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Int J Eat Disord. 2019 Jul 16. doi: 10.1002/eat.23124. [Epub ahead of print]

Moving beyond self-report data collection in the natural environment: A review of the past and future directions for ambulatory assessment in eating disorders.

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Center for Bio-behavioral Research, Sanford Research, Fargo, North Dakota.
Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota.
Department of Preventive Medicine, University of Southern California, Los Angeles, California.
Department of Psychology, Drexel University, Philadelphia, Pennsylvania.


in English, Spanish


In recent years, ecological momentary assessment (EMA) has been used to repeatedly assess eating disorder (ED) symptoms in naturalistic settings, which has allowed for increased understanding of temporal processes that potentiate ED behaviors. However, there remain notable limitations of self-report EMA, and with the rapid proliferation of technology there are ever-increasing possibilities to improve ambulatory assessment methods to further the understanding and treatment of EDs. Therefore, the purpose of this review was to (a) systematically review the studies in EDs that have utilized ambulatory assessment methods other than self-report, and (b) provide directions for future research and clinical applications.


A systematic literature search of electronic databases was conducted, and data regarding study characteristics and methodological quality were extracted.


The search identified 17 studies that used ambulatory assessment methods to gather objective data, and focused primarily on autonomic functioning, physical activity, and cognitive processes in ED and control groups.


Together the literature demonstrates the promise of using a range of ecologically valid ambulatory assessment approaches in EDs, though there remains limited research that has utilized methods other than self-report (e.g., wearable sensors), particularly in recent years. Going forward, there are several technology-enhanced momentary assessment methods that have potential to improve the understanding and treatment of EDs.


ambulatory assessment; eating disorder; ecological momentary assessment; experience sampling; naturalistic assessment; precision medicine


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