Eating Disorders—The Regulation of Positive as well as Negative Emotion Experience

Disordered eating behaviors are often conceptualized as maladaptive emotion regulation strategies. The present study investigated links between emotional experience, schematic belief systems, and psychological themes associated with eating disorders. In contrast to the majority of studies, which focus on just one or two emotions and use nonclinical samples, this study compared the full range of emotional experience in women with eating disorders to a control group. Measures used include the Differential Emotional Scale-IV, Youngs Early Maladaptive Schema Questionnaire, and Eating Disorder Inventory-2. The study provides the first empirical evidence that women diagnosed with eating disorders report experiencing pleasant as well as unpleasant emotions more frequently than do controls. A surprising finding was that pleasant emotions (joy, interest, surprise) correlated with eating disorder themes (EDI-2 subscales) more consistently than unpleasant emotions in the eating disorder group, while the reverse was true of the control group. Also of note, eating-disordered women reported significantly less anger and similar levels of fear vs. controls. While eating-disordered women scored more highly than do controls on all maladaptive schema (suggesting high levels of distress in women with eating disorders), the pattern of correlations between schema and emotion experience was distinctly different for each group and counterintuitive for the eating disorder group. In particular, pleasant emotion was highly correlated with maladaptive schema in the eating-disordered group but not in the control group. These marked group differences in the pattern of relationships between emotion experience, eating disorder themes, and belief systems suggest that it is not valid to draw conclusions about eating disorders from research that employs only nonclinical samples. The authors discuss these findings, and suggest that women with eating disorders are proficient at using disordered eating behaviors to manipulate their experience of both positive and negative emotional states, and that this dynamic should be recognized as an important maintenance factor.     

Emotional eating as a mediator between anxiety and cholesterol in population with overweight and hypertension

Although the relationship between cholesterol and mood states (especially anxiety) has been well studied, few researches have included the role of eating styles in this relationship. This study explored the associations among eating styles, negative emotional symptoms, and levels of cholesterol (and other medical variables) in a population with hypertension and overweight or obesity, analyzing the possible mediation mechanisms involved. A cross-sectional study was conducted in 68 adults with hypertension and overweight/obesity, and stepwise multiple regression analysis and mediation analyses were carried out to test the hypothesis that eating styles mediate the relationship between negative emotional symptoms and cholesterol. Several significant correlations among age, anthropometric, medical, and psychological variables (eating styles and negative emotional symptoms) were found. There was a significant indirect effect of anxiety on total cholesterol and LDL cholesterol through emotional eating. Results suggest that emotional eating has a relevant role in the rise in total and LDL cholesterol, acting as a mediator in the relationship between anxiety and cholesterol. This finding could have important implications, since it introduces a new variable in the relationship between emotions and cholesterol and, therefore, changes the way of understanding this relationship, and of treating high cholesterol in a hypertensive sample.     

Changes in defensiveness and in affective distress following inpatient treatment of eating disorders: Rorschach comprehensive system and self-report measures

Conceptualizing eating disorders (EDs) as forming a coping mechanism against facing psychic pain, in this study, we examined the contribution of weight stabilization and ED behaviors to psychological outcomes of affective distress, defensiveness, and contact with inner/external reality among 2 subgroups of adolescent inpatients with (a) "restricting type" anorexia (AN-R) and (b) bingeing/purging type EDs (B/P). We administered Rorschach Comprehensive System (CS; Exner, 2003) and self-report measures at acute admission and on discharge. Data indicated that in both subgroups, stabilization of weight and disordered eating behaviors was accompanied by reduced explicit (self-reported) affective distress, yet by elevated implicit affective distress (D, SumShd). Subgroups' different Rorschach change trends indicated different dynamic processes in defensive style and contact with inner/external reality.     

