Maintenance Factors for Eating Disorder Symptoms Based on Ecological Momentary Assessment Studies: A Systematic Review

Several prominent theories of eating disorders maintenance exist, with most corresponding to evidence-based treatments. Ecological momentary assessment (EMA) is an ideal method for testing relationships between proposed maintenance factors and eating disorder symptoms given its ability to examine antecedents and consequences. A seminal systematic review and meta-analysis of EMA studies on affect and binge eating was published in 2011, but the literature since this time and beyond these variables has not been synthesized. We searched PsycINFO, MEDLINE, and Scopus (last search March 31, 2025) for articles using EMA to study psychological/contextual variables in relation to a core eating disorder symptom in people with an eating disorder or eating disorder symptom. After screening, 179 papers were included. The majority examined affect in relation to binge eating or loss of control (LOC) eating, although affect was also considered in relation to purging, restriction, exercise, and body checking. Whereas negative affect primarily drives binge eating/LOC eating and purging, positive affect appears more relevant for exercise and (perhaps) restriction. Surprisingly few studies have considered how ED-related cognitive, affective, or behavioral variables relate to eating disorder symptoms, despite these being primary associations in leading maintenance/treatment models of eating disorders. Most studies have investigated samples of exclusively women, with some having a small proportion of male participants, and only two samples were comprised of all or almost all men. Future EMA research on eating disorders should go beyond studying affect to test whether relationships proposed in established maintenance models can be observed in daily life.