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. Author manuscript; available in PMC: 2026 Apr 22.
Published in final edited form as: Int J Eat Disord. 2025 Nov 18;59(3):607–614. doi: 10.1002/eat.24602

Characterizing Emotional Inertia and Its Relation to Eating Disorder Behaviors in Patients Seeking Treatment for Binge-spectrum Eating Disorders

Elizabeth W Lampe 1,2,3,*, Elizabeth A Velkoff 1,4,*, Stephanie M Manasse 1
PMCID: PMC13097099  NIHMSID: NIHMS2165930  PMID: 41251029

Abstract

Objective:

Emotional inertia, the tendency for emotions to persist over time, has received little attention in relation to eating disorders (ED). However, emotional inertia may reflect poor emotion regulation and unresponsiveness to environmental cues, and individuals may use ED behaviors to distract from or escape persistent emotions. We aimed to characterize emotional inertia and its relationship with ED behavior frequency among adults with EDs.

Method:

Adults (N = 94) with bulimia nervosa (BN) or binge eating disorder (BED) spectrum EDs completed 7–14 days of ecological momentary assessment, reporting negative affect (NA), positive affect (PA), and ED behaviors. Inertia was computed using within-person autoregressive estimates in a multilevel model. We compared NA and PA inertia between diagnostic groups, and as predictors of ED behavior frequency.

Results:

Average NA and PA inertia did not differ by diagnostic group. Higher NA inertia was cross-sectionally associated with greater overall frequency of compensatory behaviors in participants with BN-spectrum EDs. NA inertia was not cross-sectionally associated with binge eating but was positively associated with overall frequency of dietary restriction. The cross-sectional association of NA inertia with binge eating and dietary restriction was not moderated by diagnostic group. PA inertia was not cross-sectionally associated with frequency of any ED behaviors.

Discussion:

Emotional inertia may be important for understanding the development and maintenance of ED behaviors, particularly dietary restriction. Future research should explore temporal relationships. Interventions promoting flexible emotional responding may help to reduce emotional inertia and its effect on ED behaviors.

Keywords: bulimia nervosa, binge eating disorder, affect, emotional inertia, binge eating, loss of control eating, compensatory behaviors, dietary restriction

Introduction

Affect and its regulation are important in psychopathology (Gross & Jazaieri, 2014; Sheppes et al., 2015), including eating disorders (EDs). While mean-level differences in affect may be associated with differences in ED severity (Bicaker et al., 2022; Bodell et al., 2019), within-person affective dynamics may drive ED behaviors (Anestis et al., 2010; Berner et al., 2017). Emotional inertia (i.e., highly persistent affect between measurements; Hawkins & Clement, 1984; Heatherton & Baumeister, 1991; Herman & Polivy, 1984) is associated with psychopathology such as negative emotionality, depression, and borderline personality disorder (Houben et al., 2015; Koval et al., 2015; Kuppens et al., 2010) and highly stable negative or positive affect (NA or PA) may indicate non-responsiveness to emotionally-relevant cues, poor emotion regulation, and psychological inflexibility (Koval et al., 2021; Koval & Kuppens, 2024). Emotion dysregulation and psychological inflexibility are common in EDs (Brockmeyer et al., 2014; Levin et al., 2014; Monell et al., 2018), and affect-regulation models assert that ED behaviors serve to regulate emotions, suggesting that emotional inertia may precipitate ED behaviors.

To our knowledge, only two studies have examined emotional inertia and EDs. In the first, individuals with bulimia nervosa (BN) had higher NA inertia than those with binge eating disorder (BED), although no differences emerged between anorexia nervosa and either BN or BED (Williams-Kerver et al., 2020), and associations of emotional inertia with ED behaviors were not tested. Thus, while ED diagnostic groups may differ in mean NA inertia, this finding requires replication and no study has yet examined differences in PA inertia. In a community sample not selected for ED symptoms, neither NA nor PA inertia were associated with ED behaviors in either within-person or between-person analyses (Smith et al., 2024). Theoretical models of both emotional inertia and EDs would suggest that inertia is likely to be associated with ED symptoms, but this effect might only emerge in more symptomatic clinical samples.

