Korean Clinical Psychology Association

Current Issue

Korean Journal of Clinical Psychology - Vol. 40 , No. 1

[ Original Article ]
Korean Journal of Clinical PsychologyVol. 40, No. 1, pp.29-42
Abbreviation: KJCP
ISSN: 1229-0335 (Print) 2733-4538 (Online)
Print publication date 28 Feb 2021
Received 03 Aug 2020 Revised 02 Dec 2020 Accepted 03 Dec 2020
DOI: https://doi.org/10.15842/kjcp.2021.40.1.003

Moderating Role of Thin-ideal Internalization in the Relationship between Negative Affect and Eating: An Ecological Momentary Assessment Study
Juyoung Jeon ; Soo Hyun Park
Department of Psychology, Yonsei University, Seoul, Korea

Correspondence to : Soo Hyun Park, Department of Psychology, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, Korea; E-mail: parksoohyun@yonsei.ac.kr
The authors have no known conflict of interest to disclose.This article has been produced as part of the first author’s master thesis under the supervision of the second author.


© 2021 Korean Clinical Psychology Association

Abstract

Eating has been regarded as a regulatory behavior in coping with negative affect. However, individual differences in the relationship between negative affect and eating behavior remain relatively unexplored. This study aims to investigate this association while examining the role of potential moderators, namely thin-ideal internalization and impulse control difficulties using ecological momentary assessment (EMA) methodology. Female participants (N=72) aged 18 to 29 years completed a 7-day EMA protocol and questionnaires. Daily EMA measures included negative affect (NA) and caloric intake. Hierarchical linear modeling was applied to analyze the data. NA did not significantly predict caloric intake at the within-person level. However, the non-significant association between NA and caloric intake was negatively moderated by thin-ideal internalization on the between-person level. The moderating role of impulse control difficulties was not significant. These findings extend prior research on risk factors of emotional undereating and they highlight the importance of further research. The limitations of this study and suggestions for future research have been discussed.


Keywords: ecological momentary assessment (EMA), negative affect, eating behavior, thin-ideal internalization, emotional undereating

Author contributions statement

JYJ, graduate student in the Department of Psychology of Yonsei University, designed the study, conducted data collection and analysis, and drafted the manuscript. SHP, associate professor in the Department of Psychology of Yonsei University, supervised the research design, data collection and analysis process. All authors provided critical feedback, participated in the revision of the manuscript and approved the final submission.


