Network Analysis of Bulimia and Eating Behavior Regulation in Subclinical Population

Abstract

This study explores the complex relationships between various dimensions of eating behavior regulation and their impact on bulimia and food preoccupation using network analysis. The objective was to identify key regulatory mechanisms that influence bulimic behaviors and food-related obsessions. The study analyzed data from 659 participants, recruited via convenience sampling, using scales that measured intrinsic motivation, integrated regulation, identified regulation, introjected regulation, external regulation, amotivation, and bulimia and food preoccupation. Pearson’s correlation analysis revealed significant negative relationships between bulimia and both introjected regulation (r = −0.345, p < 0.001) and external regulation (r = −0.298, p < 0.001). Network analysis highlighted identified regulation and introjected regulation as central nodes with substantial influence over bulimia and food preoccupation, while integrated regulation demonstrated a significant indirect impact. The perception that food is necessary for life and energy, as well as for nourishment, enjoyment, social and cultural relationships, and emotional comfort, was further demonstrated using qualitative thematic analysis. The aforementioned results emphasize the pivotal functions of identified and introjected regulatory mechanisms in shaping conduct associated with food preoccupation and bulimia. According to the study, specific therapies that target these mechanisms may be essential for lowering bulimic symptoms and encouraging better eating practices.

1. Introduction

Eating behavior regulation plays an essential role in determining individuals’ relationships with food and their susceptibility to various eating disorders. Bulimia is unique among these illnesses because of its complicated etiology and profound effects on psychological and physical well-being [1,2]. Bulimia, which is best illustrated by frequent bouts of binge eating that are followed by compensatory actions like purging or excessive exercise, is a major challenge in clinical and psychological research [3].

Numerous psychological mechanisms, such as intrinsic motivation, integrated regulation, identified regulation, introjected regulation, external regulation, and amotivation, are among those that are involved in the control of eating habits [4,5,6]. These mechanisms influence how individuals perceive, engage with, and regulate their eating habits, thereby affecting their susceptibility to eating disorders like bulimia [7].

While extensive research has explored these regulatory mechanisms individually, gaps persist in understanding their interrelationships and collective influence on bulimic behaviors within a network framework. Network analysis offers a novel approach to investigate these complex interactions by examining how variables are interconnected and influence each other directly and indirectly [8]. This approach provides insights into the structural properties of regulatory mechanisms and their relative importance in the context of bulimia.

Recent studies have highlighted the significant role of anxiety and stress factors in the regulation of eating behaviors, emphasizing their impact on eating disorders. For instance, Tragantzopoulou and Giannouli [9] conducted a qualitative exploration of orthorexia nervosa, revealing how anxiety-inducing scenarios, such as the fear of food contamination and social dining, contribute to rigid eating patterns and self-isolation [9]. Their findings underscore the importance of understanding anxiety factors and coping strategies in managing eating disorders. Such insights are critical for comprehending the broader spectrum of eating behavior regulation and its implications for disorders like bulimia.

This paper aims to address this gap by conducting a network analysis of regulatory mechanisms related to eating behaviors, focusing specifically on their associations with bulimia and food preoccupation. By examining centrality measures such as betweenness, closeness, strength, and expected influence, the study seeks to identify which regulatory mechanisms play central roles in the network and how they collectively contribute to the manifestation of bulimic behaviors.

By providing a solid understanding of how regulatory pathways combine to drive bulimia, the study’s findings are anticipated to make a substantial contribution to the body of research. This research offers important insights that might guide targeted interventions and therapy tactics meant to lessen bulimic tendencies and encourage healthy eating habits by identifying important nodes and their centrality within the network.

Literature Review

Eating disorders, particularly bulimia, represent a significant public health concern due to their detrimental impact on physical health and psychological well-being [10]. Central to understanding these disorders is the exploration of regulatory mechanisms that govern individuals’ eating behaviors.

In the extensive literature on eating behavior regulation and its associations with bulimic symptoms, several studies have provided valuable insights into the complex relationships between different forms of regulatory mechanisms and disordered eating behaviors. Researchers [11] investigated motivations behind eating regulation, emphasizing their links to sustained dietary behavior change and psychological adjustment. This underscores the roles of intrinsic and identified regulation in promoting healthier eating behaviors and overall well-being. Building on this, ref. [12] explored dietary restraint and self-regulation, highlighting how these strategies influence dietary choices and the development of disordered eating patterns.

Moving to emotional regulation, ref. [13] examined its role in emotional eating among individuals with anorexia and bulimia, revealing intricate connections between emotional dysregulation and pathological eating behaviors. Research [14] provided insights into eating disorders among adolescents, emphasizing developmental factors and societal influences contributing to the onset and progression of these disorders.

Further studies analyzed the multidimensional aspects of obesity psychopathology. Ref. [15] conducted a comprehensive analysis of emotional regulation and eating behavior, highlighting significant associations between emotional dysregulation and various facets of disordered eating. Research [16] explored motivational dynamics among female dieters, linking different regulatory strategies to healthy eating behaviors and symptoms of disordered eating.

