Non-suicidal self-injury and bulimia: the role of emotion dysregulation and body dissatisfaction

PURPOSE

Risk factors of negative affect, body dissatisfaction, distress tolerance, and negative urgency are independently associated with bulimia symptoms and non-suicidal self-injury (NSSI). However, relationships of these risk factors within comorbid presentations are not fully understood. The current study examined specific roles of these risk factors within this relationship.

METHODS

An at-risk community sample of young adults (N = 429) completed an online survey of negative affect, body dissatisfaction, distress tolerance, negative urgency, bulimia symptoms, and NSSI.

RESULTS

A hypothesized path model was a good fit to the data. Results indicated direct paths from body dissatisfaction, negative urgency, and distress tolerance to bulimia symptoms. Negative urgency, distress tolerance, and bulimia symptoms were directly associated with NSSI. Consistent with hypotheses, distress tolerance and negative urgency acted as vulnerability factors, increasing the strength of associations between bulimia symptoms and NSSI. Distress tolerance also strengthened associations between negative urgency and NSSI. In addition to the direct effect, negative urgency was indirectly associated with NSSI via body dissatisfaction bulimia. Hypothesized indirect effects through distress tolerance were not supported.

CONCLUSIONS

Results support etiological models of bulimia and NSSI, and suggest deficits in emotion regulation strengthen risk of comorbid presentations. Furthermore, individuals with greater impulsivity and difficulty tolerating distress are at increased risk of engaging in both bulimia behaviors and NSSI, providing targets for clinical intervention.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

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.

Association between prenatal maternal infection and disordered eating behaviours in adolescence: a UK population-based prospective birth cohort study

BACKGROUND

Prenatal infections have been proposed as a putative risk factor for a number of psychiatric outcomes across a continuum of severity. Evidence on eating disorders is scarce. We investigated whether exposure to prenatal maternal infections is associated with an increased risk of disordered eating and weight and shape concerns in adolescence in a large UK birth cohort.

METHODS

We used data from the Avon Longitudinal Study of Parents and Children. The primary exposure was maternal experience of infections at any time in pregnancy. Study outcomes were presence of any, monthly or weekly disordered eating at 14 and 16 years of age, and weight and shape concerns at 14 years. We defined the causal effect of the exposure on these outcomes using a counterfactual framework adjusting our analyses for a number of hypothesised confounders, and imputing missing confounder data using multiple imputation.

RESULTS

In total, 4884 children had complete exposure and outcome data at age 14 years, and 4124 at 16 years. Exposed children had a greater risk of reporting weekly disordered eating at both age 14 [risk difference (RD) 0.9%, 95% confidence interval (CI) -0.01 to 1.9, p = 0.08] and 16 (RD 2.3%, 95% CI 0.6-3.9, p < 0.01), though evidence of an association was weak at age 14 years. Exposed children also had greater weight and shape concerns at age 14 years (mean difference 0.15, 95% CI 0.05-0.26, p < 0.01).

CONCLUSIONS

Exposure to prenatal maternal infection is associated with greater risk of disordered eating in adolescence. This association could be explained by in utero processes leading to impaired neurodevelopment or altered immunological profiles. Residual confounding cannot be excluded.

Prevalence and correlates of eating disorders in greek-cypriot adolescents and young adults

The present study aimed to explore the prevalence rates of eating disorders among Greek-Cypriot adolescents and young adults and examine the role of the following variables in relation to eating disorder risk: gender, age, dieting, exercise and present-ideal weight discrepancy. One thousand and eighty-one middle, high school and university students responded to self-reported measures assessing eating disorders, weight-related concerns and behaviors. Prevalence estimates were 26% for high eating disorder risk and 14.98% for subthreshold eating disorders symptoms while 12% of participants met criteria of an eating disorder diagnosis. Multivariate logistic regression confirmed well-established predictors for eating disorder risk including present to ideal weight discrepancy which had a differential effect on risk in adolescents (i.e., 6-10 kg) and young adults (11+kg). This is the first study to provide prevalence rates of the entire eating pathology spectrum among Greek-Cypriot youth. Results are discussed in terms of their implications in the development of age-specific screening tools and prevention programs.

Establishment of a multifamily therapy (MFT) service for young adults with a severe eating disorder - experience from 11 MFT groups, and from designing and implementing the model

BACKGROUND

Eating disorders are serious illnesses leading to a substantially lowered quality of life not only for the patient but also for their family. They are difficult to treat, and many patients fail to complete their treatment. At the Regional Centre for Eating Disorders (RESSP) at Nordland Hospital in Bodø, in the north of Norway, it was apparent that many young adult patients maintained an active, ongoing relationship with their family of origin, and that parents and others were often highly involved in their life and illness. It was therefore desirable to develop a treatment model involving family members; specifically a multifamily therapy (MFT) group programme.

