Distress tolerance across self-report, behavioral and psychophysiological domains in women with eating disorders and healthy controls

Background and objectives: The tendency to engage in impulsive behaviors when distressed is linked to engagement in disordered eating. The current study comprehensively examines emotional responding to a distress tolerance task by utilizing self-report and psychophysiological measures (respiratory sinus arrhythmia [RSA], skin conductance responses [SCRs] and tonic skin conductance levels [SCLs]). Methods: A treatment seeking sample with Bulimia Nervosa (BN), Binge Eating Disorder (BED), Anorexia Nervosa (AN) and healthy controls (HCs) completed ratings of self-reported emotions and psychophysiological measurements before and after completion of the Paced Auditory Serial Addition TaskComputerized (PASAT-C). Results: Overall, we found an effect of Time, such that all participants reported greater negative emotions, fewer positive emotions, lower RSA, more SCRs and higher tonic SCLs after completion of the PASAT-C relative to baseline. We did not find differences in performance on the PASAT-C between groups. We found an effect of Group, such that individuals with BN, BED and AN reported overall higher levels of negative emotions relative to HCs. Furthermore, we found an effect of Group for greater urges to binge eat and lower RSA values among BED, relative to individuals with BN, AN and HCs. Conclusion: This is the first study to examine emotional responding utilizing multiple methods among different eating disorder diagnoses. The finding that individuals with BN, BED and AN report overall greater self-reported negative emotions without concurrent deleterious effects on PASAT-C performance relative to HCs suggests that subjective distress, rather than behavioral distress, may be an important area for intervention.