احساسات منفی و میل به غذا خوردن در بولیمیا

This study examines a broad range of negative feelings as possible antecedents of binge eating in bulimia nervosa (BN). Another goal is to explore the connection between negative feelings and the desire to eat as recorded continuously during two consecutive days. This is the first study comparing data from BN patients with a relevant clinical control group. Forty female BN patients, 40 female panic disorder (PD) patients, and 40 healthy women continuously recorded their feelings and the desire to eat while in their natural environment. Both patient groups reported more negative feelings than the healthy controls. BN patients had higher within-subject correlations between most negative feelings and the desire to eat than the two control groups. BN patients rated most feelings more negatively in the hour prior to binge eating than during the rest of the day. BN patients' general mood state worsened after binge eating but returned to prebinge levels after purging. The study provides additional evidence that unspecific negative feelings play an important role in the context of binge-eating behavior in BN.

Negative mood states are often thought to be involved in perpetuating bulimia nervosa (BN). According to some theorists, binge eating may provide a mechanism for coping with stressful situations and negative mood states. Overeating may function as a distraction from negative experiences Cattanach et al., 1988, Davis et al., 1988, Elmore & de Castro, 1990, Fairburn & Cooper, 1987, Hawkins & Clement, 1984, Heatherton & Baumeister, 1991 and Hsu, 1990. According to this view, binge eating should occur at times when mood is particularly low and negative mood states should improve during the course of a binge-eating episode. The importance of negative mood states as antecedents or correlates of bulimic binge-eating episodes have been supported by clinical impressions (e.g., Chiodo, 1987) and a number of early systematic descriptions of BN patients Abraham & Beumont, 1982, Johnson et al., 1982, Mitchell et al., 1985 and Pyle et al., 1981. Here, patients often reported tension, anxiety, and sadness as typical antecedents of their binge eating. However, due to the retrospective nature of these reports, conclusions about the role of mood states in BN remain tentative. Retrospective accounts are hampered by poor memory recall and by the tendency to heuristically reconstruct events of the past (Shiffman & Stone, 1998). More specifically, retrospective assessment may also be influenced by specific evaluative biases of patients with an eating disorder (Gleaves, Williamson, & Barker, 1993). Interestingly, some laboratory studies, which minimize these problems, show similar effects of mood and eating behavior. For example, if food is provided in a laboratory situation that allows observation, BN patients rate their mood lower before binge eating than controls do before they eat a regular meal (Kaye, Gwirtsman, George, Weiss, & Jimerson, 1986). Also, if negative mood is experimentally induced loss of control is greater and the occurrence of binge eating is increased in eating disordered women (Agras & Telch, 1998, p. 76). But laboratory studies may be limited in their potential to simulate conditions representative for everyday mood states and eating behavior in BN patients. Naturalistic field studies provide a straightforward avenue for ecologically valid investigations. Moreover, if feelings are probed continuously throughout the day this yields a considerably more accurate assessment than retrospective estimations of past psychological states (Shiffman & Stone, 1998). In Johnson and Larson's (1982) landmark study, BN patients were asked to record their mood states every 2 hours. Compared to healthy controls, BN patients described themselves as generally more lonely, sad, weak, irritable, passive, and pressured. Their mood was more negative before binge eating occurred. During binge eating, their mood deteriorated further but improved afterwards. There is a number of naturalistic studies examining mood states in the context of binge eating Cooper & Bowskill, 1986, Elmore & de Castro, 1990, Gleaves et al., 1993, Lingswiler et al., 1989, Rebert et al., 1991, Schlundt et al., 1985 and Sherwood et al., 2000. Like Johnson and Larson (1982), one of these replications in BN patients assessed ratings continuously during the day (that is, independently from times of food consumption) and compared them with healthy controls (Davis et al., 1988). Here, global mood state was worse before binge eating when compared to the time before normal meals. But the interpretation of this finding is complicated by the fact that BN patients' mood before normal meals relative to their average mood was better than that of control subjects. Because only a global mood rating