METHODS

The aim was to establish an MFT service at RESSP for young adult patients suffering from severe eating disorders. This involved, (1) work preparatory to the establishment of the new service, (2) the development and implementation of a suitable MFT model, and (3) sharing the skills and knowledge gained from our experiences to other professionals in the field, and in other settings. This work of development and change can be understood as a process of innovation and is here described within the framework of implementation theory. The work took place in a clinically naturalistic context at the centre.

RESULTS

The MFT model description is based on experience during its development as well as its final form. The stages of this development process and of the changes made in order to establish the new service are described, together with its core components. To date, 68 patients and 198 family members have participated. Dropout rate has been 7.4% and the majority of patients have continued in treatment after completion of the MFT groups. BMI measurements show a significant weight-gain for those with an underweight at start. 32 other professionals have been trained in the model, and a similar service started in 3 other units.

CONCLUSION

The new model has been welcomed by patients and families alike. The MFT group programme has had a strikingly low dropout rate and a majority of patients have continued in treatment. BMI measurements show a significant weight-gain for those being underweight at start. Other therapists have been trained in the model, and similar services set up elsewhere. In order to document and increase the usefulness of the MFT treatment, a research project has been initiated to evaluate experience and outcomes both quantitatively and qualitatively.

Intolerance of uncertainty moderates the relationship between high personal standards but not evaluative concerns perfectionism and eating disorder symptoms cross-sectionally and prospectively

Two dimensions of perfectionism related to eating disorder (ED) symptoms are evaluative concerns and high standards. Evaluative concerns are consistently linked with ED symptoms, whereas there are conflicting results regarding high standards and ED symptoms. High standards are unrelated to ED symptoms in some studies and are linked to higher ED symptoms in others. Intolerance of uncertainty (IU) may influence the relation between high standards and ED symptoms; individuals elevated in both IU and high standards may find it distressing to be uncertain about future situations for fear of not living up to high expectations and use ED behaviors to cope with such uncertainty. In the current study (N = 216), we explored whether IU moderates the relationships between high standards and evaluative concerns and ED symptoms, both cross-sectionally and prospectively across two weeks. IU significantly moderated high standards and ED symptoms both cross-sectionally and across time while accounting for baseline ED symptoms, but did not moderate the relationship between evaluative concerns and ED symptoms. Higher standards were associated with greater ED symptoms in individuals higher, but not lower in IU. These findings suggest high standards may only contribute to ED symptoms when individuals are also high in IU.

Negative affect amplifies the relation between appetitive-food-related neural responses and weight gain over three-year follow-up among adolescents

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Interaction of negative affect and hippocampal food-image response predicts BMI gain.

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Interaction of negative affect, vermis and precuneus food response predicts BMI gain.

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Interaction of stress and middle occipital gyrus milkshake response predicts BMI gain.

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Weight gain associated with restrained eating and eating-disorder related behavior.

Obesity is a major public health concern that is associated with disruption in food reward-related brain function. This study examined if negative affect and stressful events enhance the relation between the food reward-related neural response and future weight gain. Initially healthy weight adolescents (N = 135) completed fMRI paradigms in which they tasted milkshakes and viewed palatable food images, and reported on negative affect and stressful events at baseline; BMI was measured annually over 3-year follow-up. Whole-brain analyses revealed that among participants with higher negative affect, weight gain over 3-year follow-up was predicted by elevated response to appetitive versus unappetitive food images in the left hippocampus, and elevated response in the vermis and the bilateral precuneus to tastes of milkshake versus tasteless solution. Among participants who experienced more stressful events, elevated right middle occipital gyrus response to milkshakes predicted future weight gain. Profiling analyses suggested that participants with higher negative affect or more stressful events who later gained weight reported engaging in more restrained eating and eating disorder-related behaviors. Results suggest that negative affect or stressful events may amplify the relation of neural response to food and the risk for future weight gain.

