Daily and momentary mood and stress are associated with binge eating and vomiting in bulimia nervosa patients in the natural environment.

TLDR

The study examined how mood and stress relate to binge eating and vomiting in bulimia nervosa patients using real‑time data collection. 131 women with BN used palmtop computers for two weeks to record affect, stress, and binge/vomit episodes six times daily, and mixed‑effects models compared mood and stress across days with and without events. Binge and purge days were associated with lower positive affect, higher negative affect, anger, and stress, and within‑day decreases in positive affect and increases in negative affect and anger reliably preceded episodes, while affect improved afterward, indicating negative reinforcement.

Abstract

The relation of mood and stress to binge eating and vomiting in the natural environments of patients with bulimia nervosa (BN) was examined using real-time data collection. Women (n = 131; mean age = 25.3 years) with BN carried a palmtop computer for 2 weeks and completed ratings of positive affect (PA), negative affect (NA), anger/hostility (AH), and stress (STRS); they also indicated binge or vomit episodes (BN-events) 6 times each day. Mixed models were used to compare mood and STRS between and within days when BN-events occurred. Between-days analyses indicated that binge and vomit days both showed less PA, higher NA, higher AH, and greater STRS than days with no BN-events. Within-day, decreasing PA, and increasing NA and AH, reliably preceded BN-events. Conversely, PA increased, and NA and AH decreased following BN-events. Demonstration of the temporal sequencing of affect, STRS, and BN-events with a large BN sample may help advance theory and clinical practice, and supports the view that binge and purge events hold negatively reinforcing properties for women with BN.