TY - JOUR
T1 - Functional Assessment of Restrictive Eating
T2 - A Three-Study Clinically Heterogeneous and Transdiagnostic Investigation
AU - Wang, Shirley B.
AU - Fox, Kathryn R.
AU - Boccagno, Chelsea
AU - Hooley, Jill M.
AU - Mair, Patrick
AU - Nock, Matthew K.
AU - Haynos, Ann F.
N1 - Publisher Copyright:
© 2021 American Psychological Association
PY - 2021
Y1 - 2021
N2 - Restrictive eating is common and associated with negative psychological outcomes across the life span and eating disorder (ED) severity levels. Little is known about functional processes that maintain restriction, especially outside of narrow diagnostic categories (e.g., anorexia nervosa). Here, we extend research on operant four-function models (identifying automatic negative, automatic positive, social negative, and social positive reinforcement functions) that have previously been applied to nonsuicidal self-injury (NSSI), binge eating, and purging to restricting. We assessed restrictive eating functions in three samples: clinically heterogeneous adolescents (Study 1: N = 457), transdiagnostic adults (Study 2: N = 145), and adults with acute or recently weight-restored anorexia nervosa (Study 3: N = 45). Study 1 indicated the four-function model was a good fit for restricting (root mean square error of approximation [RMSEA] =.06, Tucker-Lewis index [TLI] =.88). This factor structure replicated in Study 2 (comparative fit index [CFI] =.97, RMSEA =.07, TLI =.97, standardized root mean square residual [SRMR] =.09). Unlike NSSI, binge eating, and purging, which have been found to primarily serve automatic negative reinforcement functions, all three present studies found automatic positive reinforcement was most highly endorsed (by up to 85% of participants). In Studies 1 and 3, automatic functions were associated with poorer emotion regulation (ps,.05). In Study 1, social functions were associated with less social support (ps,.001). Across studies, automatic functions were associated with greater restriction ps,.05). Functions varied slightly by ED diagnosis. Across ED presentation, severity, and developmental stage, restrictive eating may be largely maintained by automatic positive reinforcement, with some variability across presentations.
AB - Restrictive eating is common and associated with negative psychological outcomes across the life span and eating disorder (ED) severity levels. Little is known about functional processes that maintain restriction, especially outside of narrow diagnostic categories (e.g., anorexia nervosa). Here, we extend research on operant four-function models (identifying automatic negative, automatic positive, social negative, and social positive reinforcement functions) that have previously been applied to nonsuicidal self-injury (NSSI), binge eating, and purging to restricting. We assessed restrictive eating functions in three samples: clinically heterogeneous adolescents (Study 1: N = 457), transdiagnostic adults (Study 2: N = 145), and adults with acute or recently weight-restored anorexia nervosa (Study 3: N = 45). Study 1 indicated the four-function model was a good fit for restricting (root mean square error of approximation [RMSEA] =.06, Tucker-Lewis index [TLI] =.88). This factor structure replicated in Study 2 (comparative fit index [CFI] =.97, RMSEA =.07, TLI =.97, standardized root mean square residual [SRMR] =.09). Unlike NSSI, binge eating, and purging, which have been found to primarily serve automatic negative reinforcement functions, all three present studies found automatic positive reinforcement was most highly endorsed (by up to 85% of participants). In Studies 1 and 3, automatic functions were associated with poorer emotion regulation (ps,.05). In Study 1, social functions were associated with less social support (ps,.001). Across studies, automatic functions were associated with greater restriction ps,.05). Functions varied slightly by ED diagnosis. Across ED presentation, severity, and developmental stage, restrictive eating may be largely maintained by automatic positive reinforcement, with some variability across presentations.
KW - assessment
KW - four-function model
KW - functions
KW - restrictive eating
UR - http://www.scopus.com/inward/record.url?scp=85119579312&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85119579312&partnerID=8YFLogxK
U2 - 10.1037/abn0000700
DO - 10.1037/abn0000700
M3 - Article
C2 - 34780230
AN - SCOPUS:85119579312
SN - 0021-843X
VL - 130
SP - 761
EP - 774
JO - Journal of abnormal psychology
JF - Journal of abnormal psychology
IS - 7
ER -