Negative and positive affect as perceived triggers for loss of control eating in treatment-seeking individuals with binge eating disorder

Christina Robinson Felonis

doi:10.17918/00001193

Outcomes from behavioral treatments for binge eating disorder (BED) are suboptimal and the need to identify areas for improvement is apparent. One potential explanation for these suboptimal outcomes is that affect is only minimally or partially targeted in existing treatments. Negative affect (NA) has been reliably shown to predict near-time loss of control eating (LOCE) episodes and poor outcomes, while positive affect (PA) has been underexplored but primarily supported as a protective factor for LOCE. However, there is a growing evidence base suggesting that for certain types of PA, situations eliciting PA, and subsets of individuals, PA may in fact contribute to LOCE. Elucidating which individuals with BED perceive NA and PA as triggers for LOCE and how this perception impacts treatment buy-in and response could be a key pathway to tailoring behavioral treatments and improving outcomes. The current study sought to address these gaps in the existing literature in 48 adults with BED receiving 25 sessions of group behavioral weight loss (BWL), either standard behavioral weight loss treatment (SBT) or an acceptance-based behavioral treatment version. PA as a perceived trigger for LOCE was examined as a predictor of outcomes from BWL as a whole and as a moderator of outcomes between treatment conditions. Several exploratory analyses were also conducted to better understand the unique clinical presentation of participants who reported PA as a perceived trigger for LOCE, the function of engaging in LOCE when experiencing NA or PA, and whether perceiving PA as a trigger for LOCE impacted the perceived helpfulness of treatment strategies. Results showed that nearly all individuals perceived NA as a trigger for LOCE and that nearly a third of individuals perceived PA as a trigger. PA as a perceived trigger for LOCE at baseline was not associated with global eating pathology or weight outcomes and was associated with better LOCE outcomes from SBT. Consistently, individuals who reported PA as a perceived trigger for LOCE found behavioral strategies most helpful, while individuals who reported NA as a perceived trigger found psychological strategies most helpful. Individuals who reported PA as a perceived trigger for LOCE were more likely to generally eat in response to PA and situations likely to elicit PA. They were also greater in age, identified more frequently as Black or African American and male, and had lower BMI, emotion dysregulation, anxiety, depression, and impulsivity. Engaging in LOCE in response to NA and PA was described as a maladaptive regulation strategy most often intended to provide comfort and pleasure. These findings indicate that PA as a perceived trigger for LOCE remains a complex construct worthy of additional exploration. Future research should seek to replicate using larger and more diverse samples and to extend these findings to other populations and behavioral treatments for BED.

Negative and positive affect as perceived triggers for loss of control eating in treatment-seeking individuals with binge eating disorder

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Negative and positive affect as perceived triggers for loss of control eating in treatment-seeking individuals with binge eating disorder

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