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Pehlivan MJ, Sherman KA, Wuthrich V, Horn M, Basson M, Duckworth T. Body image and depression in endometriosis: Examining self-esteem and rumination as mediators. Body Image 2022; 43:463-473. [PMID: 36345084 DOI: 10.1016/j.bodyim.2022.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
Endometriosis is a chronic systemic disease affecting 1 in 10 people assigned female at birth, that can result in appearance-based and functional bodily changes which can negatively impact body image. Empirical evidence supports the body dissatisfaction-driven hypothesis that negative body image leads to greater depressive symptoms; but potential underlying mechanisms are under-researched. This prospective study investigated the mediating role of two theoretically-derived intervening factors, self-esteem and rumination, in individuals living with endometriosis who typically report high rates of body image concerns and depressive symptoms. Initially, 996 participants completed the first online survey (T0) assessing demographic, medical and psychological factors. Of these, 451 completed surveys at 1-month (T1) and 2-months (T2) follow-up assessing self-esteem, rumination and depression. Bootstrapped analyses with full-information maximum likelihood estimation indicated that poor body image (T0) predicted greater depressive symptoms over time (T2). Self-esteem (T1), but not rumination (T1), mediated the body image-depression relationship. These results provide support for the body dissatisfaction-driven hypothesis and further identify that self-esteem is a key meditating factor. This highlights the importance of addressing self-esteem in body image focused interventions.
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Affiliation(s)
- Melissa J Pehlivan
- Centre for Emotional Health, Department of Psychological Sciences, Macquarie University, NSW, Australia
| | - Kerry A Sherman
- Centre for Emotional Health, Department of Psychological Sciences, Macquarie University, NSW, Australia.
| | - Viviana Wuthrich
- Centre for Emotional Health, Department of Psychological Sciences, Macquarie University, NSW, Australia
| | - Mary Horn
- Centre for Emotional Health, Department of Psychological Sciences, Macquarie University, NSW, Australia
| | - Michelle Basson
- Centre for Emotional Health, Department of Psychological Sciences, Macquarie University, NSW, Australia
| | - Tanya Duckworth
- School of Psychology, University of Adelaide, South Australia, Australia
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2
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Rekkers ME, Aardenburg L, Scheffers M, van Elburg AA, van Busschbach JT. Shifting the Focus: A Pilot Study on the Effects of Positive Body Exposure on Body Satisfaction, Body Attitude, Eating Pathology and Depressive Symptoms in Female Patients with Eating Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11794. [PMID: 36142068 PMCID: PMC9517204 DOI: 10.3390/ijerph191811794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
One of the most commonly used techniques for the treatment of body image problems in eating disorders (ED) is body exposure (BE). However, evidence of its effectiveness in clinical populations is scarce. In the Positive Body Experience (PBE) protocol, the focus of positive BE is on aesthetic, functional and tactile aspects of the body. The current study evaluates the outcomes of positive BE with regard to changes in attitudinal body image and eating pathology, as well as the factors that influence these changes, in a sample of 84 adult female patients with different EDs who did not receive any other treatment for their EDs during the period in which BE treatment occurred. The results show significant positive changes in attitudinal body image, ED behaviors and depressive symptoms, with depressive symptoms at baseline mediating the changes in attitudinal body image. This study indicates that the PBE protocol is a suitable intervention for reducing negative attitudinal body image in anorexia and bulimia nervosa patients, as well as those with binge eating disorder. Furthermore, the results suggest that positive non-weight-related and functional body satisfaction are strong catalysts for change and that depressive symptoms play an important role in the ability to change. Additional RCTs are needed to gain more insight into the effects of PBE.
