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

Quality of life following liposuction for lipoedema: a prospective outcome study

BACKGROUND

The study examines, for the first time, the impact on quality of life after liposuction for lipoedema. The influence of aesthetic plastic interventions and their effects on treatment outcomes has been a major focus of our research group over the past 20 years.

METHODS

A total of 35 patients were invited to participate in our prospective study, with 30 responding to both the pre- and postoperative questionnaires. The patients received the questionnaires pre-operatively, and 6 months after the liposuction. Our questionnaire set included a self-developed, indication-specific part, along with standardised and validated questionnaires such as the Questions on Life Satisfaction (FLZM), Patient Health Questionnaire (PHQ-4), Rosenberg Self-Esteem Scale (RSES) and the Freiburg personality inventory-revised (FPI-R).

RESULTS

Our self-developed questionnaire showed that our patients feel more balanced, more attractive and more self-confident after the treatment. The FLZM showed significant improvements in all three modules: the general satisfaction with life, the state of health and the outer appearance (body image). Using the PHQ-4, a significant improvement in the two subscales of anxiety and depression could be determined, as well as a reduction in overall mental stress. In addition, the RSES showed a significant improvement in self-esteem post-operatively. Furthermore, the FPI-R indicated a significant improvement in emotional stability.

CONCLUSIONS

Liposuction improves the quality of life in lipoedema patients. Post-operatively, our patients reported less pain and were more satisfied with their bodies and appearance. The hypothesis that liposuction in lipoedema improves the quality of life as a multidimensional construct could be confirmed.

Effectiveness of Cognitive Behavior Therapy Combined with Eye Movement Desensitization and Reprocessing on Psychological Problems and Life Quality in Patients' Postfacial Trauma

Objective

To investigate the effectiveness of cognitive behavior therapy (CBT) combined with eye movement desensitization and reprocessing (EMDR) on the esteem, anxiety, depression, posttrauma stress disorder (PTSD), and posttraumatic growth in patients with facial trauma.

Methods

A total of 92 facial trauma patients in Wenzhou People's Hospital from January 2017 to December 2019 were enrolled in this study. The patients were randomly divided into control group (n = 46) and intervention group (n = 46). Both of the control group and the intervention group received routine treatment, while the intervention group further received CBT combined with EMDR. Questionnaires were used to explore and record the general patient information. The Self-Esteem Scale (SES), Self-Anxiety Scale (SAS), Self-Depression Scale (SDS), Posttraumatic Stress Disorder Checklist Civilian Version (PCL-C), Posttraumatic Growth Inventory (PTGI), and World Health Organization Quality of Life-brief (WHOQOL-BREF) scores between the two groups were compared.

Results

After CBT combined with EMDR intervention, the SDS and SAS scores in the intervention group were significantly decreased compared with the scores before intervention with statistically significance (P < 0.001). Furthermore, the PCL-C score in the intervention group showed significant decrease in comparison with the control group (P < 0.001), while the PTGI score in the intervention group was significantly higher than the control group (P < 0.001). The WHOQOL-BREF scores were increased after treatment in the two groups compared with the scores before treatment, and the scores in the intervention group were higher than those in the control group after treatment (P < 0.01).

Conclusion

Psychological intervention therapy can effectively alleviate the anxiety, depression, and PTSD and improve the life quality and the recovery of facial trauma patients.

Weight control beliefs in the treatment of binge-eating disorder: Why might they matter?

OBJECTIVE

The belief in personal control over weight (BCWeight) is positively associated, while the belief in control over healthy lifestyle with weight acceptance (BCLifestyle) is negatively associated with disordered eating, body dissatisfaction, and low self-esteem. This study examined how weight control beliefs are impacted by cognitive behavior therapy (CBT) for binge-eating disorder (BED) that provides evidence and choice regarding weight management options; and assessed whether changes in weight control beliefs are associated with treatment outcomes.

METHOD

Participants were 57 patients consecutively referred to an outpatient eating disorder clinic from 2013-2017 for BED treatment. Using retrospective self-reported program-evaluation data, baseline to post-CBT changes in weight control beliefs were evaluated, as well as whether these changes were associated with the change in the drive for thinness, body dissatisfaction, fear of loss of control over eating, and self-esteem.

RESULTS

BCLifestyle significantly increased over CBT; BCWeight significantly decreased. Increases in BCLifestyle were associated with the reduced drive for thinness, body dissatisfaction, and fear of loss of control overeating. Decreases in BCWeight were associated with improved self-esteem.

DISCUSSION

BED CBT that provides science on weight management options is associated with positive changes in weight control beliefs, which are associated with measures of recovery from BED.

PUBLIC SIGNIFICANCE STATEMENT

Cognitive behavior therapy (CBT) for binge-eating disorder decreases the belief that one can and should control one's weight, and increases the belief that one should strive for a healthy lifestyle and accept one's weight. These changes in beliefs are associated with improved treatment outcomes. CBT that gives patients evidence on different weight management options addresses patient obesity concerns and is related to positive change in weight control beliefs.

A bifactor analysis of the Weight Bias Internalization Scale: What are we really measuring?

Internalized weight stigma (IWS) has been linked with disordered eating behavior, both directly, and as a mediator of the relationship between experienced weight stigma and maladaptive coping. However, the construct of IWS is highly correlated with the related constructs of body image and global self-esteem, and the three constructs may better be represented by underlying trait self-judgment. This overlap is not generally accounted for in existing studies. The present study investigated the shared variance between self-esteem, body image, and IWS in an international sample of higher-weight individuals. Bifactor analysis confirmed that the intermediary role of IWS in the relationship between experienced stigma and self-reported eating behavior was largely accounted for by aspects of body image and global self-esteem. Greater conceptual clarity in the study of IWS is needed to understand the mechanisms via which societal weight stigma impacts on individuals' self-directed judgments and downstream health-related behaviors.