In exploring temporal associations, ref. [17] focused on affective instability and its correlation with dysregulated eating behavior in bulimia, emphasizing the pivotal role of emotional regulation in binge-eating episodes. Research [18] extended this discussion by examining emotion regulation difficulties in the context of depression and their contribution to maladaptive coping behaviors, including disordered eating. Ref. [19] proposed emotional feeding as a form of interpersonal emotion regulation, highlighting its developmental implications for binge-eating behaviors. Research [20] investigated various self-regulation strategies in planning and monitoring eating behaviors, linking these strategies to both positive and negative outcomes in terms of eating behaviors, bulimic symptoms, and BMI. Finally, research [21] differentiated between health-focused and appearance-focused eating regulation, emphasizing their distinct impacts on body image and eating behaviors.

The associations between various regulatory mechanisms—namely intrinsic motivation, integrated regulation, identified regulation, introjected regulation [22], external regulation, and amotivation [23]—and bulimic behaviors represent an important topic in the scientific literature.

Intrinsic motivation is characterized by engaging in behaviors for the inherent satisfaction or pleasure they provide [24,25]. High intrinsic motivation for eating healthily increases the likelihood that people will stick to balanced diets and avoid disordered eating behaviors [7,26]. On the other hand, deficiencies in intrinsic drive have been connected to a higher vulnerability to bulimic behaviors, such purging and binge eating [27].

Integrated regulation involves adopting behaviors congruent with one’s values and long-term goals [24]. This form of regulation reflects a deep internalization of the importance of healthy eating, leading individuals to regulate their diet without external pressures. Research suggests that higher levels of integrated regulation are associated with reduced risk of bulimia, as individuals exhibit more stable and adaptive eating behaviors [28].

Identified regulation pertains to engaging in behaviors driven by personal goals and aspirations [24]. Individuals who identify with the benefits of healthy eating are motivated to regulate their dietary intake to achieve desired outcomes, such as improved health and well-being [29]. Studies have indicated that stronger identified regulation is linked to lower incidences of binge eating and purging behaviors in individuals vulnerable to bulimia [30].

Introjected regulation involves regulating behaviors to avoid guilt or anxiety and gain approval from others [24]. In the context of eating behaviors, introjected regulation may lead to rigid dietary control or restrictive eating patterns driven by external validation or the avoidance of negative self-perceptions [24]. High levels of introjected regulation have been associated with an increased risk of disordered eating behaviors, including binge eating episodes characteristic of bulimia [31].

External regulation refers to regulating behaviors based on external rewards or punishments [24]. In terms of eating behaviors, external regulation involves controlling food intake to meet societal or peer expectations rather than personal desires [7]. Studies indicate that a reliance on external regulation may contribute to maladaptive eating behaviors and increase vulnerability to bulimic symptoms [11].

Amotivation reflects a lack of motivation or interest in regulating one’s behavior [24]. Individuals characterized by amotivation may exhibit apathy towards healthy eating practices, leading to erratic dietary patterns and diminished self-regulation [32]. Amotivation has been identified as a risk factor for the development and perpetuation of bulimic behaviors, as it undermines individuals’ capacity to engage in adaptive dietary practices [7,33].

Therefore, the complex interplay between regulatory mechanisms and bulimic behaviors highlights the need for a comprehensive approach to understanding eating disorders. While the existing literature provides valuable insights into each regulatory mechanism’s role in eating behaviors, gaps persist regarding their collective impact within a network framework. In this study, we employed network analysis as a methodological approach to explore and quantify the influence of different regulatory mechanisms on bulimic behaviors, aiming to elucidate which regulatory factors exert the most significant impact.

Given the existing literature on the regulation of eating behaviors and their impact on bulimic symptoms, we formulated the following hypotheses for this study:

Hypothesis 1. There will be significant negative correlations between bulimia and introjected regulation and external regulation. This hypothesis is grounded in previous research indicating that internal and external pressures can exacerbate bulimic tendencies [11,20,23,24].

Hypothesis 2: Identified regulation and introjected regulation will emerge as central nodes in the network analysis, demonstrating significant influence over bulimia and food preoccupation. Prior studies have shown that identified regulation, which involves a personal valuing of behavior, and introjected regulation, driven by internal pressures, are critical in the regulation of eating behaviors [11,16,21,26,31].

Hypothesis 3: Integrated regulation will show significant indirect influence on bulimia and food preoccupation, reflecting its role in the assimilation of healthy eating behaviors into one’s self-concept, as supported by research on self-determination theory [24,29,31].

2. Materials and Methods

2.1. Participants

The research included 659 participants who were selected through convenience sampling from a variety of demographic backgrounds in both rural and urban regions of Western Romania. There were 124 male (18.82%) and 535 female participants (81.18%) in the sample.

Data collection was conducted using convenience sampling across various locations in Western Romania, encompassing a diverse range of socioeconomic backgrounds. This approach was chosen for its feasibility and appropriateness, given the study’s objectives and the demographic context. Participants were recruited through multiple channels, including social media groups, community organizations, and local events. These recruitment strategies are often more accessible and appealing to female participants, particularly when the research topic relates to food and health behaviors. Consequently, this led to a higher proportion of female participants in the study. It is important to note that our study did not intend to conduct a gender analysis, and the observed gender imbalance reflects the natural response patterns within the recruitment framework.

Informed consent was obtained from all participants prior to their involvement in the study, ensuring ethical standards were upheld throughout the research process.