Sociocultural Attitudes towards Appearance, Self-Esteem and Symptoms of Body-Dysmorphic Disorders among Young Adults

Background: Beauty and an attractive body shape are particularly important during early adulthood, as both are related to greater mating success, positive social feedback, and higher self-esteem. The media may further influence common features of beauty. We tested whether higher body-dysmorphic disorder (BDD) scores were associated with sociocultural attitudes towards appearance. Additionally, we expected that a link between higher BDD scores and higher perceived media pressure would be mediated by lower self-esteem (SE). Method: 350 young Iranian adults (mean age: 24.17 years; 76.9% females) took part in the study. Participants completed questionnaires covering sociodemographic data, sociocultural attitudes towards appearances, and SE, while experts rated participants for symptoms of body dysmorphic disorders. Results: Higher BDD scores were associated with higher scores for sociocultural attitudes towards appearance, while SE was not associated with BDD or sociocultural attitudes towards appearance. Higher scores for sociocultural attitudes towards appearance and media pressure predicted higher BDD scores, while SE had no influence. Conclusion: Among young Iranian adults, sociocultural attitudes towards appearances and BDD scores, as rated by experts’, were related, while SE was not. The shared variance between symptoms of BDD and sociocultural attitudes towards appearance was low, suggesting that other factors such as mating and career concerns together with social feedback might be more important in explaining symptoms of body dysmorphic disorders.

Associations between eating expectancies and Eating disorder symptoms in men and women

Eating expectancies, or learned expectations that an individual has about eating, prospectively predict eating disorder (ED) symptoms. Most studies examining eating expectancies have focused on one or two eating expectancies and their relation with bulimic symptoms. In addition, these studies have been conducted mostly in women. Thus, it is unclear whether: 1) associations between eating expectancies and ED symptoms vary between men and women, and 2) extend to ED symptoms other than bulimic symptoms. The current study (N = 197 undergraduate men and 246 undergraduate women) investigated sex variance in a model of eating expectancies and ED symptoms, including factors associated with ED symptoms (i.e., negative urgency, negative affect, alcohol use, drug use, and body mass index). Sex variance was tested using path analysis in a model including eating expectancies and associated factors, with excessive exercise, negative attitudes toward obesity, restricting, cognitive restraint, binge eating, purging, muscle building, and body dissatisfaction as dependent variables. Unconstrained (i.e., unconstrained paths across men and women) and constrained (i.e., constraining paths across men and women) models were tested. The unconstrained and constrained models differed significantly, indicating that the models varied by sex. For both sexes, eating expectancies were uniquely associated with ED symptoms. For men, Eating Manages Negative Affect was significantly associated with the most ED symptoms. In contrast, for women, Eating Leads to Feeling Out of Control was associated with the most ED symptoms. Previous findings regarding eating expectancies and ED symptoms in women may not generalize to men. Intervening on eating expectancies in a sex-specific way may help reduce specific ED symptoms.

Is bullying and teasing associated with eating disorders? A systematic review and meta-analysis

OBJECTIVE

Involvement in bullying and teasing has been associated with adverse health outcomes, including eating disorders (EDs). The purpose of this systematic review and meta-analysis was to examine the association between bullying/teasing and EDs.

METHOD

A systematic search was conducted. We included research articles that examined the association between bullying/teasing (victimization and perpetration) and EDs. Studies were required to compare ED cases with a reference group. We performed a qualitative synthesis of included studies. Additionally, a random-effects meta-analysis of odds ratios were performed to compare rates of bullying/teasing victimization between cases and healthy controls.

RESULTS

A total of 22 studies were included for review. Compared to healthy controls, those with EDs were significantly more likely to have been bullied and teased. Evidence of this association was particularly strong for bulimia nervosa and binge-eating disorder, but was more mixed for anorexia nervosa. It was unclear whether such victimization was more common in EDs compared to psychiatric controls. The meta-analysis showed that compared to healthy controls, those with EDs were twofold to threefold significantly more likely to have been teased about their appearance and bullied prior to onset of their ED. Few studies examined bullying perpetration. A number of methodological shortcomings of studies were noted.

DISCUSSION

Being victimized through bullying and teasing is associated with EDs, and may constitute a risk factor. Our review underscores the need for more studies, and highlights gaps in the literature. As many patients have been victims of bullying and teasing, addressing such experiences in treatment may be valuable.

Personality, emotion-related variables, and media pressure predict eating disorders via disordered eating in Lebanese university students

PURPOSE

Disordered eating behaviors are on the rise among youth. The present study investigates psychosocial and weight-related variables as predictors of eating disorders (ED) through disordered eating (DE) dimensions (namely restrained, external, and emotional eating) in Lebanese university students.

METHODS

The sample consisted of 244 undergraduates (143 female) aged from 18 to 31 years (M = 20.06; SD = 1.67). Using path analysis, two statistical models were built separately with restrained and emotional eating as dependent variables, and all possible direct and indirect pathways were tested for mediating effects. The variables tested for were media influence, perfectionism, trait emotional intelligence, and the Big Five dimensions.

