A systematic review of the existing models of disordered eating: Do they inform the development of effective interventions?

Eating-related pathology at the intersection of gender identity and expression, sexual orientation, and weight status: An intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) of the Growing Up Today Study cohorts

The objective of this study was to investigate how gender identity, the overwhelmingly prioritized dimension of social identity/position in eating-related pathology research, intersects with gender expression, sexual orientation, and weight status to structure the social patterning of eating disorders and disordered eating behaviors among young people in the U.S. Data were drawn from the 2010/2011 Growing Up Today Study (GUTS; N = 11,090-13,307). We conducted an intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) by nesting participants within social strata defined by intersecting gender identity, gender expression, sexual orientation, and weight status categories in a series of multilevel logistic models for four outcomes (past-year purging, overeating, and binge eating; lifetime eating disorder diagnosis). To illustrate the advantages of intersectional MAIHDA, we compared the results to those from unitary and conventional intersectional analyses. The intersectional MAIHDA revealed a complex social patterning of eating-related pathology characterized by heterogeneity and outcome-specificity. Several multiply marginalized strata (e.g., those including gender nonconforming, sexual minority, and/or larger-bodied girls/women) had disproportionately elevated prevalence, although all estimates were driven by additive effects. Notably, these patterns were obscured within the unitary and conventional intersectional analyses. Future epidemiologic research on eating-related pathology should continue to adopt an intersectional approach through the use of appropriate methodologies.

Assessing the impact of body image concerns on functioning across life domains: Development and validation of the Body Image Life Disengagement Questionnaire (BILD-Q) among British adolescents

Assessing the impact of body image on engagement in a range of life domains is important; however, there is a lack of validated measures for adolescents. The current research developed the Body Image Life Disengagement Questionnaire (BILD-Q) and validated it among four samples of British adolescents. Study 1 (N = 1707; 11-13 years) indicated a 9-item unidimensional scale based on Exploratory Factory Analysis. In Study 2 (N = 1403; 11-13 years), Confirmatory Factor Analysis (CFA) showed an acceptable fit overall, but better among girls than boys. Further exploration with CFA in Study 3 (N = 2034; 13-14 years) showed a good to excellent fit overall, and acceptable among both boys and girls. The scale showed good internal consistency and test-retest reliability, and gender invariance indicated the scale can be used comparatively. In Study 4 (N = 288; 13-14 years), convergent validity was supported via expected relationships with body image and related constructs. Concurrent and predictive incremental validity were also evidenced via explaining significant unique variance in well-being. These studies provide support for the BILD-Q as a reliable and valid measure of broader impacts of body image among adolescents, which may benefit intervention evaluation and policy change efforts.

A systematic review of network analysis studies in eating disorders: Is time to broaden the core psychopathology to non specific symptoms

Objective

Network theory considers mental disorders as the product of symptom interaction. A growing number of studies employing this methodology has been conducted in eating disorders (EDs). We aimed to review those studies to provide evidence and limitations for a novel conceptualisation of EDs.

Methods

According to PRISMA guidelines and PICOS criteria, studies eligible for inclusion were those employing network analysis in people with a clinically defined diagnosis of ED. Twenty‐five studies were included and were analysed in relation to diagnosis, comorbidity, and treatment outcome.

Results

Despite the central role of overvaluation of body shape and weight and cognitive restraint across ED diagnoses, ineffectiveness, interoceptive awareness and affective problems appear central symptoms. Ineffectiveness and interoceptive awareness emerge as bridge symptoms promoting comorbidity in people with anorexia nervosa and in mixed ED samples. Although few studies assessed treatment outcome, there is evidence supporting the predictive role of central network nodes.

Conclusions

Ineffectiveness, interoceptive ability and affective problems may be included in the core ED psychopathology, in addition to ED‐specific symptoms. Network analysis is a promising method to reconceptualize comorbidity. Future studies are recommended to include general psychopathology in ED networks, to assess connections with the external field and clinical meaning of network connectivity.

Overvaluation of body shape and weight and cognitive restraint appear as central nodes across eating disorder diagnoses and ages.

In addition to specific symptoms, ineffectiveness, low interoceptive ability and affective problems also emerge as central nodes in eating disorders.

There is some evidence to point to ineffectiveness and low interoceptive ability as bridge nodes promoting psychiatric comorbidity.

Only few studies assessed treatment outcome through the network analysis approach

Examining the efficacy of video-based microinterventions for improving risk and protective factors for disordered eating among young adult women

OBJECTIVE

Brief self-guided activities designed for focused and immediate benefits, termed microinterventions, have the potential to aid reach and engagement in mental health interventions; however further validation is needed. This study evaluated effects of two microinterventions for responding to appearance-ideal media on risk and protective factors for disordered eating.

METHOD

Undergraduate women (N = 202, M_age = 19.90, SD = 2.75) were allocated quasi-randomly to one of three 15-min video-based microinterventions (mindfulness, cognitive dissonance, educational control) in the lab and assessed on state outcomes at baseline and immediate posttest. One week later, trait factors were assessed and participants underwent an appearance-ideal media exposure task.

RESULTS

Both mindfulness and dissonance groups reported significant immediate benefits to state appearance-ideal internalization, perceived sociocultural pressures and related distress, and mood, compared to educational control (Glass's Δ effect sizes = .40-.94), but not state weight or appearance satisfaction. At 1-week follow-up, mindfulness and dissonance groups demonstrated improved trait appearance-ideal internalization (Δ = .40 and .42), weight and shape concerns (Δ = .27 [ns] and .44), and body appreciation (Δ = .39 and .46) compared to the educational control. There were no effects on trait perceived pressures, negative affect, or body image psychological flexibility, and no differential changes in state outcomes from premedia to postmedia exposure.

DISCUSSION

Microinterventions using mindfulness and dissonance techniques show promise for improving some risk and potential protective factors for disordered eating in the immediate and short-term. Further research is required to substantiate their place within the spectrum of eating disorder prevention, early intervention and treatment techniques.

Perfectionism interventions targeting disordered eating: A systematic review and meta-analysis

OBJECTIVE

Perfectionism is a risk factor for depression, anxiety, and eating disorders, and perfectionism interventions show evidence of the impact on the development and maintenance of these disorders. A systematic review and meta-analysis were conducted of studies using perfectionism interventions that included measures of disordered eating/body image concerns. The primary aim was to investigate the impact on perfectionism and disordered eating/body image concerns, with a secondary aim of examining the impact on depression and anxiety.

