Measuring self-esteem in dieting disordered patients: the validity of the Rosenberg and Coopersmith contrasted

Dissonance thin-ideal and didactic healthy behavior eating disorder prevention programs: results from a controlled trial

OBJECTIVE

Negative body image, a common problem among college-age women in the United States, strongly correlates with low self-esteem, disturbed eating behavior, and eating disorders. Psychoeducational programs have inconsistently shown improvement in body image, thin-ideal internalization, eating behaviors, psychosocial functioning, and self-esteem.

METHOD

In the current study, college women with body image concerns (N = 84) were randomly assigned to a cognitive dissonance-based, thin-ideal internalization, single-session workshop (DTI; n = 26); a psychoeducational, healthy behavior, single-session workshop (HB; n = 24); or a wait-list control (WL; n = 34).

RESULTS

Comparing baseline data with 4-week follow-up data, results indicated that both DTI and HB participants reported improvement in body image, thin-ideal internalization, and eating behaviors.

DISCUSSION

Results provide evidence that both interventions effectively reduce risk factors for eating pathology.

The associations between laxative abuse and other symptoms among adults with anorexia nervosa

OBJECTIVE

The purpose of the current study was to examine the association between laxative abuse and other symptoms and features among adult patients presenting with anorexia nervosa.

METHOD

One hundred and seventeen patients with anorexia nervosa were studied. Laxative abusers and nonabusers were compared.

RESULTS

Compared with nonabusers, laxative-abusing patients had higher ratings on the Ineffectiveness, Body Dissatisfaction, and Drive for Thinness subscales on the Eating Disorders Inventory (EDI), as well as more depressive and somatization symptoms. There was an association between laxative abuse and low self-esteem.

DISCUSSION

Laxative abuse appears to be associated with especially severe psychopathology and low self-esteem among subjects with anorexia nervosa.

An international collaborative database: its use in predicting length of stay for inpatient treatment of anorexia nervosa

OBJECTIVE

We describe the establishment of an Australasian multisite research database for inpatient treatment of anorexia nervosa (AN). Using this database, the second aim of this study is to investigate the extent to which length of stay (LOS) in participating facilities could be predicted at admission from patient, clinical, and site variables.

METHOD

Standardized demographic and clinical data were collated for 213 admission episodes involving 154 participants over a 20 month period from five Australian and one New Zealand specialist treatment centres.

RESULTS

While nine variables significantly predicted LOS on univariate analysis, linear regression determined that only body mass index, and having had 2-3 previous admissions made significant independent contributions to LOS.

DISCUSSION

Multisite databases offer a viable means by which to conduct clinical research, particularly in regard to low prevalence disorders such as AN. Their additional advantage is that of involving front-line practitioners recruiting participants more likely to be representative of cases seen across treatment centres. At just under a fifth of the total variance predicted by the best-fit model, LOS in hospital remains an aspect of AN treatment difficult to predict, and future studies need to explore variables other than the obvious demographic or clinical issues at admission. The clinical and planning implications are discussed.

Weight satisfaction and self-esteem among teenagers in Helsinki, Moscow and Tallinn

OBJECTIVE

Information on weight satisfaction in Eastern Europe is limited. This study compares relative weight, weight satisfaction and self-esteem of teenagers living in two post-Soviet capitals, Moscow and Tallinn, and a western capital Helsinki.

METHOD

Classroom surveys including data about weight and height, weight satisfaction and self-4 esteem among 15-18-year-old girls (n = 911) and boys (n = 650) collected in 1994-95.

RESULTS

Body mass index and self-esteem were highest in Helsinki. Nevertheless, feelings of over-weight were most common among Tallinn girls and feelings of over- and underweight among Muscovite girls. Boys were mostly satisfied with their current weight with no differences between cities. Low self-esteem was associated with feelings of overweight among girls and underweight among boys.

DISCUSSION

Somewhat unexpectedly, girls grown in non-western cultures were more dissatisfied with their weight than girls in Helsinki. These findings may partly be attributable to rapid economic and cultural transformations that were occurring in these countries during the study period.

Ten-year review of rating scales. III: scales assessing suicidality, cognitive style, and self-esteem

OBJECTIVE

This is the third article in a series of 10-year reviews of rating scales. Here, the authors review scales that are useful in tapping the affective disturbances experienced with various psychiatric disorders, including suicidality, cognitive style, and self-esteem.

METHOD

The authors sampled articles incorporating these constructs over the past 25 years and selected scales with established uses or new development. Those presented here have adequate psychometric properties and high utility for efficiently elucidating youths' functioning, plus either wide literature citations or a special niche.

RESULTS

These scales were developed bimodally. Many were developed in the 1980s when internalizing disorders were elucidated, but there has been a resurgence of interest in these constructs. Scales assessing suicidality have clear constructs, whereas scales of cognitive style demonstrate deficits in developmental relevance, and scales of self-esteem suffer from lax constructs.

CONCLUSIONS

The constructs underlying these scales tap core symptoms of internalizing disorders, mediate the expression of affective disturbances associated with various disorders, and depict the impairments resulting from these disorders. Overall, the psychometrics of these scales are adequate. These scales provide a broader representation of youths' functioning than that conveyed with diagnostic scales alone.

