Behavioral evidence of emotion dysregulation in binge eaters
Introduction
Binge eating is characterized by eating an objectively large amount of food in a short period of time with a perceived loss of control over eating (American Psychiatric Association [APA], 2013). Binge eating is the most prevalent disordered eating symptom (Hudson, Hiripi, Pope, & Kessler, 2007) and can be present across eating disorder diagnoses (APA, 2013), in people with other psychiatric diagnoses (e.g., borderline personality disorder), as well as individuals with no clinical diagnosis (Bruce & Agras, 1992). Further, binge eating is strongly associated with obesity (Spitzer et al., 1993, Stunkard and Allison, 2003). Of note, binge eating is related to significant clinical impairment and distress (Vannucci et al., 2013). Given the prevalence of binge eating and its relation to eating disorders and obesity (Stice, Cameron, Killen, Hayward, & Taylor, 1999), it is important to understand the behavioral characteristics associated with binge eating in attempts to gain a better understanding of the development and maintenance of eating disorders and obesity and to identify potential targets of prevention and intervention.
One of the most prominent theories of binge eating is the affect regulation model (Polivy & Herman, 1993). Following the principles of negative reinforcement, this model posits that binge eating becomes a learned behavior to cope with this increased negative affect, albeit in a maladaptive way (Arnow et al., 1992, Cooper et al., 2004, Rieger et al., 2010). In support of this model, research has suggested that negative affect typically precedes binge eating behaviors (Grilo et al., 1994, Haedt-Matt and Keel, 2011). Furthermore, though some studies suggested that negative affect decreases during (Deaver, Miltenberger, Smyth, Meidinger, & Crosby, 2003) and following binge eating (Engel et al., 2013; Smyth et al., 2007), a recent meta-analysis showed that negative affect ultimately increases after the binge episode (Haedt-Matt & Keel, 2011). Taken together, it is possible that binge eating may temporarily relieve negative affect; however, distress may ultimately be exacerbated due to feelings of guilt and embarrassment from losing control over eating (Corstorphine, 2006). Alternatively, results may differ due to the operationalization of negative affect or individual differences in response to binge eating (De Young et al., 2013).
Given that binge eating is believed to be a reaction to negative affect, it is important to assess emotion regulation in individuals with eating disorders. Emotion regulation difficulties have been identified across eating disorder diagnoses; especially among individuals who binge eat (Brockmeyer et al., 2014, Svaldi et al., 2012). Difficulties in emotion regulation accounted for a significant portion of the variance in prediction of eating disorder pathology among individuals with binge eating disorder (Gianini, White, & Masheb, 2013) and in a non-clinical college sample (Lavender & Anderson, 2010). Emotion dysregulation also accounted for unique variance of binge eating behaviors in non-clinical children and college students (Czaja et al., 2009, Whiteside et al., 2007). Specifically, difficulties identifying emotions and a lack of appropriate emotion regulation strategies may drive the link between emotion regulation difficulties and binge eating (Whiteside et al., 2007). Lastly, high comorbidity rates of affective disorders, namely anxiety and depression, have been reported among individuals who binge eat (Hudson et al., 2007). Taken together, it appears that difficulties with emotion regulation are often present among individuals who binge eat.
Despite a large body of research that suggests a link between impaired emotion regulation and binge eating, previous studies have relied on self-report data through surveys or ecological momentary assessment, both which may be subject to recall bias. Of note, depressive symptoms can further influence self-reported data due to a common tendency for individuals with depression to report greater pathology due to a biased negative perspective of their current situation (Gupta & Kar, 2008). However, at times individuals with depression may minimize their symptoms (Hunt, Auriemma, & Cashaw, 2003). Given the high comorbidity of binge eating with depressive symptoms (Hudson et al., 2007), this population may be subject to greater bias. Laboratory tasks that elicit frustration and measure time spent pursing a goal may serve as a proxy for distress tolerance, and thus would be particularly useful tools to examine in vivo emotion regulation in this population. These tasks represent the ability to regulate emotions and continue with goal-directed action despite induced distress, which cannot be measured through self-report. However, as with all assessments, these tasks are not without limitations. Many behaviors (such as quitting a task early) are interpreted as a proxy for distress tolerance. Without knowing that the reason behind the behavior was tied to distress tolerance, it is not possible to know for certain whether it reflects the construct proposed to be evaluated or something else (e.g., fatigue, boredom). Thus, it is important to try to evaluate the relation between the behavior and construct being measured via additional self-report, observational or behavioral measures whenever possible and show that the task did indeed induce distress. Despite this limitation, in vivo experimental testing is still important as it is less susceptible to social desirability responding and can be complementary to self-report measures. Further, by observing participants while completing the tasks, experimenters can ensure participants remain focused on the tasks. Lastly, objective in-vivo measures may be more sensitive and might be able to detect at-risk individuals prior to their becoming aware of their reactions in response to distressing emotions.
