Avoidance coping during mealtimes predicts higher eating disorder symptoms

Int J Eat Disord. 2020 Apr;53(4):625-630. doi: 10.1002/eat.23254. Epub 2020 Feb 29.


Objective: Eating disorders (EDs) are characterized by significant anxiety during mealtime that contributes to food avoidance and weight loss. Individuals with EDs commonly use avoidance coping (e.g., distraction) to tolerate meals and comply with meal plans. Although this strategy may be effective short term, a large body of anxiety literature suggests that avoidance can lead to worsening of psychological symptoms long term.

Method: The current study (N = 66 individuals diagnosed with ED) used ecological momentary assessment (EMA) to examine the short-term and long-term associations of avoidance coping on ED symptoms.

Results: Distraction during meals predicted a reduction in anxiety in the short term, and both distraction and avoidance of emotions predicted increases in excessive exercise in the short term. Distraction and avoidance of emotions predicted increases in bulimic symptoms 1 month after completion of EMA.

Discussion: These results are consistent with prior literature on avoidance and suggest that avoidance coping during meals may contribute to the increase of ED behaviors in the long term. Coping strategies that encourage approach and tolerance of difficult thoughts and emotions (e.g., acceptance-based strategies) rather that avoidance coping may promote longer-term symptom reduction.

Keywords: anxiety; avoidance; eating disorders.

MeSH terms

  • Adaptation, Psychological / physiology*
  • Anxiety / psychology*
  • Emotions / physiology*
  • Feeding and Eating Disorders / psychology*
  • Female
  • Humans
  • Male
  • Meals / psychology*