Anger and bulimic psychopathology among nonclinical women

A Retrospective Literature Review of Eating Disorder Research (1990–2021): Application of Bibliometrics and Topical Trends

Despite the growing importance of eating disorders in society and academic literature, only a few bibliometric review studies using bibliometric analysis were available. Hence, this study aimed to explore and uncover hidden research topics and patterns in articles in terms of eating disorders over the last 30 years. In total, 4111 articles on eating disorders were analyzed using bibliometrics, network analyses, and structural topic modeling as the basis of mixed methods. In addition to general statistics about the journal, several key research topics, such as eating disorder (ED) treatment, ED symptoms, factors triggering ED, family related factors, eating behaviors, and social factors, were found based on topic correlations. This study found the key research variables that are frequently studied with EDs, such as AN, BN, BED, and ARFID. This study may help clinicians comprehend important risk factors associated with EDs. Moreover, the findings about key ED research topics and their association can be helpful for future studies to construct a comprehensive ED research framework. To our knowledge, this is the first study to use topic modeling in an academic journal on EDs and examine the diversity in ED research over 30 years of published research.

Hunger games: Associations between core eating disorder symptoms and responses to rejection by peers during competition

OBJECTIVE

Individuals with eating disorder (ED) symptoms are sensitive to social threat and report maladaptive interpersonal styles that may contribute to and exacerbate negative evaluation from others. Research in this area has relied primarily on self-report. The current study examined associations between behavioral responses to social threat and core ED symptoms using a behavioral paradigm. Based on previous findings that individuals with binge-eating report being more reactive and confrontational, whereas individuals with dietary restriction tend to be more submissive and avoidant of conflict, we hypothesized that binge eating would be associated with a greater tendency to retaliate against rejection perpetrators, whereas dietary restriction would be associated with a lower tendency to retaliate when rejected.

METHOD

Undergraduate women (N = 132) completed a self-report measure of ED symptoms and participated in an online "Survivor"-type game in which they voted to either accept or reject computerized coplayers, while also receiving acceptance or rejection feedback from others.

RESULTS

Neither ED symptom was associated with how often participants retaliated against coplayers who rejected them. However, dietary restriction was related to more rejection votes overall (i.e., the tendency to reject others regardless of how others voted).

DISCUSSION

Findings suggest that individuals with dietary restriction may rely on a maladaptive defensive strategy aimed at pre-empting rejection, or alternatively, have difficulty shifting from habitual self-isolating behavior that results from over-involvement with restricting symptoms. Interventions targeting hypersensitivity to social threat or interpersonal flexibility may help reduce interpersonal stress and mitigate its impact on restricting symptoms.

Emotion regulation across eating pathology: A meta-analysis

The goal of this meta-analysis was to examine the associations between specific emotion regulation abilities (emotional awareness, emotional clarity) and strategies (acceptance of emotions, reappraisal, problem-solving, rumination, avoidance of emotions, and suppression), and eating pathology. A total of 96 studies and 239 effect sizes were included in the analysis. Relations between global and specific emotion regulation abilities and strategies and eating disorders and eating-related symptoms were examined. Results indicated medium-to-large effect sizes for the associations between adaptive emotion regulation and eating disorder and eating-related symptoms, and medium-to-large effect sizes for the associations between maladaptive emotion regulation and eating disorders and eating-related symptoms. In terms of specific emotion regulation strategies, large magnitude of associations were identified for the relations between lack of emotional awareness, clarity, acceptance, reappraisal, problem-solving, and eating disorders. Rumination, avoidance of emotions, and suppression also showed large associations with anorexia nervosa and bulimia nervosa. Overall, emotion regulation did not differ across eating disorders, a finding supporting the transdiagnostic character of emotion regulation problems in eating pathology. These findings have important theoretical and practical implications for prevention and intervention programs.

