151
|
Trompeter N, Bussey K, Forbes MK, Mond J, Hay P, Cunningham ML, Mitchison D. Emotion dysregulation across the span of eating disorder symptoms: Findings from a community sample of adolescents. Int J Eat Disord 2021; 54:1946-1955. [PMID: 34558725 DOI: 10.1002/eat.23609] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Emotion dysregulation is proposed as a key factor within eating disorder pathology. However, less is known about specific emotion regulation difficulties experienced by adolescents with varying levels of eating disorders symptoms. The present study examined the relationship between eating disorder behaviors and specific facets of emotion dysregulation, and differences in emotion dysregulation between eating disorder diagnostic groups. METHOD Participants were 2,783 adolescents, 11-19 years (M = 14 years, 9 months, SD = 1 year, 6 months), who completed self-report measures as part of the EveryBODY study. Adolescents were identified as not having eating disorder symptoms (n = 2,122) or meeting diagnostic criteria for symptoms of specific eating disorder, including: anorexia nervosa or atypical anorexia nervosa (n = 57), bulimia nervosa (n = 136), binge-eating disorder (n = 57), other specified feeding or eating disorder characterized by binge eating or purging (n = 381), and unspecified feeding or eating disorder (n = 30). RESULTS Binge eating, driven exercise, and fasting were each uniquely associated with emotion dysregulation, whereas purging was not. Similar findings were obtained within specific domains of emotion dysregulation. Findings from diagnostic groups showed a significant main effect of diagnosis on overall emotion dysregulation and most domains of emotion dysregulation. Adolescents with eating disorder symptoms consistently reported higher emotion dysregulation compared to those without these symptoms. DISCUSSION Findings indicate that emotion dysregulation is a key factor across eating disorder pathology, and potential treatment target across the spectrum of eating disorder diagnoses in adolescents.
Collapse
Affiliation(s)
- Nora Trompeter
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Kay Bussey
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Miriam K Forbes
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Jonathan Mond
- Centre for Rural Health, University of Tasmania, Launceston, Tasmania, Australia.,Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia.,Camden and Campbelltown Hospital, South Western Sydney Local Health District, Campbelltown, New South Wales, Australia
| | | | - Deborah Mitchison
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia.,Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| |
Collapse
|
152
|
Goel NJ, Sadeh-Sharvit S, Trockel M, Flatt RE, Fitzsimmons-Craft EE, Balantekin KN, Monterubio GE, Firebaugh ML, Wilfley DE, Taylor CB. Depression and anxiety mediate the relationship between insomnia and eating disorders in college women. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2021; 69:976-981. [PMID: 31971482 PMCID: PMC7375933 DOI: 10.1080/07448481.2019.1710152] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 11/27/2019] [Accepted: 12/22/2019] [Indexed: 05/20/2023]
Abstract
Objective: This study examined the associations between insomnia, anxiety, and depression in college women with eating disorders (EDs). Participants: Six hundred and ninety women from 28 US colleges who screened positive for an ED were assessed for psychiatric comorbidities. Women were, on average, 22.12 years old, mostly White (60.1%) and undergraduates (74.3%). Methods: Two mediation models were tested to determine if depression and/or anxiety mediated the relationship between insomnia and ED symptomatology. Results: One-fifth of the sample (21.7%) reported clinically moderate and severe levels of insomnia. Both depression (B = .13, p <. 001) and anxiety (B = .13, p <. 001) significantly mediated the relationship between insomnia and ED psychopathology. Conclusions: Insomnia is relatively common in college-age women with EDs. Findings suggest that this association between ED and sleep disturbances can be explained, in part, by changes in depression and anxiety. Clinicians should consider incorporating mental health assessments for insomnia, depression, and anxiety into current ED prevention, intervention, and screening efforts on college campuses.
Collapse
Affiliation(s)
- Neha J Goel
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
- Institute for Inclusion, Inquiry and Innovation (iCubed), Virginia Commonwealth University, Richmond, VA, USA
| | - Shiri Sadeh-Sharvit
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Center for m2Health, Palo Alto University, Palo Alto, CA, USA
| | - Mickey Trockel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Rachael E Flatt
- Department of Psychology and Neurosciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Grace E Monterubio
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Marie-Laure Firebaugh
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - C Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Center for m2Health, Palo Alto University, Palo Alto, CA, USA
| |
Collapse
|
153
|
Ralph-Nearman C, Williams BM, Ortiz AML, Smith AR, Levinson CA. Pinpointing core and pathway symptoms among sleep disturbance, anxiety, worry, and eating disorder symptoms in anorexia nervosa and atypical anorexia nervosa. J Affect Disord 2021; 294:24-32. [PMID: 34256182 DOI: 10.1016/j.jad.2021.06.061] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/23/2021] [Accepted: 06/27/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Sleep, anxiety, and worry are strongly related to psychiatric illness and in particular to eating disorder (ED) symptoms. However, it is unclear how these specific sleep and anxiety symptoms are interrelated with anorexia nervosa (AN) pathology. METHODS We utilized network analysis to test our theoretically-based conceptual model, by identifying core features and illness (i.e., bridge) pathways among sleep disturbance, anxiety, worry, and ED symptoms in 267 participants with a diagnosis of AN or atypical AN. RESULTS The following core symptoms were identified: shape judgement, restriction, and feeling tired. The strongest bridge symptoms included worry, feeling tired, loss of energy, and physical anxiety. Worry was connected positively to fasting, fear of gaining weight or becoming fat, loss of energy, and feeling tired, and negatively to changes in sleeping patterns. Feeling tired was connected to restriction, fasting, binge eating, and worry. Loss of energy was connected to loss of control over eating and worry. Physical anxiety was negatively connected to restriction. CONCLUSIONS We identified specific core symptoms and illness pathways supporting our theoretical conceptual model of how ED symptoms, anxiety, worry, and sleep disturbances inter-relate in AN and atypical AN. In particular we found that symptoms associated with sleep and anxiety were central and had strong connections with AN symptoms. In addition to targeting AN symptoms, these data suggest that targeting sleep disturbance, anxiety, and worry could improve treatment for AN.
Collapse
Affiliation(s)
| | - Brenna M Williams
- University of Louisville, Department of Psychological and Brain Sciences, United States
| | | | - April R Smith
- Auburn University, Department of Psychological Sciences, United States
| | - Cheri A Levinson
- University of Louisville, Department of Psychological and Brain Sciences, United States
| |
Collapse
|
154
|
Murray HB, Dreier MJ, Zickgraf HF, Becker KR, Breithaupt L, Eddy KT, Thomas JJ. Validation of the nine item ARFID screen (NIAS) subscales for distinguishing ARFID presentations and screening for ARFID. Int J Eat Disord 2021; 54:1782-1792. [PMID: 33884646 PMCID: PMC8492485 DOI: 10.1002/eat.23520] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 04/02/2021] [Accepted: 04/03/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The Nine Item Avoidant/Restrictive Food Intake Disorder (ARFID) Screen (NIAS) has three subscales aligned with ARFID presentations but clinically validated cutoff scores have not been identified. We aimed to examine NIAS subscale (picky eating, appetite, fear) validity to: (1) capture clinically-diagnosed ARFID presentations; (2) differentiate ARFID from other eating disorders (other-ED); and (3) capture ARFID symptoms among individuals with ARFID, individuals with other-ED, and nonclinical participants. METHOD Participants included outpatients (ages 10-76 years; 75% female) diagnosed with ARFID (n = 49) or other-ED (n = 77), and nonclinical participants (ages 22-68 years; 38% female, n = 40). We evaluated criterion-related concurrent validity by conducting receiver operating curve (ROC) analyses to identify potential subscale cutoffs and by testing if cutoffs could capture ARFID with and without use of the Eating Disorder Examination-Questionnaire (EDE-Q). RESULTS Each NIAS subscale had high AUC for capturing those who fit versus do not fit each ARFID presentation, resulting in proposed cutoffs of ≥10 (sensitivity = .97, specificity = .63), ≥9 (sensitivity = .86, specificity = .70), and ≥ 10 (sensitivity = .68, specificity = .89) on the NIAS-picky eating, NIAS-appetite, and NIAS-fear subscales, respectively. ARFID versus other-ED had high AUC on the NIAS-picky eating (≥10 proposed cutoff), but not NIAS-appetite or NIAS-fear subscales. NIAS subscale cutoffs had a high association with ARFID diagnosis, but only correctly classified other-ED in combination with EDE-Q Global <2.3. DISCUSSION To screen for ARFID, we recommend using a screening tool for other-ED (e.g., EDE-Q) in combination with a positive score on any NIAS subscale (i.e., ≥10, ≥9, and/or ≥10 on the NIAS-picky eating, NIAS-appetite, and NIAS-fear subscales, respectively).
Collapse
Affiliation(s)
- Helen Burton Murray
- Center for Neurointestinal Health, Gastroenterology, Massachusetts General Hospital, Boston, MA
- Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Melissa J. Dreier
- Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Hana F. Zickgraf
- Department of Psychology, University of South Alabama, Mobile, AL
| | - Kendra R. Becker
- Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Lauren Breithaupt
- Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Kamryn T. Eddy
- Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Jennifer J. Thomas
- Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| |
Collapse
|
155
|
Baudinet J, Stewart C, Bennett E, Konstantellou A, Parham R, Smith K, Hunt K, Eisler I, Simic M. Radically open dialectical behaviour therapy adapted for adolescents: a case series. BMC Psychiatry 2021; 21:462. [PMID: 34551741 PMCID: PMC8456700 DOI: 10.1186/s12888-021-03460-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 08/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Overcontrol is a transdiagnostic cluster of traits associated with excessive psychological, behavioural and social inhibitory control. It is associated with psychiatric diagnoses of depression, restrictive eating disorders and/or obsessive-compulsive personality disorder. Radically Open Dialectical Behaviour Therapy is a transdiagnostic treatment for maladaptive overcontrol. This case series evaluates an adolescent adaption (RO-A) for a transdiagnostic group of adolescents identified as overcontrolled. METHODS Twenty-eight adolescents were consecutively referred for RO-A from two different National and Specialist Child and Adolescent Mental Health Services between June 2017 and February 2020. Baseline self-report measures assessed overcontrol characteristics, relationship and attachment quality and mental health symptoms of depression and eating disorders, which were repeated at discharge. RESULTS Adolescents in this case series reported high rates of depression (78.6%), self-harm (64.3%) and eating disorders (78.6%). Most (85.7%) had two or more mental health diagnoses and all had previous mental health treatments before starting RO-A. The mean number of RO-A sessions attended was 18 group-based skills classes and 21 individual sessions over a mean period of 34 weeks. Significant improvements with medium and large effect sizes were reported in cognitive flexibility (d = 1.63), risk aversion (d = 1.17), increased reward processing (d = .79) and reduced suppression of emotional expression (d = .72). Adolescents also reported feeling less socially withdrawn (d = .97), more connected to others (d = 1.03), as well as more confident (d = 1.10) and comfortable (d = .85) in attachment relationships. Symptoms of depression (d = .71), eating disorders (d = 1.06) and rates of self-harm (V = .39) also significantly improved. Exploratory correlation analyses suggest improvements in overcontrol are moderately to strongly correlated with improvements in symptoms of depression and eating disorders. CONCLUSIONS This case series provides preliminary data that RO-A may be an effective new treatment for adolescents with overcontrol and moderate to severe mental health disorders like depression and eating disorders. RO-A led to improved management of overcontrol, improved relationship quality and reduced mental health symptoms. Further evaluation is indicated by this case series, particularly for underweight young people with eating disorders. More rigorous testing of the model is required as conclusions are only tentative due to the small sample size and methodological limitations.
Collapse
Affiliation(s)
- Julian Baudinet
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK.