Emotion processing and regulation in women with morbid obesity who apply for bariatric surgery

Emotional eating, the tendency to eat when experiencing negative affect, is prevalent in morbid obesity and may indicate that ways to deal with emotions are disturbed. Our aim was to compare emotion processing and regulation between 102 women with morbid obesity who apply for bariatric surgery and 102 women from the general population (control group) and to examine in the group with morbid obesity the association of emotion processing and regulation with emotional eating. The group with morbid obesity reported higher scores on difficulty identifying feelings (alexithymia, p?=?0.002) and suppression of emotions (p?=?0.003) than the control group. In the women with morbid obesity, more negative affect and a higher difficulty identifying feelings were correlated with more emotional eating (r?=?0.36 and r?=?0.35, p?<?0.001). Our study suggests that negative emotions and unhealthy emotion processing may play a role in emotional eating, and it indicates the possible relevance of emotion processing and emotional regulation as initiating or perpetuating mechanisms in morbid obesity.     

Perceived control,depressive symptomatology,and professional burnout: A review of the evidence

This article examines the extent to which self-reported emotional eating is a predictor of unhealthy snack consumption or, alternatively, an expression of beliefs about the relation between emotions and eating derived from concerns about eating behaviour. Three studies were conducted. Study 1 (N = 151) and Study 2 (N = 184) investigated the predictive validity of emotional eating compared to habit strength in snack consumption, employing 7-day snack diaries. Both studies demonstrated that snack consumption was not predicted by emotional eating but depended on the habit of unhealthy snacking and on restraint eating. As emotional eating was not a significant predictor of snack intake, Study 3 addressed the alternative hypothesis of emotional eating being an expression of concerns about eating behaviour. Results from this cross-sectional survey (N = 134) showed that emotional eating was significantly associated with several concerns. Together, these studies show that snack intake is better predicted by habit strength and restraint eating than by emotional eating. Additionally, the results suggest that in normal-weight women the concept of emotional eating may not capture the tendency to eat under emotional conditions, but rather reflects beliefs about the relation between emotions and eating.     

The relationship between neuroticism and night eating: exploring the mediating roles of psychological distress and maladaptive coping

Night Eating Syndrome has been shown to be associated with various negative physical and psychological consequences. This study explored the relationship between neuroticism and night eating, which had not been studied before. We also examined the possible mediating roles of psychological distress and maladaptive coping for the relationship between neuroticism and night eating. A sample of 578 Chinese college students were assessed on several measures: The Revised Eysenck Personality Questionnaire Short Scale, the Night Eating Questionnaire, the Depression Anxiety Stress Scales, and the Simplified Coping Style Questionnaire. Results indicated that neuroticism was significantly and positively related to night eating (r = .38, p < .01), and the relationship between neuroticism and night eating was partially mediated by psychological distress, but not by maladaptive coping. The results not only revealed a medium-sized relationship between neuroticism and night eating, but also pointed out the importance of psychological distress as related to the relationship between neuroticism and night eating. Unlike neuroticism, which is a personality trait, psychological distress is an emotional state, and it is much more malleable through appropriate intervention. The treatment and intervention for night eating may benefit from our attention to the psychological distress.     

Predictors and mediators of treatment outcome in patients with binge eating disorder

A randomized controlled trial (N=52) was conducted comparing cognitive-behavioral therapy with a waiting list control group to identify mediators and predictors of treatment outcome. Reduction of weight concerns mediated abstinence of binge eating at post-treatment. Abstinence was marginally mediated by changes in eating and shape concerns, depressive symptoms and global severity of general psychopathology. Neither treatment outcome nor status at 1-year follow-up could be predicted by severity of eating disorder, comorbid psychopathology or maladaptive core beliefs at baseline or at post-treatment. The only predictor for abstinence at both post-treatment and 1-year follow-up was the coping style palliative reacting: higher scores predicted less favorable outcomes. Lower expression of emotions at post-treatment predicted more reduction of eating disorder psychopathology at follow-up. No other patient characteristics allowing treatment-patient matching could be identified.     

