Nothing Tastes as Good as Thin Feels

Abstract

Anorexia nervosa is a disorder characterized by much mental and physical suffering, as exemplified by a high overall mortality rate (Papdopoulos, Ekborn, Brandt, & Ekselius, 2009) and elevated suicidal behavior . Accordingly, several studies have identified that eating-disordered behaviors (including binge eating, purging, and other weight-loss behaviors) may reduce negative emotion (NE) and negatively reinforce such behavior (Berg et al., 2013;Fairburn, Cooper, & Shafran, 2003;Smyth et al., 2007). However, in focusing on NE, researchers and clinicians have often overlooked the potential role of problems with positive emotion (PE) in anorexia. Empirical research has indicated that PE and NE may be more accurately described as bivariate rather than as existing on a unipolar scale (Larsen, McGraw, & Cacioppo, 2001), which suggests that even amid pervasive NE, PE can also be experienced. Along these lines, calls have been made to examine the neglected role of positive reinforcement in initiating and maintaining weight-loss activities in anorexia (Walsh, 2013). These activities include overt weight-loss behaviors, such as restriction, vomiting, laxative use, and exercise, as well as self-evaluation activities, such as weigh-ins and checking 512794C PXXXX10.

A perfect storm: examining the synergistic effects of negative and positive emotional instability on promoting weight loss activities in anorexia nervosa

“…In a recent study, those with anorexia nervosa who had difficulty distinguishing between discrete positive emotions also tended to report increased positive emotion in response to, and as a result of, more weight loss activities such as: restricting, self-induced vomiting, laxative misuse, exercise, and self-evaluation activities, such as weighing and checking body fat (Selby et al, 2014). Women with anorexia have also been found to have stronger implicit associations between images of emaciated women and words like “beauty” than control participants (Smith et al, 2014).…”

“…Similarly, positive emotion has also been predominantly conceptualized as a trait (Watson et al, 1988a), considered maladaptive primarily when it is consistently elevated to an excessive extent, as in the case of full-blown manic episodes, or excessively and chronically low, as in the case of depression (e.g., anhedonia). Along these lines, anorexia involves pervasive and chronic negative emotion (Engel et al, 2013), and has been associated with low mean levels of positive emotion intensity (Pryor and Wiederman, 1996; Selby et al, 2014). Yet, the conceptualization of positive emotion being primarily absent in anorexia is problematic, as women with anorexia do not necessarily appear anhedonic and, in contrast, are often working quite hard at weight loss activities and frequently report being inspired by comments from others about improvements in physical appearance after initial weight loss in the early stages of the disorder (Walsh, 2013).…”

“…Mean-level positive emotion intensity actually tends to be negatively associated with most weight-loss behaviors (Selby et al, 2014), whereas positive emotional instability may be positively associated with weight-loss behaviors and social positive reinforcement (Walsh, 2013; Selby et al, 2014). Accordingly, high instability of positive emotion in anorexia may be due to the interplay between positive emotion and weight loss behaviors, wherein positive emotion serves to reinforce successful weight loss behaviors and success with weight loss serves to motivation further weight loss behaviors (Selby et al, 2014). As a result, positive emotion may fluctuate drastically in those with anorexia nervosa, either as a result of weight loss efforts, in motivation for further weight loss efforts, or in response to environmental reinforcement of weight loss activities (Walsh, 2013).…”

“…Increasing evidence suggests that the emotional experiences of those with anorexia may be characterized both by pervasively dysregulated negative and positive emotion (Lavender et al, 2013; Selby et al, 2014). Weight-loss behaviors may be both positively reinforced (through positive emotion arising from successful weight loss or self-control) and negatively reinforced (through alleviation of negative emotions arising from body image and weight-gain concerns).…”

“…The purpose of the current study was to further investigate emotional instability and its association with weight loss behaviors in anorexia nervosa using data from one of the largest EMA studies on anorexia nervosa completed to date (Engel et al, 2013; Selby et al, 2014). Using EMA methods, the current study builds on the previous findings of Lavender et al (2013), who demonstrated negative emotional instability was associated with more frequent weight loss activities, and the recent findings by Selby et al (2014), who found that poor understanding of positive emotions predicted increased weight loss activities, by examining the association between positive emotional instability and weight loss activities in a sample of women diagnosed with anorexia nervosa.…”