Examining a momentary mediation model of appearance-related stress, anxiety, and eating disorder behaviors in adult anorexia nervosa

  • Tyler B. MasonEmail author
  • Jason M. Lavender
  • Stephen A. Wonderlich
  • Ross D. Crosby
  • Scott G. Engel
  • James E. Mitchell
  • Scott J. Crow
  • Daniel Le Grange
  • Carol B. Peterson
Original Article



Appearance-related stress may result from appearance-focused events such as seeing one’s reflection, seeing media images, and shopping for clothes. The purpose of this study was to examine the prospective association between momentary appearance-related stress and eating disorder (ED) behaviors (i.e., binge eating and vomiting) among women with anorexia nervosa (AN) using ecological momentary assessment (EMA). We hypothesized that appearance-related stress at Time 1 would predict binge eating and vomiting at Time 2, and that this prospective association would be mediated by momentary anxiety at Time 2 (controlling for anxiety at Time 1).


Women with AN completed a 2-week EMA protocol involving repeated daily assessments of experiences and behaviors.


Momentary appearance-related stress preceded binge eating and vomiting, and momentary anxiety mediated the prospective association between appearance-related stress and ED behaviors.


Targeted momentary interventions delivered in the natural environment that address appearance-related stress may have utility in the treatment of ED behaviors.


Anorexia nervosa Appearance Binge eating Purging Anxiety Ecological momentary assessment 



This work was supported by Grants R01MH059674 and T32MH082761 from the National Institute of Mental Health.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to report.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Tyler B. Mason
    • 1
    • 2
    Email author
  • Jason M. Lavender
    • 1
    • 2
  • Stephen A. Wonderlich
    • 1
    • 2
  • Ross D. Crosby
    • 1
    • 2
  • Scott G. Engel
    • 1
    • 2
  • James E. Mitchell
    • 1
    • 2
  • Scott J. Crow
    • 3
    • 4
  • Daniel Le Grange
    • 5
  • Carol B. Peterson
    • 3
    • 4
  1. 1.Department of Clinical ResearchNeuropsychiatric Research InstituteFargoUSA
  2. 2.Department of Psychiatry and Behavioral ScienceUniversity of North Dakota School of Medicine and Health SciencesFargoUSA
  3. 3.Department of PsychiatryUniversity of Minnesota Medical SchoolMinneapolisUSA
  4. 4.The Emily ProgramSt. PaulUSA
  5. 5.Department of PsychiatryUniversity of California San Francisco School of MedicineSan FranciscoUSA

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