Do momentary changes in body dissatisfaction predict binge eating episodes? An ecological momentary assessment study
Do momentary changes in body dissatisfaction predict binge eating episodes? An ecological momentary assessment study
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DOI：
10.1007/s40519-020-00849-z
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发表时间：
2020-01-27
影响因子：
2.9
通讯作者：
Juarascio, Adrienne S.
中科院分区：
文献类型：
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作者：
Srivastava, Paakhi;Michael, Megan L.;Juarascio, Adrienne S.
现有的理论模型和经验证据表明，身体不满意（BD），一个人的形状的负面主观评价[1]，在暴饮暴食（BE）病理的发生和维持中起着关键作用。BD在历史上被概念化并被视为BE病理个体的相对稳定的性格倾向，以负面评价他们的体型。这种表征BD的典型方法可以被定义为特质BD（定义为一种稳定且不变的特征，可以在广泛的背景下转移[2]）。因此，BD和BE之间的关联大多使用BD的特征样测量和BE的长期评估（例如，饮食失调检查[3]）进行测试。来自生态瞬时评估（EMA）研究的新兴数据表明，BD可能更好地概念化为一种随时间和背景而变化的流体结构（即状态BD）[3，4]。研究发现，个体经常经历BD状态的变化，其特征在于在一天内响应于不同的环境而改变BD水平[3-5]。例如，最近的一项研究使用11分Likert量表在非临床样本中评估了EMA 2周内的BD状态，发现任何两个连续时间点之间的平均人内变异为4分[6]。BD的变异性已被证明是由于各种内部（例如，压力水平）和背景因素（例如，社会环境）而引起的[7]。虽然有证据表明，状态BD在非临床样本中是可变的，但目前尚不清楚与普通人群相比具有升高的BD性状的进食障碍（ED）个体是否也经历BD的变异性。如果BD在艾德人群中是可变的，这可能会改变我们对BD在BE病理病因学和维持中的作用的概念化。虽然性状BD通常被视为BE病理学的远端风险因素，但BD的状态变化可能是BE发作的近端风险因素。患有艾德的个体的日常经历（例如在镜子中看到自己，暴露于瘦身美化媒体，浪漫伴侣的公司）可能会导致BD的变异性。例如，在一项实验研究中，当健康个体被要求将注意力集中在他们不满意的身体部位时，个体会经历BD的暂时恶化，在BD恢复到基线水平之前持续了一段时间[8]。日常身体相关的经历可能会增加ED患者的实际自我和理想自我之间的差异[9]，并可能促进BD的变异性[7]。如果ED患者的BD存在变异性，我们可以预期BD的变异性可能导致短暂的艾德症状的变化。例如，与没有BE的日子（非BE日子）相比，由于在一天的过程中BD的稳定或略微增加的高水平，在发生BE的日子（BE日子）中BD的可变性可能较低，其中状态BD可能更可能在一天中对几个因素做出反应而波动。例如，一个人谁从事身体检查可能会更频繁地这样做，在某些日子（例如，在休息日从工作），这可能会导致上升的BD水平在整个一天，并最终增加风险的暴饮暴食事件发生的一种方式，以科普高BD的痛苦。
Extant theoretical models and empirical evidence indicate that body dissatisfaction (BD), the negative subjective evaluation of one’s shape [1], plays a key role in the onset and maintenance of binge eating (BE) pathology. BD has historically been conceptualized and treated as relatively stable, dispositional tendency of individuals with BE pathology to negatively evaluate their body shape. This typical approach to characterizing BD can be defined as trait BD (defined as a stable and unchanging characteristic that is transferable across a wide range of contexts [2]). Consequently, associations between BD and BE have mostly been tested using trait-like measures of BD and longer term assessments of BE (eg, the Eating Disorder Examination [3]). Emerging data from ecological momentary assessment (EMA) studies have shown that BD may be better conceptualized as a fluid construct that varies across time and contexts (ie, state BD)[3, 4]. Studies have found that individuals often experience variability in state BD characterized by changing levels of BD within a single day in response to different contexts [3–5]. For instance, a recent study that assessed state BD over 2 weeks of EMA in a non-clinical sample using a 11-point Likert scale found a notable average within-person variation of 4 points between any two consecutive time points [6]. Variability in BD has been shown to arise due to a variety of internal (eg, stress levels) and contextual factors (eg, social settings)[7]. Although evidence suggests that state BD is variable in non-clinical samples, it is currently unknown whether individuals with eating disorders (EDs), who have elevated trait BD compared to the general population, also experience variability in BD. If BD is variable within an ED population, this could change how we conceptualize the role of BD in the etiology and maintenance of BE pathology. While trait BD is commonly viewed as a distal risk factor for BE pathology broadly, state variations in BD may be a proximal risk factor for BE episodes. Day-to-day experiences of individuals with ED (such as seeing oneself in mirrors, exposure to thin-body glorifying media, company of a romantic partner) may cause variability in BD. For instance, in an experimental study, when healthy individuals were asked to focus their attention specifically on the parts of their body with which they were dissatisfied, individuals experienced temporary worsening of BD which was sustained for a brief period before BD returned to its baseline level [8]. Day-to-day body-related experiences may increase discrepancy between one’s actual self and ideal self among individuals with EDs [9] and may promote variability in BD [7]. If individuals with EDs experience variability in BD, we may expect that variability in BD could lead to changes in momentary ED symptoms. For example, variability in BD may be lower on days when BE occurs (BE days) due to either steady or slightly increasing high level of BD over the course of a day compared to days without BEs (non-BE days) when state BD may be more likely to fluctuate in reaction to several factors throughout the day. For instance, an individual who engages in body checking may do so more frequently on some days (eg, on days off from work) which may lead to rising BD levels throughout the day and ultimately increase risk for a binge episode occurring as a way to cope with the distress of high BD.