RESULTS

In the first model, media pressure, self-control, and extraversion predicted eating disorders via emotional eating. In the second model, media pressure and perfectionism predicted eating disorders via restrained eating.

DISCUSSION

Findings from this study provide an understanding of the dynamics between DE, ED, and key personality, emotion-related, and social factors in youth. Lastly, implications and recommendations for future studies are advanced.

The relationship between risk of eating disorders, age, gender and body mass index in medical students: a meta-regression

PURPOSE

Age, gender and body mass index (BMI) are commonly described risk factors for the development of eating disorders. However, the magnitude of these factors (individually and together) is still not well-defined in some populations.

METHODS

A systematic search was performed for studies that reported the prevalence of eating disorder risk among medical students using the Eating Attitudes Test-26 (EAT-26) and age, gender and BMI as risk factors. We included studies published in English peer-reviewed journals between 1982 and 2017. A total of 14 studies were included in the analyses, and the meta-regression analyses were performed using mean age (years), gender (proportion of female subjects), and mean BMI (kg/m²) as moderators with the risk of eating disorders measured using EAT-26 as an outcome variable. Four interaction terms were created (1) age × gender (2) age × BMI (3) gender × BMI and (4) age × gender × BMI to assess if two or more independent variables simultaneously influence the outcome variable.

RESULTS

Utilizing the EAT-26, the pooled prevalence of at risk for eating disorders among medical students (k = 14, N = 3520) was 10.5% (95% CI 7.3-13.7%). Meta-regression model of age, gender and BMI alone revealed poor predictive capabilities. Meta-regression model of age × gender × BMI interaction revealed statistically significant results with a covariate coefficient of 0.001 and p value of 0.044.

CONCLUSION

Results from this sample of medical students provided evidence for the role of interactions between risk factors (e.g., age × gender × BMI) in predicting individuals at risk for eating disorders, whereas these variables individually failed to predict eating disorders.

LEVEL OF EVIDENCE

Level I, systematic review and meta-analysis.

Why is premorbid BMI consistently elevated in clinical samples, but not in risk factor samples, of individuals with eating disorders?

Body image disturbance is widely viewed as contributing to the development and maintenance of disordered eating. Yet this perspective is not inconsistent with the possibility that elevated premorbid BMIs also increase the risk of developing eating disorders. Research examining whether actual body size may play a role in eating disorder development reveals a curious pattern of findings. Few prospective risk factor studies conducted with community-based samples found a relationship between premorbid BMI and subsequent eating disorder pathology whereas retrospective research conducted with clinical samples indicates a consistent pattern of elevated premorbid BMIs relative to population norms or control groups. This study documents these disparate findings, considers potential explanations for them and proposes further study of premorbid BMI as a factor contributing to the psychopathology of eating disorders, particularly among those who come to the attention of treatment providers.

Developmental Premorbid Body Mass Index Trajectories of Adolescents With Eating Disorders in a Longitudinal Population Cohort

OBJECTIVE

To examine whether childhood body mass index (BMI) trajectories are prospectively associated with later eating disorder (ED) diagnoses.

METHOD

Using a subsample from the Avon Longitudinal Study of Parents and Children (N = 1,502), random-coefficient growth models were used to compare premorbid BMI trajectories of individuals who later developed anorexia nervosa (n = 243), bulimia nervosa (n = 69), binge-eating disorder (n = 114), and purging disorder (n = 133) and a control group without EDs or ED symptoms (n = 966). BMI was tracked longitudinally from birth to 12.5 years of age and EDs were assessed at 14, 16, and 18 years of age.

RESULTS

Distinct developmental trajectories emerged for EDs at a young age. The average growth trajectory for individuals with later anorexia nervosa veered significantly below that of the control group before 4 years of age for girls and 2 years for boys. BMI trajectories were higher than the control trajectory for all other ED groups. Specifically, the mean bulimia nervosa trajectory veered significantly above that of controls at 2 years for girls, but boys with later bulimia nervosa did not exhibit higher BMIs. The mean binge-eating disorder and purging disorder trajectories significantly diverged from the control trajectory at no older than 6 years for girls and boys.

CONCLUSION

Premorbid metabolic factors and weight could be relevant to the etiology of ED. In anorexia nervosa, premorbid low weight could represent a key biological risk factor or early manifestation of an emerging disease process. Observing children whose BMI trajectories persistently and significantly deviate from age norms for signs and symptoms of ED could assist the identification of high-risk individuals.