References
1. Ali, K., Fassnacht, D. B., Farrer, L., Rieger, E., Feldhege, J., Moessner, M., . . . Bauer, S. (2020). What prevents young adults from seeking help? Barriers toward help-seeking for eating disorder symptomatology. International Journal of Eating Disorders, 53, 894-906. Retrieved from https://doi.org/10.1002/eat.23266
2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.
3. Arnow, B., Kenardy, J., & Agras, W. S. (1995). The emotional eating scale: The development of a measure to assess coping with negative affect by eating. The International Journal of Eating Disorders, 18, 79-90. doi:10.1002/1098-108X(199507)18:1<79::AID-EAT-2260180109>3.0.CO;2-V
4. Bjørklund, O., Wichstrøm, L., Llewellyn, C. H., & Steinsbekk, S. (2019). Emotional over- and undereating in children: A longitudinal analysis of child and contextual predictors. Child Development, 90, e803-e818. Retrieved from https://doi.org/10.1111/ cdev.13110.
5. Bolger, N., & Laurenceau, J. (2013). Intensive longitudinal methods: An introduction to diary and experience sampling study. New York, NY: Guildford Press.
6. Bolker, B. M., Brooks, M. E., Clark, C. J., Geange, S. W., Poulsen, J. R., Stevens, M. H. H., & White, J. S. S. (2009). Generalized linear mixed models: A practical guide for ecology and evolution. Trends in Ecology and Evolution, 24, 127-135. Retrieved from https://doi. org/10.1016/j.tree.2008.10.008.
7. Bradburn, N. M., Rips, L. J., & Shevell, S. K. (1987). Answering autobiographical questions: The impact of memory and inference on surveys. Science, 236, 157-161.
8. Brockmeyer, T., Holtforth, M. G., Bents, H., Kämmerer, A., Herzog, W., & Friederich, H. C. (2012). Starvation and emotion regulation in anorexia nervosa. Comprehensive Psychiatry, 53, 496-501. Retrieved from https://doi.org/10.1016/j.comppsych.2011.09.003.
9. Brockmeyer, T., Skunde, M., Wu, M., Bresslein, E., Rudofsky, G., Herzog, W., & Friederich, H. C. (2014). Difficulties in emotion regulation across the spectrum of eating disorders. Comprehensive Psychiatry, 55, 565-571. Retrieved from https://doi.org/10. 1016/j.comppsych.2013.12.001.
10. Cho, Y. R. (2007). Assessing emotion dysregulation: Psychometric properties of the Korean version of the difficulties in emotion regulation scale. Korean Journal of Clinical Psychology, 26, 1015- 1038.
11. Dawe, S., & Loxton, N. J. (2004). The role of impulsivity in the development of substance use and eating disorders. Neuroscience and Biobehavioral Reviews, 28, 343-351. Retrieved from https:// doi.org/10.1016/j.neubiorev.2004.03.007.
12. Enders, C. K., & Tofighi, D. (2007). Centering predictor variables in cross-sectional multilevel models: A new look at an old issue. Psychological Methods, 12, 121-138. Retrieved from https://doi. org/10.1037/1082-989X.12.2.121.
13. Engel, S. G., Wonderlich, S. A., Crosby, R. D., Mitchell, J. E., Crow, S., Peterson, C. B., . . . Gordon, K. H. (2013). The role of affect in the maintenance of anorexia nervosa: Evidence from a naturalistic assessment of momentary behaviors and emotion. Journal of Abnormal Psychology, 122, 709-719.
14. Fairburn, C. G., & Beglin, S. J. (1994). Assessment of eating disorders: Interview or self-report questionnaire? International Journal of Eating Disorders, 16, 363-370.
15. Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: A “transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41, 509-528. Retrieved from https://doi.org/10.1016/S0005-7967(02)00088-8.
16. Fitzsimmons-Craft, E. E., Bardone-Cone, A. M., Crosby, R. D., Engel, S. G., Wonderlich, S. A., & Bulik, C. M. (2016). Mediators of the relationship between thin-ideal internalization and body dissatisfaction in the natural environment. Body Image, 18, 113-122. Retrieved from https://doi.org/10.1016/j.bodyim.2016.06.006.
17. Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26, 41-54.
18. Greeno, C. G., & Wing, R. R. (1994). Stress-induced eating. Psychological Bulletin, 115, 444-464. Retrieved from https://doi.org/10. 1037/0033-2909.115.3.444.
19. Hawkins, R. C., & Clement, P. F. (1984). Binge eating: Measurement problems and a conceptual model. In Hawkins, R. C., II, Fremouw, W. J., and Clement, P. F. (Eds.), The Binge Purge Syndrome: Diagnosis, Treatment, and Research (pp. 229-251). New York, NY: Springer.
20. Hawks, S. R., Madanat, H. N., & Christley, H. S. (2008). Behavioral and biological associations of dietary restraint: A review of the literature. Ecology of Food and Nutrition, 47, 415-449. Retrieved from https://doi.org/10.1080/03670240701821444.
21. Haynos, A.F., Wang, S.B., & Fruzzetti, A.E. (2018). Restrictive eating is associated with emotion regulation difficulties in a non-clinical sample. Eating Disorders, 26, 5-12.