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.
| | - Catherine Stewart
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Eleanor Bennett
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Anna Konstantellou
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Rhian Parham
- National and Specialist Child and Adolescent Dialectical Behaviour Therapy Service (N&S CAMHS DBT), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Keren Smith
- National and Specialist Child and Adolescent Dialectical Behaviour Therapy Service (N&S CAMHS DBT), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Katrina Hunt
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
- National and Specialist Child and Adolescent Dialectical Behaviour Therapy Service (N&S CAMHS DBT), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Ivan Eisler
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Mima Simic
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| |
Collapse
|
156
|
Bryant E, Miskovic-Wheatley J, Touyz SW, Crosby RD, Koreshe E, Maguire S. Identification of high risk and early stage eating disorders: first validation of a digital screening tool. J Eat Disord 2021; 9:109. [PMID: 34488899 PMCID: PMC8419810 DOI: 10.1186/s40337-021-00464-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/20/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Eating disorders are amongst the deadliest of all mental disorders, however detection and early intervention rates remain extremely low. Current standardised screening questionnaires can be arduous or confronting and are ill-validated for online use, despite a universal shift to digital healthcare. The present study describes the development and pilot validation of a novel digital screening tool (the InsideOut Institute-Screener) for high risk and early stage eating disorders to drive early intervention and reduced morbidity. METHODS We utilised a mixed cross-sectional and repeated measures longitudinal survey research design to assess symptom severity and recognised parameters of statistical validity. Participants were recruited through social media and traditional advertising, and through MTurk. An Eating Disorders Examination Questionnaire (EDE-Q) global score of 2.3 and assessment of eating disorder behaviours was used to determine probable ED. 1346 participants aged 14-74 (mean [SE] age 26.60 [11.14] years; 73.8% female, 22.6% male) completed the survey battery. 19% were randomised to two-week follow-up for reliability analysis. RESULTS Strong positive correlations between the IOI-S and both the EDE-Q global (rs = .88) and SCOFF (rs = .75) total score were found, providing support for the concurrent validity of the scale. Inter-item correlations were moderate to strong (rs = .46-.73). Correlations between the IOI-S and two measures of social desirability diverged, providing support for the discriminant validity of the scale. The IOI-S demonstrated high internal consistency (α = .908, ω = .910) and excellent two-week test-retest reliability (.968, 95% CI 0.959-0.975; p ≤ 0.1). The IOI-S accurately distinguished probable eating disorders (sensitivity = 82.8%, specificity = 89.7% [AUC = .944], LR+ = 8.04, LR- = 0.19) and two stepped levels of risk. CONCLUSIONS AND RELEVANCE The present study provides excellent initial support for the psychometric validity of the InsideOut Institute digital screening tool, which has the potential to streamline early intervention in the hopes of reducing current high morbidity and mortality. Further validation should be undertaken in known clinical populations. Eating disorders are amongst the deadliest of all mental disorders, however detection and early intervention rates remain extremely low. The present study describes the initial psychometric validation of a novel digital screening tool (the InsideOut Institute Screener) for high risk and early stage eating disorders, for self-referral and/or use in primary care. 1346 participants aged 14-74 of all genders completed a survey battery designed to assess common parameters of statistical validity. Strong support was found for the screener's ability to accurately measure eating disorder risk and symptomatology. The screener was highly positively correlated with a well known and extensively validated long form self-report questionnaire for eating disorder symptomatology. This study is a pilot validation and the genesis of a project that aims ultimately to drive early intervention leading to reduced morbidity and mortality rates in this illness group.
Collapse
Affiliation(s)
- Emma Bryant
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, Level 2, The Charles Perkins Centre, D17, The University of Sydney, Johns Hopkins Drive, Camperdown, NSW, 2006, Australia.
| | - Jane Miskovic-Wheatley
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, Level 2, The Charles Perkins Centre, D17, The University of Sydney, Johns Hopkins Drive, Camperdown, NSW, 2006, Australia
| | - Stephen W Touyz
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, Level 2, The Charles Perkins Centre, D17, The University of Sydney, Johns Hopkins Drive, Camperdown, NSW, 2006, Australia
| | - Ross D Crosby
- Sanford Center for Biobehavioral Research, Sanford Research, Fargo, ND, USA
| | - Eyza Koreshe
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, Level 2, The Charles Perkins Centre, D17, The University of Sydney, Johns Hopkins Drive, Camperdown, NSW, 2006, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, Level 2, The Charles Perkins Centre, D17, The University of Sydney, Johns Hopkins Drive, Camperdown, NSW, 2006, Australia
| |
Collapse
|
157
|
Gjestvang C, Bratland-Sanda S, Mathisen TF. Compulsive exercise and mental health challenges in fitness instructors; presence and interactions. J Eat Disord 2021; 9:107. [PMID: 34493315 PMCID: PMC8422740 DOI: 10.1186/s40337-021-00446-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/13/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Some physically active people exercise compulsively, which can be associated with several mental health challenges. Fitness instructors are considered important role models for an active, healthy lifestyle; yet little is known about their exercise motives and mental health. The aim of this study was to examine the presence of compulsive exercise and mental health challenges, and their interaction, in fitness instructors. METHODS A total of 270 fitness instructors from Norwegian fitness clubs were recruited for this cross-sectional study. Inclusion criteria were operating as instructors within the current year and understanding Norwegian language. Data were collected by an electronic questionnaire and included demographic information, hours of classes instructed and of personal physical activity, Compulsive Exercise Test (CET), Symptom Check List - 10 (SCL-10), Beck Depression Inventory (BDI), and Eating Disorder Examination Questionnaire (EDE-Q)). RESULTS Females had higher CET scores than males, and 9% of all respondents had CET score above clinical cutoff. Respondents with clinical CET score had higher SCL-10, BDI and EDE-Q global- and subscale scores compared with their counterparts. Although CET was positively and significantly associated with BDI, SCL-10, and EDE-Q, only the latter explained the CET score (ß = 1.23, 99% CI = 0.87, 1.59). CONCLUSION About one out of eleven instructors were above clinical CET cut-off, revealing symptoms of compulsive exercise. EDE-Q significantly contributed in a model explaining 43% of the variation of compulsive exercise.
Collapse
Affiliation(s)
- Christina Gjestvang
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - Solfrid Bratland-Sanda
- Department of Sports, Physical Education and Outdoor Studies, University of Southeast Norway, Kongsberg, Norway
| | - Therese Fostervold Mathisen
- Faculty of Health, Welfare and Organisation, Østfold University College, P.O. Box 700, 1757 Halden, Fredrikstad, Norway.
| |
Collapse
|
158
|
Aouad P, Hay P, Soh N, Touyz S, Mannan H, Mitchison D. Chew and spit (CHSP) in a large adolescent sample: prevalence, impact on health-related quality of life, and relation to other disordered eating features. Eat Disord 2021; 29:509-522. [PMID: 31770086 DOI: 10.1080/10640266.2019.1695449] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A recent general population study of Chew and Spit (CHSP) behavior in adults found a 0.4% prevalence, predominantly in females. The current study explores this further by examining the same phenomenon in secondary-school aged adolescents. This study also explores the relationship between CHSP and other demographic and eating disorder (ED) features in 5111 adolescents (11-to-19 years of age) from 13 schools in New South Wales, Australia. Participants completed measures of ED symptoms and behaviors and change to impairment with two components: psychological distress (K-10) and health related quality of life (HRQoL; PedsQL). CHSP was found to have a 12.2% (95% CI 0.114, 0.132]) point-prevalence rate. Participants who indicated engaging in CHSP reported significantly higher levels of psychological distress (K-10) and lower HRQoL scores (PedsQL) compared to those that did not report CHSP. There was a dose-response relationship between CHSP frequency, psychological distress and HRQoL physical scores but not for HRQoL emotional and HRQoL social scores. Participants who reported regular CHSP were more likely to be female, younger, and to engage in compensatory behaviors such as purging. The high frequency of CHSP behavior in adolescents with disordered eating could suggest that CHSP should be considered in routine ED screening practices. Future studies may examine how to treat CHSP or investigate more focused treatment approaches, in order to target the behavior of CHSP more directly.
Collapse
Affiliation(s)
- Phillip Aouad
- School of Psychology, University of Sydney, Sydney, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, Australia
| | - Nerissa Soh
- Honorary Associate, University of Sydney Northern Clinical School, Sydney, Australia
| | - Stephen Touyz
- School of Psychology, University of Sydney, Sydney, Australia
| | - Haider Mannan
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, Australia
| | - Deborah Mitchison
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, Australia.,Department of Psychology, Macquarie University, Sydney, Australia
| |
Collapse
|
159
|
Abstract
The Eating Disorder Examination-Questionnaire (EDE-Q) is one of the most widely used self-report measures for the assessment of eating disorder psychopathology. Numerous studies have provided norm data for different populations and suggested possible cut-off values for the EDE-Q global score that may indicate the presence of an eating disorder. This commentary argues against the unquestioned use of such cut-off scores as their application may often be unnecessary, disadvantageous, or inappropriate.
Collapse
Affiliation(s)
- Adrian Meule
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.,Schoen Clinic Roseneck, Prien am Chiemsee, Germany
| |
Collapse
|
160
|
Levinson CA, Spoor SP, Keshishian AC, Pruitt A. Pilot outcomes from a multidisciplinary telehealth versus in-person intensive outpatient program for eating disorders during versus before the Covid-19 pandemic. Int J Eat Disord 2021; 54:1672-1679. [PMID: 34245028 DOI: 10.1002/eat.23579] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/02/2021] [Accepted: 07/02/2021] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Eating disorders (EDs) are serious mental illnesses with high rates of mortality, morbidity, and personal and societal costs. Onset of the Covid-19 pandemic led to increased ED diagnoses in the general public, as well as worsening of ED symptoms in those with an existing ED diagnosis. Heightened prevalence and severity of EDs during the pandemic is complicated by the fact that traditional modes of ED care (specialty intensive treatment provided by a multidisciplinary team) have been difficult to access during the pandemic. METHODS The current between-groups study (N = 93 ED) tested a multidisciplinary intensive outpatient program (IOP) delivered via in-person (pre-pandemic; n = 60) and virtually via telehealth (during the pandemic; n = 33). RESULTS We found no differences in outcomes via delivery mode, such that regardless of in-person versus telehealth programming, ED symptoms, depression, and perfectionism significantly decreased and body mass index significantly increased. CONCLUSIONS Our findings suggest that a multi-disciplinary telehealth ED IOP program is feasible and has comparable outcomes to in-person IOP treatment. These findings have implications for treatment beyond the pandemic, suggesting that adoption of telehealth IOPs is warranted. Such delivery modes of intensive treatments for EDs could be expanded to reach underserved populations, especially in rural areas where treatment is often difficult to access.
Collapse
Affiliation(s)
- Cheri A Levinson
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Samantha P Spoor
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Ani C Keshishian
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Alexandria Pruitt
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA
| |
Collapse
|
161
|
Day S, Bussey K, Trompeter N, Hay P, Lonergan A, Mitchison D. Associations of weight- or shape-related bullying with diverse disordered eating behaviors in adolescents. Int J Eat Disord 2021; 54:1641-1651. [PMID: 34181288 DOI: 10.1002/eat.23573] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Little research has investigated variables affecting the relationship between weight- or shape-related bullying (WSB) and specific forms of disordered eating in adolescence. This study aimed to examine the relationship between WSB and eating disorder behaviors in Australian adolescents, and whether this relationship was moderated by body image attitudes. METHOD Data were used from the first wave of the EveryBODY study, a survey of body image concerns and eating disorders in a large representative sample of Australian adolescents (N = 573), aged 11-19 years. Participants completed an online survey with measures of WSB frequency, body image attitudes (drives for thinness, leanness, and muscularity), and disordered eating behaviors. RESULTS Results indicated that frequency of WSB was positively associated with purging and muscularity-oriented behavior (MOB), but not dietary restriction, binge eating, or compulsive exercise. The relationship between WSB and MOB was moderated by drive for muscularity, such that victimization frequency was positively associated with MOB for those with high, but not low, desire to attain a muscular physique. DISCUSSION Findings indicate that WSB is positively associated with purging and MOB but not other eating disorder behaviors, and that drive for muscularity moderates its effect on some behaviors. Understanding these relationships will be important in implementing tailored interventions for adolescents based on screening for victimization experiences and specific body image attitudes.