Influence of maternal reflective functioning on mothers' and children's weight: A follow-up study

Based on cross-sectional research linking poor reflective functionining (RF) to eating disorders, the current follow-up study tested whether maternal RF would explain the variance of mothers' and children's weight beyond the effects of maternal emotional dysregulation. During pregnancy (Time 1 [T1]), 51 women were administered the Difficulties in Emotion Regulation Scale (DERS) and interviewed using the Adult Attachment Interview (AAI). Seven months after delivery (Time 2 [T2]), mother-baby dyads who remained in the study (n = 44) were videotaped (Feeding Scale) during their feeding interaction. Last (Time 3 [T3]), the weight of the 34 children who were still in the study was collected at 3 years of age. Maternal AAI-RF at T1 did not correlate with the DERS at T1 nor with the quality of the feeding interacions at T2. However, it correlated, significantly, with maternal body mass index (BMI) at T1, r = -.298, P = .034, and marginally significantly with baby's BMI at T3, r = -.296, P = .089. Moreover, multiple regression models showed a trend indicating that maternal AAI-RF might explain the variance of mothers' and children's weight beyond the effects of maternal emotional dysregulation. These findings suggest that working on maternal mentalization might contribute to helping prevent childhood obesity from pregnancy.

Psychological Meanings of Eating Disorders and Their Association With Symptoms, Motivation Toward Treatment, and Clinical Evolution Among Outpatients

Unlike patients suffering from egodystonic disorders, people with eating disorders sometimes attribute positive meanings to their symptoms, and this attribution process contributes to the maintenance of the disorder. This study aims at exploring psychological meanings of eating disorders and their associations with symptoms, motivation toward treatment, and clinical evolution. Eighty-one adults with an eating disorder (anorexia nervosa, n = 46 and bulimia nervosa, n = 35) treated in a day-hospital program were asked, each week over an 8-week period, to identify the psychological meanings they ascribed to their eating disorder. Avoidance was the most frequently identified meaning, followed by mental strength, security, death, confidence, identity, care, and communication. Avoidance was more frequently mentioned by participants with bulimia than in cases of anorexia. Security and mental strength were associated with less motivation toward treatment. Death was associated with more depressive and anxious symptoms. An exploratory factor analysis showed that these meanings formed three main dimensions: Avoidance, Intrapsychic, and Relational. Findings suggest that psychological meanings associated with eating disorders can be assessed and used as a clinical tool to increase treatment acceptability and effectiveness.

Dimensional analysis of emotion trajectories before and after disordered eating behaviors in a sample of women with bulimia nervosa

There is an established relationship between increases in negative affect and engagement in binge eating and purging behaviors. Some evidence suggests that these behaviors may also be maintained via subsequent increases in positive affect. However, negative and positive affect are broad terms encompassing many emotions, and there is a theoretical speculation that every emotion consists of at least of three separate dimensions: valence, arousal, and approach/withdrawal. We conducted secondary analyses on a previously collected dataset using ecological momentary assessment in 133 women with bulimia nervosa. Participants rated their experience of discrete emotions and bulimic behaviors six times per day. Negative and positive emotions were organized within the 3-dimensional space characterized by valence, arousal, and approach/withdrawal. With multilevel modeling, we examined the trajectories of dimensionally defined emotion constructs prior and subsequent to bulimic behaviors as well as on days with and without bulimic behaviors. Negative valence, high arousal, and avoidance typified emotions that reached the highest levels before bulimic behaviors and were at the highest mean levels on days with bulimic behaviors. Arousal did not appear to moderate the trajectories of positive emotions. Application of a dimensional understanding of emotions may help elucidate the complex relationship between mood and disordered eating.

Binge eating & childhood emotional abuse: The mediating role of anger

Recent studies reveal that childhood emotional abuse (CEA) is the trauma most clearly associated with adult eating pathology. Yet, relatively little is understood about psychological mechanisms linking these distal experiences. Anger's mediational role in the relationship between CEA and adult binge eating (BE) is explored in a community-based sample of 498 adult women (mean age 44). Detailed telephone interviews assess BE (7 items), CEA (single item), and unresolved anger (single item) along with self-criticism (modified Rosenberg self-esteem scale), depression and anxiety symptoms (BSI sub-scales). Statistical analyses include Pearson correlations, Baron and Kenny's steps for mediation, and Preacher and Hayes bootstrapping method to test proposed multiple mediators simultaneously. Findings reveal significantly more respondents (n = 476 with complete data) with serious BE behaviors report a history of CEA compared to women with considerable and/or minimal BE (53% vs 37%, p = 0.002 respectively). Significant correlations are found among all study variables. Mediation analyses focus on anger together with self-criticism, depression and anxiety. Findings reveal anger and self-criticism fully mediate the CEA-BE relationship. In contrast, depression and anxiety symptoms are not significant mediators in a model that includes anger and self-criticism. Although additional research is warranted to more fully understand complex causal processes, in the interim, treatment interventions should be broadened to include assessments of anger among adult women with BE behaviors, especially those with histories of childhood abuse. Additionally, prevention strategies that incorporate learning how to express anger directly and positively may be particularly effective in reducing various disordered eating behaviors among women and girls.