Internalised Weight Stigma Moderates the Impact of a Stigmatising Prime on Eating in the Absence of Hunger in Higher- but Not Lower-Weight Individuals

A considerable body of evidence links internalised weight stigma with higher levels of disordered eating behaviour and cognitions in both normative- and higher-weight populations. However, to date, the impact of internalised weight stigma on objectively measured food intake has not been explored. In the present study, a weight-diverse sample of 158 non-smoking adults (BMI ≥ 25 kg/m2 n = 72, BMI < 25 kg/m2 n = 86) were recruited to a study on "The effects of hunger and satiety on information processing." Participants first completed a series of online questionnaires, then attended a lab visit in a fed state. Participants were randomised to read a sham news article on the negative consequences of either weight (stigma condition) or smoking (control condition) and answer some questions about the article. Then, under the pretence of a non-study-relevant break, participants were exposed to a pre-weighed selection of sweet and savoury snacks for 15 min. Mood and hunger levels were assessed prior to and after reading the vignette, and after the break. In contrast to the relationship with self-report eating behaviour, internalised weight stigma was not a significant independent predictor of total energy intake and did not moderate the relationship between exposure to the stigma prime and calories consumed. However, differences emerged on the basis of participants' weight status. Higher-weight participants with high levels of internalised weight stigma consumed fewer snack calories following exposure to a weight-stigma prime compared with a neutral prime (B = -137, SE = 58, t = -2.35, p = 0.020, 95% CI -252, -22) whereas those with low levels of internalised weight stigma tended to eat more in the weight stigma condition (B = 118, SE = 62, t = 1.91, p = 0.059, 95% CI -4, 241). In normative-weight participants, no differences in energy intake by levels of internalised weight stigma were observed. These findings suggest differences in the relationships between internalised weight stigma and self-reported disordered eating behaviour versus eating in the absence of hunger (EAH) measured under laboratory conditions. Additionally, internalised weight stigma appears to have differential effects on response to stigma in higher-weight and normative-weight individuals.

The associations of healthful weight-control behaviors with psychological distress and changes in body mass index among young adults

The aim of this research is to study young adults who try to lose weight using only healthful weight-control behaviors. Secondary analyses of the US National Longitudinal Study of Adolescent to Adult Health (Add-Health, N = 3,882) were performed. Females who used only healthful weight-control behaviors had lower self-esteem than females who did not try to lose weight, and less depressive symptoms than females who used unhealthful weight-control behaviors. Data suggested that females who used only healthful weight-control behaviors were at higher risk for gains in body mass index than females who did not try to lose weight. This study adds to the extant literature about weight-control behaviors by highlighting that people who try to lose weight using only healthful weight-control behaviors merit special attention from both scientific and practical points of view.

An exploration of the link between adult attachment and problematic Facebook use

BACKGROUND

Previous studies have reported on positive and negative psychological outcomes associated with the use of social networking sites (SNSs). Research efforts linking Facebook use with depression and low self-esteem have indicated that it might be the manner in which people engage with the site that makes its use problematic for some people. The aim of the current study was to test a theoretical model of problematic Facebook use, using adult attachment style as the predictor variable of interest.

METHOD

A cross-sectional design was employed wherein adult Facebook users (n = 717) completed measures of psychological distress, self-esteem, and adult attachment, in addition to measures of problematic Facebook use (i.e. social comparison, self-disclosures, impression management, & intrusive Facebook use). Data were analysed using hierarchical multiple regression and mediation analyses.

RESULTS

The results of this study indicated that attachment anxiety was predictive of all facets of problematic Facebook use, and that attachment avoidance was predictive of impression management, and social consequences of intrusive Facebook use. Further analyses confirmed the mediating influences of psychological distress and self-esteem on these relationships.

CONCLUSIONS

Users of Facebook with higher levels of attachment insecurity may be gravitating towards the site in order to fulfil their attachment needs. This tendency is likely to be particularly prevalent for those individuals with low self-esteem who are experiencing psychological distress.

Form and formulation: Examining the distinctiveness of body image constructs in treatment-seeking patients with binge-eating disorder

OBJECTIVE

Body-image disturbance is a core aspect of eating disorders, yet the clinical manifestations of individuals' weight and shape concerns are complex, vary considerably, and are poorly understood by clinicians and researchers. This study aimed to distinguish different aspects of body-image disturbance-including weight/shape dissatisfaction, weight/shape overvaluation, weight/shape preoccupation, and fear of weight gain-in patients with binge-eating disorder (BED). Examining how each specific body image construct relates to biopsychosocial features of BED could contribute to the refinement of conceptualization and treatment planning.

METHOD

The current study assessed body-image disturbance and eating-disorder psychopathology in 748 treatment-seeking patients with BED using established investigator-based interviews reliably administered by doctoral clinicians.

RESULTS

The 4 body image constructs, although related to one another, showed some important similarities in associations with biopsychosocial clinical features, as well as some important distinctions. The relation between overvaluation and self-esteem was, as conceptualized, more strongly negative than for other body image variables, and preoccupation was more associated than other body image variables with eating concerns. Biopsychosocial features of BED were associated with different forms of body-image disturbance, but associations of body image variables with body mass index (BMI) were not significant and associations with binge-eating frequency did not differ across body image variables.

CONCLUSION

Manifestations of body-image disturbance in BED are complex and understanding the distinctions between different body image constructs can contribute to treatment formulation. (PsycINFO Database Record

Cognitive and physical development in HIV-positive children in South Africa and Malawi: A community-based follow-up comparison study

BACKGROUND

Child development is negatively impacted by HIV with children that are infected and affected by HIV performing worse than their peers in cognitive assessments.

METHODS

We conducted a descriptive follow-up comparison study (n=989) in South Africa and Malawi. We tracked child development in 135 HIV-positive children compared to 854 uninfected children aged 4-13 years attending community-based organizations at baseline and again 12-15 months later.

RESULTS

Children with HIV were more often stunted (58.8% vs. 27.4%) and underweight (18.7% vs. 7.1%). They also had significantly poorer general physical functioning (M=93.37 vs. M=97.00). HIV-positive children scored significantly lower on digit span and the draw-a-person task.

CONCLUSIONS

These data clearly show that HIV infection poses a serious risk for child development and that there is a need for scaled up interventions. Community-based services may be ideally placed to accommodate such provision and deliver urgently needed support to these children.