Collapse
Affiliation(s)
- Sinead Day
- Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Kay Bussey
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, New South Wales, Australia
| | - Nora Trompeter
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, New South Wales, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Blacktown Clinical School, Western Sydney University, Penrith, New South Wales, Australia
| | - Alexandra Lonergan
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, New South Wales, Australia
| | - Deborah Mitchison
- Translational Health Research Institute, School of Medicine, Blacktown Clinical School, Western Sydney University, Penrith, New South Wales, Australia
| |
Collapse
|
162
|
Abstract
Background Diet and fitness apps are often promoted in university and college settings and touted as a means to improve health with little attention given to unanticipated negative effects, especially among those at risk for or with eating disorders. Aims Few researchers have studied how these apps affect women with eating disorders in university and college settings. This research investigates the unintended negative consequences of engaging with these tools. Method Data collection sessions comprised three components conducted with 24 participants: survey (demographic and eating disorder symptoms), think-aloud exercise and semi-structured interview. Thematic analysis was used to analyse data. Results Participants reported that diet and fitness apps trigger and exacerbate symptoms by focusing heavily on quantification, promoting overuse and providing certain types of feedback. Eight themes of negative consequences emerged: fixation on numbers, rigid diet, obsession, app dependency, high sense of achievement, extreme negative emotions, motivation from ‘negative’ messages, and excess competition. Although these themes were common when users’ focus was to lose weight or eat less, they were also prevalent when users wanted to focus explicitly on eating disorder recovery. Conclusions Unintended negative consequences are linked to the quantified self movement, conception of appropriate usage, and visual cues and feedback. This paper critically examines diet and fitness app design and discusses implications for designers, educators and clinicians. Ultimately, this research emphasises the need for a fundamental shift in how diet and fitness apps promote health, with mental health at the forefront.
Collapse
|
163
|
Barrack MT, Sassone J, Dizon F, Wu AC, DeLuca S, Ackerman KE, Tenforde AS. Dietary Supplement Intake and Factors Associated with Increased Use in Preadolescent Endurance Runners. J Acad Nutr Diet 2021; 122:573-582. [DOI: 10.1016/j.jand.2021.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 01/09/2023]
|
164
|
Limburg K, Bodill K, Watson HJ, Kane RT, Hagger MS, Egan SJ. Validity of the compulsive exercise test in regular exercisers. Eat Disord 2021; 29:447-462. [PMID: 31634058 DOI: 10.1080/10640266.2019.1677130] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Measurement of compulsive exercise is important for the study of eating pathology in individuals who regularly participate in sport and exercise. The current study examined the factor structure, internal consistency and validity of the compulsive exercise test (CET) in regular exercisers. Participants were recruited via the internet and from sport clubs (n = 313 adults; M = 32 years; 57% female). A three-factor model for the CET was supported which included the weight control exercise, avoidance and rule-driven behaviour, and mood improvement subscales (fit statistics for the three-factor model: χ2SB = 4.39; CFI = .95; NNFI = .94, RMSEA = .100, 95% CI: .093-.110, AIC = 656.92). The subscales lack of exercise enjoyment and exercise rigidity were not retained. All factors demonstrated acceptable internal consistency with Cronbach's α = .77 to .91. The weight control exercise and avoidance and rule-driven behaviour subscales were significantly related to eating disorder symptoms. Given the association between CET subscales and eating disorder symptoms, the CET three-factor model may be informative when assessing eating pathology in individuals who regularly exercise.
Collapse
Affiliation(s)
| | - Kate Bodill
- School of Psychology, Curtin University, Perth, Australia
| | - Hunna J Watson
- School of Psychology, Curtin University, Perth, Australia.,Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia
| | - Robert T Kane
- School of Psychology, Curtin University, Perth, Australia
| | - Martin S Hagger
- Psychological Sciences, University of California, Curtin University, Merced, USA.,Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Sarah J Egan
- School of Psychology, Curtin University, Perth, Australia
| |
Collapse
|
165
|
Kogel AK, Herpertz S, Steins-Loeber S, Diers M. Disorder specific rewarding stimuli in anorexia nervosa. Int J Eat Disord 2021; 54:1477-1485. [PMID: 33955563 DOI: 10.1002/eat.23526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To enhance our understanding of reward stimuli in anorexia nervosa (AN) and to provide a basis for future research on reward processes, disorder specific reward stimuli as well as primary and secondary reinforcers were investigated. METHOD We developed a set of pictures with "disorder specific reward" stimuli, with the six subcategories "sport," "losing weight," "healthy food," "discipline," "thin bodies," "appreciation of others," and evaluated reward ratings of these "disorder specific reward" stimuli as well as "erotic," "high caloric," and "neutral" stimuli in 25 patients with AN and 25 participants in the comparison group (CG). RESULTS We found a significant main effect for picture category and a significant interaction. The reward ratings were higher in patients with AN compared with CG for the "disorder specific reward" stimuli. In the reward subcategories, patients with AN had higher reward ratings compared with CG in all categories except of healthy food. The "disorder specific reward" stimuli of the categories "sport," "losing weight," and "healthy food" showed higher reward ratings compared with the categories "discipline," "thin bodies," and "appreciation of others" in patients with AN. DISCUSSION The previously used category "thin bodies" used to investigate the reward system might be less effective compared with stimuli from the categories "sport," "losing weight," and "healthy food."
Collapse
Affiliation(s)
- Ann-Kathrin Kogel
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Sabine Steins-Loeber
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg, Bamberg, Germany
| | - Martin Diers
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
| |
Collapse
|
166
|
Macintyre RI, Heron KE, Dawson CA, Filipkowski KB, Arigo D. Does Assessment Alter Responses? An Examination of Measurement Reactivity in an Ecological Momentary Assessment of Body Comparisons. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2021. [DOI: 10.1521/jscp.2021.40.4.304] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: Body comparisons have been implicated in body dissatisfaction and eating disorder development. Ecological momentary assessment (EMA) has been used to capture body comparisons in everyday life; however, the potential for measurement reactivity this approach has on EMA responses has yet to be examined. The present study systematically evaluated measurement reactivity in EMA of body comparisons. Methods: Undergraduate women (N = 75) completed four surveys daily for 11 days; Days 1–4 did not include comparison assessments and Days 5–11 did. Changes were examined in related EMA measures between these time periods and individual difference measures pre- and post-EMA. Results: A within-person MANOVA showed no significant change in the individual difference measures. Multilevel analyses revealed that participants reported fewer comparisons as day of study increased. When they completed EMA with versus without comparison items, they reported fewer occasions of loss of control while eating and less pleasant social company at time of assessment. Discussion: Findings suggest limited concern for reactivity in this approach, though researchers examining body comparisons, loss of control eating, and perceptions of social company should be cautious when interpreting their findings and consider examining reactivity directly. Future research on body comparisons should also consider using run-in periods to improve data quality.
Collapse
Affiliation(s)
- Rachel I. Macintyre
- The Virginia Consortium Program in Clinical Psychology Old Dominion University
| | - Kristin E. Heron
- The Virginia Consortium Program in Clinical Psychology Old Dominion University
| | - Charlotte A. Dawson
- The Virginia Consortium Program in Clinical Psychology Old Dominion University
| | | | | |
Collapse
|
167
|
AlShebali M, AlHadi A, Waller G. The impact of ongoing westernization on eating disorders and body image dissatisfaction in a sample of undergraduate Saudi women. Eat Weight Disord 2021; 26:1835-1844. [PMID: 33011958 DOI: 10.1007/s40519-020-01028-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/21/2020] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study addressed the prevalence of eating disorders and levels of eating pathology, body image, and psychological comorbidities in undergraduate women in Saudi Arabia. It examined the role of the current internalization of western culture that is under way in that country, focusing on political and economic issues rather than on issues such as media exposure per se. METHOD Participants were 503 Saudi female university students (mean age = 19.78 years). Each completed a diagnostic measure of eating disorders and measures of disordered eating attitudes and behaviours, body image, depression, social anxiety, and self-esteem. They also completed a measure of the internalization of western culture, specific to current political and cultural developments in Saudi Arabia. RESULTS Eating disorder prevalence and pathology rates among undergraduates females were comparable to western levels, though the pattern was more one of bulimic than anorexic pathology. Internalization of western values was associated with eating pathology, body image, and psychological comorbidities. CONCLUSION Eating disorders are not an exclusively western issue, as the levels in Saudi undergraduate women are similar to those in western cultures (though they tend more towards bulimic than anorexic presentations). Internalization of western values appears to be key to this pattern. LEVEL OF EVIDENCE : Level III, case-control analytic study.
Collapse
Affiliation(s)
- Munirah AlShebali
- Princess Nourah Bint Abdulrahman University, 3652 Bashir Street, P.O. Box 84428, Riyadh, 11671, Saudi Arabia.
- Department of Psychology, University of Sheffield, Sheffield, UK.
| | - Ahmad AlHadi
- SABIC Psychological Health Research and Applications Chair, Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Glenn Waller
- Department of Psychology, University of Sheffield, Sheffield, UK
| |
Collapse
|
168
|
Body checking behaviors and eating disorder pathology among nonbinary individuals with androgynous appearance ideals. Eat Weight Disord 2021; 26:1915-1925. [PMID: 33063287 DOI: 10.1007/s40519-020-01040-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/29/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Internalized sociocultural standards of attractiveness are a risk factor repeatedly linked to eating disorders; however, many nonbinary individuals do not conform to these standards. PURPOSE This study investigated the body checking behaviors and eating disorder pathology among nonbinary individuals with androgynous appearance ideals. METHODS Participants (n = 194) completed an online survey assessing body checking behaviors, body appreciation, gender congruence, and eating disorder pathology RESULTS: Body checking predicted eating disorder pathology, and body image significantly improved the model. Gender congruence did not additional variance in predicting eating pathology CONCLUSION: Though gender congruence was not a significant predictor of eating pathology, content analysis revealed unique body behaviors specific to nonbinary individuals' gender identity and gender expression. Clinical implications include expanding perceptions of eating disorder presentation when working with nonbinary individuals with androgynous appearance ideals. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
Collapse
|
169
|
Cusack CE, Cooper M, Libbey N, Galupo MP. Rumination & eating psychopathology among trans and nonbinary individuals: A path analysis integrating minority stress. Eat Behav 2021; 42:101544. [PMID: 34358854 DOI: 10.1016/j.eatbeh.2021.101544] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 11/29/2022]
Abstract
UNLABELLED Ruminative thought patterns, defined as repetitive negative self-focused attention, are considered an avoidant coping strategy for managing stress. As trans and nonbinary (TNB) individuals commonly experience prejudice and discrimination in response to their gender identities (i.e. minority stressors), rumination over these stressors may contribute to heightened risk of psychopathology in these groups. Although rumination is a general risk factor for eating disorder (ED) psychopathology, no studies to date have examined whether eating- or gender-related ruminative patterns relate to maintenance of ED psychopathology for TNB individuals. This cross-sectional study investigated whether levels of rumination (both gender-related and ED-specific) mediated the relationship between minority stress and ED psychopathology. METHOD Participants were 242 TNB adults (Mage = 24.92, SD = 6.5, Range = 18-70) recruited online, who completed measures of minority stress, gender-related rumination, ED-specific rumination, and ED psychopathology. We used Preacher-Hayes' approach to examine the parallel mediation model, with gender-related and ED-specific rumination as potential mediators. RESULTS Gender-related rumination did not mediate the relation between gender minority stress and ED psychopathology, Indirect B = -0.00 [95% BCa CI: -0.01, 0.00]; however, ED-specific rumination was significant, indicating partial mediation, Indirect B = 0.01 [95% BCa CI: 0.00, 0.02]. CONCLUSION As gender minority stress and ED-specific rumination relate to ED psychopathology, it is essential that clinicians adopt an intersectional minority stress framework in understanding ED psychopathology among TNB individuals.
