Positive Emotion and Motivational Dynamics in Anorexia Nervosa: A Positive Emotion Amplification Model (PE-AMP)

• Published in: Psychological review 2020-10, Vol.127 (5), p.853-890
• Main Authors: Selby, Edward A, Coniglio, Kathryn A
• Format: Article
• Language: English
• Subjects: Anorexia; Anorexia Nervosa; Anorexia Nervosa - psychology; Autonomy; Behavior; Cognitive-behavioral factors; Emotional regulation; Emotions; Feedback; Female; Happiness; Hospitalization; Human; Humans; Medical treatment; Models, Psychological; Motivation; Negative Emotions; Personal Autonomy; Positive Emotions; Psychopathology; Quality of Life; Relatedness; Rewards; Self determination; Sense of purpose; Suicide; Weight Loss
• ISSN: 0033-295X; 1939-1471
• DOI: 10.1037/rev0000198

The role of positive emotion in anorexia nervosa (AN) has been underappreciated in both theory and treatment. Yet, people with AN demonstrate high motivation for and sustained effort toward weight loss, achieving success to an extreme beyond the capability of most people. Positive emotion dysregulation may facilitate and reinforce such efforts. The positive emotion amplification (PE-AMP) model of AN describes a dynamic interplay between biologically based enhanced reward responding and cognitive-behavioral factors that amplify positive emotion, resulting in positive feedback cycles that motivate and reinforce weight loss behavior during the AN onset phase. These experiences subvert the pursuit of happiness by providing artificial senses of autonomy, competency, and relatedness to others (self-determination theory; Ryan & Deci, 2000) that provide a stark contrast to an otherwise negative emotional environment, resulting in the emergence and persistence of AN psychopathology as a self-sustaining sense of purpose. Ultimately, negative emotion, PE dysregulation, and artificial self-determination threats continue to drive AN behavior during the AN maintenance phase, pushing patients toward a genuine self-determination breakdown that can lead to hospitalization, health crises, relational strife and diminished quality of life, or even manifest in suicidal behavior. Future research directions and novel methodological approaches inspired by the PE-AMP model are discussed, as are important treatment implications for addressing this highly treatment-resistant disorder.