Affect Dysregulation in Context: Implications and Future Directions of Experience Sampling Research on Affect Regulation Models of Loss of Control Eating

Abstract

Loss of control eating is a core, transdiagnostic eating disorder symptom associated with psychological distress, functional impairment, and reduced quality of life. However, the factors that contribute to persistent loss of control eating despite negative consequences are not fully understood. Understanding the mechanisms that maintain loss of control eating is crucial to advance treatments that interrupt these processes. Affect regulation models of loss of control eating hypothesize that negative emotions trigger loss of control eating, and that loss of control eating is negatively reinforced because it temporarily decreases negative affect. Several variations on this basic affect regulation model have been proposed, including theories suggesting that negative affect decreases during loss of control eating rather than afterwards (escape theory), and that loss of control eating replaces one negative emotion with another that is less aversive (trade-off theory). Experience sampling designs that measure negative affect and eating behavior multiple times per day are optimally suited to examining the nuanced predictions of these affect regulation models in people's everyday lives. This paper critically reviews experience sampling studies examining associations between negative affect and loss of control eating, and discusses the implications for different affect regulation models of loss of control eating. The review concludes by proposing an expanded affect-focused model of loss of control eating that incorporates trait-level individual differences and momentary biological and environmental variables to guide future research. Clinical implications and recommendations are discussed.

Keywords: binge eating; ecological momentary assessment; emotion regulation; experience sampling; loss of control eating; negative affect.

Figure 1

Current affect regulation models of negative affect (NA) and loss of control eating (LOC). In the standard affect regulation model, NA increases prior to LOC, and decreases following LOC. Conversely, escape theory predicts that NA decreases while LOC is in progress, but increases to pre-LOC levels after LOC. Restraint theory predicts that NA disrupts the cognitive control required to maintain dietary restraint, leading to LOC. Trade-off theory predicts that LOC replaces one negative emotion (e.g., anger) with another that is less aversive (e.g., sadness). Finally, expectancy theory predicts that people engage in LOC because they expect to feel better afterwards, even though they may not actually feel better.

Figure 2

A revised affect-focused model of loss of control eating (LOC). The central figure shows the nomothetic pattern of changes in negative affect (NA) surrounding LOC found in a majority of experience sampling studies. This model is nestled within several layers of biological and environmental factors that could potentially alter the strength of NA-LOC associations. First are momentary biological factors, such as changes in hormone levels and blood sugar, that may alter reactivity to unpleasant events or stimuli. Second are trait-level individual differences that may moderate NA-LOC associations. Third are proximal environmental factors, such as interactions with peers or family members, that may increase (or decrease) NA, or affect the likelihood that NA will lead to LOC. Finally, individuals are encompassed by a broader sociocultural context.