Identifying Binge-Eating Triggers and Circumstances

A focus group of inpatients (11 female adolescents and young adults in treatment for regular binge-eating episodes at the Schoen Clinic Roseneck, Germany) complemented this literature-based approach. It was conducted to tap into antecedents that nomothetic EMA research might have overlooked so far. After an individual written brainstorming session on “triggers and circumstances associated with binge eating,” the inpatients rated the preliminary list of EMA items on relevance to their binge-eating episodes (“happens before/during/after binge eating…”: 1=[almost] never, 3=might or might not, 5=[almost] always). A moderated discussion of the brainstormed and provided items concluded the sessions.
Next, 2 researchers analyzed the rating data and integrated patient-generated items. This led to the following changes: several constructs missing in the preliminary item list were identified and items were added to cover these gaps (eg, eating based on internal opposed to external motivation: “Did you eat on your own accord?”; (not) following a regular meal structure: “How much did you follow a regular meal structure today?”; and restricting specific foods: “Are you restricting on certain foods right now?”).
The focus group participants further rated 27 of the provided items as positively associated with their binge-eating episodes (mean >3.5), 11 items as negatively associated (mean <2.5), and 9 items as unrelated to their binge-eating episodes (mean 2.5-3.5; Multimedia Appendix 2, Table S1). Some items were scored as unrelated (eg, “Right now I feel: tired” and “I engaged in increased levels of sport.”), and items with large SDs (SD >1.00; eg, “Right now I feel: relived,” “Right now I am shopping for groceries.” and “I acted upon my plans regarding my eating behavior.”) were disregarded, merged (eg, “I am in company.” with “I am on my own.”), or exchanged (eg, “I feel strained due to...work / university / school; close social network; wider social network; everyday stressors” with “Do you feel like you can handle all upcoming tasks and problems?”). As the patients expressed concerns over the redundancy of emotional states, 4 more items were disregarded (“Right now I feel: calm/ashamed/guilty/frustrated”). Finally, 4 items regarding eating behaviors such as “resistance to food craving” or “restriction” were rephrased to map more accurately on constructs introduced by the focus group (see Multimedia Appendix 3, Figure S1 for all item iterations)