METHOD

The systematic review was conducted using Medline, PsycINFO, and Scopus. Grey literature was sought via ProQuest Dissertations and Theses Global. Effect size estimates for the meta-analysis were calculated using between- and within-group comparisons.

RESULTS

Eight studies were included in the between-group analysis and nine studies for the within-group analysis. Perfectionism interventions were effective in reducing perfectionism and disordered eating with large effect sizes, and in reducing depression and anxiety with moderate effect sizes. Studies included both clinical and non-clinical populations. Substantial heterogeneity was present across most analyses.

DISCUSSION

Eating disorder treatments may benefit more from the inclusion of perfectionism interventions than depression and anxiety treatments. Possible reasoning for these variations between symptom reduction is discussed. This report provides important early evidence for the efficacy of perfectionism interventions, however, the limited number of publications in this area, the presence of heterogeneity, and lack of diversity in participant populations limits the generalizability of these findings. Future research is needed to determine whether eating disorder treatments may benefit from the routine inclusion of a perfectionism component.

Anhedonia, positive affect dysregulation, and risk and maintenance of binge-eating disorder

Low positive affect has been identified as an antecedent of binge-eating episodes among individuals with binge-eating disorder (BED), yet positive affect has received far less attention in eating disorders research than its counterpart, negative affect. In this article, we argue that the low levels of positive affect which occur with anhedonia (i.e., loss of interest or pleasure in activities) may contribute to the onset and maintenance of BED. We introduce a theoretical model in which anhedonia increases the risk for BED through its interrelationships with dysregulated eating and weight gain, and we describe potential direct (e.g., reward-related processes) as well as indirect (e.g., influences on depressive symptoms and physical activity) pathways by which anhedonia may lead to adverse eating- and weight-related outcomes. We also propose a momentary maintenance model in which low positive affect and positive affect dysregulation occurring with anhedonia maintain binge eating directly and indirectly through maladaptive health behaviors, such as decreased physical activity, less healthy eating, and fewer social interactions, which in turn maintain anhedonia. We draw upon outside literature to present evidence that aligns with the proposed risk and maintenance models and conclude by outlining avenues for future research-including methodological/measurement, theoretical, and clinical research directions.

Discrimination and Eating Disorder Psychopathology: A Meta-Analysis

Eating disorders occur in diverse populations, and discrimination may be a specific factor that is related to higher eating disorder psychopathology among marginalized individuals. To evaluate the current evidence on this topic, a meta-analysis was used to quantitatively synthesize the literature on discrimination and eating disorder psychopathology across a heterogeneous range of studies. Searches were conducted in peer-reviewed journals and accessible unpublished dissertations of all years through January 2020. Studies were coded by two authors using a tailored coding form, and zero-order bivariate correlations were used as effect size measures. There were 55 cross-sectional studies extracted for inclusion in the meta-analysis. Results showed a small-to-medium association between discrimination and eating disorder psychopathology that was consistent across domains. Effect sizes were typically higher for weight discrimination. For binge eating and general eating disorder pathology, effects were smaller in studies that had larger proportions of women, and for binge eating only, effects were higher in college samples. These findings could suggest that discrimination represents a contributory factor related to eating disorder psychopathology across types of discrimination and eating disorder psychopathology. Implications are discussed for future research on discrimination and psychopathology including possible mechanisms.

Adding maintaining factors to developmental models of anorexia nervosa: An empirical examination in adolescents

OBJECTIVE

A biopsychosocial approach has been proposed to explain the pathogenesis of anorexia nervosa (AN), despite only a few of the existing etiological models having received empirical support. The aim of this study was to empirically investigate Herpertz-Dahlmann, Seitz, and Konrad (2011, https://doi.org/10.1007/s00406-011-0246-y)'s developmental model and to consider if interpersonal reactions to the illness might serve as maintaining factors following the model proposed by Treasure and Schmidt (2013, https://doi.org/10.1186/2050-2974-1-13) METHOD: One hundred adolescents and their families were participated in the study: 50 diagnosed with AN, paired by age and parents' socio-economic status with 50 adolescents without a pathology. Biological, psychological and familial variables were assessed using ten questionnaires and a blood analysis test. Additionally, structural equation modeling was conducted to assess two hypothetical models.

RESULTS

The fit of both models was good after the addition of two covariate parameters (e.g., Comparative Fit Index > 0.96 and Tucker-Lewis Index > 0.95). Premorbid traits were linked to body dissatisfaction and to the number of stressful life events; this in turn was linked to AN symptoms. Biological and familial consequences reinforced this pathology.

CONCLUSIONS

Our findings provide support for both models, suggesting that inter relationships between bio-psycho-familial variables can influence the course of AN during adolescence.

Dietary restraint patterns and eating disorder help-seeking

OBJECTIVE

Determine whether gender differences exist in associations among central barriers to and facilitators of eating disorder (ED) help-seeking-ED stigma, negative affect, perceived ED treatment need-as a function of individuals' probability of classification within empirically derived groups characterized by different dietary restraint patterns.

METHOD

As part of the cross-sectional, multi-institute Healthy Bodies Study, women (n = 2215) and men (n = 986) attending three colleges and universities in 2015 completed measures of ED symptoms, affect, and ED help-seeking in an online survey. Structural equation mixture modeling was used to (1) classify women and men, separately, into distinct classes characterized by unique dietary restraint patterns and (2) test associations among the three ED help-seeking barriers and facilitators within each class.

RESULTS

Five dietary restraint symptoms (food amount limiting attempts, fasting, food avoidance, following food/diet rules, desiring an empty stomach) clustered within four classes among women and three classes among men, which were characterized by qualitative and quantitative similarities and differences. Further, opposite patterns were generally found in associations among the ED help-seeking barriers and facilitators for women versus men as a function of the way dietary restraint symptoms clustered within each class. For example, bivariate associations between worse ED stigma and negative affect relative to greater perceived ED treatment need were both significant only among women in their lowest restraint severity class, whereas these associations were both significant among men in their highest severity class.

DISCUSSION

These findings can help to increase the reach of ED intervention efforts, including increasing ED help-seeking rates.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Disordered eating, self-esteem, and depression symptoms in Iranian adolescents and young adults: A network analysis

OBJECTIVE

The network theory of psychopathology examines networks of interconnections across symptoms. Several network studies of disordered eating have identified central and bridge symptoms in Western samples, yet network models of disordered eating have not been tested in non-Western samples. The current study tested a network model of disordered eating in Iranian adolescents and college students, as well as models of co-occurring depression and self-esteem.