The demographic features of the participants are described in

Table 1. Demographic characteristics of participants.

Variable	Category	Frequency	Percent
Gender	Male	124	18.82
	Female	535	81.18
Residence	Urban	457	69.35
	Rural	202	30.65
Education	High School	340	51.59
	Bachelor’s Degree	175	26.56
	Master’s Degree	131	19.88
	PhD	13	1.97
Professional Status	No Occupation	195	29.59
	Public Sector	214	32.47
	Private Sector	250	37.94
Marital Status	Single	200	30.35
	In a Relationship	219	33.23
	Married	240	36.42

, which also shows the distribution of genders, residence locations, educational attainment levels, professional statuses, and marital statuses within the sampled population from Western Romania’s urban and rural areas.

The mean age of the 659 valid replies in the sample was calculated to be 31.161 years (SD = 11.967), with a range of ages between 18 and 66. With 659 valid submissions, the weight category had a mean of 69.142 units (SD = 17.024), with kilograms ranging from 40 to 163. Due to two missing data, the income was estimated from 657 observations and averaged RON 3727.457 (SD = RON 2500.628). The income distribution was between RON 0.000 and RON 15,000.000.

2.2. Instruments

Using the bulimia and food obsession sub-scale, the current study used bulimia and food preoccupation to assess attitudes toward food. Item 3 (“I find myself preoccupied with food”), item 4 (“I have had episodes of binge eating where I felt I couldn’t stop eating”), item 9 (“I vomit after I have eaten”), item 18 (“I feel that food controls my life”), item 21 (“I spend too much time and attention on food”), and item 25 (“I have the urge to vomit after meals”) make up this subscale. The Eating Attitude Test (EAT-26) [34] is the basis of the six items included in this subscale. Using a six-point Likert scale, participants scored these events according to how frequently they occurred (1 = Always, 2 = Usually, 3 = Often, 4 = Sometimes, 5 = Rarely, and 6 = Never). The subscale measuring bulimia and food obsession had a mean score of 2.65 (SD = 1.12). The subscale’s Cronbach’s alpha coefficient, which measures internal consistency, was determined to be α = 0.85, indicating good reliability. This instrument was selected for its capability to assess specific attitudes and preoccupations related to bulimia and food concerns among the study participants, providing a focused evaluation of disordered eating behaviors within the sample.

Additionally, the Regulation of Eating Behavior Scale (REBS) [11] was used to assess regulatory mechanisms influencing eating behaviors. Intrinsic motivation, integrated regulation, identified regulation, introjected regulation, external regulation, and amotivation are the six separate subscales that make up the scale. Participants indicated how much they agreed with statements on various factors and motivations influencing their food choices on a seven-point Likert scale that went from 1 (Strongly Disagree) to 7 (Strongly Agree).

The intrinsic motivation subscale investigates how much pleasure and delight people experience from preparing and eating nutritious meals A Cronbach’s alpha coefficient of α = 0.82 was used to evaluate the reliability of this subscale, indicating high internal consistency among the items. Another subscale, integrated regulation, looks at how much people consider eating healthily to be an integral part of their daily lives. A Cronbach’s alpha coefficient of α = 0.76 was obtained from the reliability analysis, showing strong internal consistency. The identified regulation measures people’s perceptions of the long-term benefits to their health and well-being of maintaining a healthy diet. The subscale had an acceptable level of internal consistency, as shown by its Cronbach’s alpha coefficient of α = 0.80. The study of “introjected regulation” looks at the shame or guilt that comes with straying from a healthy diet. This subscale’s Cronbach’s alpha coefficient was α = 0.74, which suggests satisfactory reliability. The study of external control looks at how outside influences—like expectations and societal pressures—affect people’s eating habits. A Cronbach’s alpha coefficient of α = 0.68 was used to evaluate the subscale’s reliability, indicating satisfactory internal consistency. The last subscale, amotivation, assesses people’s lack of motivation or comprehension of the significance of controlling their eating behaviors. The Cronbach’s alpha coefficient for this subscale was α = 0.70, suggesting adequate internal consistency. The reliability coefficients indicate that the subscales generally demonstrated good internal consistency, supporting the validity of using this scale to reliably explore aspects of eating behavior regulation among the study participants.

In addition, we included an open-ended question to study the participants’ subjective views of food. The question that asked “What does food represent to you?” was inspired by the [35] study. By enabling participants to freely express their ideas and feelings about food, we hoped to capture a diverse spectrum of personal and cultural meanings connected with food, offering deeper insights into their cognitive and emotional linkages. This qualitative method allowed us to collect complex data that quantitative measurements could have overlooked, expanding our understanding of food representation among research participants.

2.3. Procedure

The Institute Review Board of the Center for Research Development and Innovation in Psychology at Aurel Vlaicu University of Arad accepted the study’s ethical guidelines, which were followed in its execution. Utilizing social media channels, community organizations, and local events, a convenience sample method was employed to recruit participants from a variety of sites in Western Romania. The study’s focus on eating behaviors and bulimic symptoms made it more likely for female participants to participate, which led to a larger percentage of female participants overall. The gender imbalance seen is a reflection of the inherent response patterns in the recruitment framework, and it is important to note that the study did not set out to perform a gender analysis.