We examined differences in NA and PA inertia in adults with binge-spectrum EDs and tested the relationship of emotional inertia with frequency of ED behaviors. We predicted, consistent with previous research (Williams-Kerver et al., 2020), that NA inertia would be higher among patients with BN- than BED-spectrum EDs. Given the lack of literature in this area, we had no a priori hypothesis regarding group differences in PA inertia. Based on previous research and theoretical models, we predicted that participants with higher emotional inertia (NA or PA) would report more frequent engagement in various ED behaviors. An exploratory aim examined whether diagnostic group moderated these associations.

Methods

Participants

The sample included 97 adults (Mage = 41.88, SD = 14.05; 19 men, 78 women) with clinically significant loss of control (LOC) eating—defined as objective or subjective binge eating at least once per week over the past 3 months—who enrolled in a clinical trial for EDs at Drexel University. Eligibility required U.S. residency, smartphone access, and willingness to complete ecological momentary assessment (EMA) surveys prior to treatment. Exclusion criteria included non-fluency in English, BMI below 18.5 kg/m2, plans to pursue eating or weight-related treatment outside Drexel within 16 months, severe psychopathology (e.g., psychosis), or intellectual disabilities. The sample was 78.35% White (n = 76), 10.31% Black (n = 10), 3.09% Asian (n = 3), and 2.06% Native American/Alaska Native (n = 2); 6.19% (n = 6) reported “unknown/prefer not to say” regarding race. Most participants (91.75%, n = 89) were non-Hispanic. Mean BMI was 35.02 kg/m2 (SD = 8.80).

Procedures

Eligible participants provided informed consent and were trained in the EMA protocol. Participants received six signal-contingent EMA surveys semi-randomly throughout the day (3 delivered in the morning and 3 delivered in the afternoon/evening) and provided event-contingent surveys after episodes of LOC eating for 7–14 days prior to starting ED treatment. Study procedures were approved by the Drexel University IRB.

Measures

ED Diagnosis.

Trained evaluators administered the Eating Disorder Examination 17.0 (EDE; Fairburn et al., 2014) to evaluate eating pathology spanning the preceding three months. Diagnosis was conferred as follows: BN-spectrum: ≥ 6 compensatory behaviors in the past three months; BED-spectrum: < 6 compensatory behaviors in the past three months.

Affect.

Participants used a scale from 0 (not at all) to 4 (extremely) to rate current NA (guilty, sad, bored, anxious) and PA (cheerful, excited, attentive, confident) at each EMA survey, with NA and PA calculated as the sum (Watson et al., 1988). PANAS items were selected based on established relationships with ED behaviors (Berg et al., 2017; Brownstone et al., 2013; Deaver et al., 2003; Haedt-Matt & Keel, 2015). Cronbach’s alpha estimates for agreement among sub-emotions of NA and PA at each survey were 0.25 and 0.32, respectively, indicating fair agreement.

ED Behaviors.

All ED behaviors were assessed at both event-contingent and signal-contingent EMA surveys. LOC eating was assessed via participants’ yes/no indication of experiencing a subjective sense of LOC over their eating since the last EMA survey (mean episodes during EMA = 7.53, SD = 7.61). Participants received training on the definition of LOC eating as “the subjective experience of a sense of loss of control over one’s eating.” Compensatory behaviors since the last survey were also assessed via yes/no checkbox. Frequency was calculated by summing the number of compensatory behaviors (vomiting, laxative/diuretic/diet pill misuse, chewing and spitting, maladaptive exercise [defined for participants as engaging in exercise with the goal of compensating for calories consumed during an LOC eating episode, or feeling driven/compelled to exercise], or other) endorsed at each survey (mean episodes during EMA = 7.35, SD = 11.71). To increase statistical power, compensatory behaviors were analyzed together. Dietary restriction was measured by participants’ indication of whether they had successfully a) limited the amount eaten, b) delayed eating, and/or c) avoided palatable foods since the last EMA survey. These items were rated from 0 (Not at all) to 4 (Completely). Ratings ≥ 2 were considered endorsement, and a dietary restriction sum score was created from the three binarized items (mean episodes during EMA = 12.20, SD = 13.14).