METHOD

Participants were Iranian college students (n= 637) and adolescents (n = 1,111) who completed the Eating Disorder Examination-Questionnaire (EDE-Q), Rosenberg Self-Esteem Scale (RSES) and Beck Depression Inventory, Second Edition (BDI-II). We computed six Glasso networks and identified central and bridge symptoms.

RESULTS

Central disordered eating nodes in most models were a desire to lose weight and discomfort when seeing one's own body. Central self-esteem and depression nodes were feeling useless and self-dislike, respectively. Feeling like a failure was the most common bridge symptom between disordered eating and depression symptoms. With exception of a few differences in some edges, networks did not significantly differ in structure.

DISCUSSION

Desire to lose weight was the most central node in the networks, which is consistent with sociocultural theories of disordered eating development, as well as prior network models from Western-culture samples. Feeling like a failure was the most central bridge symptom between depression and disordered eating, suggesting that very low self-esteem may be a shared correlate or risk factor for disordered eating and depression in Iranian adolescents and young adults.

State of the Art: The Therapeutic Approaches to Bulimia Nervosa

PURPOSE

Bulimia nervosa (BN) is an eating disorder characterized by binge eating, inappropriate compensatory behaviors, and body image concerns in persons at or above a healthy weight. BN is a serious disorder with medical sequelae and marked psychosocial impairment. To reduce and eliminate symptoms of BN, psychological and pharmacologic treatments for BN have been developed. We review the current state-of-the-art treatments for BN.

METHODS

We conducted a narrative review of the BN treatment literature to synthesize the current evidence base, provide recommendations, and propose future directions for BN treatment research.

FINDINGS

Currently, the first-line, state-of-the-art treatment for adults with BN is cognitive-behavioral therapy (CBT). Interpersonal therapy is a second-line evidence-based treatment for adults with BN, and dialectical behavior therapy and integrative cognitive-affective therapy are also promising. For BN in adolescents, family-based treatment for BN or CBT are evidence-based approaches. Pharmacotherapy is best considered adjunctive to psychotherapy in adults with BN but may be helpful, depending on the type of psychotherapy and whether psychotherapy is ineffective or unavailable. Fluoxetine 60 mg/d is the medication of choice for adults with BN. Little is known with respect to pharmacologic treatment of BN in adolescents, although fluoxetine 60 mg/d holds promise.

IMPLICATIONS

Despite decades of treatment-development research in BN, there is room for improvement because nearly 60% of those with BN do not achieve remission with specialty treatment and strikingly few randomized controlled trials for BN in adolescents exist. Moreover, the field should address issues related to treatment dissemination, access, and cost.

Online imagery rescripting among young women at risk of developing an eating disorder: A randomized controlled trial

OBJECTIVE

This study compared the effectiveness of two approaches to imagery rescripting (body versus general) among young women with an elevated risk of developing an eating disorder.

METHOD

University students (N = 130 females) were randomly assigned to one of the four conditions: body or general imagery rescripting, psychoeducation, control. After initial brief laboratory training delivered online, participants in the imagery rescripting conditions were asked to practice imagery rescripting for 5 min each day for a week. Primary (global eating psychopathology, eating disorder behaviors, and body image acceptance) and secondary outcomes (self-compassion, fear of self-compassion, and dysfunctional attitudes) were measured at baseline and one-week follow up.

RESULTS

Completer analyses showed both imagery rescripting conditions and psychoeducation had significant impact on global eating psychopathology and body acceptance (d = 0.60-0.78). Psychoeducation did not impact secondary variables, whereas body imagery rescripting improved self-compassion and fear of self-compassion (d = 0.61-0.80) and general imagery rescripting improved dysfunctional attitudes (d = 0.82) compared to control. Intent to treat analyses had similar but slightly less robust results.

DISCUSSION

While three active groups had significant impact on the primary variables, imagery rescripting approaches had impact on other variables that maintain disordered eating. Future research should investigate the impact of combining psychoeducation and imagery rescripting in terms of impact on disordered eating.

Self-esteem and binge eating: Do patients with binge eating disorder endorse more negatively worded items of the Rosenberg Self-Esteem Scale?

OBJECTIVE

Self-esteem is a core aspect of eating disorder symptomatology. This study aims to examine whether method effects associated with negatively worded items of the Rosenberg Self-Esteem Scale (RSES) may interact the negative self-evaluations experienced by patients with obesity and binge eating disorder (BED). We also examined whether negatively worded items were associated with psychological distress and eating symptoms.

METHOD

Five hundred thirty three female outpatients (mean age: 42.59) with BED (n = 160) or obesity without BED (n = 373) completed the RSES and measures of interpersonal problems, psychological distress, and eating symptoms.

RESULTS

Patients with BED responded more strongly to the negatively worded items of the RSES than those with obesity. The RSES negatively worded item factor was negatively associated with higher interpersonal problems, psychological distress, and binge eating.

CONCLUSIONS

Patients with BED may be more responsive to negatively phrased items on the RSES consistent with their negative self-evaluations and self-perceptions.

Gender, Physical Self-Perception and Overall Physical Fitness in Secondary School Students: A Multiple Mediation Model

Background: Physical self-perception is often related with better physical fitness perception in adolescents. Moreover, it is an important social cognitive perspective to provide suitable mental health in this population. However, this relationship is unequal between boys and girls. The physical fitness is a marker of health in young population. The aims of the present study were the following: (1) to compare physical self-perception and self-reported overall physical fitness (OPF) between boys and girls (gender) and body mass index (BMI) status, and (2) to determine the mediating role of all physical self-perception subscales (except physical condition) and BMI status in the link between gender and OPF in adolescent students. Methods: This cross-sectional study consisted of 85 adolescent students of secondary school between 12 and 17 years of age; 41 were boys (M_age = 14.6, SD = 1.7) and 44 were girls (M_age = 14.4, SD = 1.6). Adolescent participants completed all clinical characteristics by body composition measures (age, body weight, body height, and BMI). Physical self-perception was assessed by the physical self-perception profile (PSPP) whereas the international fitness scale (IFIS) was used to predict the self-reported OPF of adolescents in the present study. Results: Gender (boys and girls) differed significantly in all PSPP subscales and OPF, whereas the BMI status (underweight = 19 students, normal weight = 53 students, overweight/obese = 13 students) showed significant differences in all clinical characteristics, physical condition (PSPP), and OPF. A multiple mediation analysis was performed using bias corrected bootstrap. This multiple mediation analysis revealed that all PSPP subscales were significant mediators between gender and OPF: attractive body (p = 0.013), sport competence (p = 0.009), physical strength (p = 0.002), and self-confidence (p = 0.002). The total direct effect of gender on OPF was significant (p = 0.002). Moreover, the multiple mediation estimated a completely standardized indirect of X on Y for attractive body (effect = 0.109), sport competence (effect = 0.066), physical strength (effect = 0.130), and self-confidence (effect = 0.193). Conclusions: These findings contribute to understanding the link between gender and OPF in adolescent students and the mediation of physical self-perception and OPF in this relationship. In addition, strategies focused to improve self-confidence and physical self-perception are necessary in female adolescent students, because boys showed better physical self-perception in all PSPP subscales. Girls are a risk group because they report low physical self-confidence with their respective insecurity feelings and psychological disorders. Thus, personal physical self-perception must be considered as an important social cognitive perspective to provide suitable mental health in children and adolescents.