Collapse
|
170
|
Aouad P, Stedal K, Walø-Syversen G, Hay P, Lindvall Dahlgren C. Chew and spit (CHSP) in bariatric patients: a case series. J Eat Disord 2021; 9:89. [PMID: 34289898 PMCID: PMC8296715 DOI: 10.1186/s40337-021-00441-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/30/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Studies into the disordered eating behaviour of chew and spit have alluded to several cohorts more likely to engage in the behaviour, one such group being bariatric surgery candidates and patients. Weight-loss surgery candidates have received little to no attention regarding engaging in chew and spit behaviour. Changes in pre- and post- surgery eating pathology related to chew and spit behaviour has yet to be explored and described in academic literature. CASE PRESENTATION The current study reports on three cases of individual women, aged 30, 35, and 62 respectively, who indicated engagement in chew and spit. All three cases underwent bariatric surgery (two underwent gastric bypass, one underwent vertical sleeve gastrectomy). Eating pathology-including chew and spit behaviour, anxiety and depression, and adherence to the Norwegian nutritional guidelines were examined pre-operatively and post-operatively (one and two-year follow-up). At baseline (pre-surgery), two participants reported that they engaged in chew and spit, compared to one patient post-surgery. All three cases reported that they, to at least some extent, adhered to dietary guidelines post-surgery. Subjective bingeing frequency appeared to be relatively low for all three cases, further declining in frequency at one-year follow-up. At baseline, one participant reported clinically significant depression and anxiety, with no clinically significant depression or anxiety reported at follow-ups in participants that chew and spit. CONCLUSIONS The current study provides a starting point for the exploration of chew and spit as a pathological symptom of disordered eating in bariatric patients. It highlights the need to further explore chew and spit before and after weight-loss surgery.
Collapse
Affiliation(s)
- Phillip Aouad
- InsideOut Institute, University of Sydney, Sydney, Australia. .,School of Medicine, Western Sydney University, Penrith, NSW, Australia.
| | - Kristin Stedal
- Regional Department for Eating Disorders, Oslo University Hospital, Oslo, Norway
| | - Gro Walø-Syversen
- Regional Department for Eating Disorders, Oslo University Hospital, Oslo, Norway
| | - Phillipa Hay
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Camilla Lindvall Dahlgren
- Regional Department for Eating Disorders, Oslo University Hospital, Oslo, Norway.,Department of Psychology, Bjørknes University College, Oslo, Norway
| |
Collapse
|
171
|
Bristow C, Allen KA, Simmonds J, Snell T, McLean L. Anti-obesity public health advertisements increase risk factors for the development of eating disorders. Health Promot Int 2021; 37:6323697. [PMID: 34279033 DOI: 10.1093/heapro/daab107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Although overweight and obesity are increasing in prevalence, eating disorders such as anorexia nervosa, bulimia nervosa and binge-eating disorder are simultaneously on the rise. It is important to address the burden of disease of overweight and obesity on the population, yet there is concern that some of these efforts may be encouraging unhealthy weight control behaviours (UWCB). Using an online survey, 137 participants were exposed to four anti-obesity public health advertisements presented in random order. Weight satisfaction, shape satisfaction, desire to control weight, desire to control shape and desire to engage in UWCB were measured on a 100-point visual analogue scale. A significant effect of the experimental condition was found after exposure to Image 1 with a decrease in weight satisfaction, and increased desire to control body weight, body shape and engage in UWCB. Mean scores for UWCB also increased, on average, across all four image conditions. Public health advertisements targeting obesity risk encouraging unhealthy weight control and subsequent disordered eating behaviours. Those responsible for the implementation of such advertisements must consider very carefully the potential to cause unintended harm.
Collapse
Affiliation(s)
- Claire Bristow
- Faculty of Education, Monash University, Melbourne Victoria, Australia
| | - Kelly-Ann Allen
- Faculty of Education, Monash University, Melbourne Victoria, Australia
| | - Janette Simmonds
- Faculty of Education, Monash University, Melbourne Victoria, Australia
| | - Tristan Snell
- School of Psychology, Faculty of Health, Deakin University, Melbourne Victoria, Australia
| | - Louise McLean
- Faculty of Education, Monash University, Melbourne Victoria, Australia
| |
Collapse
|
172
|
Bannatyne AJ, McNeil E, Stapleton P, MacKenzie-Shalders K, Watt B. Disordered eating measures validated in pregnancy samples: a systematic review. Eat Disord 2021; 29:421-446. [PMID: 31675283 DOI: 10.1080/10640266.2019.1663478] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Although disordered eating in pregnancy has been linked to numerous negative consequences, there is currently no published instrument specifically devised to identify or measure such symptoms in pregnancy. As such, this study systematically reviewed the literature to evaluate the performance of general measures of disordered eating in pregnancy samples. A systematic search of the following electronic databases was undertaken from inception to April 2019: Scopus, Medline, PsycINFO, Embase, ProQuest Dissertations and Theses, and the Cumulative Index to Nursing and Allied Health Literature. From 1724 citations, eight publications met the inclusion criteria and were included in the review. Most of the included studies (6/8) were of reasonable quality. Overall, three self-report inventories (EDE-Q, EDI-2, and DEBS) and one semi-structured clinical interview (EDE) had some form of psychometric information available. Most studies reported reliability, with only two reporting validity. No studies assessed screening accuracy. Other than the EDE-Q, which had preliminary evidence to suggest possible utility in pregnancy, the findings of this review revealed little to no evidence to support the use of general measures of disordered eating in pregnancy. A strong need for research exploring the validity of existing measures in pregnancy samples, including the EDE-Q, was also evident.
Collapse
Affiliation(s)
- Amy Jean Bannatyne
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.,School of Psychology, Bond University, Gold Coast, Australia
| | - Elyse McNeil
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.,School of Psychology & Counselling, Queensland University of Technology, Brisbane, Australia
| | - Peta Stapleton
- School of Psychology, Bond University, Gold Coast, Australia
| | | | - Bruce Watt
- School of Psychology, Bond University, Gold Coast, Australia
| |
Collapse
|
173
|
Wong VZ, Christian C, Hunt RA, Levinson CA. Network investigation of eating disorder symptoms and positive and negative affect in a clinical eating disorder sample. Int J Eat Disord 2021; 54:1202-1212. [PMID: 33819357 DOI: 10.1002/eat.23511] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/24/2021] [Accepted: 03/24/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Growing literature suggests that emotions influence the maintenance of eating disorder (ED) symptoms. However, most research has studied the relationship between ED symptoms and affect broadly (i.e., negative affect [NA], positive affect [PA]), rather than examining models comprised of multiple specific affective states (e.g., upset, proud). METHOD The current study (N = 196 individuals with EDs) used network analysis to examine the most interconnected (i.e., central) NA and PA states in EDs and test the complex associations between specific NA, PA, and ED symptoms. We estimated two networks: one with affective states only and another with affective states and ED symptoms. RESULTS Feeling distressed, afraid, attentive, and determined were the most central symptoms in the affect-only network. ED symptoms related to overvaluation of weight and shape, including affect-based ED symptoms (i.e., guilt about eating), were central in the network of affect and ED symptoms. Guilt about eating and shame were central bridge symptoms across affect and ED symptom clusters, meaning that they were each strongly connected across clusters, and may represent important pathways among affect and ED symptoms. DISCUSSION Limitations include the cross-sectional and between-person nature of these analyses, from which we cannot derive causal or within-persons processes. Clinical interventions that target central and bridge symptoms (e.g., fear, shame) may disrupt the reinforcing cycle of NA in EDs that may contribute to ED behaviors. Future research should examine relationships among affective states and ED symptoms in longitudinal and intraindividual network models to develop more effective treatments for EDs.
Collapse
Affiliation(s)
- Valerie Z Wong
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Caroline Christian
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Rowan A Hunt
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Cheri A Levinson
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA
| |
Collapse
|
174
|
Wade T, Ambwani S, Cardi V, Albano G, Treasure J. Outcomes for adults with anorexia nervosa who do not respond early to outpatient treatment. Int J Eat Disord 2021; 54:1278-1282. [PMID: 33760307 DOI: 10.1002/eat.23508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/14/2021] [Accepted: 03/15/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To better understand those patients with anorexia nervosa who do not show early response to treatment and are likely to have poorer outcome. METHOD From an existing data set of 187 patients with anorexia nervosa across 22 eating disorder outpatient services in the United Kingdom, participants who had started treatment and had at least one body mass index (BMI) observation in the first 6 weeks of treatment were eligible for these secondary analyses (N = 65), a latent class analysis of BMI change over the first 6 weeks of treatment. Fifty-six patients showed no early change in BMI. We used logistic regression to examine predictors of good outcome in the 40 participants who had 12-month follow-up data. Predictors included global EDE-Q, negative affect (Depression, Anxiety, and Stress Scales) and functional impairment (Work and Social Adjustment Scale). RESULTS Good outcome was achieved by 23% of patients and remission by 15%. Good outcome was predicted by less functional impairment at baseline. DISCUSSION Further work that can identify sub-groups of patients with anorexia nervosa who do not achieve good outcome after treatment will inform the development of targeted engagement approaches.
Collapse
Affiliation(s)
- Tracey Wade
- Blackbird Initiative, Órama Research Institute, Flinders University, South Australia, Australia
| | - Suman Ambwani
- Department of Psychology, Dickinson College, Carlisle, Pennsylvania, USA
| | - Valentina Cardi
- Department of Psychological Medicine, Kings College London, London, UK.,Department of General Psychology, University of Padova, Padova, Italy
| | - Gaia Albano
- Department of Psychological Medicine, Kings College London, London, UK.,Department of Psychology, Educational Sciences and Human Movement, University of Palermo, Palermo, Italy
| | - Janet Treasure
- Department of Psychological Medicine, Kings College London, London, UK
| |
Collapse
|
175
|
Mountford VA, Allen KL, Tchanturia K, Eilender C, Schmidt U. Implementing evidence-based individual psychotherapies for adults with eating disorders in a real world clinical setting. Int J Eat Disord 2021; 54:1238-1249. [PMID: 33719036 DOI: 10.1002/eat.23504] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/03/2021] [Accepted: 03/03/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study aimed to evaluate the effectiveness of evidenced-based psychological treatments (specifically, Cognitive-Behaviour Therapy for Eating Disorders [CBT-ED] and Maudsley Anorexia Nervosa Treatment for Adults [MANTRA]) for a transdiagnostic eating disorder population in a routine clinical setting. In particular, it aimed to determine the extent to which treatment was provided in line with current clinical guidelines (NICE, 2017) and how effective treatment was in improving eating disorder and general psychopathology. METHOD Three hundred and seventy-nine participants meeting criteria for DSM-5 anorexia nervosa, bulimia nervosa, binge-eating disorder or other specified feeding or eating disorder completed pre- and posttreatment measures of eating disorder pathology and general distress. Clinicians recorded weight and episodes of bingeing and purging. RESULTS Ninety seven percent of participants received treatment in line with evidence-based psychotherapies. Treatment was completed by 59.9% of the whole sample. Using stringent criteria and ITT analysis 21.4% met criteria for remission at end of treatment. In the underweight sample, there was a significant increase in BMI, averaging 1.38 kg/m2 over treatment, with similar outcomes for MANTRA and CBT-ED. DISCUSSION These findings, in a large transdiagnostic population, add to emerging literature on the translation of evidence-based psychotherapies to real-world clinical settings. Our results converge well with prior similar studies. Findings highlight the need for routine data collection in services and for the ongoing improvement of treatments for the eating disorders.