The influence of negative urgency, attentional bias, and emotional dimensions on palatable food consumption

We tested a theoretical model concerning the role of attentional bias and negative affect in food consumption that offers important advances. We hypothesized that the effects of negative affect manipulations on food consumption vary as a function of trait levels of negative urgency (NU; tendency to act impulsively when distressed), and attentional bias and that the roles of emotional arousal and negative emotional valence differ and should be studied separately. 190 undergraduate women were randomly assigned to either an anger or neutral mood condition. Women in both conditions completed the Food Stroop, in which the presentation of food and neutral words were counterbalanced. After the task, participants were given the opportunity to eat mandarin oranges and/or chocolate candy while the experimenter was out of the room. The type and quantity of food consumed was counted after the participant departed. As hypothesized, the roles of emotional arousal and valence differed and the effect of the induced emotion was moderated by NU. Women high in NU who experienced emotional arousal were more likely to eat candy and consumed more candy than other women. Emotional valence had no effect on candy consumption. Neither increases in emotional arousal or emotional valence influenced attentional bias to food cues. Attentional bias was also unrelated to food consumption. The impact of negative mood inductions on palatable food consumption appears to operate through emotional arousal and not negative emotional valence, and it may operate primarily for women high in NU.

A longitudinal study on emotional dysregulation and obesity risk: From pregnancy to 3 years of age of the baby

Some recent findings indicate that maternal sensitivity and emotional regulation may play a key role in predicting the risk for obesity of the child in early ages. The current article describes a longitudinal study encompassing more than 50 women, across a time-span that currently goes from pregnancy (n = 65) to three years of age of the baby (n = 53). In a previous report on our ongoing research project, we showed that emotional regulation during pregnancy and pre-pregnancy BMI significantly predicted the quality of the early, dyadic feeding interactions, at 7 months of age of the baby. The current study confirmed and extended those findings, by showing that maternal emotional dysregulation (r = .355, p = .009) and pre-pregnancy BMI (r = .389, p = .004) predicted the BMI of the child at three years of age too, with a medium to large effect size. However, neither maternal emotional regulation nor pre-pregnancy BMI significantly predicted infant attachment at one year of age.

Self-silencing and anger regulation as predictors of disordered eating among adolescent females

The main purpose of this study was to examine how self-silencing, emotional regulation, and body-esteem differentiated healthy eating from different patterns of disordered eating. A community sample of adolescent females was classified as either: 1) Restrained Eaters (n=104, M(age)=14.48); 2) Emotional Eaters (n=125, M(age)=14.52); or, 3) Healthy Eaters (n=396, M(age)=13.71). A discriminant function analysis revealed two significant functions. The first function differentiated the two disordered eating groups (i.e., the restrained and emotional eaters) from the healthy group, with the disordered eating groups scoring significantly higher on levels of self-silencing and anger regulation, and lower on body-esteem. The second function differentiated between the restrained and emotional eaters, with the emotional eaters reporting higher levels of externalized self-perception and anger, and lower levels of body-esteem. The results suggest that body-esteem and anger suppression were the most influential variables in differentiating between groups. The findings are discussed in terms of the implications for disordered eating prevention and treatment programs.

Gender-Related Discourses as Mediators in the Association Between Internalization of the Thin-Body Ideal and Indicants of Body Dissatisfaction and Disordered Eating

This study examined whether the gender-related discourses of self-objectification, self-silencing, and anger suppression mediated the association between internalization of the thin-body ideal and body dissatisfaction and eating pathology. We employed a cross-sectional design to study both university ( n = 140) and community ( n = 76) samples of women from Ireland ranging from 17 to 30 years of age ( M = 21.48, SD = 3.05). Structural equation modeling was used to test for mediation, with the final model suggesting that gender-related discourses (silencing the self/anger suppression and body surveillance) mediated the association between thin-body ideal internalization and attitudes and behaviors characteristic of disordered eating. Limitations of the current study and directions for future research are highlighted.