A network approach to eating disorder symptomatology: Do desire for thinness and fear of gaining weight play unique roles in the network?

This study used network analyses to test the hypotheses that desire for thinness and fear of gaining weight are related but distinct constructs that play a central role in disordered eating. Data from a sample of 251 college women were used. Sparse undirected eating disorder symptom networks were calculated. Bootstrapped difference tests for edge weights and centrality indices were used to compare the position of desire for thinness and fear of gaining weight. Desire for thinness and fear of gaining weight exhibited unique patterns of associations within the network. Desire for thinness was highly connected to body dissatisfaction, thoughts about dieting, and thoughts about binge eating. Fear of gaining weight was not. Desire for thinness emerged as the most central symptom. Our findings support the distinction between fear of gaining weight and desire for thinness and their different roles within the eating disorder symptom network.

An examination of risk factors that moderate the body dissatisfaction-eating pathology relationship among New Zealand adolescent girls

BACKGROUND

Eating disorders (EDs) and their subclinical variants are important health concerns for adolescent girls, and body dissatisfaction is a more common yet often debilitating experience that typically precedes the development of an ED. Despite this fact, little is known about what makes girls who are dissatisfied with their bodies more likely to engage in pathological eating behaviors. The present study explored eating pathology among a sample of adolescent girls from New Zealand and examined a variety of established risk factors that may moderate the relationship between body dissatisfaction (BD) and eating pathology.

METHODS

Adolescent girls aged between 14 and 18 (N = 231) completed questionnaires assessing eating pathology, BD, negative affect, perfectionism, self-esteem, teasing and sociocultural pressure. Regression analyses tested for moderator effects to examine which variables moderated the relationship between BD and eating pathology.

RESULTS

The analyses indicated that high levels of socially prescribed and self-oriented perfectionism, negative affect, perceived pressure from the media, and low levels of self-esteem all strengthened the relationship between BD and eating pathology.

CONCLUSIONS

The results highlight potential factors that may make adolescent girls who are dissatisfied with their bodies more susceptible to eating pathology.

Epidemiology of binge eating disorder

PURPOSE OF REVIEW

In 2013, binge eating disorder (BED) was officially recognized as a distinct eating disorder in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders. The purpose of this review is to assess the available epidemiological data to determine whether BED should be considered for inclusion in global disease burden quantification efforts, such as the Global Burden of Disease Study (GBD).

RECENT FINDINGS

A systematic search of three electronic databases (PubMed, EMBASE, and PsycINFO) found 32 studes meeting GBD inclusion criteria. The global pooled prevalence of BED was 0.9% (95% confidence intervals: 0.7-1.0%). Although women (1.4%, 1.1-1.7%) had higher prevalence than men (0.4%, 0.3-0.6%), no significant difference in prevalence was found between high-income countries (0.9%, 0.8-1.1%) and low- and middle-income countries (0.7%, 0.3-1.1%).

SUMMARY

The current article presents the findings of a recent systematic review of the epidemiology of BED and discusses the case for including BED as a new cause in future iterations of GBD.

Longitudinal and personalized networks of eating disorder cognitions and behaviors: Targets for precision intervention a proof of concept study

INTRODUCTION

Despite the high mortality and significant societal and personal costs associated with eating disorders (EDs) there are few evidence-based treatments. Part of the difficulty developing and implementing evidence-based treatments in EDs is due to the extremely high heterogeneity (e.g., variability in treatment outcome, symptom presentation etc) present.

METHODS

To begin to identify specific symptom heterogeneity within persons, the current study used novel within and between group and intra-individual network analyses to create longitudinal and within-person networks of ED cognitions and behaviors (N = 66 individuals diagnosed with an ED). This article provides a proof of concept study for how to use between and within-person network analyses both for the EDs and other forms of psychopathology.

RESULTS

We found that cognitions focused on desiring thinness played a likely maintaining role in ED pathology, across network type and across time. Furthermore, we showed that three individuals with the same diagnosis (anorexia nervosa) differed in which symptoms maintained the disorder. We use these participants to exemplify how to use intra-individual network analysis to personalize treatment focused on the primary maintaining symptoms. Finally, we found that amount of time (e.g., 4 hr vs. simultaneously) impacts how symptoms maintain each other.

CONCLUSIONS

These findings have implications for the development of novel personalized evidence-based treatments for EDs, as well as implications for how the field understands how psychopathology maintains itself. These data represent a first-step towards using intra-individual network analyses in the ED field, as well as for hypotheses generation in future research.