All participants gave their informed consent prior to participation, guaranteeing that they understood the goal of the study and their rights, including the confidentiality and anonymity of their answers. An online platform was used for data collection, enabling participants to complete the self-report questionnaires whenever it was most convenient for them. These surveys evaluated bulimia symptoms, regulatory mechanisms controlling eating patterns, and attitudes about food.

The associations between the variables were investigated using quantitative studies, such as network analysis and Pearson’s correlation, when the data collection was complete. Qualitative information pertaining to participants’ subjective opinions on food was examined using thematic analysis of the open-ended question. To guarantee precision and uniformity in the analysis of the qualitative data, the study team employed an iterative coding procedure.

The open-ended replies from the participants were coded and interpreted using a systematic approach in the qualitative analysis. In order to become acquainted with the data, the research team’s three members first independently went over each response, looking for repeated phrases, patterns, and important topics. From there, they created preliminary codes. The team then came together to talk about their draft codes. By working together, the researchers were able to recognize patterns and discrepancies in their assessments, which facilitated the creation of a comprehensive coding framework. The initial codes had been organized using this framework into more general categories and subcategories, which acted as an itinerary for further investigation. The coding framework was implemented iteratively, with codes and categories continuously improved, as the team went over the data. A more sophisticated interpretation of the data was made possible using this iterative procedure, which made sure that any new patterns that emerged during the research were taken into account. The group held multiple rounds of deliberations to decide on the final coding system in order to guarantee the accuracy and consistency of the study. Through these discussions, disagreements over the coding were settled, with each researcher defending their interpretations until the team as a whole reached a consensus over the representation and accuracy of the codes. Following the establishment of consensus, the coded data were examined and combined to provide thematic conclusions. After that, these discoveries were incorporated into the research to offer more in-depth qualitative insights, improving the overall understanding of the participants’ perspectives.

The study aimed to provide a thorough knowledge of the complex connections between regulatory mechanisms and bulimic behaviors by integrating data from both quantitative and qualitative approaches.

2.4. Data Analysis

Data collection was conducted using an online method to accommodate participant preferences and ensure confidentiality. Participants completed self-report questionnaires assessing their attitudes toward food, regulatory mechanisms influencing eating behaviors, and symptoms of bulimia.

Correlation analysis was performed using Pearson’s correlation coefficient to examine associations among variables. Statistical significance was set at p < 0.05. Network analysis was employed to visualize and analyze the complex interrelationships among variables identified in the correlation analysis. This involved constructing a network with nodes representing each variable and edges representing their associations.

Qualitative data were obtained from the single open-ended question designed to explore participants’ food representation. To find patterns, themes, and categories in the qualitative data, thematic analysis was performed. In order to guarantee accuracy and consistency in the interpretation of qualitative data, our research team went through an iterative process of coding replies and reaching consensus. The Institutional Review Board of the Center of Research Development and Innovation in Psychology at Aurel Vlaicu University of Arad granted ethical permission for the study. Prior to data collection, informed permission was acquired from every participant. Measures were taken to protect participants’ confidentiality and anonymity throughout the study.

Data from both quantitative (correlation and network analyses) and qualitative (thematic analysis) approaches were integrated to provide a comprehensive understanding of the relationships between regulatory mechanisms and bulimic behaviors.

3. Results

3.1. Descriptive Statistics

Descriptive statistics for the Regulation of Eating Behavior Scale (REBS) subscales and the bulimia and food preoccupation subscale are summarized in

Table 2. Descriptive statistics for subscales.

Subscale	Mean	Std. Deviation	Minimum	Maximum
Bulimia and food preoccupation	28.821	4.889	6.000	36.000
Intrinsec motivation	20.739	6.500	4.000	28.000
Integrated regulation	17.909	6.580	4.000	28.000
Identified regulation	21.598	6.046	4.000	28.000
Introjected regulation	16.971	6.020	4.000	28.000
External regulation	10.074	6.656	4.000	28.000
Amotivation	9.578	5.826	4.000	28.000

. The analysis included responses from a total of 659 participants, with no missing data across any of the subscales. The mean scores for each subscale provide insights into participants’ tendencies regarding different aspects of eating behavior regulation. Standard deviations indicate the degree of variability in responses within each subscale.

