Bidirectional temporal relationships between emotional state and eating across eating disorders: a network approach

Several models of eating disorders (EDs) suggest that emotions and eating influence each other in a vicious cycle, producing part of the observed symptoms. However, no research tested whether such cycles exist across EDs. We therefore explored networks of prospective relationships between negative and positive emotions and eating-related behaviors (hunger, food craving, calorie intake, and binges) across EDs and healthy controls (HCs).

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), and in HCs (N = 57). Prospective relationships were analyzed with modified vector-autoregressive networks.

Unlike HCs, ED groups showed many emotion-eating relationships. Calorie intake predicted subsequent increased negative or reduced positive affect in every ED, and so did binges in AN-BP, BN, and BED; post-binge negative affect was predicted to last up to 10 h. AN-R showed positive emotional eating, with more desire to eat and hunger during positive mood, while BED showed negative emotional eating, with worry predicting desire to eat and hunger, and irritation predicting calorie intake directly. Binges were not predicted by negative emotions, likely due to a long temporal distance between measurements. All EDs showed restriction-promoting feedback loops mediated by negative affect following calorie intake. In particular, AN-BP showed a panic-like cycle wherein a lack of hunger predicted worry, and this worry predicted a further reduction in hunger.

Post-eating dysphoria was present in all EDs, while restriction-promoting feedback loops were present in most EDs.