Intraclass correlation values for adolescent health outcomes in secondary schools in 21 European countries

BACKGROUND

Cluster randomised controlled trials (CRCTs) are increasingly used to evaluate the effectiveness of interventions for improving health. A key feature of CRCTs is that individuals in clusters are often more alike than individuals in different clusters, irrespective of treatment. This similarity within clusters needs to be taken into account when planning CRCTs to obtain adequate sample sizes, and when analysing clustered data to obtain correct estimates.

METHODS

Nationally representative data from 15 to 16 year olds were analysed, from 21 of the 35 countries that participated in the 2007 European School Survey Project on Alcohol and Other Drugs. Within country school level intra-class correlation coefficients (ICCs) were calculated for substance use (self-reported alcohol use, regular alcohol use, binge drinking, any smoking, regular smoking, and illicit drug use) and psychosocial health (depressive mood and self-esteem). Unadjusted and adjusted ICCs are presented. ICCs are adjusted for student sex and socioeconomic status.

RESULTS

ICCs ranged from 0.01 to 0.21, with the highest (0.21) reported for regular smoking. Within country school level ICCs varied substantially across health outcomes, and among countries for the same health outcomes. Estimated ICCs were consistently higher for substance use (range 0.01-0.21), than for psychosocial health (range 0.01-0.07). Within country ICCs for health outcomes varied by changes in the measurement of particular health outcomes, for example the ICCs for regular smoking (range 0.06-0.21) were higher than those for having smoked at all in the last month (range 0.03-0.17).

CONCLUSIONS

For school level ICCs to be effectively utilised in informing sample size requirements for CRCTs and adjusting estimates from meta-analyses, the school level ICCs need to be both country and outcome specific.

Do not forget the boys - gender differences in children living in high HIV-affected communities in South Africa and Malawi in a longitudinal, community-based study

Gender is an important factor in child development. Especially in sub-Saharan Africa, girls have often been shown to be less likely to access education compared to boys. The consequence of this has been that that programmes addressing child development are often aimed at girls in order to redress gender imbalances. This study examines the effect of gender on the development of children attending community-based organisations in high HIV-affected areas, and explores whether community-based organisation attendance was associated with any changes in gender differences over time. Baseline data from 989 children and 12-15 month follow from 854 (86% response rate) were used to examine gender differences in children from Malawi and South Africa. At baseline, where there were differences by gender, these tended to disadvantage boys. It was found that boys were significantly more often found to be subjected to violence. Boys showed worse performance at school and more behavioural problems than girls. These gender differences persisted from baseline to follow-up. At follow-up, boys self-reported significantly worse average quality of life than girls. Only harsh discipline differed by gender in progression over time: boys experienced a stronger reduction in harsh physical discipline than girls from baseline to follow-up. Since harsh discipline was associated with boys' worse educational outcomes and behavioural problems, our data cautiously suggests that gender differences could be reduced over time. In conclusion, our data suggests that, perhaps due to the narrow equity approach focusing on provision for girls, boys may be overlooked. As a result, there are some specific experiences where boys are generally worse off. These differences have distinct ramifications for the educational and emotional development of boys. A broader equity approach to child development might be warranted to ensure that the needs of both girls and boys are considered, and that boys are not overlooked.

Perfectionism, weight and shape concerns, and low self-esteem: Testing a model to predict bulimic symptoms

Previous studies have tested multivariate models of bulimia pathology development, documenting that a confluence of perfectionism, body dissatisfaction, and low self-esteem is predictive of disordered eating. However, attempts to replicate these results have yielded controversial findings. The objective of the present study was to test an interactive model of perfectionism, weight and shape concerns, and self-esteem in a sample of patients affected by Eating Disorder (ED). One-hundred-sixty-seven ED patients received the Structured Clinical Interview for DSM-IV Axis I (SCID-I), and they completed the Eating Disorder Examination Questionnaire (EDE-Q), the Rosenberg Self-Esteem Scale (RSES), and the Multidimensional Perfectionism Scale (MPS-F). Several mediation analysis models were fit to test whether causal effects of concern over weight and shape on the frequency of bulimic episodes were mediated by perfectionism and moderated by low levels of self-esteem. Contrary to our hypotheses, we found no evidence that the causal relationship investigated was mediated by any of the dimensions of perfectionism. As a secondary finding, the dimensions of perfectionism, perceived criticism and parental expectations, were significantly correlated with the presence of bulimic symptoms. The validity of the interactive model remains controversial, and may be limited by an inadequate conceptualization of the perfectionism construct.

Factor structure and construct validity of the Eating Disorder Examination-Questionnaire in college students: further support for a modified brief version

OBJECTIVE

The Eating Disorder Examination-Questionnaire (EDE-Q) is widely used in research studies across clinical and nonclinical groups. Relatively little is known about psychometric properties of this measure and the available literature has not supported the proposed scale structure. This study evaluated the factor structure and construct validity of the EDE-Q in a nonclinical study group of young adults.

METHOD

Participants were 801 young adults (573 females and 228 males) enrolled at a large public university in the Midwestern United States who completed the EDE-Q and a battery of behavioral and psychological measures.

RESULTS

Confirmatory factor analysis (CFA) revealed an inadequate fit for the original EDE-Q structure but revealed a good fit for an alternative structure suggested by recent research with predominately overweight/obese samples. CFA supported a modified seven-item, three-factor structure; the three factors were interpreted as dietary restraint, shape/weight overvaluation, and body dissatisfaction. Factor loadings and item intercepts were invariant across sex and overweight status. The three factors had less redundancy than the original EDE-Q scales and demonstrated improved convergent and discriminant validity in relation to relevant other measures.

DISCUSSION

These factor-analytic findings, which replicate findings from studies with diverse predominately overweight/obese samples, supported a modified seven-item, three-factor structure for the EDE-Q with improved psychometric characteristics. The findings provide further empirical support for the distinction between body dissatisfaction and overvaluation and have implications for assessment and research. These findings need to be replicated in samples of persons with eating-disorder psychopathology including those with anorexia nervosa, bulimia nervosa, and allied states.

