall and within-day levels of PA [ 9 , 13 ].…”

“…Individuals with LOCE have been found to experience lower overall and within-day levels of PA [ 9 , 13 ]. Accordingly, expansions to the affect regulation model argue that individuals may also engage in LOCE to increase PA due to a lack of adaptive pleasurable activities in their day-to-day lives [ 11 ]. EMA studies have supported these expansions by finding that low PA precedes the near-time occurrence of a LOCE episode, and that PA stabilizes following engagement in this behavior [ 9 , 10 , 14 ].…”

The role of emotion regulation in eating disorders: a network meta-analysis approach

“…Emotion regulation strategies can be broadly divided into adaptive strategies, including emotional awareness, acceptance and cognitive reappraisal, and maladaptive strategies, such as avoidance and suppression of emotions (Aldao, Nolen-Hoeksema, & Schweizer, 2010b;Gross, 2015). Although the maladaptive strategies can be useful in some scenarios, excessive reliance on these methods to manage emotions has been linked to various psychiatric conditions including eating disorders (EDs) (Aldao, Nolen-Hoeksema, & Schweizer, 2010a;Mason et al, 2021;Oldershaw, Lavender, Sallis, Stahl, & Schmidt, 2015;Trompeter, Bussey, Forbes, & Mitchison, 2021). Thus, further investigation of the role of emotions regulation in EDs is of interest.…”