22. Heinberg, L. J., Thompson, J. K., & Stormer, S. (1995). Development and validation of the sociocultural attitudes towards appearance questionnaire. International Journal of Eating Disorders, 17, 81-89.
23. Herle, M., Fildes, A., Steinsbekk, S., Rijsdijk, F., & Llewellyn, C. H. (2017). Emotional over-and under-eating in early childhood are learned not inherited. Scientific Reports, 7, 1-9.
24. Heron, K. E., Scott, S. B., Sliwinski, M. J., & Smyth, J. M. (2014). Eating behaviors and negative affect in college womens everyday lives. International Journal of Eating Disorders, 47, 853-859. Retrieved from https://doi.org/10.1002/eat.22292.
25. Jansen, P. W., Roza, S. J., Jaddoe, V. W. V., Mackenbach, J. D., Raat, H., Hofman, A., . . . Tiemeier, H. (2012). Children’s eating behavior, feeding practices of parents and weight problems in early childhood: Results from the population-based Generation R Study. International Journal of Behavioral Nutrition and Physical Activity, 9, 1-11. Retrieved from https://doi.org/10.1186/1479-5868-9- 130.
26. Kaplan, H. I., & Kaplan, H. S. (1957). The psychosomatic concept of obesity. Journal of Nervous and Mental Disease, 125, 181-201.
27. Kim, Y. R., Heo, S. Y., Kang, H., Song, K. J., & Treasure, J. (2010). Childhood risk factors in Korean women with anorexia nervosa: Two sets of case-control studies with retrospective comparisons. International Journal of Eating Disorders, 43, 589-595. Retrieved from https://doi.org/10.1002/eat.20752.
28. Landsberger, H. A. (1958). Hawthorne revisited, Cornell studies in industrial and labor relations. Vol. IX. Ithaca, NY: Cornell University.
29. Lee, S., & Oh, K. (2003). Validation study of the Sociocultural Attitudes towards Appearance Questionnaire in Korea. Korean Journal of Clinical Psychology, 22, 91-926.
30. Macht, M. (2008). How emotions affect eating: A five-way model. Appetite, 50, 1-11. Retrieved from https://doi.org/10.1016/j.appet.2007.07.002.
31. Mason, T. B., Do, B., Wang, S., & Dunton, G. F. (2020). Ecological momentary assessment of eating and dietary intake behaviors in children and adolescents: A systematic review of the literature. Appetite, 144, 104465. Retrieved from https://doi.org/10.1016/ j.appet.2019.104465.
32. McNeish, D. (2017). Small sample methods for multilevel modeling: A colloquial elucidation of REML and the Kenward-Roger correction. Multivariate Behavioral Research, 52, 661-670. Retrieved from https://doi.org/10.1080/00273171.2017.1344538.
33. Meule, A., Richard, A., Schnepper, R., Reichenberger, J., Georgii, C., Naab, S., . . . Blechert, J. (2019). Emotion regulation and emotional eating in anorexia nervosa and bulimia nervosa. Eating Disorders, 1-17. Retrieved from https://doi.org/10.1080/10640266.201 9.1642036.
34. Ministry of Health and Welfare. (2020). The seventh Korea national health and nutrition examination survey (KNHANES VII), 2018. Korea Centers for Disease Control and Prevention. Retrieved from https://knhanes.cdc.go.kr/knhanes/sub04/sub04_03.do?class- Type=7.
35. Mond, J. M., Myers, T. C., Crosby, R. D., Hay, P. J., & Mitchell, J. E. (2010). Bulimic eating disorders in primary care: Hidden morbidity still? Journal of Clinical Psychology in Medical Settings, 17, 56-63. Retrieved from https://doi.org/10.1007/s10880-009-9180-9.
36. Murray, S., Anorenius, A., & Avena, N. M. (2015). Neurochemical components of undereating and overeating. In Smolak, L., & Levine, M. P (Eds.) The Wiley handbook of eating disorders (pp. 394-407). Hoboken, NJ: John Wiley & Sons.
37. Park, H. S., & Lee, J. M. (2016). A validation study of Korean version of PANAS-revised. The Korean Journal of Psychology: General, 35, 617-641. Retrieved from http://dx.doi.org/10.22257/kjp.2016. 12.35.4.617.
38. Pearson, C. M., Riley, E. N., Davis, H. A., & Smith, G. T. (2014). Research review: Two pathways toward impulsive action: An integrative risk model for bulimic behavior in youth. Journal of Child Psychology and Psychiatry and Allied Disciplines, 55, 852-864. Retrieved from https://doi.org/10.1111/jcpp.12214.
39. Phillipou, A., Meyer, D., Neill, E., Tan, E. J., Toh, W. L., Van Rheenen, T. E., & Rossell, S. L. (2020). Eating and exercise behaviors in eating disorders and the general population during the COVID-19 pandemic in Australia: Initial results from the COLLATE project. International Journal of Eating Disorders, 53, 1158-1165. Retrieved from https://doi.org/10.1002/eat.23317.
40. Polivy, J., & Herman, C. P. (2005). Mental health and eating behaviours: A bi-directional relation. Canadian Journal of Public Health, 96, S49-S53. Retrieved from https://doi.org/10.1007/BF03405201.
41. Raudenbush, S.W., Bryk, A.S., & Congdon, R. (2019). HLM 8 for Windows [Computer software]. Lincolnwood, IL: Scientific Software International. Inc.