State-Based Markers of Disordered Eating Symptom Severity

Recent work using naturalistic, repeated, ambulatory assessment approaches have uncovered a range of within-person mood- and body image-related dynamics (such as fluctuation of mood and body dissatisfaction) that can prospectively predict eating disorder behaviors (e.g., a binge episode following an increase in negative mood). The prognostic significance of these state-based dynamics for predicting trait-level eating disorder severity, however, remains largely unexplored. The present study uses within-person relationships among state levels of negative mood, body image, and dieting as predictors of baseline, trait-level eating pathology, captured prior to a period of state-based data capture. Two-hundred and sixty women from the general population completed baseline measures of trait eating pathology and demographics, followed by a 7 to 10-day ecological momentary assessment phase comprising items measuring state body dissatisfaction, negative mood, upward appearance comparisons, and dietary restraint administered 6 times daily. Regression-based analyses showed that, in combination, state-based dynamics accounted for 34-43% variance explained in trait eating pathology, contingent on eating disorder symptom severity. Present findings highlight the viability of within-person, state-based dynamics as predictors of baseline trait-level disordered eating severity. Longitudinal testing is needed to determine whether these dynamics account for changes in disordered eating over time.

Improving emotion recognition in anorexia nervosa: An experimental proof-of-concept study

OBJECTIVE

Previous research has found increasing evidence for difficulties in emotion recognition ability (ERA) and social cognition in anorexia nervosa (AN), and recent models consider these factors to contribute to the development and maintenance of the disorder. However, there is a lack of experimental studies testing this hypothesis. Therefore, the present proof-of-concept study examined whether ERA can be improved by a single session of a computerized training in AN, and whether this has short-term effects on eating disorder symptoms.

METHOD

Forty inpatients (22.20 ± 7.15 years) with AN were randomly assigned to receive a single session of computerized training of ERA (TERA) or a sham training (training the recognition of different types of clouds). ERA, self-reported eating disorder symptoms, and body mass index (BMI) were assessed within 3 days before and after training.

RESULTS

After training, both groups showed improved ERA, reduced self-reported eating disorder symptoms, and an increased BMI. As compared to patients in the control group, patients who received TERA showed greater improvements in ERA and self-reported eating disorder symptoms.

DISCUSSION

ERA can be effectively trained in patients with AN. Moreover, short-term improvements in self-reported eating disorder symptoms provide tentative support for the hypothesis that difficulties in ERA contribute to the maintenance of AN, and that specific trainings of ERA hold promise as an additional component in AN treatment. Future studies are needed to replicate these findings in larger samples, and to investigate long-term effects and transfer into real-world settings.

Time course of body recognition in women with weight and shape concerns assessed by steady-state visual evoked potentials (SSVEP)

This study aimed to examine self-body recognition in women with high (HWSC) and low weight and shape concerns (LWSC). Thus, the detection rate, the reaction time and the perceptual threshold for recognizing one's own body in a morphed body were measured in n = 25 women with HWSC and n = 26 women with LWSC. Furthermore, by using steady-state visual evoked potentials (SSVEPs), neuronal correlates of body recognition were recorded. The perceptual threshold for recognizing one's own body was higher for women with HWSC in the case of a morph with a thinner body. No group differences emerged for morphs with obese or average-weight bodies. The SSVEP amplitudes did not differentiate between one's own and another body in either group. The results suggest that for women with HWSC, their negative body schemata might hamper recognition of their own body in a thinner morph. Otherwise, self-body recognition is similar in women with LWSC and HWSC.

Moving towards specificity: A systematic review of cue features associated with reward and punishment in anorexia nervosa

Models of anorexia nervosa (AN) posit that symptoms are maintained through deficient reward and enhanced punishment processing. However, theoretical and empirical inconsistencies highlight the need for a more nuanced conceptualization of this literature. Our goal was to comprehensively review the research on reward and punishment responding in AN from a cue-specific lens to determine which stimuli evoke or discourage reward and punishment responses in this population, and, ultimately, what properties these rewarding and punishing cues might share. A systematic review interrogating reward and punishment responses to specific cues yielded articles (n = 92) that examined responses to disorder relevant (e.g., food) and irrelevant (e.g., money) stimuli across self-report, behavioral, and biological indices. Overall, in most studies individuals with AN exhibited aversive responses to cues signaling higher body weights, social contexts, and monetary losses, and appetitive responses to cues for weight loss behaviors and thinness. Findings were more mixed on responses to palatable food and monetary gains. Results highlight that reward and punishment responding in AN are context specific and may be affected by varied stimulus qualities (e.g., predictability, controllability, delay, effort). Increasing specificity in future research on reward and punishment mechanisms in AN will better inform development of precisely-targeted interventions.

Self-directed behaviors differentially explain associations between emotion dysregulation and eating disorder psychopathology in patients with or without objective binge-eating

BACKGROUND

Emotion dysregulation and negative self-directed behaviors are key characteristics of eating disorders (EDs), but their interaction in relation to ED psychopathology is insufficiently explored, and empirically robust and clinically relevant models are needed.

METHODS

This study examined whether the association between emotion dysregulation and ED psychopathology was mediated by different negative self-directed behaviors in 999 ED patients divided into two sub-samples based on absence or presence of objective binge-eating episodes (OBE). Several simple and extended mediation models were examined using the Difficulties in Emotion Regulation Scale (DERS) as independent variable, the Structural Analysis of Social Behavior (SASB) as mediator, and the Eating Disorder Examination Questionnaire (EDE-Q) as dependent variable.