The current study aimed to evaluate whether individuals who binge eat demonstrate more dysregulated emotion in response to a non-food, non-eating related, behavioral distress tolerance task. Specifically, in the current study we used the Paced Auditory Serial Addition Task-Computer (PASAT-C), a well-validated paradigm known to insight negative affect (Lejuez, Kahler, & Brown, 2003). The PASAT-C assesses the ability to persist in a distressing task. Scores on this measure were used to compare the in-vivo, objectively measured emotion regulation abilities of undergraduate females who binge eat and those who do not. We hypothesized that the binge eating group would be more likely to choose to quit the task early (i.e., less likely to complete the task), spend less time on the task, and show a greater increase in negative emotions in response to the task in comparison to the non-binge eating control group. If confirmed, this would suggest that individuals who binge eat are quicker to engage in behaviors to escape or avoid negative emotions and demonstrate an increased emotional response to distressing stimuli.
Section snippets
Participants and procedures
Undergraduate females (ages 18–25 years) from Temple University were recruited for the current study from a pool of participants who completed self-report measures on a secure online portal to earn class credit. Inclusion criteria included a) endorsing four or more binge episodes (on the Eating Disorder Examination-Questionnaire; n = 50) in the past 28 days OR b) denial of any binge eating, purging, or fasting (healthy controls, n = 51). Exclusion criteria for all participants included:
Results
Analyses included 47 females in the control group and 40 females in the binge eating group. The average age of participants was 20.01 years (SD = 1.72). Overall the sample was primarily Caucasian (64.4%; 14.9% African American, 11.5% Asian) and the mean BMI was 23.25 kg/m2 (SD = 3.61) (see Table 1 for demographic details). Groups did not differ based on age (p = 0.11) or ethnicity (p = 0.40). As expected, BMI was significantly greater in the binge eating group (p < 0.001). The average BMI of
Discussion
In addition to confirming greater self-reported difficulties with emotion regulation, this study is the first to demonstrate in-vivo that individuals who binge eat exude greater difficulties with emotion regulation on the PASAT-C. As hypothesized, binge eaters quit the PASAT-C task significantly earlier than controls and were nearly three times more likely to quit early. Although both groups reported increases of frustration and irritability, the binge eating group was significantly more
Conclusion
This study showed that binge eaters demonstrate greater emotion dysregulation in a behavioral task – unrelated to eating. Thus, emotion dysregulation and reacting to distress might be a more global trait that needs to be addressed in the treatment of binge eating. Further, this preliminary research highlights the potential utility of the PASAT-C in detecting differences among individuals who binge eat and those who do not, even at a subclinical level. As this was identified in a non-treatment
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Acknowledgements
The authors would like to thank the members of the Writing Task Force in the Center for Healthy Eating and Activity Research for their feedback on drafts of this manuscript.
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2022, Journal of Affective DisordersCitation Excerpt :Further research is needed to understand the disorder-specific processes that may interact with low DT to result in specific manifestations of impulsive-type psychopathology. Therefore, while the current findings lend support to the recent development of transdiagnostic interventions designed to target low DT for individuals with impulsive-type psychopathology (e.g., Hall et al., 2018, 2021; Ritschel et al., 2015), they also suggest that such interventions may need to be combined with disorder-specific interventions. In addition to the moderating effect of DT measurement type, we found evidence for age group and sample type moderating some of the relationships examined.