Self-esteem and peer-perceived social status in early adolescence and prediction of eating pathology in young adulthood

OBJECTIVE

Self-esteem is implied as a factor in the development of eating disorders. In adolescence peers have an increasing influence. Support for the role of self-esteem in eating disorders is ambiguous and little is known about the influence of social status as judged by others. The present study investigates whether self-esteem and peer status in early adolescence are associated with eating pathology in young adulthood.

METHOD

This study is part of TRAILS, a longitudinal cohort study on mental health and social development from preadolescence into adulthood. At age 11, participants completed the Self-Perception Profile for Children, assessing global self-esteem and self-perceptions regarding social acceptance, physical appearance, and academic competence. At age 13, peer status among classmates was assessed regarding likeability, physical attractiveness, academic performance, and popularity in a subsample of 1,007 participants. The Eating Disorder Diagnostic Scale was administered at age 22. The present study included peer-nominated participants with completed measures of self-perception at age 11 and eating pathology at age 22 (N = 732; 57.8% female).

RESULTS

In a combined model, self-perceived physical attractiveness at age 11 and peer popularity at age 13 were inversely correlated with eating pathology at 22 years, while likeability by peers at age 13 was positively related to eating pathology.

DISCUSSION

Both self-perceptions and peer status in early adolescence are significant predictors of eating pathology in young adults. Specific measures of self-esteem and peer-perceived status may be more relevant to the prediction of eating pathology than a global measure of self-esteem.

Mindfulness as a Moderator of the Association Between Eating Disorder Cognition and Eating Disorder Behavior Among a Non-clinical Sample of Female College Students: A Role of Ethnicity

The present cross-sectional study examined whether mindfulness moderated the association between eating disorder cognition and eating disorder behaviors among Asian American, Black American, and White American female college students in the United States. Participants (N = 463, age range = 18–25 years) completed self-report measures online. Results revealed that mindfulness moderated the association between eating disorder cognition and eating disorder behavior in the White American group, but not in Asian American or Black American samples. Future research should replicate these differential findings across ethnic groups and investigate the factors that may contribute to this group difference.

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.

Psychometric properties of the Purpose-In-Life Test and age-related differences among women diagnosed with eating disorders

The aim of this study was to analyze the psychometric properties of the Purpose-In-Life Test (PIL), as well as the age-related differences in meaning in life in women diagnosed with eating disorders. Participants were 250 Spanish women diagnosed with eating disorders who ranged from 12 to 60 years old. Confirmatory Factor Analysis, descriptive analyses, estimation of the internal consistency of the PIL, correlations between the PIL and the Beck Hopelessness Scale (BHS), Overweight Preoccupation Scale (OPS), and Body Investment Scale (BIS), and age differences were calculated. A 19-item model that showed a good fit and internal consistency, a negative correlation between the PIL and both the BHS and OPS, and a positive correlation with the BIS, as well as significant differences between the adolescents and the mature adults, were found. It would be advisable to increase the inclusion of meaning in life in psychotherapeutic interventions with women diagnosed with eating disorders.

Altered Processing and Integration of Multisensory Bodily Representations and Signals in Eating Disorders: A Possible Path Toward the Understanding of Their Underlying Causes

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM V) eating problems are the clinical core of eating disorders (EDs). However, the importance of shape and weight overvaluation symptoms in these disorders underlines the critical role of the experience of the body in the etiology of EDs. This article suggests that the transdiagnostic centrality of these symptoms in individuals with EDs may reflect a deficit in the processing and integration of multisensory bodily representations and signals. Multisensory body integration is a critical cognitive and perceptual process, allowing the individual to protect and extend her/his boundaries at both the homeostatic and psychological levels. To achieve this goal the brain integrates sensory data arriving from real-time multiple sensory modalities and internal bodily information with predictions made using the stored information about the body from conceptual, perceptual, and episodic memory. In this view the emotional, visual, tactile, proprioceptive and interoceptive deficits reported by many authors in individuals with EDs may reflect a broader impairment in multisensory body integration that affects the individual's abilities: (a) to identify the relevant interoceptive signals that predict potential pleasant (or aversive) consequences; and (b) to modify/correct the autobiographical allocentric (observer view) memories of body related events (self-objectified memories). Based on this view, the article also proposes a strategy, based on new technologies (i.e., virtual reality and brain/body stimulation), for using crossmodal associations to reactivate and correct the multisensory body integration processes.