Membership in Fraternities and Sororities, Depression, and Suicidal Ideation

College student membership in fraternities/sororities may have positive or negative effects on their behavior. This study investigated the relationships between fraternity/sorority membership, depression, and suicidal behavior. 293 undergraduate students (232 women, 61 men; M age= 22.6 yr., SD=1.5, range=18–24; 127 sorority sisters, 35 fraternity brothers) from a rural state college participated in the study. Depression, self-esteem and perceived social support were measured with the Beck Depression Inventory, the Rosenberg Self-esteem Scale, and the Multidimensional Scale of Perceived Social Support, respectively. Depression and suicidal ideation correlated negatively with self-esteem and perceived social support, but were not correlated with membership in fraternities/sororities.

Eating disorder examination-questionnaire factor structure and construct validity in bariatric surgery candidates

BACKGROUND

The Eating Disorder Examination-Questionnaire (EDE-Q) is increasingly used in studies with bariatric surgery patients although little is known about psychometric properties of this self-report measure in this clinical group. The current study evaluated the factor structure and construct validity of the EDE-Q in bariatric surgery candidates.

METHODS

Participants were a consecutive series of 174 obese bariatric surgery candidates who completed the EDE-Q and a battery of behavioral and psychological measures.

RESULTS

Confirmatory factor analysis (CFA) revealed an inadequate fit for the original EDE-Q structure but revealed a good fit for an alternative structure suggested by recent research with obese samples. CFA supported a seven-item, three-factor structure; the three factors were interpreted as dietary restraint, shape/weight overvaluation, and body dissatisfaction. The three factors converged with other relevant collateral measures.

CONCLUSIONS

These factor analytic findings, which replicate recent findings from studies with diverse obese samples, demonstrated convergent validity. Implications of these findings for clinical assessment and research with bariatric surgery patients are discussed.

Pretreatment outcome indicators in an eating disorder outpatient group: the effects of self-esteem, personality disorders and dissociation

OBJECTIVE

The prognosis for eating disorders (ED) is unsatisfactory, and the literature about outcome indicators is controversial. The present study evaluates the roles of self-esteem, personality disorders (PD), and dissociation as outcome predictors.

METHOD

Fifty-seven ED outpatients were recruited from a population beginning a Cognitive Behavioral Therapy-Enhanced (CBT-E) treatment. All patients received the Structured Clinical Interview for DSM-IV Axis I (SCID-I), the Structured Clinical Interview for DSM-IV Axis II (SCID-II), and completed the Eating Disorder Examination Questionnaire (EDE-Q), the Dissociation Questionnaire (DIS-Q), and the Rosenberg Self-Esteem Scale (RSES). One month after the end of treatment, recovery was evaluated as meeting the DSM-IV criteria for EDs.

RESULTS

A small group of patients recovered (42.2%). Low self-esteem and dissociation results correlated with a negative outcome.

DISCUSSION

Dissociation may be an important moderator of psychotherapy and treatment success, as already suggested by previous studies on non-eating-related disorders.

Treatment engagement in eating disorders: who exits before treatment?

OBJECTIVE

Traditionally, drop-out has been investigated subsequent to treatment entry; yet some individuals "exit early," attending assessment but failing to commence the treatment offered. Early exit burdens administrative and clinical resources and means that individuals may not receive the care needed for recovery. This study aimed to describe the prevalence and characteristics associated with early exit at a statewide, outpatient eating disorder service.

METHOD

From a pool of 972 consecutive referrals of adults and youth (16+ years), two groups were formed; an "early exit" group of individuals who attended assessment but chose to exit the service prior to treatment entry and a "non-early exit" group that attended assessment and entered treatment. The groups were compared on sociodemographic, clinical, and administrative features.

RESULTS

The prevalence of early exit was 18.7%. The early exit group exhibited less pathology compared with the non-early exit group; specifically, a lower presence of Axis I comorbidity (p = .04) and self-induced vomiting (p = .04).

DISCUSSION

The findings, considered in the context of previous research, suggest that there are no measured features to date that are robustly associated with early exit from outpatient eating disorder services. Future research should investigate decision-making processes at assessment, to inform patient-centered approaches that optimize transition to treatment.

Predictive significance of the overvaluation of shape/weight in obese patients with binge eating disorder: findings from a randomized controlled trial with 12-month follow-up

BACKGROUND

Undue influence of body shape or weight on self-evaluation - referred to as overvaluation - is considered a core feature across eating disorders, but is not a diagnostic requirement for binge eating disorder (BED). This study examined the concurrent and predictive significance of overvaluation of shape/weight in obese patients with BED participating in a randomized clinical trial testing cognitive behavioral therapy (CBT) and behavioral weight loss (BWL). Method A total of 90 participants were randomly assigned to 6-month group treatments of CBT or BWL. Assessments were performed at baseline, throughout- and post-treatment, and at 6- and 12-month follow-ups after completing treatments with reliably administered semi-structured interviews and established measures.

RESULTS

Participants categorized with overvaluation (n = 52, 58%) versus without overvaluation (n = 38, 42%) did not differ significantly in demographic features (age, gender and ethnicity), psychiatric co-morbidity, body mass index or binge eating frequency. The overvaluation group had significantly greater levels of eating disorder psychopathology and poorer psychological functioning (higher depression and lower self-esteem) than the non-overvaluation group. Overvaluation of shape/weight significantly predicted non-remission from binge eating and higher frequency of binge eating at the 12-month follow-up, even after adjusting for group differences in depression and self-esteem levels.

CONCLUSIONS

Our findings suggest that overvaluation does not simply reflect concern commensurate with being obese or more frequent binge eating, but also is strongly associated with heightened eating-related psychopathology and psychological distress, and has negative prognostic significance for longer-term treatment outcomes. Overvaluation of shape/weight warrants consideration as a diagnostic specifier for BED as it provides important information about severity and treatment outcome.

Outcomes of a 12-month technology-based intervention to promote weight loss in adolescents at risk for type 2 diabetes

BACKGROUND

Obese adolescents are at risk for type 2 diabetes mellitus (T2DM). Obesity interventions delivered through media, such as the web and text messages [short message service (SMS)] may be beneficial when targeting obese adolescents..

