Graduation Year

2026

Document Type

Dissertation

Degree

Ph.D.

Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Psychology

Major Professor

Diana Rancourt, Ph.D.

Committee Member

Peter Clayson, Ph.D.

Committee Member

Eunsook Kim, Ph.D.

Committee Member

Kristen Salomon, Ph.D.

Committee Member

Edelyn Verona, Ph.D.

Keywords

anorexia nervosa, anxiety, avoidant/restrictive food intake disorder, hypervigilance

Abstract

Aversive conditioning theories of restrictive eating disorders propose that gastrointestinal (GI) visceral sensitivity (i.e., hypervigilant monitoring and worry about GI sensations) is implicated in the maintenance of restrictive eating disorders (i.e., anorexia nervosa [AN], atypical anorexia nervosa [AAN], and avoidant/restrictive food intake disorder [ARFID]). Specifically, a negative reinforcement process is posited in which disordered eating behaviors (e.g., restriction, purging) help to mitigate or avoid GI-related distress, and are thereby reinforced. However, this theorized process has yet to be tested. For the current study, participants from the University of South Florida and surrounding Tampa community who screened positive for a restrictive eating disorder were recruited. Participants completed a virtual baseline visit which included diagnostic interviews for eating disorders. Next, they were enrolled in a 14-day ecological momentary assessment (EMA) component where they completed six prompts per day via their smartphone. At each prompt, they reported on their GI visceral sensitivity, disordered eating behaviors, and GI symptoms. Dynamic structural equation models were used in Mplus v8.1 to test negative reinforcement hypotheses that 1) within-person elevations in GI visceral sensitivity would prospectively predict engagement in disordered eating behaviors at the next prompt and 2) following disordered eating behavior engagement, a within-person decrease in GI visceral sensitivity would be observed. Last, it was hypothesized that participants with higher average GI visceral sensitivity over the monitoring period would also have a higher latent propensity for disordered eating behaviors. Purging model results were fully consistent with hypotheses and aversive conditioning theories, while restricting and compulsive exercise results were partially consistent. Supporting the measurement and conceptualization of GI visceral sensitivity as a momentary process, GI visceral sensitivity fluctuated within the same individuals across the EMA period. GI symptom reporting was prevalent across the EMA period and concurrently related to disordered eating engagement, underscoring the importance of considering GI symptoms in future research and clinical work with patients with eating disorders. Implications and future directions for mobile mental health interventions, including just-in-time adaptive interventions, are discussed.

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