Statistical Analysis

Analyses were conducted in R version 4.3.2 (R Core Team, 2023). Evaluation of covariates is presented in supplementary materials. Three participants reporting high frequency of ED behaviors (> 5 behaviors per day) were identified as statistical outliers and were excluded from analyses. Sensitivity analyses including these participants provided similar results (see Supplementary materials).

To reduce bias resulting from variability in the time between affect ratings, emotional inertia estimates were calculated with only signal-contingent responses. We performed a natural log transformation on NA and PA sum scores to correct for positive skew. Following normalization, NA and PA inertia scores continued to exhibit zero-inflation, thus emotional inertia estimates were calculated using models assuming an underlying zero-inflated gaussian distribution. Consistent with previous work (Smith et al., 2024; Williams-Kerver et al., 2020), we calculated NA and PA inertia from separate within-person and within-day t-1 auto-regressive estimates using a multilevel model with a random intercept and slope by person. Person-level auto-regressive coefficients for NA and PA were then used as emotional inertia scores, with higher scores indicating greater inertia (i.e., lower variability in emotional states).

Both signal- and event-contingent EMA surveys contributed to ED behavior count calculations. NA and PA inertia scores were an independent variable in models examining the effect of emotional inertia on the frequency of ED behaviors during the EMA period. All models used a negative binomial distribution given positively skewed ED behavior counts and included linear and quadratic emotional inertia terms with orthogonal polynomials to test for curvilinear effects. All models covaried for sex, EMA compliance, and total days of EMA participation. Average affect was highly correlated with emotional inertia; we opted not to include this covariate to reduce multicollinearity but sensitivity analyses with this covariate are available in Supplemental materials. Models for compensatory behaviors were only conducted in participants with BN-spectrum EDs. Given that previous work has found higher NA inertia in BN compared to BED (Williams-Kerver et al., 2020), additional models for LOC eating and dietary restriction included a moderator term for diagnostic group.

Results

Sample Descriptives

Participants completed 12.16 days of EMA on average (SD = 2.47). Average NA inertia was −0.006 (SD = 0.389) and average PA inertia was 0.006 (SD = 0.325). Average NA inertia did not significantly differ by diagnostic group (t(93) = −1.95, p = 0.054, MBED = −0.079, MBN = 0.077, Mdiff = 0.156), and neither did PA inertia (t(96) = −0.538, p = 0.592, MBED = −0.011, MBN = 0.025, Mdiff = 0.036).

Tests of Hypotheses

NA inertia was not associated with frequency of LOC eating and this association was not moderated by diagnostic group. NA inertia was significantly associated with higher overall frequency of dietary restriction (est = 2.628, S.E. = 0.966, p = 0.007; Table 1, Figure 1b), however this association was not significant after controlling for diagnostic group. Among participants with BN-spectrum EDs, higher NA inertia was associated with higher overall frequency of engagement in compensatory behaviors (est = 3.548, S.E. = 1.797, p = 0.048; Table 1, Figure 1a). PA inertia was not significantly associated with overall frequency of ED behaviors and ED diagnosis did not moderate these associations. Sensitivity analyses revealed that relationships between NA inertia and dietary restriction or compensatory behaviors were no longer statistically significant after covarying for average NA across the recording period, though the directionality of these relationships remained unchanged.

Table 1.

Associations of emotional inertia with ED behavior engagement.