The mean score for the bulimia and food preoccupation subscale was 28.821 (SD = 4.889), indicating that on average, participants reported moderate levels of preoccupation with food and bulimic behaviors. The range of scores (6 to 36) suggests variability in how participants experience these behaviors, with some exhibiting minimal symptoms and others showing more significant preoccupation. The intrinsic motivation subscale had a mean score of 20.739 (SD = 6.500), highlighting a generally high level of self-determined motivation to engage in healthy eating behaviors. This suggests that many participants find personal satisfaction and enjoyment in regulating their eating habits for health benefits. The scores ranged from 4 to 28, indicating diverse levels of intrinsic motivation among participants. For the integrated regulation subscale, the mean was 17.909 (SD = 6.580). This subscale measures how well healthy eating behaviors are assimilated into one’s self-concept. The scores ranged from 4 to 28, reflecting varying degrees of integration of these behaviors into participants’ lifestyles. The mean score suggests that many participants recognize healthy eating as consistent with their values and life goals. The identified regulation subscale, with a mean score of 21.598 (SD = 6.046), indicates that participants generally understand and accept the personal importance of healthy eating behaviors. This type of motivation is characterized by a conscious valuing of a behavioral goal, which is reflected in the relatively high mean score and the full range of possible scores (4 to 28). Introjected regulation had a mean score of 16.971 (SD = 6.020), which measures behaviors driven by internal pressures and feelings of obligation. The scores ranged from 4 to 28, suggesting variability in the extent to which participants feel compelled by guilt or self-approval. The mean score indicates a moderate level of this type of regulation, pointing to internal conflicts regarding eating behaviors in some participants. The external regulation subscale had a mean score of 10.074 (SD = 6.656), reflecting the extent to which participants’ eating behaviors are influenced by external factors such as social pressures or rewards. The range of scores (4 to 28) indicates that while some participants are highly influenced by external factors, others report minimal external regulation. Finally, the amotivation subscale, with a mean score of 9.578 (SD = 5.826), highlights a lack of motivation to regulate eating behaviors. Scores ranged from 4 to 28, showing a broad range of amotivation levels among participants. The mean score suggests that while some participants feel disengaged and unmotivated regarding their eating behaviors, this is not universally the case.

3.2. Correlation Analysis

Pearson’s correlation coefficients (

Table 3. Correlation analysis.

Variable	1	2	3	4	5	6	7
1. Bulimia and food preoccupation	—
2. Intrinsic motivation	0.016	—
3. Integrated regulation	0.001	0.667 ***	—
4. Identified regulation	−0.025	0.667 ***	0.664 ***	—
5. Introjected regulation	−0.345 ***	0.329 ***	0.354 ***	0.493 ***	—
6. External regulation	−0.298 ***	−0.022	0.008	0.054	0.434 ***	—
7. Amotivation	−0.186 ***	−0.206 ***	−0.161 ***	−0.221 ***	0.191 ***	0.530 ***	—

*** p < 0.001. Note: for bulimia and food preoccupation, lower scores represent agreement and higher scores represent disagreement, whereas for the 6 subscales of the Regulation of Eating Behavior Scale (REBS), lower scores represent strong disagreement and higher scores represent strong agreement.

) were calculated to assess the relationships between bulimia and food preoccupation and the six subscales measured using the Regulation of Eating Behavior Scale (REBS).

The correlation analysis between the bulimia and food preoccupation subscale and other regulatory mechanisms reveals several important relationships. It is essential to note that the bulimia subscale is inversely polarized, meaning higher scores indicate lower levels of bulimic behaviors. This inverse relationship will further be considered when interpreting the correlation coefficients.

The very weak and non-significant positive correlation with intrinsic motivation (r = 0.016) suggests that intrinsic motivation to engage in healthy eating behaviors is not strongly related to bulimic behaviors. The negligible and non-significant correlation with integrated regulation (r = 0.001) indicates that the integration of healthy eating into one’s self-concept does not correlate bulimic behaviors. Again, the weak and non-significant negative correlation with identified regulation (r = −0.025) suggests a slight tendency where recognizing the personal importance of healthy eating is associated with fewer bulimic behaviors.

Regarding the introjected regulation (r = −0.345, p < 0.001), the significant negative correlation, when considering the inverse polarity of the bulimia scale, indicates that higher introjected regulation (internal pressures like guilt or self-approval) is strongly associated with more bulimic behaviors. It implies that internal pressures to eat healthily can contribute to an increase in bulimic tendencies. Similarly for external regulation (r = −0.298, p < 0.001), this significant negative correlation suggests that higher external regulation (external pressures such as social rewards or punishments) is strongly associated with more bulimic behaviors. External motivations to eat healthily are linked to increased bulimic tendencies. As for amotivation (r = −0.186, p < 0.001), the significant negative correlation indicates that higher amotivation (a lack of motivation to regulate eating behaviors) is associated with more bulimic behaviors. Participants who are less motivated to regulate their eating tend to exhibit higher levels of bulimic behaviors.

Pearson’s correlation analysis indicated significant negative correlations between bulimia and introjected regulation (r = −0.345, p < 0.001) and external regulation (r = −0.298, p < 0.001). These findings support Hypothesis 1 (Hypothesis 1: There will be significant negative correlations between bulimia and introjected regulation, and external regulation), demonstrating that higher levels of introjected and external regulation are associated with increased bulimic behaviors. This aligns with previous research, confirming that internal pressures like guilt and external pressures such as social rewards contribute to bulimic tendencies.

These findings emphasize the complex dynamics between different types of motivation for regulating eating behaviors and the presence of bulimic tendencies. Particularly, introjected and external regulation along with amotivation forms of motivation are positively associated with bulimic behaviors, suggesting these motivational dynamics can increase the risk of developing bulimia. Conversely, intrinsic, identified, and integrated regulations are not significantly related to bulimia, highlighting that internal satisfaction and self-concept integration concerning healthy eating do not necessarily influence bulimic behaviors.

3.3. Network Analysis

The network analysis was conducted using JASP version 0.17.3. The dataset, initially prepared in SPSS, was imported into JASP for analysis. The primary aim was to explore the interrelationships among various dimensions of eating behavior regulation and their impact on bulimia and food preoccupation. Utilizing JASP’s built-in functionalities, we visualized the connections between variables and calculated centrality measures. The network plot generated using JASP displayed the nodes (representing variables) and edges (representing relationships), providing a clear and interpretable diagram. Additionally, centrality measures such as betweenness, closeness, and strength were calculated to identify the most influential variables within the network.