METHODS

A randomized controlled trial, Pace-Internet for Diabetes Prevention Intervention (PACEi-DP), compared three forms of an obesity intervention to usual care (UC): (a) website only (W); (b) website, monthly group sessions, and follow-up calls (WG); and (c) website and SMS (WSMS). Participants were overweight or obese adolescents at risk for T2DM (n = 101; age 12-16 years; mean body mass index (BMI) percentile = 97.6; 74.3% Hispanic). In addition to the website, WSMS participants received SMS supporting intervention goals and behavioral strategies and communicated via SMS with a case manager. WG participants had additional group activities related to weight loss and received follow-up calls from a health coach. UC participants were given printed materials and encouraged to attend three initial group sessions. Repeated measures mixed model regression analyses tested treatment effects for anthropometric, behavioral, and behavioral change strategy outcomes.

RESULTS

There were no treatment effects for BMI, adiposity, physical activity, or diet at 12 months. Treatment effects were observed for sedentary behavior, with the W arm having a greater decrease in sedentary behavior (4.9 to 2.8 h/day) than the UC arm (p = .006).

CONCLUSION

Although not sufficient to produce weight loss, the combination of web intervention and group sessions with telephone follow-up yielded improvements in sedentary behavior and in the use of behavior change strategies expected to lead to behavior change.

Psychiatric disorder co-morbidity and correlates in an ethnically diverse sample of obese patients with binge eating disorder in primary care settings

OBJECTIVE

To examine DSM-IV lifetime/current psychiatric disorder co-morbidity and correlates in ethnically-diverse obese patients with binge eating disorder (BED) seeking treatment for obesity and binge eating in primary care.

METHOD

A consecutive series of 142 participants (43% Caucasian, 37% African-American, 13% Hispanic-American, and 7% "other" ethnicity) were evaluated with semi-structured interviews.

RESULTS

67% of BED patients had at least one additional lifetime psychiatric disorder, with mood (49%), anxiety (41%), and substance-use (22%) disorders most common. In terms of current co-morbidity, 37% had at least one other psychiatric disorder, with anxiety (27%) and mood (17%) most common. Few gender differences were observed but psychiatric co-morbidity rates differed across ethnic/racial groups with larger differences for current diagnoses. African-American and Hispanic groups were more than twice as likely as the Caucasian group to have additional current psychiatric disorders, mood disorders, and anxiety disorders. Psychiatric co-morbidity was associated with greater eating-disorder psychopathology and poorer functioning, but not with binge-eating or BMI.

CONCLUSION

Our study presents new findings suggesting that among obese BED patients in primary care, ethnic/racial minority groups are more likely than Caucasian groups to present with psychiatric co-morbidity. Within BED, psychiatric co-morbidity shows few gender differences but is associated with greater eating-disorder psychopathology and poorer functioning.

Subjective binge eating with compensatory behaviors: a variant presentation of bulimia nervosa

OBJECTIVES

To determine whether a variant bulimic-type presentation, whereby one meets criteria for bulimia nervosa (BN) except that binge eating episodes are not objectively large (i.e., "subjective bulimia nervosa," SBN), has comparable clinical severity to established eating disorders, particularly BN.

METHOD

Treatment-seeking adults with BN (N = 112), SBN (N = 28), anorexia nervosa restricting type (AN-R) (N = 45), and AN-binge/purge type (AN-B/P) (N = 24) were compared.

RESULTS

Overall, SBN could not be meaningfully distinguished from BN. SBN and BN had equivalent eating pathology, depression and anxiety symptoms, low quality of life, impulsivity, Axis I comorbidity, and lifetime psychiatric history, and comparable clinical severity to AN-R and AN-B/P.

DISCUSSION

Individuals with SBN, differing from BN only by the smaller size of their binge eating episodes, had a form of eating disorder comparable in clinical severity to threshold AN and BN and warranting clinical attention. Health professionals and the community require greater awareness of this variant to optimize detection, treatment-seeking, and outcomes.

Role identity and the work role after myocardial infarction

This study was designed to determine the roles most salient for individuals following a myocardial infarction (MI) and identify relationships among worker demographics, depression, illness intrusion, role identity, and self-esteem. Thirty participants 18 years or older, paid employees working 20 or more hours per week immediately prior to the MI, receiving care at one of the identified clinics, able to read English, and having a diagnosis of an acute MI within the past year completed questionnaires regarding role identity, illness intrusion, self-esteem, and depression. The results demonstrated the work role was significant for individuals after an MI. In addition, participants felt their current occupation had much to do with how they felt about themselves. The correlation between being employed now and an individual's occupation supported the finding that workers value their work role.

Does enhanced cognitive behaviour therapy for eating disorders improve quality of life?

Quality of life (QOL) is the degree of enjoyment and satisfaction experienced in life, and embraces emotional well-being, physical health, economic and living circumstances, and work satisfaction. QOL recovery with eating disorder treatment has received sparse attention, and until now, no study has investigated QOL recovery with enhanced cognitive behaviour therapy (CBT-E). Patients (n = 196) admitted to a specialist eating disorders outpatient programme and receiving CBT-E completed measures of QOL, eating disorder psychopathology, depression, anxiety and self-esteem, before and after treatment. QOL at intake was compared with community norms, and QOL below the norm was predicted from sociodemographic and clinical correlates with logistic regression. Baseline QOL below the norm was associated with depression and anxiety Axis I comorbidity, and severity of depressive symptoms. Predictors of post-treatment QOL were baseline QOL and level of depressive symptoms and self-esteem at post-treatment. CBT-E was associated with gains in QOL over the course of treatment, in addition to eating disorder symptom relief.