LOC Eating
Emotional Valence Moderator Term Est S.E. z p Rate ratio 95% CI
Negative -- Intercept −1.056 0.798 −1.323 0.186 6.660 [5.56, 8.04]
Linear inertia 0.879 0.959 0.916 0.359 1.090 [0.90, 1.33]
Quadratic inertia −0.589 0.929 −0.634 0.526 0.940 [0.78, 1.15]
EMA period length 0.102 0.039 2.585 0.010* 1.290 [1.06, 1.56]
Compliance 0.879 0.637 1.380 0.168 1.150 [0.93, 1.41]
Sex 0.542 0.244 2.219 0.027* 1.240 [1.02, 1.50]
Diagnosis Intercept −1.048 0.810 −1.293 0.196 6.270 [5.19, 7.62]
Linear inertia −0.358 1.260 −0.284 0.777 1.140 [0.91, 1.43]
Diagnosis 0.133 0.203 0.653 0.513 1.060 [0.87, 1.30]
Quadratic inertia −0.518 1.142 −0.454 0.650 0.850 [0.67, 1.08]
EMA period length 0.107 0.040 2.635 0.008* 1.300 [1.06, 1.59]
Compliance 0.768 0.634 1.211 0.226 1.130 [0.92, 1.38]
Sex 0.493 0.250 1.972 0.049* 1.220 [1.00, 1.47]
Linear*Diagnosis 3.446 2.130 1.618 0.106 1.190 [0.95, 1.49]
Quadratic*Diagnosis −2.336 2.193 −1.065 0.287 0.890 [0.69, 1.13]
Positive -- Intercept −0.974 0.799 −1.220 0.223 6.680 [5.57, 8.07]
Linear inertia −0.204 0.923 −0.221 0.825 0.980 [0.81, 1.18]
Quadratic inertia 0.576 0.935 0.616 0.538 1.060 [0.90, 1.27]
EMA period length 0.108 0.040 2.717 0.007* 1.310 [1.07, 1.59]
Compliance 0.655 0.622 1.054 0.292 1.110 [0.90, 1.35]
Sex 0.566 0.246 2.301 0.021* 1.260 [1.03, 1.52]
Diagnosis Intercept −1.222 0.815 −1.499 0.134 6.630 [5.53, 8.00]
Linear inertia −0.348 1.246 −0.279 0.780 0.970 [0.81, 1.17]
Diagnosis 0.263 0.193 1.359 0.174 1.140 [0.94, 1.38]
Quadratic inertia 0.400 1.236 0.324 0.746 1.070 [0.90, 1.28]
EMA period length 0.118 0.040 2.922 0.003* 1.340 [1.09, 1.64]
Compliance 0.655 0.622 1.054 0.292 1.110 [0.91, 1.35]
Sex 0.562 0.251 2.234 0.026* 1.250 [1.02, 1.52]
Linear*Diagnosis 0.172 1.890 0.091 0.928 1.010 [0.83, 1.22]
Quadratic*Diagnosis 0.486 1.851 0.262 0.793 1.030 [0.86, 1.23]
Dietary Restriction
Emotional Valence Moderator Term Est S.E. z p Rate ratio 95% CI
Negative -- Intercept −1.753 0.804 −2.181 0.029* 9.910 [8.28, 11.96]
Linear inertia 2.628 0.966 2.721 0.007* 1.310 [1.07, 1.60]
Quadratic inertia −1.234 0.942 −1.310 0.190 0.880 [0.71, 1.10]
EMA period length 0.156 0.040 3.914 < 0.001* 1.470 [1.21, 1.79]
Compliance 1.581 0.644 2.456 0.014* 1.280 [1.03, 1.60]
Sex 0.461 0.240 1.918 0.055 1.200 [0.99, 1.46]
Diagnosis Intercept −1.451 0.811 −1.789 0.074 9.500 [7.88, 11.55]
Linear inertia 1.256 1.259 0.997 0.319 1.320 [1.06, 1.65]
Diagnosis 0.040 0.202 0.195 0.845 1.020 [0.83, 1.25]
Quadratic inertia −1.699 1.156 −1.469 0.142 0.820 [0.65, 1.05]
EMA period length 0.148 0.041 3.640 < 0.001* 1.440 [1.18, 1.76]
Compliance 1.451 0.640 2.269 0.023* 1.260 [1.00, 1.57]
Sex 0.372 0.245 1.521 0.128 1.160 [0.94, 1.41]
Linear*Diagnosis 3.075 2.127 1.446 0.148 1.170 [0.93, 1.47]
Quadratic*Diagnosis −0.447 2.193 −0.204 0.838 0.980 [0.77, 1.24]
Positive -- Intercept −1.143 0.810 −1.411 0.158 10.240 [8.52, 12.42]
Linear inertia −0.279 0.942 −0.297 0.767 0.970 [0.80, 1.18]
Quadratic inertia 0.599 0.955 0.627 0.530 1.060 [0.90, 1.27]
EMA period length 0.145 0.040 3.599 < 0.001* 1.430 [1.16, 1.76]
Compliance 1.056 0.638 1.656 0.098 1.180 [0.95, 1.47]
Sex 0.456 0.246 1.850 0.064 1.200 [0.98, 1.46]
Diagnosis Intercept −1.525 0.823 −1.854 0.064 10.110 [8.43, 12.23]
Linear inertia 0.776 1.245 0.623 0.533 0.970 [0.80, 1.17]
Diagnosis 0.254 0.196 1.299 0.194 1.130 [0.93, 1.38]
Quadratic inertia 1.104 1.227 0.899 0.368 1.050 [0.88, 1.26]
EMA period length 0.168 0.041 4.110 < 0.001* 1.520 [1.22, 1.87]
Compliance 1.092 0.636 1.717 0.086 1.190 [0.96, 1.47]
Sex 0.424 0.249 1.702 0.089 1.190 [0.96, 1.45]
Linear*Diagnosis −2.359 1.914 −1.233 0.218 0.890 [0.73, 1.08]
Quadratic*Diagnosis −1.277 1.882 −0.679 0.497 0.940 [0.79, 1.12]
Compensatory Behaviors (BN-spectrum only)
Emotional Valence Term Est S.E. z p Rate ratio 95% CI
Negative Intercept 0.609 1.181 0.516 0.606 8.240 [6.37, 10.82]
Linear inertia 3.548 1.797 1.974 0.048* 1.400 [0.98, 1.97]
Quadratic inertia −0.308 1.829 −0.169 0.866 0.970 [0.72, 1.34]
EMA period length 0.001 0.060 0.021 0.983 1.000 [0.72, 1.38]
Compliance 1.659 1.017 1.631 0.103 1.280 [0.92, 1.76]
Sex −0.006 0.418 −0.014 0.989 1.000 [0.74, 1.31]
Positive Intercept 0.417 1.198 0.348 0.728 8.530 [6.53, 11.33]
Linear inertia −0.857 1.462 −0.586 0.558 0.920 [0.68, 1.22]
Quadratic inertia 0.873 1.479 0.590 0.555 1.090 [0.85, 1.45]
EMA period length 0.043 0.059 0.725 0.468 1.110 [0.80, 1.53]
Compliance 0.925 0.978 0.946 0.344 1.150 [0.83, 1.56]
Sex 0.239 0.434 0.552 0.581 1.090 [0.79, 1.43]
Open in a new tab