Anger expression in eating disorders: clinical, psychopathological and personality correlates

The goals of the study were to compare anger expressions in individuals with eating disorders and healthy controls, and to explore the relation among eating disorder symptoms, comorbid psychopathology, personality traits, and impulsive behaviours. Participants comprised 135 eating disorder patients consecutively admitted to our unit and 103 healthy controls. Assessment measures included the Eating Disorders Inventory 2 (EDI-2), Bulimic Investigatory Test Edinburgh (BITE), Symptom Checklist-Revised (SCL-90-R), Social Avoidance Distress Scale (SAD), Temperament and Character Inventory-Revised (TCI-R), State-Trait Anger Expression Inventory 2 (STAXI-2), and other clinical and psychopathological indices. In the control group also the General Health Questionnaire-28 (GHQ-28) was also used. Women with eating disorders obtained significantly higher mean scores than controls on all STAXI-2 scales except for Anger Control. When various purging methods were assessed independently, the frequency of laxative use was associated with anger suppression. Eating disorder symptoms and specific personality traits were positively associated with different forms of anger expression. Finally, patients with higher scores on anger suppression were more likely to report self-harming behaviors. Eating disorder patients may have inadequate anger expression and deficits in coping with anger and frustration. Furthermore, different purging methods may be related to different facets of anger.

Aggressiveness, anger, and hostility in eating disorders

OBJECTIVE

Despite evidence of a link between the behavioral and cognitive dimensions of aggressiveness and eating disorders, only few studies have tested this relation empirically.

METHODS

A total of 112 female patients with anorexia nervosa (n = 61) or bulimia nervosa (n = 51) and 631 young girls attending 7 high schools in the same health district as the patients (northeast Italy) were invited to fill in a set of self-report instruments including the Eating Attitudes Test, the Bulimic Investigatory Test of Edinburgh, the Body Attitudes Test, and the Buss-Perry Aggression Questionnaire (AQ).

RESULTS

In both healthy controls and patients, scores on the measures of eating disorder symptoms were positively related to the scores on the AQ: the strength of the association did not differ between healthy controls and patients. However, patients diagnosed with eating disorders were not more likely to disclose a propensity to aggression than the healthy controls drawn from the community: patients with anorexia nervosa scored lower than controls on the physical aggression and on the verbal aggression subscales of the AQ (P < .05). On the other hand, patients with bulimia nervosa scored higher than controls on the anger subscale of the AQ (P < .05) but did not differ from them on the other subscales of the questionnaire.

CONCLUSIONS

The results confirm the higher propensity to anger in patients with bulimia nervosa; in patients with anorexia nervosa, difficulties in expressing anger and outward-directed aggressiveness can be a prevailing feature. The younger age of controls and exclusive reliance on self-report measures might have concealed some differences between patients and community subjects.

Bulimia nervosa and substance use disorder: similarities and differences

The purpose of this study was to compare bulimia nervosa (BN) and substance use disorders (SUD) in cognitive-motivational terms. The cognitive orientation theory was used as a framework for testing the hypothesis that the commonality between BN and SUD consists of a similar motivational disposition for eating disorders, rather than for addiction, as was previously claimed. It was expected that BN and SUD patients would differ from controls but not from each other. The participants were 31 BN, 20 SUD, and 20 healthy controls. They were administered questionnaires for assessing anxiety, depression, addiction and the cognitive orientation for eating disorders. On most parameters BN and SUD scored higher than controls but did not differ from each other except in norm beliefs. Treatment of BN should consider the similarity of BN to SUD in the pathological tendency for eating disorders.

