3 - (SYM 49) Comparing Predictive Relationships and Duration of Effects Among Key Eating Disorder Cognitions, Emotions, and Behaviors in Anorexia Nervosa and Atypical Anorexia Nervosa

Little is known about key symptoms strongly associated with eating disorder (ED) pathology or the duration of relationships over time among key symptoms (fear of weight gain, feeling fat, and over-evaluation of weight/shape) on cognitions (concern for mistakes, high standards, desire for thinness, urge to restrict, fear of weight gain), emotions (weight/shape dissatisfaction, body dissatisfaction, anxiety), interoceptive symptoms (tired/fatigued, feeling fat, physical sensations), and ED behaviors (restriction, body checking, following food rules, meal skipping) in anorexia nervosa (AN) or atypical AN (AAN). In the present study 23 participants (AN n=14; AAN n=9) were assessed for fear of weight gain, feeling fat, over-evaluation of weight/shape, and ED cognitions, emotions, interoceptive symptoms, and behaviors four times/day across 30 days (3,720 observations per person) using ecological momentary assessments. We used multi-level modeling to examine how fear of weight gain, feeling fat, and over-evaluation of weight/shape impacted subsequent cognitions, emotions, interoceptions, and ED behaviors. Multiple time lags (i.e., t, t+1, t+2, and t+3) were examined to test the duration of the effects and how these effects compared between AN and AAN. Fear of weight gain was concurrently associated with all outcomes (ds≥0.10) except skipping meals, with an interaction of weight/shape dissatisfaction, body dissatisfaction, feeling fat, and skipping meals (ds≥0.09). Feeling fat was associated with all outcomes except skipping meals and food rules. Feeling fat and desire for thinness, weight/shape dissatisfaction, body dissatisfaction, and fear of weight gain were associated across all time lags (ds≥0.47), and had an interaction by diagnoses, along with skipping meals and body checking (ds≥0.09). Over-evaluation of weight/shape was associated with all outcomes (ds≥0.10), with clinical perfectionism (personal standards and concern over mistakes) effects lasting throughout all time lags (ds≥0.11), with an interaction of high standards, concern over mistakes, and restriction (ds=≥0.11) by diagnosis. Findings point to some relationships enduring over time, with some differences by diagnosis. Overall, intervening on fear of weight gain, feeling fat, and over-evaluation of weight/shape may disrupt specific cognitions, emotions, and behaviors, such as clinical perfectionism, to treat AN and AAN more effectively. Knowing how long these relationships last may lead to more effective just-in-time interventions for AN and AAN.