Note. ED = eating disorder; LOC = loss of control; EMA = ecological momentary assessment; est = estimate; S.E. = standard error; CI = confidence interval; BN = bulimia nervosa. Diagnosis was coded as 0 = binge-eating disorder-spectrum and 1 = BN-spectrum.

Figure 1.

Figure 1.

Open in a new tab

Association of negative emotional inertia and A) compensatory behaviors, and B) dietary restriction.

Discussion

Emotional inertia is a relevant affective dynamic in EDs. Contrary to hypotheses, NA inertia was not cross-sectionally associated with frequency of LOC eating. In line with hypotheses, higher NA inertia was cross-sectionally associated with greater overall frequency of dietary restriction and, among patients with BN-spectrum EDs, greater overall frequency of compensatory behaviors. However, the effect sizes were relatively small, and after controlling for average levels of NA these effects were no longer statistically significant. There were no significant cross-sectional effects of PA inertia. These findings contribute to a growing literature examining affective dynamics in psychopathology (Trull et al., 2015) and EDs specifically (Wayda-Zalewska et al., 2022; Williams-Kerver et al., 2020), which is an important direction of research within the context of increasing attention to idiographic approaches to understanding and treating EDs (Bryant et al., 2025). We consider these findings to be a preliminary step in examining emotional inertia in EDs, as there has been little research on this specific affect dynamic in this population.

