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

Tyler B. Mason, Jason M. Lavender, Stephen A. Wonderlich, Ross D. Crosby, Scott G. Engel, James E. Mitchell, Scott J. Crow, Daniel Le Grange, Carol B. Peterson

Research output: Contribution to journalArticle

7 Scopus citations


Purpose: 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). Methods: Women with AN completed a 2-week EMA protocol involving repeated daily assessments of experiences and behaviors. Results: Momentary appearance-related stress preceded binge eating and vomiting, and momentary anxiety mediated the prospective association between appearance-related stress and ED behaviors. Conclusions: Targeted momentary interventions delivered in the natural environment that address appearance-related stress may have utility in the treatment of ED behaviors.

Original languageEnglish (US)
Pages (from-to)637-644
Number of pages8
JournalEating and Weight Disorders
Issue number5
StatePublished - Oct 1 2018



  • Anorexia nervosa
  • Anxiety
  • Appearance
  • Binge eating
  • Ecological momentary assessment
  • Purging

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