Collapse
Affiliation(s)
- Victoria A Mountford
- Eating Disorder Service, South London and Maudsley NHS Foundation Trust, Middle House, Maudsley Hospital, London, UK.,Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.,Maudsley Health, Abu Dhabi, UAE
| | - Karina L Allen
- Eating Disorder Service, South London and Maudsley NHS Foundation Trust, Middle House, Maudsley Hospital, London, UK.,Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Kate Tchanturia
- Eating Disorder Service, South London and Maudsley NHS Foundation Trust, Middle House, Maudsley Hospital, London, UK.,Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Cara Eilender
- Eating Disorder Service, South London and Maudsley NHS Foundation Trust, Middle House, Maudsley Hospital, London, UK.,Department of Clinical Psychology, University College London, London, UK
| | - Ulrike Schmidt
- Eating Disorder Service, South London and Maudsley NHS Foundation Trust, Middle House, Maudsley Hospital, London, UK.,Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| |
Collapse
|
176
|
Tan JO, Spector-Hill I. Identifying and managing eating disorders in type 1 diabetes mellitus: An all-Wales study. Clin Child Psychol Psychiatry 2021; 26:617-628. [PMID: 34159830 DOI: 10.1177/13591045211009591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Co-morbid diabetes and eating disorders have a particularly high mortality, significant in numbers and highly dangerous in terms of impact on health and wellbeing. However, not much is known about the level of awareness, knowledge and confidence amongst healthcare professionals regarding co-morbid Type 1 Diabetes Mellitus (T1DM) and eating disorders. AIM To understand the level of knowledge and confidence amongst healthcare professionals in Wales regarding co-morbid T1DM and eating disorder presentations, identification and treatment. RESULTS We conducted a survey of 102 Welsh clinicians in primary care, diabetes services and eating disorder services. 60.8% expressed low confidence in identification of co-morbid T1DM and eating disorders. Respondents reported fewer cases seen than would be expected. There was poor understanding of co-morbid T1DM and eating disorders: 44.6% identified weight loss as a main symptom, 78.4% used no screening instruments, and 80.3% consulted no relevant guidance. The respondents expressed an awareness of their lack of knowledge and the majority expressed willingness to accept training and education. CONCLUSION We suggest that priority must be given to education and training of all healthcare professionals in primary care, diabetes services and mental health services who may see patients with co-morbid T1DM and eating disorders.
Collapse
|
177
|
Grammer AC, Best JR, Fowler LA, Balantekin KN, Stein RI, Conlon RPK, Saelens BE, Welch RR, Perri MG, Epstein LH, Wilfley DE. General and Eating Disorder Psychopathology in Relation to Short- and Long-Term Weight Change in Treatment-Seeking Children: A Latent Profile Analysis. Ann Behav Med 2021; 55:698-704. [PMID: 32914852 PMCID: PMC8240132 DOI: 10.1093/abm/kaaa076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Concurrent general psychopathology (GP) and eating disorder psychopathology (EDP) are commonly reported among youth with overweight/obesity and may impact weight change. PURPOSE We identified patterns of GP and EDP in children with overweight/obesity and examined the impact on weight change following family-based behavioral obesity treatment (FBT) and maintenance interventions. METHODS Children (N = 172) participated in 4 month FBT and subsequent 8 month weight maintenance interventions. GP and EDP were assessed prior to FBT (baseline). Child percentage overweight was assessed at baseline, post-FBT (4 months), and post-maintenance (12 months). Latent profile analysis identified patterns of baseline GP and EDP. Linear mixed-effects models examined if profiles predicted 4- and 12-month change in percentage overweight and if there were two-way and three-way interactions among these variables, adjusting for relevant covariates. RESULTS Results indicated a three-profile structure: lower GP and EDP (LOWER); subclinically elevated GP and EDP without loss of control (LOC; HIGHER); and subclinically elevated GP and EDP with LOC (HIGHER + LOC). Across profiles, children on average achieved clinically meaningful weight loss (i.e., ≥9 unit change in percentage overweight) from baseline to 4 month FBT and sustained these improvements at 12 month maintenance. There was no evidence that latent profiles were related to percentage overweight change from baseline to FBT (p > .05) or baseline to maintenance (p > .05). There was no evidence for two-way or three-way interactions (p > .05). CONCLUSION Concurrent GP and EDP do not portend differential short- or long-term weight change following FBT and maintenance. Future research is warranted on the durability of weight change among youth with GP and EDP. TRIAL REGISTRATION NCT00759746.
Collapse
Affiliation(s)
- Anne Claire Grammer
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - John R Best
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Lauren A Fowler
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Katherine N Balantekin
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Richard I Stein
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Rachel P Kolko Conlon
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Brian E Saelens
- Department of Pediatrics, University of Washington and Seattle Children’s Research Institute, Seattle, WA, USA
| | - R Robinson Welch
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael G Perri
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Leonard H Epstein
- Department of Pediatrics, Division of Behavioral Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| |
Collapse
|
178
|
Disordered Eating, Development of Menstrual Irregularity, and Reduced Bone Mass Change After a 3-Year Follow-Up In Female Adolescent Endurance Runners. Int J Sport Nutr Exerc Metab 2021; 31:337-344. [PMID: 34098530 DOI: 10.1123/ijsnem.2021-0011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 11/18/2022]
Abstract
This prospective study evaluated the 3-year change in menstrual function and bone mass among 40 female adolescent endurance runners (age 15.9 ± 1.0 years) according to baseline disordered eating status. Three years after initial data collection, runners underwent follow-up measures including the Eating Disorder Examination Questionnaire and a survey evaluating menstrual function, running training, injury history, and prior sports participation. Dual-energy X-ray absorptiometry was used to measure bone mineral density and body composition. Runners with a weight concern, shape concern, or global score ≥4.0 or reporting >1 pathologic behavior in the past 28 days were classified with disordered eating. Compared with runners with normal Eating Disorder Examination Questionnaire scores at baseline, runners with disordered eating at baseline reported fewer menstrual cycles/year (6.4 ± 4.5 vs. 10.5 ± 2.8, p = .005), more years of amenorrhea (1.6 ± 1.4 vs. 0.3 ± 0.5, p = .03), and a higher proportion of menstrual irregularity (75.0% vs. 31.3%, p = .02) and failed to increase lumbar spine or total hip bone mineral density at the 3-year follow-up. In a multivariate model including body mass index and menstrual cycles in the past year at baseline, baseline shape concern score (B = -0.57, p value = .001) was inversely related to the annual number of menstrual cycles between assessments. Weight concern score (B = -0.40, p value = .005) was inversely associated with lumbar spine bone mineral density Z-score change between assessments according to a multivariate model adjusting for age and body mass index. These finding support associations between disordered eating at baseline and future menstrual irregularities or reduced accrual of lumbar spine bone mass in female adolescent endurance runners.
Collapse
|
179
|
Zhang YY, Burns BD, Touyz S. Exploring a core psychopathology in disordered eating: the feelings of fat scale. J Eat Disord 2021; 9:64. [PMID: 34078463 PMCID: PMC8170806 DOI: 10.1186/s40337-021-00401-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 03/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Feelings of fat are common for people with eating disorders, but ways of measuring its intensity are needed. Therefore, our goal was to develop a self-report feelings of fat scale that asked participants to indicate how intensely they currently felt statements such as "I feel fat". With such a scale we can determine how strongly feelings of fat relate to evidence of disordered eating. METHODS We conducted three studies of eating disorders with undergraduate women taking introductory psychology classes. The combined sample was 472 participants. A previous eating disorder diagnosis was self-reported by 33 participants and a current diagnosis by 11. All participants completed the EDE-Q and the seven (Study 1) or nine item (Studies 2 and 3) "State Feelings of Fat" (SFF) scales we developed. Each item asked them to rate the intensity with which they felt statements such "I feel fat" on a seven-point scale from "not at all" to "the most I have ever felt". RESULTS Both the seven and nine item SFF scales were highly coherent (Cronbach's α were .94, .95 and .94), but factor analysis supported the seven-item version. We found high correlations between SFF and EDE-Q scores (Study 1: .816; Study 2: .808; Study 3: .841). SFF scores distinguished participants self-reporting no eating disorder diagnosis from those with a former diagnosis, t (361) = 2.33, p = .021, who in turn were distinguished from those with a current diagnosis, t (42) = 2.09, p = .043. Due to the high coherence of the scale, the single item "I feel fat" captured most of the variance in EDE-Q scores (r [472] = .793). CONCLUSIONS We have constructed an eating disorders relevant feelings of fat scale. Given that the EDE-Q is considered a valid questionnaire for measuring severity of eating disorders, our findings suggests that feelings of fat are core to the psychopathology of eating disorders. To the extent that EDE-Q scores are stable it also suggests that feelings of fat are surprisingly stable. Furthermore, the single item "I feel fat" alone may capture most of what the EDE-Q measures.
Collapse
Affiliation(s)
- Yichelle Y Zhang
- School of Psychology, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Bruce D Burns
- School of Psychology, The University of Sydney, Sydney, NSW, 2006, Australia.
| | - Stephen Touyz
- School of Psychology, The University of Sydney, Sydney, NSW, 2006, Australia
| |
Collapse
|
180
|
Cooper M, Collison AO, Collica SC, Pan I, Tamashiro KL, Redgrave GW, Schreyer CC, Guarda AS. Gastrointestinal symptomatology, diagnosis, and treatment history in patients with underweight avoidant/restrictive food intake disorder and anorexia nervosa: Impact on weight restoration in a meal-based behavioral treatment program. Int J Eat Disord 2021; 54:1055-1062. [PMID: 33973254 DOI: 10.1002/eat.23535] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/28/2021] [Accepted: 04/28/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Gastrointestinal (GI) concerns are often presumed to complicate nutritional rehabilitation for restrictive eating disorders, yet their relationship to weight restoration outcomes is unclear. This retrospective chart review examined GI history and weight-related discharge outcomes in primarily adult, underweight inpatients with anorexia nervosa (AN, N = 107) or avoidant/restrictive food intake disorder (ARFID, N = 22) treated in a meal-based, behavioral eating disorder program. METHOD Lifetime GI symptomatology, diagnoses, diagnostic tests, and procedures were abstracted from medical records. Generalized linear models examined associations of GI diagnoses, tests, and procedures with discharge BMI and rate of weight gain. RESULTS Ninety-nine percent of patients reported GI symptomatology and 83% had one or more GI diagnoses; with constipation and GERD most common. GI diagnoses (p <.01) and testing (p <.001) were more common in ARFID than AN. Average inpatient weight gain (1.59 kg/week), and discharge BMI (18.5 kg/m2 ), did not differ by group. Slower weight gain in patients with (1.3 kg/week), versus without (1.7 kg/week), history of tube feeding (p = .02), accounted for a main effect of GI procedures on inpatient rate of gain (p = .01). DISCUSSION Despite ubiquitous GI symptomatology, meal-based weight restoration achieved average weekly weight gain above recommended APA guidelines for hospitalized patients with an eating disorder. History of tube feeding was associated with slower mean weight gain, which remained, however, within recommended APA guidelines.
Collapse
Affiliation(s)
- Marita Cooper
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Amira O Collison
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Sarah C Collica
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Isabella Pan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kellie L Tamashiro
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Graham W Redgrave
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Colleen C Schreyer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Angela S Guarda
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
181
|
Abstract
Pathological exercise behavior is pervasive in eating disorder psychopathology, yet minimal treatment guidance exists for extinguishing it as little is known about how to differentiate pathological from healthy exercise. The purpose of this study was to characterize pathological exercise in terms of motivation to increase the specificity with which both pathological and healthy exercise is described and to inform treatment interventions. Latent profile analysis characterized homogenous groups based on exercise motivation in two samples: college women (n = 200) and women with eating psychopathology (n = 211). These profiles were compared on levels of eating and general psychopathology and emotion dysregulation. Three profiles emerged describing sedentary, pathological exercise, and athlete groups in the first sample, and five profiles describing neutral, sedentary, weight loss, athlete, and pathological exercise groups emerged in the second sample. Findings indicate that motivation style is salient in defining pathological exercise and may, therefore, be a clinically useful treatment target.
