Functional Assessment of Restrictive Eating: A Three-Study Clinically Heterogeneous and Transdiagnostic Investigation

Shirley B. Wang, Kathryn R. Fox, Chelsea Boccagno, Jill M. Hooley, Patrick Mair, Matthew K. Nock, Ann F. Haynos

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Restrictive eating is common and associated with negative psychological outcomes across the life span and eating disorder (ED) severity levels. Little is known about functional processes that maintain restriction, especially outside of narrow diagnostic categories (e.g., anorexia nervosa). Here, we extend research on operant four-function models (identifying automatic negative, automatic positive, social negative, and social positive reinforcement functions) that have previously been applied to nonsuicidal self-injury (NSSI), binge eating, and purging to restricting. We assessed restrictive eating functions in three samples: clinically heterogeneous adolescents (Study 1: N = 457), transdiagnostic adults (Study 2: N = 145), and adults with acute or recently weight-restored anorexia nervosa (Study 3: N = 45). Study 1 indicated the four-function model was a good fit for restricting (root mean square error of approximation [RMSEA] =.06, Tucker-Lewis index [TLI] =.88). This factor structure replicated in Study 2 (comparative fit index [CFI] =.97, RMSEA =.07, TLI =.97, standardized root mean square residual [SRMR] =.09). Unlike NSSI, binge eating, and purging, which have been found to primarily serve automatic negative reinforcement functions, all three present studies found automatic positive reinforcement was most highly endorsed (by up to 85% of participants). In Studies 1 and 3, automatic functions were associated with poorer emotion regulation (ps,.05). In Study 1, social functions were associated with less social support (ps,.001). Across studies, automatic functions were associated with greater restriction ps,.05). Functions varied slightly by ED diagnosis. Across ED presentation, severity, and developmental stage, restrictive eating may be largely maintained by automatic positive reinforcement, with some variability across presentations.

Original languageEnglish (US)
Pages (from-to)761-774
Number of pages14
JournalJournal of abnormal psychology
Issue number7
StatePublished - 2021

Bibliographical note

Funding Information:
This article has been posted as a preprint on PsyArXiv ( q2ezw). Shirley B. Wang is supported by the National Science Foundation Graduate Research Fellowship under Grant DGE-1745303. Ann F. Haynos receives support from Grant K23MH112867 from the National Institute of Mental Health, as well as grants from the Klarman Family Foundation, and the Hilda and Preston Davis Foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Science Foundation.

Publisher Copyright:
© 2021 American Psychological Association


  • assessment
  • four-function model
  • functions
  • restrictive eating
  • Feeding and Eating Disorders/diagnosis
  • Humans
  • Adolescent
  • Adult

PubMed: MeSH publication types

  • Journal Article


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