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Ecological momentary assessment of stressful events and negative affect in bulimia nervosa

Date Published: 2/15

Abstract:

Objective—Negative affect precedes binge eating and purging in bulimia nervosa (BN), but little is known about factors that precipitate negative affect in relation to these behaviors. We aimed to assess the temporal relation among stressful events, negative affect, and bulimic events in the natural environment using ecological momentary assessment.

Method—A total of 133 women with current BN recorded their mood, eating behavior, and the occurrence of stressful events every day for two weeks. Multi-level structural equation mediation models evaluated the relations among Time 1 stress measures (i.e., interpersonal stressors, work/ environment stressors, general daily hassles, and stress appraisal), Time 2 negative affect, and Time 2 binge eating and purging, controlling for Time 1 negative affect.

Results—Increases in negative affect from Time 1 to Time 2 significantly mediated the relations between Time 1 interpersonal stressors, work/environment stressors, general daily hassles, and stress appraisal, and Time 2 binge eating and purging. When modeled simultaneously, confidence intervals for interpersonal stressors, general daily hassles, and stress appraisal did not overlap, suggesting that each had a distinct impact on negative affect in relation to binge eating or purging.

Conclusions—Our findings indicate that stress precedes the occurrence of bulimic behaviors and that increases in negative affect following stressful events mediate this relation. Results suggest that stress and subsequent negative affect may function as maintenance factors for bulimic behaviors and should be targeted in treatment.

Authors: Andrea B. Goldschmidt, Ph.D.1, Stephen A. Wonderlich, Ph.D.2, Ross D. Crosby, Ph.D.2, Scott G. Engel, Ph.D.2, Jason M. Lavender, Ph.D.2, Carol B. Peterson, Ph.D.3, Scott J. Crow, M.D.3, Li Cao, M.A.2, and James E. Mitchell, M.D.2

1 Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
2 Department of Clinical Research, Neuropsychiatric Research Institute, and Department of Clinical Neuroscience, University of North Dakota School of Medicine, Fargo, North Dakota, USA
3 Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA

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