Daily Body (Dis-)Satisfaction and Dietary Restriction in Women Across the Eating Disorder Spectrum

Body dissatisfaction is a key risk factor in eating disorder development: It is theorized to promote dietary restriction, thereby contributing to symptom onset. Evidence for this pathway primarily comes from cross-sectional or multi-wave questionnaire studies in bulimia nervosa (BN) and anorexia nervosa (AN). Fewer studies have tested day-to-day links between body dissatisfaction and dietary restriction, which would indicate their temporal relationships. Using a daily diary design, we examined prospective day-to-day associations between these two symptoms across four eating disorder (ED) groups and a non-ED control group (CG).

One hundred eighty one female participants (14-60 years; M = 28.2, SD = 11.4) were recruited from German-speaking countries (96% German or Austrian nationals). The sample included patients with BN (n = 40), binge-eating/purging type AN (ANbp, n = 23), restricting type AN (ANr, n = 24), binge-eating disorder (BED, n = 36), as well as a non-ED CG (n = 58). Daily body dissatisfaction and dietary restriction were assessed on eight consecutive evenings. Day-to-day associations were tested using multilevel (mixed-effects) lagged regression models.

In patients with BN and ANbp, days with higher body dissatisfaction preceded days with higher dietary restriction. This association was not observed in patients with ANr, BED, or in the non-ED CG. Dietary restriction did not predict next day's body dissatisfaction.

Prospective links between body dissatisfaction and restriction mainly characterize patients with BN and ANbp. Hence, intervention targets at both the group level and the symptom level (body dissatisfaction rather than dietary restriction) seem necessary. In these subgroups, intervening on days characterized by high body dissatisfaction may help reduce dietary restriction on the following day.