Temporal Relationships between Mood and Eating across Eating Disorders: A Network Approach

Emotions and eating bidirectionally influence each other in eating disorders, contributing to the observed symptomatology. Network modelling can reveal these relationships, but it has rarely been conducted with prospective, naturalistic data. We explored networks looking at prospective relationships between negative and positive emotions on one hand and transdiagnostic eating-related behaviors (hunger, food craving, and calorie intake) on the other. These variables were assessed six times a day across eight days in female participants with Binge-Eating Disorder (BED, N=37), Bulimia Nervosa (BN, N=42), and Anorexia Nervosa of the binge-purge (AN-BP, N=26) and restrictive (AN-R, N=29) subtypes. Most prominent were associations of calorie intake with subsequent negative affect, seen in every group, particularly in BN. We also observed several possible affect-mediated pathways for restriction: in BN and AN-BP, hunger predicted reduced negative affect, and there were clear restriction- and hunger-promoting feedback loops mediated by emotional responses; in AN-R, depression predicted less hunger and desire-to-eat. We also observed differing patterns of emotional eating. AN-R showed positive emotional eating, with happiness predicting desire-to-eat and thereby eating. BED showed negative emotional eating, with worry predicting subsequent hunger and desire-to-eat, and irritation predicting calorie intake. AN-R and BN showed bored eating, while AN-BP showed no negative emotional eating whatsoever. Lastly, when it comes to emotional experience, patients with AN-BP experienced the most intense and persistent negative affect across the sample, and their network was most dissimilar to that of AN-R, supporting their study as a separate group with elevated emotional distress.