The network analysis (

Table 4. Network analysis; centrality measures per variable.

Variable	Network
	Betweenness	Closeness	Strength	Expected Influence
Bulimia and food preoccupation	−0.680	−1.145	−1.564	−1.993
Intrinsic motivation	−0.680	−0.397	−0.174	0.478
Integrated regulation	−0.680	−0.455	−0.365	0.669
Identified regulation	1.436	1.433	1.602	1.006
Introjected regulation	1.436	1.381	0.835	0.138
External regulation	−0.151	−0.286	0.025	0.222
Amotivation	−0.680	−0.532	−0.359	−0.522

and Figure 1), coupled with the findings from the correlation analysis, provides a comprehensive understanding of the relationships between bulimia and various regulatory mechanisms of eating behavior. The network consisted of seven nodes representing the variables: bulimia and food preoccupation, intrinsic motivation, integrated regulation, identified regulation, introjected regulation, external regulation, and amotivation. The network revealed 19 non-zero edges out of a possible 21, indicating a sparsity of 0.095.

Bulimia and food preoccupation demonstrated low centrality across all measures: betweenness (−0.680), closeness (−1.145), strength (−1.564), and expected influence (−1.993). These low centrality scores suggest that while bulimia and food preoccupation is a central node within the network, it does not exert the highest influence compared to other variables. This aligns with the correlation analysis findings, where significant negative correlations were found with introjected regulation, external regulation, and amotivation, indicating that these forms of motivation are strongly associated with bulimic behaviors.

Intrinsic motivation showed low centrality scores in betweenness (−0.680), closeness (−0.397), and strength (−0.174), but had a positive expected influence (0.478). The weak correlation with bulimia (r = 0.016) suggests that intrinsic motivation does not significantly impact bulimic behaviors. This is further supported by its low centrality, indicating that intrinsic motivation plays a minimal role in the network of eating behavior regulation.

Integrated regulation also exhibited low centrality: betweenness (−0.680), closeness (−0.455), strength (−0.365), and a positive expected influence (0.669). The near-zero correlation with bulimia (r = 0.001) reflects its minimal influence on bulimic behaviors, corroborated by its low centrality measures in the network.

Identified regulation displayed high centrality across all measures: betweenness (1.436), closeness (1.433), strength (1.602), and expected influence (1.006). Despite a non-significant negative correlation with bulimia (r = −0.025), its high centrality indicates that identified regulation is a pivotal variable within the network, potentially influencing other regulatory mechanisms and their association with bulimia.

Introjected regulation had high centrality: betweenness (1.436), closeness (1.381), strength (0.835), and a moderate expected influence (0.138). The significant negative correlation with bulimia (r = −0.345, p < 0.001) suggests that higher introjected regulation is associated with more bulimic behaviors. Its high centrality in the network highlights its critical role in linking bulimia with other regulatory mechanisms.

External regulation demonstrated mixed centrality: betweenness (−0.151), closeness (−0.286), strength (0.025), and a positive expected influence (0.222). The significant negative correlation with bulimia (r = −0.298, p < 0.001) indicates that higher external regulation is associated with increased bulimic behaviors. Its mixed centrality suggests a dynamic role within the network, where it has direct associations with bulimia but is less central in connecting other nodes.

Amotivation showed low centrality: betweenness (−0.680), closeness (−0.532), strength (−0.359), and negative expected influence (−0.522). The significant negative correlation with bulimia (r = −0.186, p < 0.001) indicates that higher amotivation is associated with more bulimic behaviors. Its low centrality suggests that while it directly impacts bulimia, it is not a key connector within the network.

Network analysis and centrality measures showed that identified regulation (betweenness = 1.436, closeness = 1.433, strength = 1.602, expected influence = 1.006) and introjected regulation (betweenness = 1.436, closeness = 1.381, strength = 0.835, expected influence = 0.138) emerged as highly central nodes with significant influence over bulimia and food preoccupation. These results validate Hypothesis 2 (Hypothesis 2: Identified regulation and introjected regulation will emerge as central nodes in the network analysis, demonstrating significant influence over bulimia and food preoccupation), highlighting the pivotal roles of identified and introjected regulation in the network of eating behavior regulation.

The network analysis results also revealed that integrated regulation (betweenness = −0.680, closeness = −0.455, strength = −0.365, expected influence = 0.669) had a significant indirect influence on bulimia and food preoccupation. Although the direct correlation with bulimia was negligible (r = 0.001), its positive expected influence indicates an indirect impact, supporting Hypothesis 3 (Hypothesis 3: Integrated regulation will show significant indirect influence on bulimia and food preoccupation). This underscores the role of integrated regulation in the broader context of eating behavior regulation, consistent with self-determination theory.

The network analysis reveals that introjected regulation and external regulation are crucial in the activation of bulimic behaviors. These regulatory mechanisms, characterized by internal and external pressures, show significant negative correlations with bulimia, indicating that higher levels of these pressures are associated with increased bulimic tendencies. Their high centrality measures in the network further emphasize their importance in influencing bulimia.