The relationship of momentary anger and impulsivity to bulimic behavior

Past research has suggested that negative affect may be a causal factor for eating disordered behaviors. More specifically, research has shown that anger appears to be one aspect of negative affect that is particularly relevant in bulimic patients. Previous studies have also shown that the relationship between negative affect and eating disordered behaviors may partially depend upon personality variables such as impulsivity. The present study examined whether the relationship between anger and eating disordered behaviors is moderated by impulsivity. Subjects completed an ecological momentary assessment (EMA) protocol for an average of 2 weeks. Findings revealed that overall antecedent anger level and the variability of antecedent anger predicted binge-eating episodes and that these relationships were moderated by participants' level of impulsivity. These findings suggest that personality variables impact the way that anger and eating behaviors relate. They also suggest that the variability of antecedent anger may be a fruitful avenue for future research for those interested in causal variables associated with bulimia nervosa.

A 12 to 24 weeks pilot study of sertraline treatment in obese women binge eaters

Previous studies tested the efficacy of sertraline in Binge Eating Disorder (BED) over a period of 6 weeks. The present open study assesses the efficacy of sertraline over a period of 24 weeks in obese persons with binge eating behaviour (with or without the full criteria for BED) confirmed by high scores on the Binge Eating Scale (BES). Thirty-two obese outpatients (14 with BED and 18 without full criteria for BED), without co-occurring psychiatric comorbidities, were treated with sertraline (dose range 100-200 mg/d). Subjects were assessed at baseline and at 8, 12 and 24 weeks of treatment for number of binges, weight and psychopathology. After 8 weeks of treatment a significant improvement in the BES score and a significant weight loss emerged. These results were maintained over 24 weeks. A moderate drop out rate was detected, but no significant association with the severity of side effects was found. Further studies are needed to confirm the usefulness of sertraline in the treatment of patients with BED and also in binge eaters with a less severe eating psychopathology.

Aggressiveness, anger and eating disorders: a review

Anger and aggressive behaviours, especially those self-directed, are frequent in subjects suffering from anorexia nervosa and bulimia nervosa. They increase the complexity of the clinical features, change the prognosis and cause a more difficult management of these disorders. In order to elucidate the complex relationships between eating disorders, anger and aggressiveness, the history of traumatic experiences, the prevalence of dissociative, obsessive, impulsive and compulsive symptoms, as well as the role of severe personality disorders in subjects suffering from anorexia nervosa, bulimia nervosa and self-injurious behaviours are considered. In the final section of this paper, a model exploring such a relationship in the light of the undefined sense of self is described.

Factors related to severity of vomiting behaviors in bulimia nervosa

Assessments of the severity of vomiting (weekly frequency), depressive and eating-related psychopathology, anger level and management, and personality dimensions were used to characterize patients with bulimia nervosa binge purging type (BN-BP). The sample comprised 130 outpatients with BN and 130 control women. The Eating Disorder Inventory-2 (EDI-2), the State-Trait Anger Expression Inventory, the Beck Depression Inventory, and the Temperament and Character Inventory (TCI) were administered to all patients. The Self-Directedness dimension of the TCI and the Bulimia subscale of the EDI-2 were the strongest predictors of the severity of bulimic behavior; anger levels and anger expression were not so strongly related to illness severity. A more severe form of bulimic symptomatology probably has substrata in specific character deficits (low Self-Directedness on the TCI) and particular psychopathological features (high bulimia on the EDI-2). Patients with a high frequency of vomiting need specific therapeutic interventions to enhance the character dimension of Self-Directedness.

Anger and bulimic psychopathology: gender differences in a nonclinical group

OBJECTIVE

The current study addressed the link between anger and bulimic psychopathology between young adult men and women.

METHOD

Volunteers (125 males and 125 females) completed two self-report questionnaires measuring anger (State Trait Anger Inventory [STAXI]) and bulimic attitudes and behaviors (Bulimic Investigatory Test, Edinburgh [BITE]).

RESULTS

Although overall levels of anger did not differ broadly across genders, bulimic attitudes were associated with state anger in men but with anger suppression in women.

DISCUSSION

Men appear to engage in bulimic behaviors to reduce anger states, whereas women appear to use such behaviors to reduce the likelihood of anger states from arising. Further experimental validation of these findings is required in both clinical and nonclinical groups.