Collapse
|
182
|
Nagl M, Jepsen L, Linde K, Kersting A. Social media use and postpartum body image dissatisfaction: The role of appearance-related social comparisons and thin-ideal internalization. Midwifery 2021; 100:103038. [PMID: 34051430 DOI: 10.1016/j.midw.2021.103038] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 11/23/2020] [Accepted: 05/07/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES For many women, the postpartum period is a particularly vulnerable time to experience body image dissatisfaction. We aimed to examine the impact of social media usage frequency in the context of postpartum body image dissatisfaction and eating disorder psychopathology. We therefore empirically tested a hypothetical model assuming that social media usage influences postpartum body image dissatisfaction and eating disorder psychopathology via multiple mediation through appearance-related social comparisons and thin ideal internalization. DESIGN Cross-sectional online-survey. SETTING Online forums, social media groups, community groups PARTICIPANTS: Two-hundred-fifty-two new mothers who had given birth within the last 26 weeks prior to the assessment. MEASUREMENTS Social media use was assessed by the average frequency of using Facebook, Instagram, Youtube or other per week. Body image dissatisfaction was assessed with the Body Shape Questionnaire and eating disorder psychopathology with the Eating Disorder Examination-Questionnaire. Path analyses using SPSS Amos were conducted to examine whether the hypothetical model fitted our data. RESULTS After minor modification, the final model revealed a good fit to the data, CFI = .977, TLI = .964, SRMR = .061, RMSEA = .056 (90%CI .027, .084), and as expected the indirect multiple mediation pathway via appearance-related social comparisons and thin ideal idealization was significant, IE = 4.395; 95%BCaCI 2.969, 7.394; p = .001. The number of target groups for appearance-related social comparisons did not moderate the results. KEY CONCLUSIONS Our results provide first evidence that social media use may play an important role in postpartum body dissatisfaction and eating disorder psychopathology. Mediational pathways proposed by socio-cultural theories of body image also hold for the postpartum period. IMPLICATIONS FOR PRACTICE Practitioners in the field should be aware of the association between social media use and body image dissatisfaction and mediating factors among new mothers and sensitive when directing new mothers to those media.
Collapse
Affiliation(s)
- Michaela Nagl
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, University of Leipzig, Leipzig, Germany.
| | - Lene Jepsen
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Katja Linde
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, University of Leipzig, Leipzig, Germany
| |
Collapse
|
183
|
Self-report versus clinical interview: Discordance among measures of binge eating in a weight-loss seeking sample. Eat Weight Disord 2021; 26:1259-1263. [PMID: 32920776 DOI: 10.1007/s40519-020-01002-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE Obese, behavioral weight-loss (BWL) seeking individuals may be prone to over-reporting binge-eating (BE). However, many studies rely on self-reported measures of BE in this population, which may be inaccurate. As such, this is the first-ever study to examine the concordance rates among one self-reported and one clinician- administered measure of BE in a BWL-seeking sample with overweight/obesity. METHODS At baseline of a BWL trial, participants (N = 94) completed two measures of BE: The Eating Disorders Examination Questionnaire (EDE-Q) and the interview-based Eating Disorder Examination (EDE, Overeating section). RESULTS Cohen's kappa detected poor agreement between measures (κ < 0). A paired samples t-test detected large, significant differences in OBE frequency across the EDE-Q and EDE, p < 0.001. The self-reported EDE-Q detected a significantly greater frequency of OBEs compared to the EDE (MEDE-Q = 0.73, SD = 1.29 vs. MEDE = 0.06, SD = 0.34). The EDE-Q detected that approximately 50% of participants have experienced OBEs, while the EDE detected that only 5% of participants have experienced OBEs. The frequency of OBEs detected by the EDE-Q was statistically greater than the frequency of OBEs detected by the EDE, p < 0.001. DISCUSSION Results suggest poor agreement between one self-reported measure and the "gold-standard," clinician-administered measure of BE in a BWL-seeking sample with overweight/obesity. The EDE-Q exhibited high sensitivity but low-to-moderate specificity of OBEs, with the number of false positives (41) outweighing that of true positives (4). Studies measuring BE in this population should consider relying solely on assessor-administered measures, as this sample may require clinical guidance or clarification on the definition and features of BE. LEVEL OF EVIDENCE Level V, cross-sectional, descriptive study.
Collapse
|
184
|
Park BY, Chung CS, Lee MJ, Park H. Accurate neuroimaging biomarkers to predict body mass index in adolescents: a longitudinal study. Brain Imaging Behav 2021; 14:1682-1695. [PMID: 31065926 DOI: 10.1007/s11682-019-00101-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Obesity is often associated with cardiovascular complications. Adolescent obesity is a risk factor for cardiovascular disease in adulthood; thus, intensive management is warranted in adolescence. The brain state contributes to the development of obesity in addition to metabolic conditions, and hence neuroimaging is an important tool for accurately assessing an individual's risk of developing obesity. Here, we aimed to predict body mass index (BMI) progression in adolescents with neuroimaging features using machine learning approaches. From an open database, we adopted 76 resting-state functional magnetic resonance imaging (rs-fMRI) datasets from adolescents with longitudinal BMI scores. Functional connectivity analyses were performed on cortical surfaces and subcortical volumes. We identified baseline functional connectivity features in the prefrontal-, posterior cingulate-, sensorimotor-, and inferior parietal-cortices as significant determinants of BMI changes. A BMI prediction model based on the identified fMRI biomarkers exhibited a high accuracy (intra-class correlation = 0.98) in predicting BMI at the second visit (1~2 years later). The identified brain regions were significantly correlated with the eating disorder-, anxiety-, and depression-related scores. Based on these results, we concluded that these functional connectivity features in brain regions related to eating disorders and emotional processing could be important neuroimaging biomarkers for predicting BMI progression.
Collapse
Affiliation(s)
- Bo-Yong Park
- Department of Electrical and Computer Engineering, Sungkyunkwan University, Suwon, 16419, South Korea.,Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, 16419, South Korea
| | - Chin-Sang Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, South Korea
| | - Mi Ji Lee
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, South Korea.
| | - Hyunjin Park
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, 16419, South Korea. .,School of Electronic and Electrical Engineering, Sungkyunkwan University, Suwon, 16419, South Korea.
| |
Collapse
|
185
|
Pérez Martín PS, Martínez JA, Valecillos AJ, Gainza García L, Galán Berasaluce M, Checa Díaz P. [Early detection and prevalence of risk of eating disorders in Primary Care in Guadalajara city]. Semergen 2021; 47:230-239. [PMID: 33863649 DOI: 10.1016/j.semerg.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/22/2020] [Accepted: 01/01/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To know the percentage of adolescent patients at risk of developing an eating disorder (ED); to identify the prevalence of risk for Anorexia Nervosa, Bulimia Nervosa and Unspecified Eating Disorders (NERD) according to age, sex, health centers, nationality and family data; determine the percentage of young people with subclinical forms and study the feasibility of using tools for the early detection of this pathology in Primary Care. MATERIAL AND METHODS Observational, cross-sectional and multicentre study developed in the five health centers of the city of Guadalajara. Sample of 291 adolescents (124 males and 167 females) obtained through stratified, multi-stage and proportional random sampling according to age, sex and health centers. Sociodemographic, anthropometric and family variables were studied and the EAT-26, SCOFF and EDE-Q6.0 tests were applied in the first round and the EDE-12 interview in the second round. RESULTS The global prevalence of risk of eating disorders was 17.5% (95% CI: 13.7%-19.4%). The variables, having siblings, being single-parent and having obesity were statistically significant. Among the various types of EDs, the NERD were statistically significant with respect to Anorexia and Bulimia. The subscale concern for the silhouette was statistically significant with respect to the others. The SCOFF questionnaire showed a sensitivity of 91.6% and a specificity of 91.0% and the EDE-Q, 99.3% and 91.7% respectively. CONCLUSIONS High percentage of adolescents at risk of developing an eating disorder. The unspecified type of eating disorders and the concern for the silhouette subscale predominate. The SCOFF test proves to be a good screening instrument in Primary Care.
Collapse
Affiliation(s)
- P S Pérez Martín
- Medicina de Familia y Comunitaria, Centro de Salud Guzmán el Bueno, Madrid, España.
| | - J A Martínez
- Universidad de Alcalá de Henares, Madrid, España
| | - A J Valecillos
- Medicina de Familia y Comunitaria, Centro de Salud El Balconcillo, Guadalajara, España
| | - L Gainza García
- Medicina de Familia y Comunitaria, Centro de Salud Brihuega, Guadalajara, España
| | - M Galán Berasaluce
- Medicina de Familia y Comunitaria, Centro de Salud Gu-Sur, Guadalajara, España
| | - P Checa Díaz
- Medicina de Familia, Centro de Salud Alcolea del Pinar, Guadalajara, España
| |
Collapse
|
186
|
Ambulatory and longitudinal relationships between mindfulness and eating problems: The mediating role of self-objectification. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01668-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
187
|
Relations between implicit attitudes towards eating disorder stimuli and disordered eating symptoms among at-risk college women. Eat Behav 2021; 41:101499. [PMID: 33780689 DOI: 10.1016/j.eatbeh.2021.101499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 03/03/2021] [Accepted: 03/08/2021] [Indexed: 11/23/2022]
Abstract
This study examined implicit attitudes towards different eating disorder (ED) relevant stimuli- emaciation, hard-exercise, the self, and eating related stimuli-and their relationship with explicit ED symptoms in two symptomatic samples of college-aged women. Study 1 found that positive implicit attitudes towards eating and self-relevant images were associated with greater state body image satisfaction and self-esteem and with less ED-related intentions. Study 2 found that positive implicit attitudes towards eating and self-relevant images were associated with less trait global ED psychopathology and distress and greater self-esteem. Overall, positive implicit evaluations of eating and self-related stimuli were negatively associated with ED symptoms and related psychopathology and positively related to self-esteem. However, implicit attitudes towards emaciation and hard exercise were not associated with explicit ED symptoms in either sample. These findings suggest that implicit attitudes towards eating and self-related stimuli, in particular, may be viable targets for reconditioning in novel treatment paradigms such as therapeutic evaluative conditioning interventions.
Collapse
|
188
|
Sahlan RN, Saunders JF, Perez M, Blomquist KK, Fitzsimmons-Craft EE, Bodell LP. The validation of a Farsi version of the Loss of Control over Eating Scale (F-LOCES) among Iranian adolescent boys and girls. Eat Behav 2021; 41:101502. [PMID: 33812127 DOI: 10.1016/j.eatbeh.2021.101502] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/22/2021] [Accepted: 03/25/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Few studies have been conducted on disordered eating in Iran, with limited research on loss of control (LOC) eating in adolescents. The purpose of the current study was to evaluate the validation of a Farsi version of the Loss of Control over Eating Scale (F-LOCES) among Iranian adolescents. METHOD Participants were 504 boys (Age mean = 15.35; Body Mass Index [zBMI] mean = 0.01) and 607 girls (Age mean = 15.71; zBMI mean = -0.01) who completed a battery of questionnaires including the F-LOCES. RESULTS Confirmatory Factor Analysis (CFA) and bi-factor model indicated that the F-LOCES had good fit to the data and supported a three-factor model. Additionally, the scale was invariant across all the groups. Girls had higher scores than boys on the behavioral subscale. Additionally, individuals with elevated eating pathology and zBMI endorsed higher LOC eating. As expected, the F-LOCES scores were positively associated with zBMI, disordered eating symptoms, and depression, and negatively associated with self-esteem. DISCUSSION Findings suggest that the F-LOCES is a reliable and valid measure of LOC eating in Iranian adolescents. The availability of the F-LOCES will enable researchers to examine the developmental trajectories, predictors, and outcomes of LOC eating.