Significance of overvaluation of shape and weight in an ethnically diverse sample of obese patients with binge-eating disorder in primary care settings

Undue influence of shape or weight on self-evaluation--referred to as overvaluation--is a core feature across eating disorders, but is not a diagnostic requirement for binge-eating disorder (BED). This study examined overvaluation of shape/weight in ethnically diverse obese patients with BED seeking treatment in primary care. Participants were a consecutive series of 142 (105 female and 37 male) participants with BED; 43% were Caucasian, 37% were African-American, 13% were Hispanic-American, and 7% were of "other" ethnicity. Participants categorized with overvaluation (N=97; 68%) versus without clinical overvaluation (N=45; 32%) did not differ significantly in ethnicity/race, age, gender, body mass index, or binge-eating frequency. The overvaluation group had significantly greater levels of eating disorder psychopathology, poorer psychological functioning (higher depression, lower self-esteem), and greater anxiety disorder co-morbidity than the group who did not overvalue their shape/weight. The greater eating disorder and psychological disturbance levels in the overvaluation group relative to the non-overvaluation group persisted after controlling for psychiatric co-morbidity. Our findings, based on an ethnically diverse series of patients seeking treatment in general primary care settings, are consistent with findings from specialist clinics and suggest that overvaluation does not simply reflect concerns commensurate with being obese or with frequency of binge-eating, but is strongly associated with heightened eating-related psychopathology and psychological distress. Overvaluation of shape/weight warrants consideration as a diagnostic specifier for BED as it provides important information about severity.

An exploratory study of clinical measures associated with subsyndromal pathological gambling in patients with binge eating disorder

Both binge eating disorder (BED) and pathological gambling (PG) are characterized by impairments in impulse control. Subsyndromal levels of PG have been associated with measures of adverse health. The nature and significance of PG features in individuals with BED is unknown. Ninety-four patients with BED (28 men and 66 women) were classified by gambling group based on inclusionary criteria for Diagnostic and Statistical Manual-IV (DSM-IV) PG and compared on a range of behavioral, psychological and eating disorder (ED) psychopathology variables. One individual (1.1% of the sample) met criteria for PG, although 18.7% of patients with BED displayed one or more DSM-IV criteria for PG, hereafter referred to as problem gambling features. Men were more likely than women to have problem gambling features. BED patients with problem gambling features were distinguished by lower self-esteem and greater substance problem use. After controlling for gender, findings of reduced self-esteem and increased substance problem use among patients with problem gambling features remained significant. In patients with BED, problem gambling features are associated with a number of heightened clinical problems.

A quasi-experimental evaluation of a community-based art therapy intervention exploring the psychosocial health of children affected by HIV in South Africa

OBJECTIVES

To evaluate the efficacy of the Make A Difference about Art programme, a community art programme in South Africa for children affected by HIV and AIDS, which aims to reduce psychosocial problems by increasing self-esteem, self-efficacy and HIV insight.

METHODS

A quasi-experimental cross-sectional post-intervention survey of 297 children aged 8-18 years (177 programme attendees and a control group of 120). Participants completed an inventory comprising standardized, validated psychosocial measures of depression, emotional and behavioural problems, self-esteem and self-efficacy and key sociodemographic variables potentially relevant as risk and protective factors.

RESULTS

Attending the intervention was predictive of significantly higher self-efficacy, but was not associated with differences in self-esteem, depression, or emotional/behavioural problems. This association remained in the multivariate analysis, controlling for potential confounders. Double parental death exerted a powerful effect on child psychosocial health, eliminating the association between intervention attendance and higher self-efficacy. However, an interaction was found between bereavement status and intervention attendance on child self-efficacy, indicating that the intervention programme may ameliorate some of the psychosocial vulnerabilities associated with becoming an orphan. Other key risk factors for poor psychosocial health in this sample were AIDS-related stigma and community and household violence. Social connection emerged as a key protective factor.

CONCLUSIONS

Our findings suggest that such interventions may offer opportunities to increase the self-efficacy of vulnerable children to protect their psychological health.

Self-esteem in adolescent patients with attention-deficit/hyperactivity disorder during open-label atomoxetine treatment: psychometric evaluation of the Rosenberg Self-Esteem Scale and clinical findings

To report on (1) psychometric properties of the Rosenberg Self-Esteem Scale (SES) studied in adolescents with ADHD, (2) correlations of SES with ADHD scale scores, and (3) change in patient-reported self-esteem with atomoxetine treatment. ADHD patients (12–17 years), treated in an open-label study for 24 weeks. Secondary analyses on ADHD symptoms (assessed with ADHD-RS, CGI, GIPD scales) and self-esteem (SES) were performed. One hundred and fifty-nine patients were treated. A dichotomous structure of the SES could be confirmed. Reliability and internal consistency were moderate to excellent. Highest coefficients were found for the correlation between SES and GIPD scores. Self-esteem significantly increased over time, accompanied by an improvement of ADHD symptoms and related perceived difficulties. The Rosenberg SES was shown to be internally consistent, reliable, and sensitive to treatment-related changes of self-esteem. According to these findings, self-esteem may be an important individual patient outcome beyond the core symptoms of ADHD.

Chronic dieting among extremely obese bariatric surgery candidates

BACKGROUND

Extremely obese bariatric surgery candidates report numerous episodes of both successful and unsuccessful dieting attempts, but little is known about the clinical significance of frequent dieting attempts in this patient group.

METHODS

The current study examined psychological and weight-related correlates of self-reported dieting frequency in 219 bariatric surgery candidates (29 men and 190 women). Prior to surgery, patients completed a battery of established self-report assessments. Patients were dichotomized into chronic dieters (n=109) and intermittent dieters (n=110) based on a median split of self-reported percent time spent dieting during adulthood. The two dieting groups were compared on demographics, eating and weight history, eating disorder psychopathology, and global functioning.

RESULTS

Chronic dieters had significantly lower pre-operative body mass indexes (BMIs), lower highest-ever BMIs, more episodes of weight cycling, and earlier ages of onset for overweight and dieting than intermittent dieters. After controlling for differences in BMI, chronic dieters were found to have statistically but not clinically significant elevations in eating concerns, dietary restraint, and body dissatisfaction than infrequent dieters. The two groups, however, did not differ significantly on depressive symptoms, self-esteem, or health-related quality of life; nor did they differ in binge-eating status.

