Maintenance factors for eating disorder symptoms based on ecological momentary assessment studies: A systematic review.

Several prominent theories of eating disorders maintenance exist, with most corresponding to evidence-based treatments. Ecological momentary assessment (EMA) is ideal for testing relationships between proposed maintenance factors and eating disorder symptoms given its ability to examine antecedents and consequences. A seminal systematic review and meta-analysis of EMA studies on affect and binge eating was published in 2011, but the literature since this time and beyond these variables has not been synthesized. We searched PsycINFO, MEDLINE, and Scopus (last search December 16, 2025) for articles using EMA to study psychological/contextual variables in relation to core eating disorder symptoms in people with an eating disorder or eating disorder symptom. After screening, 185 papers were included. Most examined affect in relation to binge eating or loss of control eating. Whereas negative affect primarily drives binge eating and purging, positive affect appears more relevant for exercise and (perhaps) restriction. Few studies considered how eating disorder-related cognitive, affective, or behavioral variables relate to eating disorder symptoms, despite these being primary associations in leading maintenance/treatment models. Most studies investigated samples of exclusively women, with only two samples comprised of all or almost all men. Network analysis and machine learning approaches are beginning to be used to identify individualized predictors of eating disorder symptoms. Future EMA research on eating disorders should go beyond studying affect to test whether relationships proposed in established maintenance models can be observed in daily life. Understanding both group- and person-level antecedents and consequences of eating disorder symptoms can help improve treatment success.