Collapse
Affiliation(s)
- Reza N Sahlan
- Department of Clinical Psychology, Iran University of Medical Sciences, Tehran, Iran
| | - Jessica F Saunders
- Department of Psychological Science, Georgia College and State University, Milledgeville, GA, USA
| | - Marisol Perez
- Department of Psychology, Arizona State University, Tempe, AZ, USA
| | | | | | - Lindsay P Bodell
- Department of Psychology, University of Western Ontario, London, Ontario, Canada.
| |
Collapse
|
189
|
Christian C, Williams BM, Hunt RA, Wong VZ, Ernst SE, Spoor SP, Vanzhula IA, Tregarthen JP, Forbush KT, Levinson CA. A network investigation of core symptoms and pathways across duration of illness using a comprehensive cognitive-behavioral model of eating-disorder symptoms. Psychol Med 2021; 51:815-824. [PMID: 31907093 DOI: 10.1017/s0033291719003817] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND In the past decade, network analysis (NA) has been applied to psychopathology to quantify complex symptom relationships. This statistical technique has demonstrated much promise, as it provides researchers the ability to identify relationships across many symptoms in one model and can identify central symptoms that may predict important clinical outcomes. However, network models are highly influenced by node selection, which could limit the generalizability of findings. The current study (N = 6850) tests a comprehensive, cognitive-behavioral model of eating-disorder symptoms using items from two, widely used measures (Eating Disorder Examination Questionnaire and Eating Pathology Symptoms Inventory). METHODS We used NA to identify central symptoms and compared networks across the duration of illness (DOI), as chronicity is one of the only known predictors of poor outcome in eating disorders (EDs). RESULTS Our results suggest that eating when not hungry and feeling fat were the most central symptoms across groups. There were no significant differences in network structure across DOI, meaning the connections between symptoms remained relatively consistent. However, differences emerged in central symptoms, such that cognitive symptoms related to overvaluation of weight/shape were central in individuals with shorter DOI, and behavioral central symptoms emerged more in medium and long DOI. CONCLUSIONS Our results have important implications for the treatment of individuals with enduring EDs, as they may have a different core, maintaining symptoms. Additionally, our findings highlight the importance of using comprehensive, theoretically- or empirically-derived models for NA.
Collapse
Affiliation(s)
- Caroline Christian
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States of America
| | - Brenna M Williams
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States of America
| | - Rowan A Hunt
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States of America
| | - Valerie Z Wong
- Department of Psychology, Yale University New Haven, CT, United States of America
| | - Sarah E Ernst
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States of America
| | - Samantha P Spoor
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States of America
| | - Irina A Vanzhula
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States of America
| | | | - Kelsie T Forbush
- Department of Psychology, University of Kansas, Lawrence, KS, United States of America
| | - Cheri A Levinson
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States of America
| |
Collapse
|
190
|
Vuillier L, Joseph J, Somerville MP, Harrison A. Believing emotions are uncontrollable is linked to eating disorder psychopathology via suppression and reappraisal. J Eat Disord 2021; 9:43. [PMID: 33794999 PMCID: PMC8015150 DOI: 10.1186/s40337-021-00395-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 03/11/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Research suggests that beliefs about emotional controllability influence the use of emotion regulation strategies, which in turn impact psychological health and illness. However, no research has yet investigated whether emotional controllability is linked to eating psychopathology. The current study investigates whether these concepts are related, as individuals with eating disorders have problems with emotion regulation. METHOD We collected self-report data from 718 participants from a community sample using validated questionnaires, and ran mediational analyses to assess the relationship between emotional controllability and eating psychopathology, via reappraisal and suppression, two emotion regulation strategies. RESULTS Our mediational analyses suggest that believing emotions to be uncontrollable relates to high levels of suppression (β = -.08), low levels of reappraisal (β = .19) and poorer eating disorder psychopathology (β = -.11). Reappraisal and suppression were found to partially mediate the relationship between emotional controllability and eating psychopathology. DISCUSSION The current study has demonstrated relationships that support investigations relating emotional controllability, emotion regulation and psychological health. This research has potential implications for developing interventions to target beliefs about emotions in order to help improve emotion regulation skills and eating psychopathology.
Collapse
Affiliation(s)
- Laura Vuillier
- Faculty of Science and Technology, Department of Psychology, Bournemouth University, Poole, UK.
| | - Jemma Joseph
- Faculty of Science and Technology, Department of Psychology, Bournemouth University, Poole, UK
| | | | - Amy Harrison
- UCL Institute of Education, University College London, London, UK
| |
Collapse
|
191
|
Horsager C, Faerk E, Lauritsen MB, Østergaard SD. Food addiction comorbid to mental disorders: A nationwide survey and register-based study. Int J Eat Disord 2021; 54:545-560. [PMID: 33458821 DOI: 10.1002/eat.23472] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 12/30/2020] [Accepted: 12/30/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Substance use disorder is highly prevalent among individuals with mental disorders. However, it remains largely unknown whether this is also the case for "food addiction"-a phenotype characterized by an addiction-like attraction to predominantly highly processed foods with a high content of refined carbohydrates and fat. Therefore, the primary aim of this study was to estimate the weighted prevalence of food addiction among individuals with mental disorders. METHOD A total of 5,000 individuals aged 18-62 were randomly drawn from eight categories of major mental disorders from the Danish Psychiatric Central Research Register and invited to participate in an online questionnaire-based survey, which included the Yale Food Addiction Scale 2.0. Data on health care and sociodemographics from the Danish registers were linked to all invitees-enabling comprehensive attrition analysis and calculation of the weighted prevalence of food addiction. RESULTS A total of 1,394 (27.9%) invitees participated in the survey. Across all diagnostic categories, 23.7% met the criteria for food addiction. The weighted prevalence of food addiction was highest among individuals with eating disorders (47.7%, 95%CI: 41.2-54.2), followed by affective disorders (29.4%, 95%CI: 22.9-36.0) and personality disorders (29.0%, 95%CI: 22.2-35.9). When stratifying on sex, the prevalence of food addiction was higher among women in most diagnostic categories. DISCUSSION Food addiction is highly prevalent among individuals with mental disorders, especially in those with eating disorders, affective disorders and personality disorders. Food addiction may be an important target for efforts aimed at reducing obesity among individuals with mental disorders.
Collapse
Affiliation(s)
- Christina Horsager
- Aalborg University Hospital, Psychiatry, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Emil Faerk
- Aalborg University Hospital, Psychiatry, Aalborg, Denmark
| | - Marlene Briciet Lauritsen
- Aalborg University Hospital, Psychiatry, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Søren Dinesen Østergaard
- Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
192
|
Review: questionnaires as measures for low energy availability (LEA) and relative energy deficiency in sport (RED-S) in athletes. J Eat Disord 2021; 9:41. [PMID: 33789771 PMCID: PMC8011161 DOI: 10.1186/s40337-021-00396-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A sustained mismatch between energy intake and exercise energy expenditure (EEE) can lead to Low Energy Availability (LEA), health and performance impairments characteristic of Relative Energy Deficiency in Sport (RED-S). Questionnaires can conveniently identify symptoms and/or LEA/ RED-S risk factors. This study aimed to systematically identify, and critique questionnaires used or developed to measure LEA/ RED-S risk in athletic populations. METHODS A systematic search was conducted using PubMed database. Full text articles were included if: (i) the questionnaire(s) in the study identified LEA and/or RED-S risk; (ii) studies developed questionnaires to identify LEA and/or RED-S risk; (iii) participants belonged to athletic population(s); and (iv) in English. RESULTS Thirty-three articles met the inclusion criteria and were reviewed, 13 questionnaires were identified. Eight questionnaires had undergone validation procedures, and three questionnaires included questions related to EEE. The most widely used validated questionnaires were Low Energy Availability in Females Questionnaire (LEAF-Q) (48% articles) and Eating Disorder Examination Questionnaire (EDE-Q) (12% articles). The LEAF-Q determines LEA risk from symptoms but cannot be used in males as nearly half of the items (n = 12) relate to menstrual function. The EDE-Q serves as a surrogate marker of LEA risk in both sexes, as it measures a major risk factor of LEA, disordered eating. Better validation is needed for many questionnaires and more are needed to address LEA/RED-S risk in male athletes. CONCLUSION These questionnaires may be effective in identifying intentional energy restriction but less valuable in identifying inadvertently failure to increase energy intake with increased EEE.
Collapse
|
193
|
Dunkley CR, Brotto LA. Disordered Eating and Body Dissatisfaction Associated with Sexual Concerns in Undergraduate Women. JOURNAL OF SEX & MARITAL THERAPY 2021; 47:460-480. [PMID: 33730967 DOI: 10.1080/0092623x.2021.1898502] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
While research has shown an association between eating disorders and sexual dysfunction, few studies have examined the association between disordered eating and sexuality in non-clinical samples. Here we measured self-reported symptoms of disordered eating, body dissatisfaction, and psychological features characteristic of eating disorders in relation to sexual difficulties among a sample of n = 656 (mean age = 20.59 years) undergraduate women. Disordered eating symptoms were associated with sexual distress, sexual function problems, more cognitive distractions during sexual activity, and poorer sexual self-efficacy. Psychological features characteristic of those with an eating disorder were found to mediate the association between disordered eating and sexual concerns. These findings suggest that eating concerns are associated with sexual difficulties even among women without an eating disorder diagnosis. Further, results highlight the importance of assessing eating disorder symptoms and body dissatisfaction among those seeking treatment for sexual concerns.
Collapse
Affiliation(s)
- Cara R Dunkley
- Department of Psychology, University of British Columbia Sexual Health Research, Vancouver, BC, Canada
| | - Lori A Brotto
- Department of Obstetrics and Gynacology, University of British Columbia Sexual Health Research, Vancouver, BC, Canada
| |
Collapse
|
194
|
Vanzhula IA, Kinkel-Ram SS, Levinson CA. Perfectionism and Difficulty Controlling Thoughts Bridge Eating Disorder and Obsessive-Compulsive Disorder Symptoms: A Network Analysis. J Affect Disord 2021; 283:302-309. [PMID: 33578342 DOI: 10.1016/j.jad.2021.01.083] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/10/2021] [Accepted: 01/30/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Eating disorders (ED) and obsessive-compulsive disorder (OCD) are highly comorbid, but little is known about how this comorbidity is maintained. Prior research suggests that obsessive thoughts and perfectionism may be shared maintenance factors for EDs and OCD. METHODS The current study used network analysis to (1) identify bridge pathways in an ED-OCD comorbidity network and (2) test if perfectionism symptoms bridge between ED-OCD symptoms in a combined network model including ED, OCD, and Perfectionism symptoms. Participants (N = 1,619) were a mixed sample of undergraduate students and individuals diagnosed with EDs. RESULTS Difficulty controlling thoughts was the symptom with the highest bridge centrality in both models, connecting with ED-related worry and doubts. In the ED-OCD-Perfectionism comorbidity network, doubts about simple everyday things and repeating things over and over bridged between ED and OCD symptoms. Additionally, specific and distinct pathways were identified between OCD and two types of ED pathology: restricting (checking compulsions and rigidity around food) and binge eating (hoarding and binge eating symptoms). LIMITATIONS Due to the cross-sectional nature of the data, no directional inferences can be made. Due to a higher OCD symptom prevalence rate than reported in previous studies, our undergraduate sample may not be representative of other college populations. CONCLUSIONS The presence of intrusive cognitions and maladaptive perfectionism may contribute to the maintenance of co-occurring ED and OCD symptoms. These findings begin to delineate specific pathways among OCD and ED symptoms, which can be used in the development of interventions to disrupt connections among these disorders.