RESULTS

An associational pathway was found where higher emotion dysregulation was associated with more negative self-directed behaviors, which in turn was associated with higher ED psychopathology. Self-directed behaviors of importance differed between patient groups. In participants without OBE, lower self-love and higher self-attack were influential, whereas in participants with OBE, lower self-affirmation and higher self-blame were influential.

CONCLUSIONS

Self-directed behaviors may help to explain the association between emotion dysregulation and ED psychopathology. Our findings have both theoretical and clinical implications that are pathology-specific. Addressing specific self-directed behaviors could be an important way of helping patients deal with their emotions in relation to ED psychopathology.

Influence of Physical Activity Interventions on Body Representation: A Systematic Review

Distorted representation of one's own body is a diagnostic criterion and corepsychopathology of disorders such as anorexia nervosa and body dysmorphic disorder. Previousliterature has raised the possibility of utilising physical activity intervention (PI) as atreatment option for individuals suffering from poor body satisfaction, which is traditionallyregarded as a systematic distortion in "body image." In this systematic review,conducted according to the PRISMA statement, the evidence on effectiveness of PI on body representation outcomes is synthesised. We provide an update of 34 longitudinal studies evaluating the effectiveness of different types of PIs on body representation. No systematic risk of bias within or across studies were identified. The reviewed studies show that the implementation of structured PIs may be efficacious in increasing individuals' satisfaction of their own body, and thus improving their subjective body image related assessments. However, there is no clear evidence regarding an additional or interactive effect of PI when implemented in conjunction with established treatments for clinical populations. We argue for theoretically sound, mechanism-oriented, multimethod approaches to future investigations on body image disturbance. Specifically, we highlight the need to consider expanding the theoretical framework for the investigation of body representation disturbances to include further body representations besides body image.

Looking to the future: Priorities for translating research to impact in the field of appearance and body image

The field of body image and appearance research and practice is progressing; however, there is still work to be done to ensure broad societal impact. This article consolidates reflections from a range of established and early career experts in the field of appearance and body image, with a focus on stimulating and guiding future agenda setting and translation from research to impact. We conducted a thematic analysis of transcripts from nine recorded 5-minute presentations, delivered by researchers and clinicians as part of a special invited presentation session at a biennial international conference, 'Appearance Matters,' in the UK. Four themes were identified: Moving Beyond the Individual; Consolidation and Collaboration; Commitment to Implementation; and Positive and Protective Frameworks. These themes are discussed alongside recommendations for researchers and practitioners working in these fields to advance research, advocacy, and impact outside of academia.

The Impact of a Dissonance-Based Eating Disorders Intervention on Implicit Attitudes to Thinness in Women of Diverse Sexual Orientations

Dissonance-based body image programs have shown long-term effectiveness in preventing eating disorders and reducing risk factors for eating disorders in women. Here we report on the potential for one such intervention to impact on implicit attitudes toward thinness as well as an explicit measure of eating attitudes, across a sexually diverse group of young women. The Succeed Body Image Programme was adapted to remove heteronormative assumptions and was delivered to a final sample of 56 undergraduate women who reported their sexual orientation as either “predominantly heterosexual” (our term; 1 or 2 on a 7-point Kinsey scale, n = 38) or non-heterosexual (3–7 on the Kinsey scale, n = 18). Before and after the intervention, they completed the Eating Attitudes Test-26, and an associative reaction time task based on the Implicit Association Test, in which bodies of low and higher weight were paired with socially desirable or undesirable traits. A total of 37 predominantly heterosexual women completed a control intervention in which they read NHS leaflets on eating disorders and healthy weight. Results showed that the intervention made predominantly heterosexual participants less prone, versus control, to associating thinness with positive traits on the IAT and all women completing the intervention reported a lower level of disordered eating attitudes at post- than pre-test. Non-heterosexual women, however, showed a non-significant increase in thin-bias on the IAT, perhaps due to their low baseline. These results imply that intensive dissonance-based programs can change attitudes at the automatic, implicit level as well as merely giving women tools to overcome those implicit attitudes.

Eye-tracking study on the effects of happiness and sadness on body dissatisfaction and selective visual attention during mirror exposure in bulimia nervosa

OBJECTIVE

Abundant research points to the central role of body image disturbances in the occurrence of eating disorders (ED). While emotional arousal has been identified as a trigger for binge eating in bulimia nervosa (BN), empirical knowledge on the influence of emotions on body image in individuals with BN is scarce. The present study sought to experimentally examine effects of a positive and negative emotion induction on body dissatisfaction and selective attention towards negatively valenced body parts among people with BN.

METHOD

In a randomized-controlled cross-over design, happiness and sadness were induced by film clips one-week apart in women with BN (n = 23) and non-ED controls (n = 26). After the emotion induction, participants looked at their body in a full-length mirror, while their attentional allocation was recorded with the help of a mobile eye tracker. Participants repeatedly rated their momentary body dissatisfaction.

RESULTS

Induction of happiness led to a significant decrease in self-reported body dissatisfaction. Furthermore, attentional bias (higher gaze duration and frequency) towards the most disliked body part relative to the most liked body part was significantly greater in the sadness than happiness condition in BN. No significant effects of emotion induction on gaze duration and gaze frequency during mirror exposure were found for controls.

DISCUSSION

In line with assumptions of current models on ED, findings support the notion that emotional state influences the body image of patients with BN.

How do we target the factors that maintain anorexia nervosa? A behaviour change taxonomical analysis

All psychological treatments for anorexia nervosa appear to have equal (albeit modest) effects. This may be explained because they target similar processes. Although different psychological treatments have been developed for anorexia nervosa treatment, their taxonomical components have not been compared. This study undertook a taxonomical analysis of behaviour change techniques (BCTs), using the CALO-RE analysis tool, from the manuals of Enhanced Cognitive Behavioural Therapy (CBT-E), Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA), Family Based Therapy (FBT), Specialist Supportive Clinical Management (SSCM), and Focal Psychodynamic Psychotherapy (FPT). The highest number of BCTs were found in FPT (72,5%), and the lowest were in SSCM (30%). The other interventions had a similar range of BCTs which mainly focused on goal planning (FBT (50%), CBT-E (47.5%), MANTRA (42.5%)). Modelling, shaping, and training communication, self-monitoring, and fear arousal were the less commonly used BCTs across manuals. Manualized psychological interventions for people with anorexia nervosa share a substantial number of behaviour change techniques which might explain their similar levels of effectiveness. New strategies may be needed in order to improve outcomes.