情绪对饮食行为的影响

人类的饮食行为受到诸多因素的影响, 包括生理因素、心理因素及社会文化因素等, 其中情绪对饮食行为的影响日益受到研究者的重视, 这种影响一般表现为摄入量的多少和食物(热量)的选择。通过探讨不同情绪下临床和非临床个体食物摄入量的表现, 总结发现消极情绪导致个体暴饮暴食的可能更大。积极情绪影响下的饮食行为的研究结果则存在分歧: 生理角度解释为积极情绪能够促进个体的享乐机制, 导致进食行为增加; 而自我控制理论则认为积极情绪增加了个人资源以抵制美食诱惑。此外, 进一步探讨了情绪影响下饮食行为的神经生理机制。未来在饮食相关的临床研究和治疗上, 需要对情绪影响下的饮食行为有更深入的神经机制方面的探究。     

Loss of control over eating in obese youngsters

OBJECTIVE: To investigate loss of control over eating in a sample of obese youngsters seeking treatment. METHOD: Obese youngsters (aged 10-16) were categorized into those having experienced loss of control (LC) and those who had not (NoLC) using the child version of the Eating Disorder Examination. Furthermore, the LC group was subdivided into an objective binge eating (OBE) and a subjective binge eating (SBE) group. The groups were compared on psychological measures. RESULTS: LC subjects (17.9%) showed more concern about eating, weight and shape. They also reported more emotional and external eating behaviors and more depression. Youngsters who report SBE show resemblances to both NoLC and OBE subjects. DISCUSSION: LC subjects are characterized by more eating-related psychopathology and higher levels of depression. Especially obese youngsters with OBE turned out to be a pathological group.     

Relationships between psychological stress,coping and disordered eating: A review

Abstract

Objective: Psychological stress and inadequate coping skills have been hypothesized to play important roles in the etiology of disordered eating. This paper reviews the empirical evidence which has emerged regarding the proposed relationships among stress. coping skills and various forms of disordered eating. Method: A search of psychological and medical databases was conducted to identify studies examining life events, and other types of psychological stress and coping strategies, in relation to the onset of disordered eating. Results: Despite methodological limitations such as the use of non-representative samples and retrospective methodologies, evidence of relationships between stress. coping and disordered eating was obtained in the majority of studies reviewed. Discussion: The implications of these findings am discussed and suggestions for future research, including the utilization of longitudinal. prospective studies, am presented.     

Subtypes of Victims and Aggressors in Children's Peer Groups

This study reports an investigation of the behavioral profiles and psychosocial adjustment of subgroups of victims and aggressors in elementary school peer groups. Peer nomination scores for aggression and victimization were used to classify 354 inner-city children (mean age of 10.3 years) into one of four subgroups: aggressive victims, nonaggressive victims, nonvictimized aggressors, and normative contrasts. Subgroup comparisons were then conducted using multi-informant assessment of social behavior, social acceptance-rejection, behavioral regulation, academic functioning, and emotional distress. Children in each of the victim-aggressor subgroups were characterized by a degree of social and behavioral maladjustment. However, impairments in behavioral and emotional regulation were most evident for the aggressive victim subgroup. Aggressive victims were also characterized by academic failure, peer rejection, and emotional distress. The results of this investigation highlight the distinctive nature of the aggressive victim subgroup.     

Rorschach variables related to blood glucose control in insulin-dependent diabetes patients

In this article, we explored relations between selected Rorschach variables and blood glucose control in Insulin-Dependent Diabetes Mellitus (IDDM) patients. Three domains of psychological functioning are taken into consideration: emotional distress, coping and problem solving, and cognitive efficiency. Seventy-one IDDM patients (38 men, 33 women; mean age 42.2 +/- 14.9 years) from an outpatient unit took the Rorschach Comprehensive System (Exner, 1986). Nine variables were selected as independent variables. Blood glucose, a dependent variable, was measured by the proportion of glycated hemoglobin. Results of 2 regression analyses show that Y and C' correlate to higher blood glucose. WSum C and the absence of texture related to lower levels of blood glucose. A confounding effect of complications was observed. The findings suggest that emotional factors should be accorded greater attention in behavioral self-regulations in diabetes.     

The Moderating Effects of Mindfulness on Psychological Distress and Emotional Eating Behaviour

Current evidence and theory suggests that emotional eating resulting from attempts to manage psychological distress, such as anxiety, depression, and stress, is considered to be a major contributor to obesity. Mindfulness has been shown to be related to disordered eating behaviours. Employing a non‐clinical sample of 42 males and 115 females, the present study investigated the contribution of mindfulness as a potential moderator between psychological distress and engagement in emotional eating, while controlling for the effects of gender and general nutrition knowledge. Consistent with predictions, psychological distress was positively associated with engagement in emotional eating, while mindfulness was found to share an inverse relationship. Moreover, after controlling for gender and general nutrition knowledge, the interaction between psychological distress and mindfulness was found to significantly predict the tendency to engage in emotional eating over and above the individual effects of these variables. The findings from the current study add to the current literature supporting the use of mindfulness‐based interventions for treatment of emotional eating practices in individuals experiencing anxiety, stress, and lower levels of depression.     