CONCLUSIONS

Chronic dieting is commonly reported among extremely obese bariatric candidates and is not associated with poorer psychological functioning or binge eating and may be beneficial in attenuating even greater weight gain. Our findings provide preliminary data to suggest that requiring additional presurgical weight loss attempts may not be warranted for the vast majority of extremely obese bariatric candidates.

Dieting frequency in obese patients with binge eating disorder: behavioral and metabolic correlates

This study examined the clinical significance of self-reported frequency of time spent dieting in obese patients with binge eating disorder (BED). A total of 207 treatment-seeking obese BED patients (57 men and 150 women) were dichotomized by dieting frequency and gender and compared on a number of historical, psychological, and metabolic variables. Frequent dieters reported significantly earlier age of onset for binge eating, dieting, and obesity, more episodes of weight cycling, greater weight suppression, and greater eating disorder pathology than infrequent dieters; no differences, however, emerged on current binge eating frequency or psychological distress. Among women but not among men, frequent dieters had consistently lower chances of abnormalities in total cholesterol, high-density lipoprotein (HDL) cholesterol, and the total/HDL cholesterol ratio while infrequent dieters had greater chances of abnormalities on these variables. Dietary restraint was inversely correlated with abnormalities in triglycerides, HDL cholesterol, and the total/HDL cholesterol ratio but was unrelated to low-density lipoprotein (LDL) cholesterol. In summary, frequent dieters of both genders had greater lifetime and current eating and weight concerns, and in women, decreased chance of metabolic abnormalities than infrequent dieters. Our findings suggest that frequent dieting attempts, particularly in women, are associated with greater eating disorder pathology but may have a beneficial effect on metabolic functioning and cardiovascular disease risk independent of actual weight status. These findings may have implications for clinical advice provided to obese BED patients.

Prediction of disturbed eating attitudes in adolescent girls: a 3-year longitudinal study of eating patterns, self-esteem and coping

OBJECTIVE

The purpose was to examine the extent to which yearly assessments of eating patterns and attitudes, self-esteem and coping strategies over a 3-year period among adolescent girls predicted the degree of disturbed eating attitudes at the year 3-assessment. Our main hypothesis was that such attitudes year 3 would be predicted by eating attitudes, restrained, emotional, and external eating behaviour, as well as by low self-esteem and coping by acting out or avoidance.

METHOD

Three-hundred and seventy- eight Swedish adolescent girls were assessed once a year for three years.

RESULTS

The results suggest that eating patterns and attitudes were the strongest predictors of disturbed eating attitudes year 3. Self-esteem and coping had a limited predictive value for eating attitudes year 3, and the effect of self-esteem appeared to be mediated by coping.

DISCUSSION

The results suggest that early eating patterns (e.g., more disturbed eating attitudes and restrained eating behaviors) and attitudes are potentially important predictors for the development of more serious eating disturbances among adolescent girls.

Psychometric evaluation of the eating disorder examination-questionnaire for bariatric surgery candidates

OBJECTIVE

Despite increasing use of the Eating Disorder Examination-Questionnaire (EDE-Q) in bariatric surgery patients, little is known about the utility and psychometric performance of this self-report measure in this clinical group. The primary purpose of the current study was to evaluate the factor structure and construct validity of the EDE-Q in a large series of bariatric surgery candidates.

METHODS AND PROCEDURES

Participants were 337 obese bariatric surgery candidates. Participants completed the EDE-Q and a battery of behavioral and psychological measures.

RESULTS

Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) produced a 12-item, 4-factor structure of the EDE-Q. The four factors, interpreted as Dietary Restraint, Eating Disturbance, Appearance Concerns, and Shape/Weight Overvaluation, were found to be internally consistent and converged with other relevant measures of psychopathology.

DISCUSSION

Factor analysis of the EDE-Q in bariatric surgery candidates did not replicate the original subscales but revealed an alternative factor structure. Future research must further evaluate the psychometric properties, including the factor structure, of the EDE-Q in this and other diverse populations and consider means of improving this measure's ability to best assess eating-related pathology in bariatric surgery patients.

State self-esteem ratings in women with bulimia nervosa and bulimia nervosa in remission

OBJECTIVE

Bulimia nervosa (BN) is associated with low self-esteem. This study was designed to assess whether low self-esteem persists in nondepressed individuals who have recovered from BN (BN-R).

METHOD

Study groups included BN (n = 22), BN-R (n = 20), and healthy controls (n = 42). Participants were medication-free, and none met criteria for current major depression. Assessment instruments included the State Self-Esteem Scale (SSES), a self-rating scale designed to measure state-related changes in self-esteem.

RESULTS

Consistent with previous reports, SSES scores for BN were lower than for controls (p < .001). For BN-R, SSES scores were higher than for BN (p < .001), but lower than for controls (p < .025). For BN-R, scores on the SSES Appearance subscale were inversely correlated with ratings of dietary restraint (p < .005).

CONCLUSION

This study provides new evidence for persistent low self-esteem following recovery from BN. Follow-up studies are needed to assess whether low self-esteem contributes to recurrent dieting and risk for relapse.

Spontaneous imagery in women with bulimia nervosa: an investigation into content, characteristics and links to childhood memories

The study investigated the presence and characteristics of spontaneous imagery in women with bulimia nervosa (BN) and their links to childhood memories. Using a semi-structured interview, data was collected from three groups of female participants: BN participants (N=13), dieting (N=18) and non-dieting controls (N=20). BN participants reported more spontaneous images than non-dieting control participants. Their images were recurrent and significantly more negative and anxiety provoking than those of controls. They involved more sensory modalities than in dieting controls and were more vivid than in non-dieting controls. BN images typically involved the visual, organic and cutaneous modalities. They were linked to a specific childhood memory, similar in emotional tone and sensory modalities. Once depression was controlled, many of the between-group differences became non-significant. The results suggest that imagery may be a significant feature of BN, potentially distinguishing those with BN from controls, although further research into the link between mood, imagery and memory is needed. The findings have clinical implications, particularly for assessment and for the application of imagery rescripting in BN.