My fitness pal usage in men: Associations with eating disorder symptoms and psychosocial impairment

My Fitness Pal (MFP) is a calorie-tracking smartphone application that is gaining popularity worldwide. Although MFP has the potential to be a cheap and efficient weight-loss tool, concerns that MFP could trigger, maintain, or exacerbate eating disorder symptoms have been raised. Preliminary research has documented associations between MFP use and eating disorder symptoms in women with eating disorders and in undergraduate students. However, whether these associations exist additionally in a male-only sample has not been tested. Thus, we aimed to estimate MFP usage and examine its association with eating disorder symptoms and psychosocial impairment in a male sample. Cross-sectional data were analysed from 122 male participants (M_age = 28.4, SD = 8.93) recruited primarily through fitness-related social media sites. Around half (56%) of the sample reported having used MFP. Nearly 40% of users perceived MFP as a factor contributing to disorder eating symptoms to some extent. MFP users reported significantly higher levels of attitudinal (dichotomous thinking, shape, weight, and eating concerns) and behavioural (binge eating, dietary restraint) eating disorder symptoms and psychosocial impairment than non-users. Effect sizes were large. MFP use also predicted unique variance in global attitudinal symptoms after controlling for eating disorder behaviours, impairment, and demographics. That nearly one-third of men perceived MFP as a factor contributing to their disordered eating highlights the possible utility of enquiring about the use of calorie-tracking apps when screening and assessing for eating disorder symptoms in men.

Anorexia Nervosa and a Lost Emotional Self: A Psychological Formulation of the Development, Maintenance, and Treatment of Anorexia Nervosa

In this paper, we argue that Anorexia Nervosa (AN) can be explained as arising from a 'lost sense of emotional self.' We begin by briefly reviewing evidence accumulated to date supporting the consensus that a complex range of genetic, biological, psychological, and socio-environmental risk and maintenance factors contribute to the development and maintenance of AN. We consider how current interventions seek to tackle these factors in psychotherapy and potential limitations. We then propose our theory that many risk and maintenance factors may be unified by an underpinning explanation of emotional processing difficulties leading to a lost sense of 'emotional self.' Further, we discuss how, once established, AN becomes 'self-perpetuating' and the 'lost sense of emotional self' relentlessly deepens. We outline these arguments in detail, drawing on empirical and neuroscientific data, before discussing the implications of this model for understanding AN and informing clinical intervention. We argue that experiential models of therapy (e.g., emotion-focused therapy; schema therapy) be employed to achieve emergence and integration of an 'emotional self' which can be flexibly and adaptively used to direct an individual's needs and relationships. Furthermore, we assert that this should be a primary goal of therapy for adults with established AN.

The Role of Sociocultural Factors in the Etiology of Eating Disorders

Most theories emphasize the role of sociocultural factors in the etiology of eating disorders (EDs). This article uses a broad search strategy to identify current etiologic studies. Women with an ED outnumber men in each diagnosis, but gender differences vary by diagnosis. Men were underrepresented in study samples, and information about variable risk factors in men is sparse. Findings suggest transdiagnostic risk factors and disorder-specific risk factors. Extracting data from population-based registers represents a major advance. Novel analytic approaches suggest complex pathways to ED. Although used in several studies, reliance on a transdiagnostic ED category (vs diagnosis-specific groupings) is premature.

Body Image in the Context of Eating Disorders

Body dissatisfaction is a risk factor for development of eating disorders and represents a core psychopathologic feature of eating disorders. Prevention and treatment interventions address established risk and maintaining factors for body dissatisfaction: appearance pressures, internalization of appearance ideals, upward appearance comparison, avoidance and checking, and body disparagement. It is essential to address body dissatisfaction within eating disorders treatment to improve outcomes and reduce risk of relapse. Future directions in research and treatment aim to reach populations increasingly recognized as in need, including children, men, and individuals at higher weights, with the ultimate goal of reducing the significant distress associated with body dissatisfaction.

The role of self-esteem in the treatment of patients with anorexia nervosa - A systematic review and meta-analysis

OBJECTIVE

We aimed to provide a comprehensive overview of the role of self-esteem in the treatment of patients with anorexia nervosa (AN). Specifically, our objectives were to investigate the differences in self-esteem between individuals with AN and healthy controls, or individuals with other eating disorders, and to examine self-esteem as an outcome, predictor, moderator, and mediator in AN treatment.

METHOD

The databases PsycINFO, PSYNDEXplus, Ovid MEDLINE®, and ProQuest were searched for studies published from 1990 to 2018. To estimate aggregated effect sizes, we performed random-effects meta-analyses.

RESULTS

A screening of 1,596 abstracts and 203 full-texts identified 68 relevant publications. Results suggest a significantly lower global self-esteem in individuals with AN than in healthy controls (d = -1.90, p < .001). In contrast, global self-esteem of AN and bulimia nervosa (BN) patients was found to be comparable (d = 0.05, p = .529). It might be specific to AN patients that negative self-evaluations may not affect scholastic and professional abilities. Significantly moderate self-esteem increases were observed in treated AN patients at the end of treatment (d = 0.56, p < .001), short-term (d = 0.50, p < .001), and long-term (d = 0.75, p < .001) follow-up. Self-esteem did not predict end of treatment remission-or weight-related outcome and treatment dropout. However, small to moderate predictive effects were detected on short-term (r = .15, p = .007) and long-term remission or weight (r = .33, p = .017). Finally, first indications point to self-esteem as a mediator in adult AN inpatient treatment.

DISCUSSION

The review provides insights relevant for theory, research, and practice. Implications concern the overall support for transdiagnostic approaches and the recommendation to consider low initial self-esteem for decisions on after-care.