Objective and subjective bulimic episodes in the classification of bulimic-type eating disorders: Another nail in the coffin of a problematic distinction

We sought to further explore the validity of the distinction between objective bulimic episodes (OBEs) and subjective bulimic episodes (SBEs) in the study of bulimic-type eating disorders. Drawing on data obtained at the second, interview phase of a large-scale epidemiological study, we identified mutually exclusive subgroups of women with bulimic-type eating disorders who engaged in regular OBEs but not SBEs (n = 37) or regular SBEs but not OBEs (n = 52). These subgroups were compared on a wide range of outcomes, including socio-demographic characteristics, current levels of eating disorder psychopathology, general psychological distress and impairment in role functioning, current and lifetime impairment in quality of life specifically associated with an eating problem, (self)-recognition of an eating problem, health service utilization and use of psychotropic medication. The only difference between groups was that participants who reported regular OBEs were heavier than those who reported regular SBEs. The findings converge with those of previous research in suggesting that bulimic-type eating disorders characterized by regular SBEs, but not OBEs, do not differ in any clinically meaningful way from those characterized by regular OBEs, but not SBEs. Inclusion of bulimic-type eating disorders characterized by regular SBEs as a provisional category requiring further research in DSM-V appears warranted.     

A comparison of selected Rorschach variables of violent female offenders and female non-offenders

A national sample of incarcerated violent female offenders (N = 45) and a sample of female non-offenders (N = 30) were compared on nine selected Rorschach CS (Exner, 2003) variables and three of the aggression variables of Gacono and Meloy (1994). The results indicate that an avoidant and inconsistent coping style was more characteristic of the offenders than the non-offenders. The offenders were characterized by social immaturity and limited capacities to cope with stress as compared with the non-offenders. No significant differences were found between the two groups in handling intense emotions. Although the aggressive scores revealed no discrimination between the groups, significant correlations were found between the aggressive content score and childhood victimization. An inverse relation was found between the aggressive past score and the emotional intensity of the violent offense. The study indicates that the selected RCS variables related to adaptive resources for coping discriminate between violent offenders and non-offenders, but that the variables related to affective features need further examination.     

Mediation of self‐regulation and mood in the relationship of changes in high emotional eating and nutritional behaviors: Moderating effects of physical activity

High emotional eating (EE) is prevalent in women with obesity. A previous study's subsample of obese women classified as high emotional eaters participated in either a physical activity‐focused experimental (n = 29) or an educationally focused comparison (n = 22) behavioral treatment and was assessed over phases of expected weight loss (baseline–month 6) and short‐ and long‐term regain (months 6–12 and 6–24, respectively). The study's aim was to assess theory‐based psychological and behavioral mediation and moderation of changes in nutritional behaviors via emotional eating change in order to inform behavioral weight‐loss treatments. During the weight‐loss phase, significant improvements in eating self‐regulation and mood significantly mediated the relationship of reduced EE and intake of both fruits and vegetables (FV) and sweets. Self‐regulation was a significant independent mediator. Physical activity significantly moderated the relationship between EE and self‐regulation changes. All variables demonstrated large positive effects and significant time × group interactions favoring the experimental group. During the short and long‐term phases of expected weight regain, there were no significant changes in FV intake, although consumption of sweets significantly increased during months 6–24. Change in FV and sweets significantly predicted weight change, which was significantly greater in the experimental vs. comparison group over both the initial 6 months (?6.1% vs. ?2.6%) and full 24 months of the study (?7.6% vs. ?1.3%). Findings suggest that behavioral treatments should address EE through improvements in self‐regulation and mood, and supported physical activity will aid in that process. The need for an improved understanding of weight‐loss maintenance remains.     