Collapse
Affiliation(s)
- Irina A Vanzhula
- University of Louisville, Department of Psychological & Brain Sciences
| | | | - Cheri A Levinson
- University of Louisville, Department of Psychological & Brain Sciences.
| |
Collapse
|
195
|
Globus I, Kissileff HR, Hamm JD, Herzog M, Mitchell JE, Latzer Y. Comparison of Interview to Questionnaire for Assessment of Eating Disorders after Bariatric Surgery. J Clin Med 2021; 10:jcm10061174. [PMID: 33799746 PMCID: PMC7999484 DOI: 10.3390/jcm10061174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/22/2021] [Accepted: 02/25/2021] [Indexed: 11/16/2022] Open
Abstract
The Eating Disorder Examination Interview Bariatric Surgery Version (EDE-BSV) assesses eating pathology after bariatric surgery but requires significant training and time to administer. Consequently, we developed a questionnaire format called the Eating Disorders After Bariatric Surgery Questionnaire (EDABS-Q). This study evaluates the consistency of responsiveness between the two formats. After surgery, 30 patients completed the EDE-BSV and EDABS-Q in a restricted randomized design. Patient reported behavior for each item which was converted to a score following the Eating Disorder Examination-Questionnaire (EDE-Q) scoring scheme. Responses fell into three distributions: (1) dichotomous, (2) ordinal, or (3) unimodal. Distributions of items were not different between the two formats and order did not influence response. Tests of agreement (normal approximation of the binomial test) and association (χ2 analyses on binary data and spearman rank order correlations on ordinal items) were performed. Percent concordance was high across items (63-100%). Agreement was significant in 31 of 41 items (Bonferroni-P < 0.001). Association was significant in 10 of 21 in χ2-appropriate items (Bonferroni-P < 0.002), and the ordinal items had highly significant correlations between formats (Bonferroni-P < 0.0125). The EDABS-Q is an adequate substitute for the EDE-BSV and may be useful for research and clinical evaluation of eating pathology after bariatric surgery.
Collapse
Affiliation(s)
- Inbal Globus
- School of Public Health, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, Haifa 3498838, Israel;
- Maccabi Healthcare Services, Hamered 27, Tel-Aviv 6812509, Israel
| | - Harry R. Kissileff
- Mount Sinai Morningside Hospital, 1111 Amsterdam Avenue, New York, NY 10025, USA; (H.R.K.); (J.D.H.)
- Diabetes, Obesity, and Metabolism Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, USA
| | - Jeon D. Hamm
- Mount Sinai Morningside Hospital, 1111 Amsterdam Avenue, New York, NY 10025, USA; (H.R.K.); (J.D.H.)
- Diabetes, Obesity, and Metabolism Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, USA
- Institute of Human Nutrition, Vagelos College of Physicians & Surgeons, Columbia University, 630 W 168th Street #1512, New York, NY 10032, USA
| | - Musya Herzog
- Department of Counseling & Clinical Psychology, Teachers College, Columbia University, 525 W 120th Street, New York, NY 10027, USA;
| | - James E. Mitchell
- University of North Dakota School of Medicine, 1244 Wildwood Way, Chaska, MN 55318, USA;
| | - Yael Latzer
- Faculty of Social Welfare and Health Sciences, University of Haifa, 199 Aba Khoushy Avenue, Mount Carmel, Haifa 3498838, Israel
- Eating Disorders Institution, Rambam Health Care Campus, HaAliya HaShniya St. 8, Haifa 3109601, Israel
- Correspondence: ; Tel.: +972-54-4736673 or +1-917-935-1824
| |
Collapse
|
196
|
Dreier MJ, Coniglio K, Selby EA. Mapping features of pathological exercise using hierarchical-dimensional modeling. Int J Eat Disord 2021; 54:422-432. [PMID: 33185893 DOI: 10.1002/eat.23406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/23/2020] [Accepted: 10/24/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Pathological exercise is common among those with eating disorders and has typically been characterized as excessive, compulsive, or compensatory in nature. Little is known about how pathological exercise is associated with other eating disorder behaviors or personality traits, or whether these associations differ between men and women. METHOD We used hierarchical dimensional modeling in three samples, including college women (N = 205), women with eating psychopathology (N = 268), and college men (N = 235), to examine latent associations between pathological exercise and eating disorder psychopathology, namely compulsivity, emotion regulation, and body dissatisfaction. RESULTS Using Goldberg's (2006) "bass-ackwards" method, we identified separate 10-factor solutions (women) or an 11-factor solution (men). A distinct muscle building factor arose in the three-factor solution for men, and it also notably arose in the six- and eight-factor solutions for community and college women, respectively, highlighting an important understudied motivation factor in both healthy and pathological exercise. Each solution accounted for 64.8% (college women), 51.9% (women with eating psychopathology), and 43.9% (college men) of the variance in excessive exercise, respectively. DISCUSSION Findings indicate that pathological exercise is associated with different psychological traits (e.g., poor emotion regulation, compulsivity) across populations, and such differences may necessitate unique treatment approaches tailored accordingly.
Collapse
Affiliation(s)
- Melissa J Dreier
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kathryn Coniglio
- Department of Psychology, Rutgers University, Piscataway, New Jersey, USA
| | - Edward A Selby
- Department of Psychology, Rutgers University, Piscataway, New Jersey, USA
| |
Collapse
|
197
|
Convertino AD, Brady JP, Albright CA, Gonzales M, Blashill AJ. The role of sexual minority stress and community involvement on disordered eating, dysmorphic concerns and appearance- and performance-enhancing drug misuse. Body Image 2021; 36:53-63. [PMID: 33232935 DOI: 10.1016/j.bodyim.2020.10.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/09/2020] [Accepted: 10/22/2020] [Indexed: 02/08/2023]
Abstract
Prior research has established that sexual minority (SM) individuals are more likely to experience disordered body image behaviors and concerns than heterosexual individuals. This increased risk may be explained by minority stress theory - that SM individuals are subject to SM-specific stressors, leading to health disparities - but this has not yet been fully examined. Furthermore, this theory states that SM community involvement may mitigate negative outcomes. The current study examines whether minority stress is associated with screening positive for an eating disorder, screening positive for body dysmorphic disorder, and appearance- and performance-enhancing drug misuse in a sample of SM individuals (483 women and 479 men) in the US. This study also examines whether the effect of minority stress is moderated by SM community involvement. Logistic regressions were conducted for each type of minority stress (internalized homophobia, sexual orientation concealment, and heterosexist discrimination) interacting with community involvement. After correction for multiple comparisons, all minority stressors and community involvement were positively associated with increased odds of disordered body image behaviors and concerns, with no evidence of a buffering effect for community involvement. The lack of a buffering effect is contrary to minority stress theory and may inform future prevention efforts.
Collapse
Affiliation(s)
- Alexandra D Convertino
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, United States
| | - John P Brady
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, United States
| | - Christopher A Albright
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, United States
| | - Manuel Gonzales
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, United States
| | - Aaron J Blashill
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, United States; Department of Psychology, San Diego State University, College of Sciences, 5500 Campanile Drive, San Diego, CA, 92182, United States.
| |
Collapse
|
198
|
Gonzales M, Blashill AJ. Ethnic/racial and gender differences in body image disorders among a diverse sample of sexual minority U.S. adults. Body Image 2021; 36:64-73. [PMID: 33171428 PMCID: PMC7987714 DOI: 10.1016/j.bodyim.2020.10.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 10/15/2020] [Accepted: 10/22/2020] [Indexed: 12/16/2022]
Abstract
This study assessed the occurrence of probable eating disorders (EDs), ED symptoms, probable body dysmorphic disorder (BDD), BDD symptoms, drive for muscularity, and appearance and performance enhancement drug (APED) misuse, in an ethnically/racially diverse sample of 962 cisgender sexual minority (SM) individuals in the United States, aged 18-30 years old. The overall occurrence of probable ED, probable BDD, and APED misuse in the current sample was 32.7 %, 50.9 %, and 30.6 %, respectively. With respect to ethnicity/race, Hispanic SMs reported the highest rates of EDs, BDD, APED misuse, and drive for muscularity, and may therefore be particularly at risk for developing body image disorders (BIDs). With respect to gender, SM men reported significantly greater drive for muscularity and APED misuse compared to SM women, while SM women reported significantly higher occurrence of probable ED and ED symptoms. The occurrence of EDs, BDD, and APED misuse were higher among SMs in this sample compared to previous rates found among heterosexual samples, suggesting that SMs, regardless of gender and ethnicity/race, are vulnerable to experiencing BIDs and APED misuse. Future research is needed to identify the mechanisms that place SMs at (increased) risk for BIDs, which will aid prevention/intervention development.
Collapse
Affiliation(s)
- Manuel Gonzales
- Department of Psychology, College of Sciences, San Diego State University, 5500 Campanile Drive, San Diego CA 92182-4611, United States.
| | - Aaron J Blashill
- San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology, United States; Department of Psychology, College of Sciences, San Diego State University, 5500 Campanile Drive, San Diego CA 92182-4611, United States.
| |
Collapse
|
199
|
Smith AJ, Farstad SM, von Ranson KM. Self-reported eating disorder psychopathology prevalence in community-based female and male Albertans: Gender and age group comparisons. Int J Eat Disord 2021; 54:438-444. [PMID: 33296105 DOI: 10.1002/eat.23434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/25/2020] [Accepted: 11/26/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE We describe and compare eating disorder (ED) psychopathology prevalence in Canadian females and males across five age groups. METHOD This secondary data analysis study used the Eating Disorder Examination Questionnaire (EDE-Q) to assess ED psychopathology in 1,316 Alberta community-based female and male participants, aged 15 to 71. RESULTS Overall, 15.3% of female and 8.2% of male participants reported clinically-significant ED disturbances. Female participants reported greater global ED psychopathology than male participants, except older men and women aged 65-71, who reported similar, relatively low levels of global ED psychopathology. Women aged 65-71 endorsed less global ED psychopathology than younger females. More females than males reported regular binge eating and self-induced vomiting, whereas other ED behaviors were endorsed at similar rates. DISCUSSION This large-scale study, the first involving a Canadian sample, contributes to a small literature on ED psychopathology in community-based samples. The finding that 15% of female and 8% of male Albertans aged 15 to 71 endorsed clinically-significant ED disturbances is concerning; however, women aged 65-71 reported lower ED psychopathology than younger females. Gender and age differences were observed in global ED psychopathology. Routine ED screening of non-clinical adolescents and adults is warranted to permit prevention and early intervention.
Collapse
Affiliation(s)
- Alyssa J Smith
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Sarah M Farstad
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | | |
Collapse
|
200
|
Abstract
Abstract
Background
Negative illness representations such as self-blame impede treatment-seeking behavior and therapy motivation in individuals with eating disorders (EDs). However, only one study so far has investigated how different explanatory models influence these beliefs in EDs. We aimed to expand these findings by introducing an explanatory model based on network theory (NT).
Methods
We presented three explanatory models to a diverse web-recruited sample (n = 290, 141 females, 149 males) with clinically elevated ED symptomatology. Participants either watched a video with a biological-genetic (BG), cognitive-behavioral (CB) or an NT explanatory model and were asked about illness representations before and after watching the video.
Results
The BG group showed significantly greater reductions in self-blame but a significant decrease in personal control and less optimistic expectation regarding timeline compared to the CB and NT groups. There were no group differences regarding the perception of the clinician, comprehensibility of the explanatory model and credibility of a CBT intervention.
Conclusions
Given the increasing popularity of biological-genetic explanatory models of EDs, it is important to note the disadvantages we found to be associated with these models. Our findings indicate that explanatory models emphasizing cognitive-behavioral (CB) principles and/or network theoretical (NT) underpinnings of EDs may serve to promote optimism and greater perceptions of personal agency in affected populations.
This trial's registration number is 316.
Collapse
|