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Restrictive eating in anorexia nervosa: Examining maintenance and consequences in the natural environment
Author(s) -
FitzsimmonsCraft Ellen E.,
Accurso Erin C.,
Ciao Anna C.,
Crosby Ross D.,
Cao Li,
Pisetsky Emily M.,
Le Grange Daniel,
Peterson Carol B.,
Crow Scott J.,
Engel Scott G.,
Mitchell James E.,
Wonderlich Stephen A.
Publication year - 2015
Publication title -
international journal of eating disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.785
H-Index - 138
eISSN - 1098-108X
pISSN - 0276-3478
DOI - 10.1002/eat.22439
Subject(s) - anorexia nervosa , binge eating , affect (linguistics) , appetite , psychology , eating disorders , meal , eating behavior , anorexia , bulimia nervosa , developmental psychology , clinical psychology , psychiatry , medicine , obesity , communication
Objective This study examined negative and positive affect in relation to restrictive eating episodes (i.e., meals/snacks perceived as restrictive) and whether restrictive eating was associated with likelihood of subsequent eating disorder behaviors (i.e., additional restrictive eating, binge eating, vomiting, laxative use, weighing, exercising, meal skipping, drinking fluids to curb appetite, body checking). Method Women with anorexia nervosa ( N = 118) completed a 2‐week ecological momentary assessment protocol. Results For both restrictive and nonrestrictive eating, negative affect significantly increased from prebehavior to the time of the behavior but remained stable thereafter, while positive affect remained stable from prebehavior to the time of the behavior but decreased significantly thereafter. Across time, negative affect was significantly lower and positive affect was significantly greater in restrictive than nonrestrictive episodes. Engagement in restrictive eating was associated with an increased likelihood of subsequent restrictive eating, laxative use, and body checking, but not other behaviors. Engagement in nonrestrictive eating was associated with a decreased likelihood of subsequent restrictive eating, binge eating, vomiting, laxative use, weighing, meal skipping, drinking fluids to curb appetite, and body checking. Discussion Despite similar patterns of affect across eating episodes over time, results suggest affect may be involved in the maintenance of restrictive eating in anorexia nervosa since restrictive episodes were associated with lower negative and greater positive affect across time compared to nonrestrictive episodes. Further, while restrictive episodes increased the likelihood of only three subsequent eating disorder behaviors, nonrestrictive episodes were protective since they decreased likelihood of all but one behavior. © 2015 Wiley Periodicals, Inc (Int J Eat Disord 2015; 48:923–931).