Eating disturbances in female prisoners: the role of anger

Women in prison have high levels of impulsive damaging behaviours, including disordered eating. In addition, they display pathological levels of the emotional precursors that have been associated with eating disorders, particularly anger. The present study examines levels of disordered eating behaviours in female prisoners, and whether those behaviours are associated with anger. The sample consisted of 91 sentenced women at a medium-sized prison in the UK. The women completed an interview-based screening tool for eating disorders, alongside a standardised measure of anger. Using the established cut-off on the measure concerned, 25% of the women were at risk for an eating disorder. This prevalence rate is exactly twice that observed in a non-eating-disordered community sample, using the same measure. Furthermore, different facets of anger were associated with different aspects of eating psychopathology. The most plausible explanation for this association appears to be that many women enter prison with high levels of anger-driven impulsivity, and that the constraints of the prison environment result in a focus on eating behaviours. Future research directions are discussed.

Self-reported competencies and problems among Swedish girls with eating disorders and a control sample, using the youth self-report

OBJECTIVE

To study self-reported competencies and problems in adolescent girls with eating disorders, anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS) compared to matched normal controls.

METHOD

The Youth Self-Report (YSR) was completed by 211 girls between 13 and 17 years of age with eating disorders and 211 controls matched for age, sex, and geographical area.

RESULTS

Girls with eating disorders scored lower on all competence scales and higher on most problem 'scales compared to controls. Type of diagnosis had no effect on competence scales, but BN-patients scored higher than AN- and EDNOS-patients on many problem scales. AN-bingers/purgers reported more problems than restrictors on somatic complaints, delinquent behaviour, and the externalizing dimension.

DISCUSSION

We conclude that the YSR gives important information concerning self-reported competencies and concomitant symptoms of general psychopathology in eating disordered adolescent girls.

Social anxiety and social comparison: differential links with restrictive and bulimic attitudes among nonclinical women

This study investigated the relationship of two social psychological constructs (social anxiety and social comparison) with bulimic and restrictive eating attitudes among nonclinical women. Eighty young women completed a measure of social anxiety (the Fear of Negative Evaluation Scale, FNE), a measure of social comparison (the Iowa-Netherlands Comparison Orientation Measure, INCOM), the Beck Depression Inventory (BDI), and the Eating Disorders Inventory (EDI). The results indicate a differential link between the two different social processes and the nature of eating psychopathology. Specifically, heightened social anxiety predicted drive for thinness, while levels of social comparison predicted bulimic attitudes. The findings support a model where the two social processes are each associated with different patterns of eating pathology.

Anger and core beliefs in the eating disorders

OBJECTIVE

The link between emotion and eating pathology has long been established, but relatively little is known about the role of anger, partly because the existing literature has tended to concentrate on anger as a unitary construct. Nor is there any understanding of the cognitive factors that drive this affect in the eating disorders. This study had two aims: to determine levels of different facets of anger across eating disorder diagnoses and behaviors; and to investigate whether facets of anger are related to the individual's negative core beliefs.

METHOD

The sample consisted of 140 women who met DSM-IV criteria for eating disorders, and 50 female control participants (university undergraduates). The women completed self-report questionnaires of anger levels and unhealthy core beliefs, and the presence of bulimic behaviors was recorded at assessment.

RESULTS

The eating-disordered women had higher levels of state anger and anger suppression, particularly if the diagnosis included bulimic symptoms. Different aspects of anger were associated with specific bulimic behaviors. Unhealthy core beliefs were associated with higher levels of trait anger in both groups but with anger suppression in the clinical women only.

DISCUSSION

Suggestions are made regarding ways in which state anger and anger suppression might be understood and treated in women with eating disorders.

Dropout from brief psychotherapy within a combination treatment in bulimia nervosa: role of personality and anger

BACKGROUND

To explore the personality, psychopathology, and clinical features of bulimic patients who do not complete psychotherapy, within a combined treatment.

METHODS

86 patients with bulimia nervosa (BN; DSM-IV) were evaluated before beginning treatment. The Eating Disorder Inventory II (EDI-II), State-Trait Anger Expression Inventory (STAXI), and the Temperament and Character Inventory (TCI) were administered to all patients.

RESULTS

3 subjects failed to engage in psychotherapy. Comparing patients who dropped out (n = 28) with those who did not drop out from psychotherapy (n = 55), significant differences were found in some psychopathologic (EDI-II, STAXI) and personality (TCI) variables. In particular, patients who dropped out from the treatment were more impulsive and more likely to feel anger; they were also less cooperative and less self-directive. No significant differences in sociodemographic, clinical variables and in response to fluoxetine were found between the two groups (dropout and completers).