Acculturation's influence on antifat attitudes, body image and eating behaviors

Antifat attitudes (AFA) refer to the belief that overweight and obese individuals are responsible for their weight. Using 264 Latina and European American females, a regression showed that AFA positively correlated with body dissatisfaction and eating concerns. An ANOVA revealed that European American females reported significantly greater AFA than Latinas. Furthermore, European American females and high acculturated Latinas reported significantly greater AFA than both bicultural and low acculturated Latinas. No differences existed between European Americans and high acculturated Latinas. Language-use significantly interacted with body dissatisfaction to predict AFA. The role of AFA, acculturation, and suggestions for future research are discussed.

Factors affecting dropout in outpatient eating disorder treatment

OBJECTIVE

To evaluate the incidence and effects of factors potentially influencing eating disordered patients' dropping out of outpatient cognitive-behavioural therapy (CBT).

METHOD

Sixty-seven (64 female, 3 male) patients with eating disorders participated in the study. All patients followed a multidisciplinary team approach for a median period of 9 months. Several factors potentially affecting dropout were retrospectively assessed prior to treatment.

RESULTS

The dropout rate was significantly higher in patients with purging anorexia nervosa (AN) compared to those with restrictive AN, bulimia nervosa and eating disorder not otherwise specified (33% vs. 27%, 25% or 21%, respectively, p<0.05). Among several factors influencing dropout, there was a significant association of patient low cooperativeness, purging episodes, restrictive eating, use of several weight control practices and psychiatric co-morbidity in patients who dropped out compared to completers (all p<0.05).

CONCLUSIONS

In outpatient eating disorder treatment, non-compliance and premature interruption of therapy are affected primarily by factors which are related to patients' attitude and behaviour. These factors should be carefully addressed in patients with eating disorders to improve outcome.

Eating attitudes and behaviours in South african adolescents and young adults

We examined the presence and severity of disordered eating attitudes and behaviours in a group of 895 South Africans. The Eating Attitude Test-26 (EAT-26), the Bulimic Investigatory Test, Edinburgh (BITE) and the Rosenberg Self-esteem Scale (RSE), were administered to high-school and college students (515 White, 126 Black, and 254 'Coloured'). There were few differences between these three groups on measures of eating disorder pathology and self-esteem. A small number of participants (3.5%) were identified as at 'high risk' for an eating disorder as shown by scores in the clinical range for both the EAT-26 and BITE. Weight, self-esteem and age were predictors for this subgroup. This study suggests that ethnicity per se may not 'protect' against the development of disordered eating attitudes and behaviours in nonwestern black populations. These findings remain tentative until future survey studies employ interviews to confirm eating disorder diagnosis.

Comparison of two self-report instruments for assessing binge eating in bariatric surgery candidates

This study compared two self-report methods for assessing binge eating in severely obese bariatric surgery candidates. Participants were 249 gastric bypass candidates who completed the Questionnaire on Eating and Weight Patterns-Revised (QEWP-R) and the Eating Disorder Examination-Questionnaire (EDE-Q) prior to surgery. Participants were classified by binge eating status (i.e., no or recurrent binge eating) with each of the measures. The degree of agreement was examined, as well as the relationship between binge eating and measures of convergent validity. The two measures identified a similar number of patients with recurrent binge eating (i.e., at least 1 binge/week); however, overlap was modest (kappa=.26). Agreement on twice weekly binge eating was poor (kappa=.05). The QEWP-R and EDE-Q both identified clinically meaningful groups of binge eaters. The EDE-Q appeared to differentiate between non/infrequent bingers and recurrent bingers better than the QEWP-R, based on measures of convergent validity. In addition, the EDE-Q demonstrated an advantage because it identified binge eaters with elevated weight and shape overconcern. Using the self-report measures concurrently did not improve identification of binge eating in this study. More work is needed to determine the construct validity and clinical utility of these measures with gastric bypass patients.

Measuring acculturation among male Arab immigrants in the United States: an exploratory study

Given the absence of empirical measures that assess acculturation patterns among male Arab immigrants, a new acculturation instrument was developed and evaluated. One hundred and fifteen adult male Arab immigrants were administered the Male Arab Acculturation Scale (MAAS), and psychometrically established measures of ethnic identity and self-esteem. Satisfactory reliability is reported for the two acculturation scales, separation/assimilation and integration/marginalization. Ethnic identity, self-construal, personal self-esteem, and collective self-esteem appear to be differentially associated with acculturation patterns among male Arab immigrants.

An evaluation of a prevention program for disordered eating in adolescent girls: examining responses of high- and low-risk girls

A prevention program for disordered eating was evaluated. Grade 9 girls (N = 173) were assigned to a prevention intervention (n = 114) or a no-treatment control group (n = 59). High-risk, but not low-risk, girls reported significant improvements in body dissatisfaction, drive for thinness, and interoceptive awareness at post-intervention. These changes were not maintained at three-month follow-up, although nonsignificant trends were still apparent for high-risk girls. Individual session analyses indicated that the program was rated positively overall. The importance of assessing effects of programs on different recipient types is discussed.

Psychometric Properties of the Self-Concept Questionnaire

Abstract. The aim of the present study was to examine the psychometric properties of the Swedish version of the Self-Concept Questionnaire (SCQ). Data from three samples were used: (1) a representative sample of women (18-30 years) from the general population of Sweden (n = 826), (2) a student sample (n = 124), and (3) a clinical sample (n = 43) comprising patients with eating disorders. Principal component analysis (PCA) resulted in a five-factor solution that accounted for 46% of the variance. The students responded to the SCQ twice within 3 weeks and the SCQ showed high test-retest reliability with no significant differences in the mean total scores between the first and second set of responses. In all the samples, the SCQ showed very high internal consistency, ranging from .94 to .97. The SCQ showed high validity as it correlated highly with Rosenberg scale of self-esteem in the patient group, and the Ineffectiveness subscale of the Eating Disorders Inventory in the student sample. Furthermore, the SCQ showed high discriminant validity by differentiating clinical from non-clinical subjects. In summary, the Swedish version of SCQ has been shown to possess good concurrent and discriminant validity as well as high reliability. Given its multidimensionality and encouraging preliminary psychometric properties, the SCQ can be a valuable instrument in assessing self-esteem in clinical settings as well as in the studies of the general population.