Examining a momentary mediation model of appearance-related stress, anxiety, and eating disorder behaviors in adult anorexia nervosa
- 202 Downloads
Appearance-related stress may result from appearance-focused events such as seeing one’s reflection, seeing media images, and shopping for clothes. The purpose of this study was to examine the prospective association between momentary appearance-related stress and eating disorder (ED) behaviors (i.e., binge eating and vomiting) among women with anorexia nervosa (AN) using ecological momentary assessment (EMA). We hypothesized that appearance-related stress at Time 1 would predict binge eating and vomiting at Time 2, and that this prospective association would be mediated by momentary anxiety at Time 2 (controlling for anxiety at Time 1).
Women with AN completed a 2-week EMA protocol involving repeated daily assessments of experiences and behaviors.
Momentary appearance-related stress preceded binge eating and vomiting, and momentary anxiety mediated the prospective association between appearance-related stress and ED behaviors.
Targeted momentary interventions delivered in the natural environment that address appearance-related stress may have utility in the treatment of ED behaviors.
KeywordsAnorexia nervosa Appearance Binge eating Purging Anxiety Ecological momentary assessment
This work was supported by Grants R01MH059674 and T32MH082761 from the National Institute of Mental Health.
Compliance with ethical standards
Conflict of interest
The authors have no conflicts of interest to report.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 4.Solmi F, Sonneville KR, Easter A, Horton NJ, Crosby RD, Treasure J, Rodriguez A, Jarvelin MR, Field AE, Micali N (2015) Prevalence of purging at age 16 and associations with negative outcomes among girls in three community-based cohorts. J Child Psychol Psychiatry 56:87–96. doi: 10.1111/jcpp.12283 CrossRefPubMedGoogle Scholar
- 6.DaCosta M, Halmi KA (1992) Classifications of anorexia nervosa: question of subtypes. Int J Eat Disord 11:305–313. doi: 10.1002/1098-108X(199205)11:4<305::AID-EAT2260110403>3.0.CO;2-2 CrossRefGoogle Scholar
- 17.Engel SG, Wonderlich SA, Crosby RD, Mitchell JE, Crow S, Peterson CB et al (2013) The role of affect in the maintenance of anorexia nervosa: evidence from a naturalistic assessment of momentary behaviors and emotion. J Abnorm Psychol 122:709–719. doi: 10.1037/a0034010 CrossRefPubMedPubMedCentralGoogle Scholar
- 18.Smyth JM, Wonderlich SA, Heron KE, Sliwinski MJ, Crosby RD, Mitchell JE, Engel SG (2007) Daily and momentary mood and stress are associated with binge eating and vomiting in bulimia nervosa patients in the natural environment. J Consult Clin Psychol 75:629–638. doi: 10.1037/0022-006X.75.4.629 CrossRefPubMedGoogle Scholar
- 19.Deep AL, Nagy LM, Weltzin TE, Rao R, Kaye WH (1995) Premorbid onset of psychopathology in long-term recovered anorexia nervosa. Int J Eat Disorder 17:291–297. doi: 10.1002/1098-108X(199504)17:3<291::AID-EAT2260170310>3.0.CO;2-# CrossRefGoogle Scholar
- 27.White EK, Warren CS, Cao L, Crosby RD, Engel SG, Wonderlich SA, Mitchell JE, Peterson CB, Crow SJ, Le Grange D (2016) Media exposure and associated stress contribute to eating pathology in women with AN: daily and momentary associations. Int J Eat Disord 49:617–621. doi: 10.1002/eat.22490 CrossRefPubMedGoogle Scholar
- 28.First M, Spitzer R, Gibbon M, Williams J (1995) Structured clinical interview for DSM–IV axis I disorders: Patient Edition (SCIDI/P). Biometrics, New YorkGoogle Scholar
- 29.Lorr M, McNair DM, Droppleman LF (1971) Manual: profile of mood states. Educational and Industrial Testing Service, San DiegoGoogle Scholar
- 33.Muthén K, Muthén BO (2015) Mplus user’s guide, 7th edn. Muthén & Muthén, Los AngelesGoogle Scholar
- 35.Wonderlich SA, Peterson CB, Smith TL, Klein MH, Mitchell JE, Crow SJ (2015) Integrative cognitive-affective therapy for bulimia nervosa: a treatment manual. Guilford Publication, New YorkGoogle Scholar
- 40.Jansen A, Voorwinde V, Hoebink Y, Rekkers M, Martijn C, Mulkens S (2016) Mirror exposure to increase body satisfaction: should we guide the focus of attention towards positively or negatively evaluated body parts? J Behav Ther Exp Psychiatry 50:90–96. doi: 10.1016/j.jbtep.2015.06.002 CrossRefPubMedGoogle Scholar