Emotional food craving across the eating disorder spectrum: an ecological momentary assessment study

Abstract

Purpose: Emotional eating during negative emotions might underlie disordered eating behavior (i.e., binge eating and food restriction). Positive emotions, by contrast, seem to promote healthier eating behavior. Naturalistic research on the links between emotions and eating across individuals with binge-eating disorder (BED), bulimia nervosa (BN), binge-purge anorexia nervosa (AN-BP), and restrictive anorexia nervosa (AN-R) is, however, lacking.

Methods: Individuals without eating disorders (comparison group, CG, n = 85), and patients with BED (n = 41), BN (n = 50), AN-BP (n = 26), and AN-R (n = 29) participated in an ecological momentary assessment study. Six daily notifications over eight days prompted ratings of momentary food craving and emotional states differing in valence and arousal.

Results: Results supported specific emotion-food-craving patterns in each group. Compared to the CG, arousing negative emotions and higher cravings co-occurred in patients with BN. In patients with AN-BP (at trend level also in patients with AN-R) less arousing negative emotions and lower cravings co-occurred. In patients with AN, positive emotions and higher cravings co-occurred whereas in patients with BED less arousing positive emotions and lower cravings co-occurred.

Conclusion: The found emotion-craving associations may underlie group-specific (dys-)functional eating behaviors, i.e., binge eating and food restriction during negative emotions in patients with BN and AN, and normalized appetitive responses during positive emotions in patients with BED and AN. Therapeutic efforts could target arousing negative emotions in patients with BN, and less arousing negative emotions in patients with AN. Positive emotions could be used in a salutogenetic approach in patients with BED and AN.

Keywords: Eating disorders; Ecological momentary assessment; Emotional eating; Emotions; Experience sampling method; Food craving.

Fig. 1

Visualization of simple slopes for momentary emotional states predicting food craving for each group. Groups: CG comparison group (without eating disorders and with normal weight), AN-R anorexia nervosa restrictive subtype, AN-BP anorexia nervosa binge-purge subtype, BN bulimia nervosa, BED binge-eating disorder. Each panel shows the simple slope for one emotional-state scale: A high arousal-negative valence, B low arousal-negative valence, C high arousal-positive valence, D low arousal-positive valence