Eating disorder-specific risk factors moderate the relationship between negative urgency and binge eating: A behavioral genetic investigation

Theoretical models of binge eating and eating disorders include both transdiagnostic and eating disorder-specific risk factors. Negative urgency (i.e., the tendency to act impulsively when distressed) is a critical transdiagnostic risk factor for binge eating, but limited research has examined interactions between negative urgency and disorder-specific variables. Investigating these interactions can help identify the circumstances under which negative urgency is most strongly associated with binge eating. We examined whether prominent risk factors (i.e., appearance pressures, thin-ideal internalization, body dissatisfaction, dietary restraint) specified in well-established etiologic models of eating disorders moderate negative urgency-binge eating associations. Further, we investigated whether phenotypic moderation effects were due to genetic and/or environmental associations between negative urgency and binge eating. Participants were 988 female twins aged 11-25 years from the Michigan State University Twin Registry. Appearance pressures, thin-ideal internalization, and body dissatisfaction, but not dietary restraint, significantly moderated negative urgency-binge eating associations, with high levels of these risk factors and high negative urgency associated with the greatest binge eating. Twin moderation models revealed that genetic, but not environmental, sharing between negative urgency and binge eating was enhanced at higher levels of these eating disorder-specific variables. Future longitudinal research should investigate whether eating disorder risk factors shape genetic influences on negative urgency into manifesting as binge eating. (PsycINFO Database Record

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.

Understanding eating disorders within internalizing psychopathology: A novel transdiagnostic, hierarchical-dimensional model

BACKGROUND

Several problems with the classification and diagnosis of eating disorders (EDs) have been identified, including proliferation of 'other specified' diagnoses, within-disorder heterogeneity, and frequent diagnostic migration over time. Beyond problems within EDs, past research suggested that EDs fit better in a spectrum of internalizing psychopathology (characterized by mood and anxiety disorders) than in a separate diagnostic class.

PURPOSE

To develop a transdiagnostic, hierarchical-dimensional model relevant to ED psychopathology that: 1) reduces diagnostic heterogeneity, 2) includes important dimensions of internalizing psychopathology that are often excluded from ED diagnostic models, and 3) predicts clinical impairment.

PROCEDURES

Goldberg's (2006) method and exploratory structural equation modeling were used to identify a hierarchical model of internalizing in community-recruited adults with EDs (N=207).

FINDINGS

The lowest level of the hierarchy was characterized by 15 factors that defined specific aspects of eating, mood, and anxiety disorders. At the two-factor level, Internalizing bifurcated into Distress (low well-being, body dissatisfaction, suicidality, dysphoria, ill temper, traumatic intrusions) and Fear-Avoidance (claustrophobia, social avoidance, panic symptoms, dietary restricting, excessive exercise, and compulsions). Results showed that the lowest level of the hierarchy predicted 67.7% of the variance in clinical impairment. In contrast, DSM eating, mood, and anxiety disorders combined predicted 10.6% of the variance in impairment secondary to an ED.

CONCLUSIONS

The current classification model represents an improvement over traditional nosologies for predicting clinically relevant outcomes for EDs.

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.

Virtual Reality as a Promising Strategy in the Assessment and Treatment of Bulimia Nervosa and Binge Eating Disorder: A Systematic Review

Several lines of evidence suggest that Virtual Reality (VR) has a potential utility in eating disorders. The objective of this study is to review the literature on the use of VR in bulimia nervosa (BN) and binge eating disorder (BED). Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement for reporting systematic reviews, we performed a PubMed, Web of Knowledge and SCOPUS search to identify studies employing VR in the assessment and treatment of BN and BED. The following search terms were used: "virtual reality", "eating disorders", "binge eating", and "bulimia nervosa". From the 420 articles identified, 19 were selected, nine investigated VR in assessment and 10 were treatment studies (one case-report, two non-controlled and six randomized controlled trials). The studies using VR in BN and BED are at an early stage. However, considering the available evidence, the use of VR in the assessment of those conditions showed some promise in identifying: (1) how those patients experienced their body image; and (2) environments or specific kinds of foods that may trigger binge-purging cycle. Some studies using VR-based environments associated to cognitive behavioral techniques showed their potential utility in improving motivation for change, self-esteem, body image disturbances and in reducing binge eating and purging behavior.

Premorbid BMI predicts binge-purge symptomatology among individuals with anorexia nervosa

OBJECTIVE

A finding consistent with the transdiagnostic approach to eating disorders is that about half of those with restricting anorexia nervosa (AN) eventually undergo a transition to the binge/purge (BP) subtype or to bulimia nervosa. Given evidence that individuals with bulimic symptoms exhibit elevated weights premorbidly, we tested the hypothesis that among those with AN, highest premorbid BMI would predict which individuals with AN would develop AN-BP.