42. Schaefer, L. M., Smith, K. E., Anderson, L. M., Cao, L., Crosby, R. D., Engel, S. G., . . . Wonderlich, S. A. (2020). The role of affect in the maintenance of binge-eating disorder: Evidence from an ecological momentary assessment study. Journal of Abnormal Psychology, 129, 387-396. Retrieved from https://doi.org/10.1037/ abn0000517.
43. Schaumberg, K., Welch, E., Breithaupt, L., Hübel, C., Baker, J. H., Munn-Chernoff, M. A., . . . Bulik, C. M. (2017). The science behind the Academy for Eating Disorders’ nine truths about eating disorders. European Eating Disorders Review, 25, 432-450. Retrieved from https://doi.org/10.1002/erv.2553.
44. Seo, M. H., Lee, W.Y., Kim, S. S., Kang, J. H., Kang, J. H., Kim, K. K.,. . .Han, J. S. (2019). Corrigendum: 2018 Korean Society for the Study of Obesity guideline for the management of obesity in Korea. Journal of Obesity & Metabolic Syndrome, 28, 143-143. Retrieved from https://doi.org/10.7570/jomes.2019.28.2.143.
45. Smink, F. R. E., Van Hoeken, D., & Hoek, H. W. (2012). Epidemiology of eating disorders: Incidence, prevalence and mortality rates. Current Psychiatry Reports, 14, 406-414. Retrieved from https:// doi.org/10.1007/s11920-012-0282-y.
46. Smyth, J., Wonderlich, S., Crosby, R., Miltenberger, R., Mitchell, J., & Rorty, M. (2001). The use of ecological momentary assessment approaches in eating disorder research. International Journal of Eating Disorders, 30, 83-95. Retrieved from https://doi.org/10. 1002/eat.1057.
47. Stice, E. (2001). A prospective test of the dual-pathway model of bulimic pathology: Mediating effects of dieting and negative affect. Journal of Abnormal Psychology, 110, 124-135. Retrieved from https://doi.org/10.1037/0021-843X.110.1.124.
48. Stice, E. (2016). Interactive and mediational etiologic models of eating disorder onset: Evidence from prospective studies. Annual Review of Clinical Psychology, 12, 359-381. Retrieved from https:// doi.org/10.1146/annurev-clinpsy-021815-093317.
49. Stice, E, Gau, J. M., Rohde, P., & Shaw, H. (2017). Risk factors that predict future onset of each DSM-5 eating disorder: Predictive specificity in high-risk adolescent females. Journal of Abnormal Psychology, 126, 38-51. Retrieved from https://doi.org/10.1037/ abn0000219.
50. Stice, E., Marti, C. N., Shaw, H., & Jaconis, M. (2009). An 8-year longitudinal study of the natural history of threshold, subthreshold, and partial eating disorders from a community sample of adolescents. Journal of Abnormal Psychology, 118, 587.
51. Stone, A., & Shiffman, S. (1994). Ecological momentary assessment (EMA) in behavorial medicine. Annals of Behavioral Medicine, 16, 199-202.
52. Stone, A., Shiffman, S., Atienza, A., & Nebeling, L. (2007). The science of real-time data capture: Self-reports in health research. Oxford, England: Oxford University Press.
53. Taren, D. L., Tobar, M., Hill, A., Howell, W., Shisslak, C., Bell, I., & Ritenbaugh, C. (1999). The association of energy intake bias with psychological scores of women. European Journal of Clinical Nutrition, 53, 570-578. Retrieved from https://doi.org/10.1038/sj. ejcn.1600791.
54. Taylor, S., Landry, C. A., Paluszek, M. M., Fergus, T., McKay, D., & Asmundson, G. J. G. (2020). COVID stress syndrome: concept, structure, and correlates. Depression and Anxiety, 37, 706-714. Retrieved from https://doi.org/10.1002/da.23071.
55. Thompson, J. K., & Stice, E. (2001). Thin-ideal internalization: Mounting evidence for a new risk factor for body-image disturbance and eating pathology. Current Directions in Psychological Science, 10, 181-183.
56. Troop, N. A. (2016). The effect of current and anticipated body pride and shame on dietary restraint and caloric intake. Appetite, 96, 375-382. Retrieved from https://doi.org/10.1016/j.appet.2015. 09.039.
57. Van Strien, T., Frijters, J. E. R., Bergers, G. P. A., & Defares, P. B. (1986). The dutch eating behavior questionnaire (DEBQ) for assessment of restrained, emotional, and external eating behavior. The International Journal of Eating Disorders, 5, 295-315.
58. Vogele, C., & Gibson, E. L. (2010). Mood, emotions and eating disorders. In Agras, W. Stewart (Eds.) The Oxford handbook of eating disorders (pp. 180-205). Oxford, England: Oxford University Press.
59. Weissman, R. S., Bauer, S., & Thomas, J. J. (2020). Access to evidence-based care for eating disorders during the COVID-19 crisis. International Journal of Eating Disorders, 53, 369-376. Retrieved from https://doi.org/10.1002/eat.23279.
60. Whitehouse, A. M., Cooper, P. J., Vize, C. V., Hill, C., & Vogel, L. (1992). Prevalence of eating disorders in three Cambridge general practices: Hidden and conspicuous morbidity. British Journal of General Practice, 42, 57-60.
61. Yoon, J. M., & Shim, E.J. (2019). The moderating role of difficulties in emotion regulation in the relationship between negative affect and binge eating in emotional eaters. The Korean Journal of Health Psychology, 24, 45-68.