Eating Disorder Symptoms and Proneness in Gay Men, Lesbian Women, and Transgender and Non-conforming Adults: Comparative Levels and a Proposed Mediational Model

In this study we sought to compare eating disorder attitudes and behaviors, and proneness to an eating disorder (“ED proneness”), between gay men, lesbian women, and transgender and gender non-conforming (TGNC) adults. A further aim was to identify and compare risk and protective factors, and examine a mediational model based on the interpersonal theory of eating disorders (IPT-ED), whereby the association between interpersonal factors and ED proneness would be mediated by psychological constructs pertaining to the self and negative affect. Data was obtained from a larger national study of health risk and protective factors among sexual minority and gender diverse populations. The sample included 97 gay men, 82 lesbian women, and 138 TGNC adults. Participants completed the National College Health Assessment, Eating Disorders Screen for Primary Care, Patient Health Questionnaire Depression scale, Generalized Anxiety Disorder 7 scale, Self-Compassion Scale-Short Form, Negative Social Exchange subscale of the Multidimensional Health Profile, Interpersonal Needs Questionnaire, and Perceived Stigma Scale. There was a significant difference between groups in ED proneness, with lesbian women (66.7%) having a significantly higher percentage than gay men (47.6%). There was also a significant difference between groups in weight-based self-worth, with the lowest percentage in gay men (63%) and the highest percentage in lesbian women (82%), as well as dissatisfaction with eating patterns, with the highest percentage in TGNC adults (69.8%) and the lowest percentage in gay men (47.7%). There was a low percentage of inappropriate compensatory behaviors, with no significant difference between groups. Logistic regression analyses showed that the predictor variables of ED proneness were depression, perceived stigma, and self-compassion in gay men; depression in lesbian women; and self-compassion in the TGNC adults. Mediation analyses showed that thwarted belongingness (i.e., an unmet to belong) and perceived stigma had an indirect association with ED proneness that was mediated by self-compassion and depression (for perceived stigma alone) in gay men, depression in lesbian women, and self-compassion in TGNC adults. The interpersonal theory of eating disorders therefore extends to sexual minority and gender diverse populations; however, the results suggest a broadening of theoretical models and intervention programs to include the role of stigma and self-compassion.

Low body esteem and dietary restraint among 7-year old children: The role of perfectionism, low self-esteem, and belief in the rewards of thinness and muscularity

Body image concerns and dietary restraint have been shown to emerge among young children (aged 5 to 8 years). However, to date, little is known regarding the way in which individual characteristics and endorsement of sociocultural appearance ideals are associated with these concerns and behaviors in this age group. The aim of the current study was to examine perceived rewards of thinness and muscularity as a mediator of the relationships between personality traits (perfectionism and self-esteem), and body esteem and dietary restraint among 7-year-old children. Participants were 261 children, Mage (SD) = 7.46 (0.32), assessed during interview on a range of scales measuring variables of interest. Findings revealed that, with the addition of direct pathways leading to dietary restraint, the model was a good fit to the data. Furthermore, multi-group analyses revealed no gender differences. These results highlight the role of children's individual personality characteristics as well as the degree to which they uphold thin and muscular appearance ideals in body image and eating concerns in 7 year olds. Additional efforts should be made to engage this age group with prevention resources and to target personality characteristics as well as beliefs in the rewards of appearance ideals.

Cyber Victimization Is Associated With Eating Disorder Psychopathology in Adolescents

Introduction: Technology is constantly evolving in a vast number of fields. In this way, cyber victimization is associated with psychopathology, and body appearance is a primary target of cyberbullies. Thus, the literature demonstrates a clear association between bullying and unhealthy eating behaviors in adolescents. However, studies that have examined the association between cyber victimization and eating disorder psychopathology are scarce. Objective: (1) To analyze whether there are differences in the cyber victimization scores depending on the gender, controlling for age; (2) to analyze whether cyber victimization is negatively associated with eating disorder psychopathology; (3) to analyze whether this association is moderated by the level of Appearance Evaluation. Method: Participants in the present study included 676 adolescents, 367 girls and 309 boys from several cities of Spain. The mean age for the overall sample was 14.28 years (SD = 1.65), ranging from 12 to 19. The participants filled out the questionnaires ECIPQ, MBSRQ, and EAT. Results: Cyber victimization was associated with eating disorders psychopathology, Appearance Evaluation, and Overweight Preoccupation. Appearance Evaluation moderated the association between Cyber victimization and the eating disorder psychopathology. Conclusion: It is necessary to assess vulnerability to eating disorders in adolescents who have been victims of cyberbullying.

Testing the relative associations of different components of dietary restraint on psychological functioning in anorexia nervosa and bulimia nervosa

Although empirical evidence identifies dietary restraint as a transdiagnostic eating disorder maintaining mechanism, the distinctiveness and significance of the different behavioural and cognitive components of dietary restraint are poorly understood. The present study examined the relative associations of the purportedly distinct dietary restraint components (intention to restrict, delayed eating, food avoidance, and diet rules) with measures of psychological distress (depression, anxiety, and stress), disability, and core eating disorder symptoms (overvaluation and binge eating) in patients with anorexia nervosa (AN) and bulimia nervosa (BN). Data were analysed from a treatment-seeking sample of individuals with AN (n = 124) and BN (n = 54). Intention to restrict, food avoidance, and diet rules were strongly related to each other (all r's > 0.78), but only weakly-moderately related to delayed eating behaviours (all r's < 0.47). In subsequent moderated ridge regression analyses, delayed eating was the only restraint component to independently predict variance in measures of psychological distress. Patient diagnosis did not moderate these associations. Overall, findings indicate that delayed eating behaviours may be a distinct component from other indices of dietary restraint (e.g., intention to restrict, food avoidance, diet rules). This study highlights the potential importance of ensuring that delayed eating behaviours are screened, assessed, and targeted early in treatment for patients with AN and BN.

Imagery rescripting and cognitive dissonance: A randomized controlled trial of two brief online interventions for women at risk of developing an eating disorder

OBJECTIVE

This pilot study compared two brief online interventions, imagery rescripting and cognitive dissonance, to an assessment-only control condition in a sample of body-dissatisfied young women at risk of developing an eating disorder. We examined the degree to which each intervention reduced disordered eating and modified risk and protective factors for eating disorders.

METHOD

Female university students (N = 107, 17-28 years of age) completed a screening questionnaire, followed by random allocation to one of the three conditions, followed by a baseline assessment, body dissatisfaction induction, and brief online intervention. Participants in the active conditions then completed online daily home practice and a postintervention questionnaire.

RESULTS

Findings provide qualified support for the imagery rescripting intervention, with participants reporting higher body image acceptance (Cohen's d = 0.49) than the cognitive dissonance condition, and higher self-compassion (d = 0.59) and lower levels of disordered eating (d = 0.59) than the control condition, at postintervention. There was no significant impact of cognitive dissonance on any factors. Change in body image acceptance and self-compassion mediated the relationship between allocated condition and change in disordered eating at postintervention.