METHOD

The current study used longitudinal data from a community sample of adolescents with AN in Sweden. Premorbid weights were obtained from growth charts, and participants were re-assessed at 6, 10, and 18 years after first presentation with AN.

RESULTS

A greater highest premorbid BMI z score predicted a greater likelihood of developing binge/purge symptoms over 18 years.

DISCUSSION

Among individuals who develop an eating disorder, premorbid BMI may be implicated in the type and course of the eating disorder that emerges.

Are the Gut Bacteria Telling Us to Eat or Not to Eat? Reviewing the Role of Gut Microbiota in the Etiology, Disease Progression and Treatment of Eating Disorders

Traditionally recognized as mental illnesses, eating disorders are increasingly appreciated to be biologically-driven. There is a growing body of literature that implicates a role of the gut microbiota in the etiology and progression of these conditions. Gut bacteria may act on the gut–brain axis to alter appetite control and brain function as part of the genesis of eating disorders. As the illnesses progress, extreme feeding patterns and psychological stress potentially feed back to the gut ecosystem that can further compromise physiological, cognitive, and social functioning. Given the established causality between dysbiosis and metabolic diseases, an altered gut microbial profile is likely to play a role in the co-morbidities of eating disorders with altered immune function, short-chain fatty acid production, and the gut barrier being the key mechanistic links. Understanding the role of the gut ecosystem in the pathophysiology of eating disorders will provide critical insights into improving current treatments and developing novel microbiome-based interventions that will benefit patients with eating disorders.

Prevention of eating disorders: A systematic review and meta-analysis

OBJECTIVE

To systematically review and quantify the effectiveness of Eating Disorder (ED) prevention interventions.

METHODS

Electronic databases (including the Cochrane Controlled Trial Register, MEDLINE, PsychInfo, EMBASE, and Scopus) were searched for published randomized controlled trials of ED prevention interventions from 2009 to 2015. Trials prior to 2009 were retrieved from prior reviews.

RESULTS

One hundred and twelve articles were included. Fifty-eight percent of trials had high risk of bias. Findings indicated small to moderate effect sizes on reduction of ED risk factors or symptoms which occurred up to three-year post-intervention. For universal prevention, media literacy (ML) interventions significantly reduced shape and weight concerns for both females (-0.69, confidence interval (CI): -1.17 to -0.22) and males (-0.32, 95% CI -0.57 to -0.07). For selective prevention, cognitive dissonance (CD) interventions were superior to control interventions in reducing ED symptoms (-0.32, 95% CI -0.52 to -0.13). Cognitive behavioural therapy (CBT) interventions had the largest effect size (-0.40, 95% CI -0.55 to -0.26) on dieting outcome at 9-month follow-up while the healthy weight intervention reduced ED risk factors and body mass index. No indicated prevention interventions were found to be effective in reducing ED risk factors.

CONCLUSIONS

There are a number of promising preventive interventions for ED risk factors including CD, CBT and ML. Whether these actually lower ED incidence is, however, uncertain. Combined ED and obesity prevention interventions require further research.

Testing for interactive and non-linear effects of risk factors for binge eating and purging eating disorders

Almost no research has tested whether risk factors interact in the prediction of future eating disorder onset, which might suggest qualitatively distinct etiologic pathways. Accordingly, this prospective study tested for possible interactions between risk factors in the prediction of binge eating and purging eating disorders in adolescents. It also examined sex differences in pathways to risk. Two analytical approaches were used: (1) classification tree analysis (CTA), which is ideally suited to identifying non-linear interactions and the optimal cut-points for defining risk, with follow-up random forest analyses; and (2) two-way interaction terms in a series of logistic regression models. Data were drawn from the Western Australian Pregnancy Cohort (Raine) Study, a population-based study that followed participants from pre-birth to young adulthood. This study involved 1297 adolescents (49% male), 146 (11%) of whom developed bulimia nervosa, binge eating disorder or purging disorder in late adolescence. In CTA, sex was the first and most potent predictor of eating disorder risk with females showing a 5-fold increase in risk relative to males. For males and females, weight and eating concerns were the next most potent predictor of risk and three risk groups emerged, reflecting non-linear risk. For females with intermediate weight and eating concerns, externalizing problems emerged as an additional predictor. Interaction terms in logistic regression models did not produce significant results after correcting for multiple testing. Findings advance knowledge on risk pathways to eating disorder onset, highlight non-linear risk processes, and provide cut-points for prospectively identifying high-risk youth for prevention programs.