was assessed in this study the specific quality of emotions or feelings cannot be determined. Few studies also examine the mood changes during and after the binge–purge episodes. Clinical experience and interview data (Mitchell et al., 1985) indicate that in some cases binge eating and purging can actually lead to negative thoughts and emotions. There is also evidence from field studies that mood states do not necessarily improve after binge eating but that depressed feelings can come up during binge eating (Cooper & Bowskill, 1986). After the binge–purge episode, Elmore and de Castro (1990) found an amelioration in anxiety, which was the only variable that was more negative before binge-eating episodes, but they also found an increase in depression. None of the naturalistic studies we reviewed investigated whether BN patients experience a greater urge to eat when they experience negative feelings independently from the occurrence of binge-eating episodes. The examination of correlates of the desire to eat is important because food cravings are a central part of bulimic pathology. Because craving does not always lead to binge eating (Waters, Hill, & Waller, 2001), a lot of information is lost if the correlates of craving are only studied in conjunction with actual binge-eating episodes. It is obvious that further studies are needed to elucidate the connection among mood states, the desire to eat, and binge–purge episodes in BN. One goal of this study is to examine a broad range of negative feelings as possible antecedents of binge-eating episodes. This will allow for an adequate replication of Johnson and Larson's (1982) findings. Another goal is to examine whether there is a connection between negative feelings and the desire to eat in BN patients throughout the day. This will extend the literature on the correlates of food craving in BN. To research these questions, study participants were asked to record their feelings and eating behavior while in their natural environment in order to optimize ecological validity (Shiffman & Stone, 1998). A fixed-schedule time sampling approach was chosen in order to minimize the possible attribution bias that may occur when ratings are only done at times of food consumption or any other significant event. Healthy women without psychopathology were recruited as a control group. To determine whether certain negative feelings and their relationship with the desire to eat are specific to BN, a group of patients with panic disorder (PD; with or without agoraphobia) were included as a second control group in the study. PD patients are suitable for this comparison because they have no tendency toward disturbed eating, but do experience negative mood states comparable to those of BN patients. The feelings studied here are often associated with the experience of psychological distress and were picked because of their significance in previous studies. “Sadness” and “anxiety” are very specific mood states that are mentioned most often in the literature on emotional eating (e.g., Bulik et al., 1991, Cooper & Bowskill, 1986, Johnson & Larson, 1982 and Kaye et al., 1986). “Tension,” “insecurity,” and “emotional balance” represented less specific or vague mood states. The “feeling of physical well-being” extended the assessment to bodily states. In addition to ratings for “hunger,” which presumably reflects a physical sensation, ratings for “desire to eat” were included to capture more of the psychological aspects of wanting food (Ganley, 1989). Because BN patients may have abnormal perceptions of hunger (Halmi, Sunday, Puglisi, & Marchi, 1989), this study focuses on the desire to eat. Halmi et al. (1989) suggested that this variable may be a better predictor of eating behavior in BN. In addition to the comparison between groups, we studied mood changes within the binge–purge episodes of BN patients. The assessment of mood changes around binge-eating episodes required event sampling (see Shiffman & Stone, 1998) and asked for retrospective ratings. These data allowed us to test four hypotheses. First, the mood ratings throughout the day were expected to be more negative in BN patients than in controls. PD patients were expected to have similar negative mood states as the BN patients. Second, if an increased desire to binge were a stress reaction in BN patients (e.g., Cattanach et al., 1988), a correlation between desire to eat and negative feelings would be expected. In PD patients and healthy controls, no significant correlation between these feelings and the desire to eat was predicted. Third, it was expected that, in contrast to the rest of the day, more negative feelings would precede binge-eating episodes in BN patients. Fourth, it was expected that BN patients would report more negative global mood states before binge eating than after purging.