Patterns of emotion-specific appraisal,coping, and cardiovascular reactivity during an ongoing emotional episode

The authors examined emotion-specific patterns of appraisal, coping, and cardiovascular reactivity during real ongoing emotional episodes. In this study, 109 participants performed a neutral opinion-expression task, where a confederate elicited anger, shame, or pride using verbal and nonverbal behavior. The authors assessed cognitive appraisals, emotional reactions, coping, outcomes (state self-esteem and outcome satisfaction), and cardiovascular reactivity. Results indicated substantial and theoretically consistent differences between the 3 emotions (and differences from a nonemotion condition) for cognitive appraisals, self-reported coping, behavioral coping, self-esteem, and cardiovascular reactivity. The results are discussed in relation to their implications for emotion theory and for psychological and physical health. Overall, the results suggest that researchers can study emotion-related issues using authentic emotional reactions.     

夜间进食综合征的研究进展

夜间进食综合征是一种表现为早晨没有食欲、晚饭后过量进食或夜间醒来进食的饮食障碍,并且与睡眠问题相关。在国内外文献进行分析研究的基础上,本文先后介绍了夜食症的概念内涵、发病的生理神经机制及主要的干预措施和治疗手段,并对现有研究的不足进行总结,提出了未来研究的方向,旨在为研究者在此领域的进一步探索提供参考。     

Developing an Acceptance-Based Behavioral Treatment for Binge Eating Disorder: Rationale and Challenges

Binge eating disorder (BED), characterized by recurrent eating episodes in which individuals eat an objectively large amount of food within a short time period accompanied by a sense of loss of control, is the most common eating disorder. While existing treatments, such as cognitive behavioral therapy (CBT), produce remission in a large percentage of individuals with BED, room for improvement in outcomes remains. Two reasons some patients may continue to experience binge eating after a course of treatment are: (a) Difficulty complying with the prescribed behavioral components of CBT due to the discomfort of implementing such strategies; and (b) a lack of focus in current treatments on strategies for coping with high levels of negative affect that often drive binge eating. To optimize treatment outcomes, it is therefore crucial to provide patients with strategies to overcome these issues. A small but growing body of research suggests that acceptance-based treatment approaches may be effective for the treatment of binge eating. The goal of the current paper is to describe the development of an acceptance-based group treatment for BED, discuss the structure of the manual and the rationale and challenges associated with integrating acceptance-based strategies into a CBT protocol, and to discuss clinical strategies for successfully implementing the intervention.     

An acceptance-based behavioral intervention for weight loss: a pilot study

On average, participants in behavioral weight-loss interventions lose 8 kilograms (kg) at 6 months, but there is marked variability in outcomes with some participants losing little or no weight. Individuals with difficulties with internal disinhibition (i.e., eating in response to emotions or thoughts) typically lose less weight in such programs and may require an innovative, specialized approach. This pilot study examined the preliminary acceptability and efficacy of a 24-week acceptance-based behavioral intervention for weight loss among overweight and obese adults reporting difficulty with eating in response to emotions and thoughts. Participants were 21 overweight or obese men and women (mean age=52.2±7.6 years; baseline mean body mass index=32.8±3.4). Eighty-six percent completed the 6-month program and a 3-month follow-up assessment. Ratings of program satisfaction averaged 4.9 on a five-point scale. Multilevel modeling analyses indicated participants lost an average of 12.0 kg (SE=1.4) after 6 months of treatment and 12.1 kg (SE=1.9) at 3-month follow-up, thus exceeding the weight losses typically seen in behavioral treatment programs. Decreases in internal disinhibition and weight-related experiential avoidance were found at 6- and 3-months follow-up. Greater decreases in weight-related experiential avoidance were associated with greater weight loss at the end of the program (r=.64, p=.002), suggesting a potential mechanism of action. Although there have been a few preliminary studies using acceptance-based approaches for obesity, this is the first study to specifically target emotional overeaters, a subgroup that might be particularly responsive to this new approach. Our findings provide initial support for the feasibility, efficacy, and acceptability of this approach for this subgroup of participants. Further study with longer follow-up, a more diverse sample, and comparison to a standard behavioral program is clearly warranted.