Trajectories of higher- and lower-order dimensions of negative and positive affect relative to restrictive eating in anorexia nervosa.

Abstract

Despite robust support for the role of affect in the maintenance of binge eating and purging, the relationship between affect and restrictive eating remains poorly understood. To investigate the relationship between restrictive eating and affect, ecological momentary assessment data from 118 women with anorexia nervosa (AN) were used to examine trajectories of higher-order dimensions of negative affect (NA) and positive affect (PA), as well as lower-order dimensions of NA (Fear, Guilt) and PA (Joviality, Self-Assurance) relative to restrictive eating. Affect trajectories were modeled before and after restrictive eating episodes and AN subtype was examined as a moderator of these trajectories. Across the sample, Guilt significantly increased before and decreased after restrictive eating episodes. Global NA, Global PA, Fear, Joviality, and Self-Assurance did not vary relative to restrictive eating episodes across the sample. However, significant subtype by trajectory interactions were detected for PA indices. Among individuals with AN restricting subtype, Global PA, Joviality, and Self-Assurance decreased prior to and Self-Assurance increased following restrictive eating episodes. In contrast, Global PA and Self-Assurance increased prior to, but did not change following, restrictive eating episodes among individuals with AN binge eating/purging subtype. Results suggest that dietary restriction may function to mitigate guilt across AN subtypes and to enhance self-assurance among individuals with AN restricting subtype.

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.…”

Subtypes of Adaptive and Maladaptive Perfectionism in Anorexia Nervosa: Associations with Eating Disorder and Affective Symptoms

“…These results may be partially explained in connection with the affect regulation literature in AN. Certain eating disorder behaviors (e.g., purging, restrictive eating, body-checking) have been found to regulate affect among individuals with AN (Engel et al 2013; Espeset et al 2012; Haynos et al 2017). However, the mechanism by which these behaviors impact mood remains unclear.…”

The posited effect of positive affect in anorexia nervosa: Advocating for a forgotten piece of a puzzling disease

“…Further, daily PA lability has been associated with greater weight loss behaviors, self‐weighing, and body‐checking among individuals with AN (Selby et al, ). Momentary analyses of the same data found elevated PA during and after restrictive eating episodes, compared to normal meals (Fitzsimmons‐Craft et al, ), and that restrictive eating resulted in increased self‐assurance among those with restricting subtype (Haynos et al, ). Finally, lower PA preceded days for which restrictive eating was more likely (Engel et al, ), lending further evidence that restrictive eating may be utilized to momentarily enhance reward experiencing.…”

“…A growing body of work has conceptualized AN as a disorder of emotion dysregulation (e.g., Haynos & Fruzzetti, 2011). While the evidence for the role of negative affect (NA) in predicting engagement in eating disorder behaviors is growing (Haynos et al, 2017), we concurrently propose that the role of positive affect (PA) in the onset and maintenance of AN is comparatively far less prioritized and incorporated into etiological theories of AN or treatment development efforts for AN. Some early theories of AN have credited PA from weight loss as critical to the onset of the disorder (e.g., Slade, 1982), but have been eclipsed by more recent theories that have posited that cognitive (Fairburn, Cooper, & Shafran, 2003) or behavioral (Walsh, 2013) mechanisms are central to the disorder (Table 1).…”