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A naturalistic examination of negative affect and disorder-related rumination in anorexia nervosa

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Abstract

In anorexia nervosa (AN), volitional inhibition of rewarding behaviors, such as eating, involves a conflict between the desire to suppress appetite and the inherent motive to consume. This conflict is thought to have costs that carry over into daily life, e.g., triggering negative affect and/or recurring ruminations, which may ultimately impact long term outcome. Hence, increasing research effort is being dedicated to understand the link between emotional and ruminative processes in the etiology and maintenance of AN. We investigated whether affective states influence disorder-related rumination in AN applying “ecological momentary assessment”, a method which allows the experimenter to gain insight into psychological processes in the natural environment and assess data in real time. Participants (AN = 37, healthy controls = 33) were given a smartphone for 14 days. A ringtone signaled at six random time-points each day to fill in a questionnaire, which gauged disorder-typical thoughts about food and weight as well as affective state. Analyses, applying hierarchical linear models confirmed that AN patients spend more time thinking about food, body shape and weight than controls (p < 0.001). Additionally, the results support the hypothesis that momentary negative affect (but not baseline depression (p = 0.56) or anxiety symptoms (p = 0.60) are positively associated with a higher amount of disorder-related rumination in patients (p < 0.001). Our findings are in line with theories which claim that ruminative thinking induces a vulnerability to negative stimuli which, in turn, fosters heightened negative affect. Thus, therapeutic interventions could be improved by implementing modules that specifically target disorder-related rumination.

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Acknowledgements

This work was supported by the Deutsche Forschungsgemeinschaft (EH 367/5-1; SFB 940/1), and Swiss Anorexia Nervosa Foundation.

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Authors and Affiliations

  1. Translational Developmental Neuroscience Section, Eating Disorder Services and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, University Hospital C. G. Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany

    Maria Seidel, Juliane Petermann, Franziska Ritschel, Ilka Boehm, Joseph A. King, Daniel Geisler, Fabio Bernardoni, Veit Roessner & Stefan Ehrlich

  2. International School of Management and Technical University of Dortmund, Dortmund, Germany

    Stefan Diestel

  3. Department of Psychology, Technische Universität Dresden, Dresden, Germany

    Thomas Goschke

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  1. Maria Seidel
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Correspondence to Stefan Ehrlich.

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Dr. Roessner has received payment for consulting and writing activities from Lilly, Novartis, and Shire Pharmaceuticals, lecture honoraria from Lilly, Novartis, Shire Pharmaceuticals, and Medice Pharma, and support for research from Shire and Novartis. He has carried out (and is currently carrying out) clinical trials in cooperation with the Novartis, Shire, and Otsuka companies. All other authors reported no biomedical financial interests or potential conflicts of interest.

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Seidel, M., Petermann, J., Diestel, S. et al. A naturalistic examination of negative affect and disorder-related rumination in anorexia nervosa. Eur Child Adolesc Psychiatry 25, 1207–1216 (2016). https://doi.org/10.1007/s00787-016-0844-3

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