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Appetite. 2014 Dec;83:69-74. doi: 10.1016/j.appet.2014.08.014. Epub 2014 Aug 15.

Bidirectional associations between binge eating and restriction in anorexia nervosa. An ecological momentary assessment study.

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University of North Dakota, 319 Harvard St., Stop 8380, Grand Forks, ND 58202, USA; Neuropsychiatric Research Institute, Faro, ND, USA. Electronic address:
Neuropsychiatric Research Institute, Faro, ND, USA.
Neuropsychiatric Research Institute, Faro, ND, USA; University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA.
University of Minnesota, Minneapolis, MN, USA; The Emily Program, St. Paul, MN, USA.
University of Minnesota, Minneapolis, MN, USA.
The University of Chicago, Chicago, IL, USA.


This study examined the association between restrictive eating behaviors and binge eating in anorexia nervosa (AN) using data collected in the natural environment. Women (N = 118) with DSM-IV full or subthreshold AN reported eating disorder behaviors, including binge eating episodes, going ≥ 8 waking hours without eating, and skipping meals, during 2 weeks of ecological momentary assessment (EMA). Time-lagged generalized estimating equations tested the following hypotheses: 1) dietary restriction would predict binge eating while controlling for binge eating the previous day; 2) binge eating would predict restriction the subsequent day while controlling for restriction the previous day. After controlling for relevant covariates, the hypotheses were not supported; however, there appeared to be a cumulative effect of repeatedly going 8 consecutive hours without eating (i.e. fasting) on the risk of binge eating among individuals who recently engaged in binge eating. In addition, skipping meals was associated with a lower risk of same day binge eating. The relationship between binge eating and dietary restriction appears to be complex and may vary by type of restrictive eating behavior. Future research should aim to further clarify the nature of the interaction of binge eating and restrictive eating among individuals with AN in order to effectively eliminate these behaviors in treatment.


Anorexia nervosa; Binge eating; Restriction

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