Identified regulation, while not significantly correlated with bulimia, holds a central position within the network, suggesting it might influence bulimic behaviors indirectly through its interactions with other regulatory mechanisms. Conversely, intrinsic motivation and integrated regulation show minimal direct impact on bulimic behaviors, as indicated by their low centrality and weak correlations.

3.4. Qualitative Thematic Analysis of What Does Food Represent to One

Using a qualitative content analysis approach based on an iterative coding procedure, themes were identified by systematically categorizing and interpreting the responses. This method involved reading through the responses multiple times, coding them based on recurring words and phrases, and grouping these codes into broader themes. This process allowed for the extraction of insights into the various connotations and functions of food in people’s lives.

The analysis identified several broad themes reflecting participants’ attitudes toward food. A significant portion of participants (22.5%) described food as essential for existence, using terms like “a necessity” and “a need to survive”. Another notable theme, reported by 20% of respondents, emphasized food’s role as a source of energy, with frequent mentions of words such as “energy”, “fuel”, and “source of energy”.

Additionally, 25% of participants highlighted the importance of food in fostering nutrition and wellness, with phrases like “health”, “nutrients”, “balanced diet”, and “healthy lifestyle”, reflecting this perspective. For many respondents (17.5%), food was associated with happiness and pleasure, with terms such as “pleasure”, “enjoyment”, and “happiness” being commonly used.

Furthermore, 7.5% of participants emphasized food’s role in social and cultural contexts, using expressions like “exploring cultures”, “sharing with others”, and “spending quality time with loved ones”. Finally, another 7.5% of respondents noted the emotional and psychological impact of food, with terms like “comfort”, “relaxation”, and “stress relief” indicating food’s role in emotional support and mental health.

4. Discussion

This study employed a mixed-methods approach to investigate the complex relationship between regulatory mechanisms of eating behaviors and their impact on bulimic symptoms. The methodology included correlation analysis, network analysis, and thematic analysis to provide a comprehensive understanding of these dynamics.

The correlation analysis revealed significant associations between bulimia and several regulatory mechanisms, consistent with prior research. Specifically, bulimia and food preoccupation showed negative correlations with identified regulation and introjected regulation. These findings suggest that individuals experiencing higher levels of bulimic symptoms may face challenges in internalizing and identifying with self-regulatory behaviors [36,37,38,39,40,41,42,43,44]. Moreover, the study extends these insights by considering amotivation, which also exhibited a significant negative correlation with bulimia and food preoccupation. This finding suggests that individuals lacking motivation or drive regarding eating behaviors may be more prone to experiencing symptoms of bulimia. Understanding these correlations provides a detailed perspective on how different regulatory mechanisms—both internal and external—contribute to the manifestation of bulimic symptoms.

The network analysis offered valuable insights into the structural relationships among regulatory mechanisms and their implications for bulimic symptoms. Bulimia and food preoccupation emerged as a central node in the network, evidenced by its moderate centrality measures [45]. These results suggest that while bulimia and food preoccupation hold a central position within the network, its overall influence compared to other variables is relatively modest. This aligns with the findings from the correlation analysis, which indicated significant negative correlations between bulimia and food preoccupation and introjected regulation, external regulation, and amotivation, underscoring the associations between these regulatory mechanisms and bulimic behaviors.

Identified regulation and introjected regulation exhibited notably higher centrality measures, indicating their critical roles in connecting different nodes within the [46]. Despite a non-significant negative correlation with bulimia, identified regulation’s high centrality suggests its potential influence on other regulatory mechanisms and their relationships with bulimic symptoms. Conversely, introjected regulation showed significant negative correlation with bulimia, emphasizing its substantial impact on increasing bulimic behaviors and highlighting its pivotal role within the regulatory network.

Integrated regulation displayed low centrality measures, alongside a positive expected influence and a near-zero correlation with bulimia. These findings indicate that integrated regulation plays a minimal role in influencing bulimic behaviors within the network structure. External regulation exhibited mixed centrality and a positive expected influence. Despite its moderate centrality, external regulation showed a significant negative correlation with bulimia, suggesting its direct association with increased bulimic behaviors but less influence in connecting other nodes. Amotivation demonstrated low centrality and negative expected influence, alongside a significant negative correlation with bulimia. These results indicate that higher levels of amotivation are linked to increased bulimic behaviors, albeit without a prominent role in connecting other variables within the network. This highlights the need for interventions targeting motivation levels, as enhancing motivation could potentially reduce bulimic tendencies.

Qualitative insights from thematic analysis provided a deeper understanding of participants’ lived experiences related to regulatory mechanisms and bulimic behaviors. Various themes underscored the complex dynamic between personal motivations and societal influences on eating behaviors [47]. For example, the emphasis on food as a source of energy and a requirement for survival reflects basic human needs and is consistent with traditional nutritional perspectives [36,37]. Nonetheless, a number of participants reported that a great deal of attention was paid to the psychological and emotional aspects of food, indicating that interventions meant to treat eating disorders should take into account people’s emotional relationships with food in addition to the nutritional aspects [38,39]. This is in line with earlier studies that show eating behaviors and disordered eating patterns are significantly influenced by emotional regulation [38,40,41,42].