Our results raise questions for future research. The high correlations between average affect and affect inertia (see Supplemental tables) and lack of statistically significant relationships between emotional inertia and ED behaviors when covarying for average levels of affect raise the question of whether inertia adds meaningful information beyond average affect. Within this sample, most participants exhibited relatively stable affect between observations. Future work should examine more granular timescales and include samples exhibiting higher affective variability to better elucidate the specific contributions of inertia above average levels of affect. We, like previous researchers, modeled emotional inertia at the between-person level. However, emotional inertia is, by definition, a time-varying construct whose relationship with behavioral outcomes may vary over time. Sufficiently modeling within-person variability in emotional inertia may require that affect measurements be substantially more frequent than most EMA protocols, potentially by using passive forms of data collection such as heart rate variability collected with wearable sensors (Schmidt et al., 2019). To model the role of emotional inertia in ED behaviors, including potentially causal relationships, future research should examine whether within-day variation in emotional inertia predicts momentary risk for ED behaviors. Especially as high emotional inertia may be a warning sign for depression onset (Koval et al., 2021; Koval & Kuppens, 2024), future studies should assess the role of emotional inertia in the development and maintenance of ED behaviors.

Targeting emotional inertia may be a fruitful line of intervention. Based on the conceptualization of emotional inertia as reflecting non-responsiveness of emotions to context, interventions emphasizing behavioral flexibility and mindful awareness may be particularly effective, as they are thought to increase the extent to which emotions are responsive to context. This may be achieved through therapeutic modalities including ones already empirically supported in EDs, such as cognitive-behavioral therapy and dialectical behavior therapy (Fairburn, 2008; Linehan, 1993; Safer et al., 2001). Moreover, momentary interventions may be particularly useful (Smith & Juarascio, 2019), making it possible to provide interventions when high NA inertia is detected. Future work should evaluate changes in emotional inertia as a potential mechanism driving treatment effects in EDs.

Strengths and Limitations

Strengths of this study include our use of a clinical sample, allowing us to show that, in contrast to findings from community samples, NA inertia is associated with ED behaviors in a more severe population. Our transdiagnostic binge-spectrum sample also enabled us to examine differences between and moderation by diagnostic group. As with all research, this study has limitations. Use of an abbreviated PANAS may have reduced construct validity or comparability with prior studies using the full measure. We did not include individuals with anorexia nervosa or other EDs, for whom affect dynamics may differ (Wayda-Zalewska et al., 2022); future research should address this gap. While our treatment-seeking sample ensured a moderate level of ED severity, further research is needed to assess emotional inertia across other variables (e.g., remission status, severity, comorbidities). Our exclusion criteria, derived from the clinical trials participants were scheduled to join, may have led to omission of subgroups, such as individuals with more severe ED symptoms. Due to low rates of compensatory behavior endorsement within our sample, we could not examine relationships of emotional inertia with specific compensatory behaviors. Future work should clarify these relationships. We did not conduct an a priori power analysis for this study; future research should replicate these results in fully-powered samples. Finally, our analyses combined all LOC eating episodes. While some studies suggest subjective binge eating reflects greater general distress (Brownstone & Bardone-Cone, 2021; Goldschmidt et al., 2016), others indicate differing NA trajectories compared to objective binge eating (Berg et al., 2015). Future work should explore whether inertia for both NA and PA, rather than mean NA alone, differentiates subjective from objective binge episodes.

Conclusions

In addition to continuing to test the role of emotional inertia in ED behavior, researchers should examine whether emotional inertia may be a mechanism of existing treatments, and how to strengthen this effect.

Supplementary Material

supplementary materials

Public Significance Statement.

We used ecological momentary assessment to study emotional inertia (i.e., stability of emotions over time) in people with bulimia nervosa or binge eating disorder. Inertia of negative emotions was associated with overall frequency of engaging in compensatory behaviors and dietary restriction among people who experience loss of control eating. Inertia of negative emotions may contribute to maintenance of restriction and compensatory behaviors, and therefore is a potential treatment target.

Funding:

Stephanie Manasse was supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases (K23DK124514).

Footnotes

Conflicts of interest: The authors declare no potential conflict of interest.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

supplementary materials
NIHMS2165930-supplement-supplementary_materials.docx (57.2KB, docx)

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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