Emotional Food Craving Across the Eating Disorder Spectrum – An Ecological Momentary Assessment Study

Abstract

Introduction. Emotional eating might underlie disordered eating behavior as suggested by the affect regulation model in binge-type eating disorders (EDs; binge-eating in response to negative emotions) and the emotion avoidance model in restrictive-type EDs (food restriction to avoide negative emotions). Positive affect by contrast seems to promote healthier eating behavior. However, comprehensive, naturalistic research on these acccounts across eating disorders is scarce.Method. Healthy participants (CG, n=85), and patients with Binge-Eating Disorder (BED, n=41), Bulimia Nervosa (BN, n=50), binge-purge (ANbp, n=26), and restrictive Anorexia Nervosa (ANr, n=29) participated in an Ecological Momentary Assessment study. Six notifications/day, across eight days prompted ratings of momentary food craving (FC) and affective states–differing in valence and arousal. Results. FC-patterns differed as a function of valence and arousal: During negative valence high arousal states (NegHigh) BN reported higher FC compared to CG (in line with affect regulation accounts). Compared to ANbp, ANr reported higher FC, while ANbp reported lower FC during NegHigh. During negative valence low arousal states (NegLow) ANbp reported lower FC compared to CG (in line with emotion avoidance accounts). Results also revealed beneficial effects of positive affect (Pos): During Pos (regardless of arousal) FC-levels in both AN groups approached healthy CG levels. During positive valence low arousal states (PosLow) FC-levels in BED approached healthy CG levels.Discussion. This suggests that emotion regulation and food exposure trainings might help during negative affective states across the ED spectrum, while fostering positive emotions might aid in reducing acute restriction (AN) or binge-eating urges (BED).