The social and cultural aspects of food, as noted by several participants, further suggest that eating habits are formed by social interactions and cultural norms in addition to personal preferences [40]. Developing successful interventions that are socially inclusive and culturally sensitive requires an understanding of these influences. This result is consistent with previous research that emphasizes how cultural context affects eating habits and the incidence of eating disorders [38,40]. Furthermore, participants who linked food to comfort and stress alleviation indicated that it might be used as a tool for emotional control [41]. This suggests that food can be a useful therapeutic tool. In managing bulimic behaviors, addressing these emotional connections may be especially pertinent, since it implies that therapeutic interventions may benefit from examining and changing the emotional associations people have with food. Studies that highlight the importance of emotional control in the management of eating disorders lend credence to this strategy [39,41,42]. These qualitative findings complemented the quantitative analyses, offering detailed perspectives on the psychosocial factors contributing to bulimic symptoms.

The current findings align with previous research indicating that internalized regulatory mechanisms play a crucial role in managing eating behaviors and potentially mitigating bulimic symptoms [43,44,45,46,47,48,49,50,51]. The correlations observed between bulimia and identified regulatory mechanisms underscore the importance of promoting self-regulation and reducing external pressures in clinical interventions [52,53].

From a practical standpoint, the identification of specific regulatory mechanisms associated with bulimic symptoms suggests targeted intervention strategies. Interventions could focus on internalized motivations (e.g., identified and integrated regulations) while addressing external influences (e.g., societal pressures) through cognitive-behavioral approaches or psychoeducation [54].

Overall, our results, which emphasize how attachments to food shape bulimic behaviors, are consistent with Puttevils and collaborators’ [55] systematic review that highlights the distinct emotion regulation mechanisms used in bulimia nervosa and anorexia. This emphasizes how important it is to design interventions specifically designed to address the unique emotional regulation issues related to bulimia. Our results are also in line with the conclusions made by Leppanen and collaborators [56], emphasizing the emotional and psychological aspects of food and their significance in bulimic behaviors. Rumination and difficulty accepting feelings were identified as the main obstacles associated with emotion regulation in eating disorders by their network meta-analysis. The congruence of our findings with theirs emphasizes the necessity of focused interventions addressing particular issues with emotion regulation, especially in the context of bulimia, where emotional dysregulation is a key component of symptomatology.

Theoretical implications highlight the need for further exploration into the temporal dynamics and causal relationships between regulatory mechanisms and bulimic symptoms. Longitudinal studies could investigate how changes in regulatory processes precede or follow changes in bulimic behaviors, offering insights into potential pathways for intervention development [44].

This study has a number of drawbacks that need to be acknowledged despite its merits. Because cross-sectional data make it difficult to conclude about causality, longitudinal approaches are needed to identify temporal relationships. Furthermore, the sample size was chosen more for convenience than through a formal power analysis, which may have limited the findings’ generalizability even if it was enough for the statistical analyses that were performed. Concerns over the sample’s representativeness are raised when convenience sampling is used to recruit participants, especially from particular geographic areas. As such, it is important to interpret the data’s clinical significance cautiously because they may not be entirely generalizable to larger populations.

In addition, there was a substantial gender disparity in the sample, with a greater percentage of female participants than male participants. This imbalance raises questions about the findings’ potential generalizability to different gender contexts and highlights the need for more studies to guarantee more equitable representation. Furthermore, using self-reported data alone causes biases, which highlights the necessity for objective assessments to be included in future research. A further investigation of cultural differences in eating habits and regulatory systems is warranted, which emphasizes the need for more diverse research populations.

Lastly, research on the effectiveness of therapies aimed at certain regulatory systems found in this study should be conducted in the future. Research on comparative effectiveness should evaluate how therapies designed to improve internalized motives differ from those that address external constraints in terms of their ability to reduce bulimic symptoms.

Finally, this work contributes to our understanding of how regulatory processes impact bulimic behaviors by conducting a multidimensional analysis. By combining quantitative and qualitative methodologies, the findings highlight the complexities of eating patterns and provide new routes for targeted treatments and future study.

5. Conclusions

This study adopted a multimodal strategy to investigate the links between eating behavior regulation systems and bulimic symptoms. Several major findings emerged from the correlation, network, and topic analyses, offering insight on the complex dynamics that underpin bulimia and regulatory mechanisms.

The findings have important implications for theory, practice, and future study. The theoretical implications highlight the significance of integrating social cognitive theories, such as Bandura’s (2023) social cognitive theory [54], to better understand how internal and externalized regulatory processes interact to impact bulimic symptoms. Practical implications include the creation of targeted therapies that increase internal drive while addressing external demands in order to successfully reduce bulimic behaviors.

Despite its contributions, this study has drawbacks, including a cross-sectional design and a dependence on self-reported data. Future research should use longitudinal designs and objective evaluations to demonstrate causal links while minimizing biases. Furthermore, investigating cultural differences in regulating systems and broadening the scope to include other groups may give further insight into the generalizability of findings.

In conclusion, this study contributes to our understanding of how regulatory processes influence bulimic symptoms by combining quantitative and qualitative techniques. By explaining the complex interrelationships between these factors, the study adds to the body of knowledge on eating disorders and supports tailored therapies aimed at encouraging healthy eating habits.