Gender differences in patients with binge eating disorder

OBJECTIVE

This study examined gender differences in patients with binge eating disorder (BED).

METHOD

Participants were 182 adults (35 male, 147 female) who were consecutively evaluated for outpatient clinical trials and met criteria for BED as outlined in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders. They were administered a battery of measures to examine developmental, eating and weight-related disturbances, and psychological features associated with BED.

RESULTS

Men and women did not differ significantly on several developmental variables (age at first overweight, age at first diet, age at onset of regular binge eating, or number of weight cycles). Men had significantly higher current body mass index (BMI), highest adult BMI, and were significantly more likely to be classified as obese. Men and women did not differ significantly on measures of current eating disorder features (binge eating, eating concerns, weight or shape concerns) but women reported significantly greater body image dissatisfaction and drive for thinness. Men and women did not differ significantly on current depression or self-esteem but men reported a greater frequency of past drug abuse problems.

DISCUSSION

Although men and women who present for treatment for BED show many similarities in current eating disorder features, we observed a number of gender differences on important developmental and physical variables as well as associated psychological features.

Self-functioning traits affecting meal compliance in eating disorder patients

The objective of this study was to measure the extent to which self-functioning traits relate to meal compliance in eating disorder patients by using multiple regression analysis. Compliance was the dependent variable. It was recorded on a meal flowsheet during breakfast, lunch and dinner and compiled for the 8 days immediately preceding each patient's discharge. The independent variables were gender, self-esteem (Rosenberg Scale) and 7 subscales of the Eating Disorder Inventory (EDI-2): drive for thinness, body dissatisfaction, ineffectiveness, perfectionism, interpersonal distrust, interoceptive awareness and maturity fears. A random sample of 30 subjects who completed the above instruments before May 1999 were included in the study. The results suggest that close to 50% of their meal compliance can be explained by variations in four explanatory variables: gender, ineffectiveness, interoceptive awareness and distrust. The adjusted r2 was 0.497 and the significance of the equation, measured by the p-value, was p = 0.0002. We conclude that multiple regression analysis is a valuable tool to identify patients' traits with the strongest effect in meal compliance.

Teasing history, onset of obesity, current eating disorder psychopathology, body dissatisfaction, and psychological functioning in binge eating disorder

OBJECTIVE

The primary goal of this study was to examine associations among teasing history, onset of obesity, current eating disorder psychopathology, body dissatisfaction, and psychological functioning in women with Binge Eating Disorder (BED).

RESEARCH METHODS AND PROCEDURES

Subjects were 115 female adults who met DSM-IV criteria for BED. Measurements assessing teasing history (general appearance [GAT] and weight and size [WST] teasing), current eating disorder psychopathology (binge frequency, eating restraint, and concerns regarding eating, shape, and weight), body dissatisfaction, and psychological functioning (depression and self-esteem) were obtained.

RESULTS

History of GAT, but not WST, was associated with current weight concerns and body dissatisfaction, whereas both GAT and WST were significantly associated with current psychological functioning. Patients with earlier onset of obesity reported more WST than patients with later onset of obesity, but the groups did not differ significantly in GAT, current eating disorder psychopathology, body dissatisfaction. or psychological functioning. Obese women reported more WST than non-obese women, but no differences in GAT or the other outcome variables were observed. Higher frequency of GAT was associated with greater binge frequency in obese women, and with greater eating restraint in non-obese women.

DISCUSSION

Although physical appearance teasing history is not associated with variability in most eating disorder psychopathology, it is associated with related functioning, most notably body dissatisfaction, depression, and self-esteem. Our findings also suggest that the age of onset of obesity and current body mass index status in isolation are not associated with eating psychopathology or associated psychological functioning in adult patients with BED.

Onset of dieting vs binge eating in outpatients with binge eating disorder

OBJECTIVE

To examine the potential significance of the sequence of the onset of dieting and binge eating in binge eating disorder (BED).

DESIGN

BED patients were interviewed and completed a battery of psychometrically well-established measures of current eating behaviors, eating disorder psychopathology, and associated psychological functioning.

SUBJECTS

Participants were 98 consecutive outpatients with BED evaluated for a clinical trial.

MEASURES

Interview data, self-report measures and measured body weight were examined.

RESULTS

Participants who reported that dieting preceded binge eating (DIETfirst, 65%) were compared to those who reported that binge eating preceded their first diet (BINGEfirst, 35%). The study groups did not differ in demography, current or highest body mass index, current eating behaviors or psychopathology, or psychological functioning. The two groups did not differ in age of first diet; however, the BINGEfirst group was significantly younger when first overweight, at onset of binge eating, and at onset of BED diagnosis. The BINGEfirst group reported a higher frequency of being teased about their weight.

CONCLUSIONS

A substantial subgroup of BED patients report that binge eating preceded their first diet. This finding, which replicates previous reports for BED and appears higher than that generally reported for bulimia nervosa, may have implication for etiologic models of binge eating.