Bidirectional Temporal Relationships between Emotional State and Eating across Eating Disorders: A Network Approach

Objective: Several models of eating disorders suggest that emotions and eating bidirectionally influence each other in a vicious cycle, producing part of the observed symptoms. However, no research studied whether such cycles exist and how they look like in multiple eating disorders (EDs). We therefore explored networks of prospective relationships between negative and positive emotions and transdiagnostic eating-related behaviors (hunger, food craving, and calorie intake) across EDs. Method: These variables were assessed six times a day for eight days in women with restrictive (AN-R, N=29) and binge-purge (AN-BP, N=26) Anorexia Nervosa, Bulimia Nervosa (BN, N=42), and Binge-Eating Disorder (BED, N=37). Prospective relationships were analyzed with modified vector-autoregressive networks. Results: Every group showed negative affect following calorie intake; this was predicted to be especially intense in BN and especially long-lasting in AN-BP. AN-R further showed ‘positive emotional eating’, with happiness predicting desire-to-eat at the next timepoint and thereby subsequent eating. BED further showed ‘negative emotional eating’, with worry predicting hunger and desire-to-eat, and irritation predicting calorie intake. AN-R and BN showed ‘bored eating’, while AN-BP showed no emotional eating. We also observed affect-mediated pathways for restriction: in AN-R, depressed mood predicted reduced hunger and desire-to-eat; in AN-BP and BN, hunger predicted reduced negative affect; and in all three groups, there were restriction- or hunger-promoting feedback loops mediated by emotion. Discussion: Substantial post-eating dysphoria was present in all EDs. Restriction-promoting feedback loops were present in AN-R, AN-BP, and BN, while BED only showed negative emotional eating.