Relationship of mood alterations to bingeing behavior in bulimia. British Journal of Psychiatry, 149, 479-485

The British Journal of Psychiatry (Impact Factor: 7.99). 11/1986; 149:479-85. DOI: 10.1192/bjp.149.4.479
Source: PubMed


Twelve women with bulimia participated in a study in which they binged and vomited on the day after hospital admission. Caloric intake, time spent bingeing and vomiting, and self-reported mood ratings demonstrated much variation from subject to subject. Both subjective and objective ratings of mood indicated that anxiety decreased more frequently and to a greater extent than depression, both during and after bingeing and vomiting. The present data, obtained in a controlled setting, tend to confirm previous information on binge episodes obtained by self-report from bulimic patients. Bingeing and vomiting episodes may provide bulimic patients with a physiological mechanism for temporarily relieving a dysphoric mood state.

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Available from: Walter H Kaye, Oct 11, 2015
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    • "This effect would be missed by this meta-analysis and the majority of EMA studies which relied on global measures of mood (Alpers & Tuschen-Caffier, 2001; Davis, Freeman, & Solyom, 1985; Deaver et al., 2003; Engel et al., 2005; Hilbert & Tuschen- Caffier, 2007; Sherwood et al., 2000; Smyth et al., 2007; Stein et al., 2007). Partially supporting this possibility, four EMA studies included in the current review found that anxiety decreased from pre-to post-binge eating (Elmore & de Castro, 1990; Hetherington et al., 1994; Kaye et al., 1986; Redlin et al., 2002) while depression (Elmore & de Castro, 1990; Hetherington et al., 1994; Kaye et al., 1986) and guilt (Redlin et al., 2002) increased, and another study found that anger and irritability decreased while sadness and shame increased post-binge eating (Johnson & Larson, 1982). However, other studies found consistent post-binge increases in anxiety, depression, and hostility (Powell & Thelen, 1996); anxiety and shame/guilt (Corstorphine et al., 2006); or anger, guilt, and depression (Wegner et al., 2002), suggesting that a trade-off in facets of negative affect have not been reliably observed. "
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    ABSTRACT: The affect regulation model of binge eating, which posits that patients binge eat to reduce negative affect (NA), has received support from cross-sectional and laboratory-based studies. Ecological momentary assessment (EMA) involves momentary ratings and repeated assessments over time and is ideally suited to identify temporal antecedents and consequences of binge eating. This meta-analytic review includes EMA studies of affect and binge eating. Electronic database and manual searches produced 36 EMA studies with N = 968 participants (89% Caucasian women). Meta-analyses examined changes in affect before and after binge eating using within-subjects standardized mean gain effect sizes (ESs). Results supported greater NA preceding binge eating relative to average affect (ES = 0.63) and affect before regular eating (ES = 0.68). However, NA increased further following binge episodes (ES = 0.50). Preliminary findings suggested that NA decreased following purging in bulimia nervosa (ES = -0.46). Moderators included diagnosis (with significantly greater elevations of NA prior to bingeing in binge eating disorder compared to bulimia nervosa) and binge definition (with significantly smaller elevations of NA before binge vs. regular eating episodes for the Diagnostic and Statistical Manual of Mental Disorders definition compared to lay definitions of binge eating). Overall, results fail to support the affect regulation model of binge eating and challenge reductions in NA as a maintenance factor for binge eating. However, limitations of this literature include unidimensional analyses of NA and inadequate examination of affect during binge eating, as binge eating may regulate only specific facets of affect or may reduce NA only during the episode.
    Psychological Bulletin 05/2011; 137(4):660-81. DOI:10.1037/a0023660 · 14.76 Impact Factor
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    • "Several studies support this model by showing that people often report high negative mood before the occurrence of binge episodes (Davis et al., 1985; Davis et al., 1988; Lingswiler et al., 1989; Powell and Thelen, 1996; Telch and Agras, 1996; Agras and Telch, 1998) and decreases in negative mood following binge eating (Kaye et al., 1986). "
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    ABSTRACT: This study applied a functional approach to the study of bingeing and purging behaviors. Based on a four-function theoretical model of bingeing and purging, it was hypothesized that these behaviors are performed because of their intrapersonally reinforcing (e.g., emotion regulation) and/or interpersonally reinforcing (e.g., help-seeking, attention-getting behavior) properties. Participants were 298 adult females who had engaged in bingeing or purging in the last 3 months and who provided data via an online survey of these behaviors. Confirmatory factor analyses revealed support for a four-function model of bingeing and purging in which people use these behaviors for intrapersonal reinforcement functions and also for interpersonal reinforcement. Understanding the functions of binge eating and purging has direct implications for assessment and treatment of these behaviors.
    Psychiatry Research 08/2010; 178(3):518-24. DOI:10.1016/j.psychres.2009.05.010 · 2.47 Impact Factor
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    • "Other studies have shown that vomiting also has a substantial impact on affective state, acting as a potential negative reinforcer by reducing anxiety levels (Johnson & Larson, 1982; Kaye et al., 1986) following eating. "
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    ABSTRACT: While there is considerable evidence that bulimic behaviors serve the function of modifying internal states (e.g., satiety, mood), there is less clarity over the roles of the different behaviors across the binge-purge cycle. The present study examines the impact of bingeing and vomiting upon these internal states at different time points, and evaluates the potential reinforcement of those behaviors by the changes in internal states. Twenty-three women with diagnoses of bulimia nervosa completed a diary of all binge-vomit episodes over the course of 7 days, rating their internal states (satiety, negative mood, positive mood) at four time points during each episode. There were substantial changes across the cycle in levels of hunger, fullness, guilt/shame, anxiety/worry, and happiness/relief, but not in other states. The changes indicate that the binge-vomit cycle is maintained by the effects of both behaviors, but that the vomiting behavior evokes the strongest pattern of reinforcement. Further research is needed to determine the levels of internal states during the binge itself.
    Journal of Nervous & Mental Disease 07/2006; 194(6):446-9. DOI:10.1097/01.nmd.0000221303.64098.23 · 1.69 Impact Factor
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