CONCLUSIONS

We found a characteristic profile in the bulimic patients who dropped out from brief psychotherapy, i.e., they are less cooperative and more predisposed to anger. These data suggest that dropping out in a subgroup of BN patients could be related to borderline personality traits and to difficulties in making and maintaining a therapeutic relationship. Implications for treatment are discussed.

Mood, eating attitudes, and anger in obese women with and without Binge Eating Disorder

OBJECTIVE

The aim of this study was to evaluate the anger levels and their management in obese patients.

METHODS

A total of 103 obese women [51 with Binge Eating Disorder (BED) and 52 without BED] were included in the study and compared to 93 healthy controls. They were assessed with the State-Trait Anger Expression Inventory (STAXI), Beck Depression Inventory (BDI), and Eating Disorder Inventory-2 (EDI-2).

RESULTS

The BDI score is higher in obese subjects than in controls and obese binge eaters have higher levels of depression than obese patients without BED. Differences among the three groups can be found in almost all subscales of the EDI-2, even after controlling for the variable depression (BDI). For STAXI, the only difference among the three groups, which remains significant after controlling for depression, is the tendency to express anger outside (AX-OUT), which is higher in obese binge eaters. The correlation study highlights the importance of impulsivity in the group of obese binge eaters, whereas in obese patients without BED, the tendency toward anger suppression (AX-IN) is seen.

DISCUSSION

Obese patients with BED might be considered a subgroup deserving greater psychiatric interest, both for the greater severity of the eating disorder and for the comorbidity with subthreshold depressive symptoms and with borderline personality traits. In obese patients without BED, eating behavior seems more correlated to the psychological functioning typical of psychosomatic disorders. Implications for treatment are discussed.

Raising voice, risking retaliation: Events following interpersonal mistreatment in the workplace

This study advances the literature on workplace deviance, addressing retaliation victimization in the context of interpersonal mistreatment. Using survey data from 1,167 public-sector employees, the authors investigated experiences of work retaliation victimization and social retaliation victimization among employees who have vocally resisted interpersonal mistreatment. Regression analyses suggest that different victim voice mechanisms trigger different forms of retaliation, depending on the social positions of the mistreatment victim and instigator. Discriminant function analyses demonstrate lower professional, psychological, and physical well-being among mistreated employees who have been further victimized with retaliation. These analyses also reveal health-related costs associated with victim silence--that is, enduring mistreatment without voicing resistance. Results are interpreted in light of theory on power, emotions, and justice in organizations.

Causes of eating disorders

Anorexia nervosa and bulimia nervosa have emerged as the predominant eating disorders. We review the recent research evidence pertaining to the development of these disorders, including sociocultural factors (e.g., media and peer influences), family factors (e.g., enmeshment and criticism), negative affect, low self-esteem, and body dissatisfaction. Also reviewed are cognitive and biological aspects of eating disorders. Some contributory factors appear to be necessary for the appearance of eating disorders, but none is sufficient. Eating disorders may represent a way of coping with problems of identity and personal control.

Anger and personality in eating disorders

OBJECTIVE

This study was designed to examine how anger, temperament and character profiles differ across subtypes of eating disorders (EDs) in comparison to healthy controls and to analyze the relationship between anger expression, eating attitudes and personality dimensions.

METHOD

One hundred and thirty-five outpatients (50 of whom suffered from anorexia nervosa restrictor type [AN-R], 40 from anorexia nervosa binge/purging [AN-BP] and 45 from bulimia nervosa [BN]) and 50 control subjects were recruited and administered State-Trait Anger Expression Inventory (STAXI), Temperament and Character Inventory (TCI) and Eating Disorder Inventory II (EDI-II).

RESULTS

STAXI showed greater levels of anger in patients with BN than in those with AN. TCI showed different personality profiles, in accordance with previous studies. Correlations were found between the management of anger feelings and psychological and personality traits typical of patients with EDs.

CONCLUSIONS

Clinically, impulsivity seems to be the psychopathologic element most strongly correlated to anger. Moreover, it appears clear that anger is better managed by individuals with greater character strength.