DISCUSSION

These findings provide preliminary support for the use of online-adapted imagery-based techniques (e.g., imagery rescripting) to reduce risk for the development of an eating disorder by strengthening protective factors (i.e., body image acceptance and self-compassion) and reducing disordered eating. Further exploration of the use of imagery strategies in the prevention of disordered eating is required, including prospective tests of the mechanisms of action.

Preoccupation with shape or weight, fear of weight gain, feeling fat and treatment outcomes in patients with anorexia nervosa: A longitudinal study

OBJECTIVE

The study aimed to evaluate the trajectories of change over time in body-image concern components in patients with anorexia nervosa treated by means of intensive enhanced cognitive behavioural therapy. Moreover, it aimed to study the role of body-image concern components in changes in eating and general psychopathology as well as work and social functioning.

METHOD

Sixty-six adult patients with anorexia nervosa were recruited. Body mass index (BMI); Eating Disorder Examination 'Dietary Restraint' and 'Eating Concern' subscales; Brief Symptom Inventory (BSI); and Work and Social Adjustment Scale (WSAS) scores were recorded at admission, end of treatment, and at 6- and 12-month follow-ups. The trajectories of change of three components of body image concern, namely 'preoccupation with shape or weight', 'fear of weight gain' and 'feeling fat', were assessed.

RESULTS

The treatment was associated with a significant improvement in outcome variables and body-image concern components. Baseline 'preoccupation with shape or weight' predicted improvement in Eating Concern, BSI and WSAS scores, while the change in 'fear of weight gain' was associated with improvement in dietary restraint. Baseline and end-of-therapy scores for all three measured body-image concern components predicted achievement of BMI ≥18.5 kg/m² at 6- and 12-month follow-ups.

DISCUSSION

These findings highlight the importance of assessing and addressing body-image concern in the management of patients with anorexia nervosa.

Risk and maintenance factors for young women's DSM-5 eating disorders

Recent research with young women attending colleges, who are at the average age of eating disorder (ED) onset, established that the ED symptoms are not only prevalent but also relatively stable over the college period. Nonetheless, our knowledge regarding the course and modifiable factors associated with both the onset and maintenance of diagnosable (DSM-5) EDs in this population is limited. The objective of this report was to address these key research gaps. Data were examined from 2713 women who completed assessments of potential vulnerability factors and EDs in the autumn semester of the first (baseline) and fourth (follow-up) college years. A total of 13.1% of the sample met DSM-5 criteria for an ED diagnosis at baseline. At 4-year follow-up, 7.6% of the sample met DSM-5 criteria for an ED, with 67.5% of these cases representing women who had maintained an ED diagnosis from baseline, and 32.5% representing new onset EDs. Elevated appearance-ideal internalization, body dissatisfaction, self-objectification, dieting, and negative affectivity at baseline as well as changes in these factors between assessments all predicted onset and maintenance of DSM-5 EDs at 4-year follow-up. Self-objectification (thinking about and monitoring the body's appearance from an external observer's perspective) was the largest contributor to both ED onset and maintenance. In addition to enhancing our knowledge about the course of young women's (DSM-5) EDs during college, this work highlights potentially similar psychological foci for prevention and treatment efforts. Implications for improving existing preventive and treatment approaches are outlined.

Anorexia Nervosa, Theory and Treatment: Where Are We 35 Years on from Hilde Bruch's Foundation Lecture?

Hilde Bruch's foundation lecture in 1982 is a milestone from which to survey current theory and treatment for anorexia nervosa. Bruch described problems in body perception, emotion processing and interpersonal relationships as core theoretical aspects of the illness and built her theory of psychopathology on these aspects, as well as on animal studies on attachment. She also noted that many psychological problems result as consequence of starvation. In the first part of this paper, we parse Bruch's clinical descriptions into elements of psychopathology (disturbances in body perception, attachment, emotion expression, perception and regulation, social comparison, interpersonal, and family and therapeutic relationships), in order to assemble and update the theoretical evidence for a model of the illness. In the second part, we describe and extend her description of three core targets of treatment: family relationships, patient's inner confusion and nutritional restoration. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

A Pilot, Multicentre Pragmatic Randomised Trial to Explore the Impact of Carer Skills Training on Carer and Patient Behaviours: Testing the Cognitive Interpersonal Model in Adolescent Anorexia Nervosa

AIM

The aim of the study is to establish the acceptability, feasibility and approximate size of the effect of adding a carer intervention [Experienced Caregivers Helping Others (ECHO)] to treatment as usual (TAU) for adolescents with anorexia nervosa.

METHODS

The study is a pilot randomised trial comparing TAU (n = 50) alone or TAU plus ECHO with (n = 50) or without (n = 49) telephone guidance. Effect sizes (ESs) were regression coefficients standardised by baseline standard deviations of measure.

RESULTS

Although engagement with ECHO was poor (only 36% of carers in the ECHO group read over 50% of the book), there were markers of intervention fidelity, in that caregivers in the ECHO group showed a moderate increase in carer skills (ES = 0.4) at 12 months and a reduction in accommodating and enabling behaviour at 6 months (ES = 0.17). In terms of efficacy, in the ECHO group, carers spent less time care giving (ES = 0.40, p = 0.04) at 1 year, and patients had a minor advantage in body mass index (ES = 0.17), fewer admissions, decreased peer problems (ES = -0.36) and more pro-social behaviours (ES = 0.53). The addition of telephone guidance to ECHO produced little additional benefit.

CONCLUSIONS

The provision of self-management materials for carers to standard treatment for adolescent anorexia nervosa shows benefits for both carers and patients. This could be integrated as a form of early intervention in primary care. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Conceptualising Binge Eating: A Review of the Theoretical and Empirical Literature

Binge eating is a distressing symptom common to bulimia nervosa (BN), anorexia nervosa binge/purge subtype (AN-BP) and binge-eating disorder (BED). Over the last 40 years, many attempts have been made to conceptualise this symptom in terms of its antecedents, function, triggers, consequences, and maintaining factors. Cognitive theories of binge eating have evolved as new evidence has emerged. This literature review summarises the main and most influential cognitive models of binge eating across different eating disorder presentations. Many theories have examined binge eating in the context of restriction or compensatory behaviours, as is often observed in cases of BN. Few theories have examined binge eating as it occurs in BED specifically. The long-term efficacy of cognitive behavioural therapy (CBT) treatment based on these models leaves much to be desired, and indicates that there may be maintaining factors of binge eating not addressed in the typical CBT treatment for eating disorders. More recent cognitive models of binge eating propose possible maintaining beliefs, but further study is required to validate these models. Suggestions for future research are presented.