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Affiliation(s)
- Marlies E. Rekkers
- Faculty of Social Sciences, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands
- Department of Human Movement and Education, Windesheim University of Applied Sciences, Campus 2-6, 8017 CA Zwolle, The Netherlands
| | - Lisanne Aardenburg
- GGZ inGeest, Mental Health Institute, Laan van de Helende Meesters 433, 1186 DL Amstelveen, The Netherlands
| | - Mia Scheffers
- Department of Human Movement and Education, Windesheim University of Applied Sciences, Campus 2-6, 8017 CA Zwolle, The Netherlands
| | - Annemarie A. van Elburg
- Faculty of Social Sciences, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands
- Rintveld, Centre for Eating Disorders, Altrecht Mental Health Institute, 3705 WE Zeist, The Netherlands
| | - Jooske T. van Busschbach
- Department of Human Movement and Education, Windesheim University of Applied Sciences, Campus 2-6, 8017 CA Zwolle, The Netherlands
- University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Rob Giel Onderzoekcentrum, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
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3
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Srivastava P, Felonis CR, Clancy OM, Wons OB, Abber SR, Juarascio AS. Real-time predictors of body dissatisfaction in females with binge eating: an ecological momentary assessment study. Eat Weight Disord 2022; 27:1547-1553. [PMID: 34524652 DOI: 10.1007/s40519-021-01296-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Body dissatisfaction (BD) is supported as a maintenance factor for eating disorders (EDs) characterized by binge eating (BE). Although it is traditionally conceptualized as a trait construct, ecological momentary assessment (EMA) studies have shown that it fluctuates within-day and that momentary elevations in BD prospectively predict near-time ED behaviors. However, less is known about the contextual factors that precipitate these fluctuations in BD. METHODS The current study thus sought to examine whether certain internal (i.e., negative affect, shape/weight-related cognitions) and environmental (i.e., attending social events, being exposed to thin-ideal media, spending time on social media) factors prospectively predict momentary elevations in BD in females with BE. Participants (n = 25) completed an EMA protocol over 14 days. RESULTS Data on BD and internal and environmental factors were analyzed using generalized estimating equations. Results showed that (1) greater than one's usual negative affect and shape/weight-related cognitions, and (2) spending time on social media prospectively predicted momentary elevations in BD. Interestingly, attending social events prospectively predicted momentary reductions in BD. CONCLUSION These findings may have important implications for conceptualizing and managing BD to prevent ED behaviors. LEVEL OF EVIDENCE Level II, controlled trial without randomization.
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Affiliation(s)
- Paakhi Srivastava
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA, 19104, USA.
| | - Christina R Felonis
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA, 19104, USA.,Department of Psychology, Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA, 19104, USA
| | - Olivia M Clancy
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA, 19104, USA.,Department of Psychology, Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA, 19104, USA
| | - Olivia B Wons
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA, 19104, USA.,Department of Psychology, Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA, 19104, USA
| | - Sophie R Abber
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA, 19104, USA.,Department of Psychology, Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA, 19104, USA
| | - Adrienne S Juarascio
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA, 19104, USA.,Department of Psychology, Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA, 19104, USA
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4
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Jones H, McIntosh VV, Britt E, Carter JD, Jordan J, Bulik CM. The effect of temperament and character on body dissatisfaction in women with bulimia nervosa: The role of low self‐esteem and depression. EUROPEAN EATING DISORDERS REVIEW 2022; 30:388-400. [PMID: 35368118 PMCID: PMC9325425 DOI: 10.1002/erv.2899] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 03/11/2022] [Accepted: 03/17/2022] [Indexed: 11/09/2022]
Abstract
Objective Method Results Conclusions Low self‐esteem and depression were examined as mediators of associations between temperament and character dimensions and body dissatisfaction in women with bulimia nervosa. Harm avoidance contributed significantly to body dissatisfaction. The association between harm avoidance and body dissatisfaction was mediated by low self‐esteem alone and depression and low self‐esteem in serial.
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Affiliation(s)
- Hannah Jones
- School of Psychology, Speech and Hearing University of Canterbury Christchurch New Zealand
| | - Virginia V.W. McIntosh
- School of Psychology, Speech and Hearing University of Canterbury Christchurch New Zealand
| | - Eileen Britt
- School of Psychology, Speech and Hearing University of Canterbury Christchurch New Zealand
| | - Janet D. Carter
- School of Psychology, Speech and Hearing University of Canterbury Christchurch New Zealand
| | - Jennifer Jordan
- Department of Psychological Medicine University of Otago Christchurch New Zealand
- Clinical Research Unit Canterbury District Health Board Christchurch New Zealand
| | - Cynthia M. Bulik
- Department of Psychiatry University of North Carolina Chapel Hill North Carolina USA
- Department of Nutrition University of North Carolina Chapel Hill North Carolina USA
- Department of Medical Epidemiology and Biostatistics Karolinska Institutet Stockholm Sweden
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5
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Dougherty EN, Goldschmidt AB, Johnson NK, Badillo K, Engel SG, Haedt-Matt AA. Gender differences in the relation between interpersonal stress and momentary shape and weight concerns in youth with overweight/obesity. Body Image 2022; 40:249-255. [PMID: 35074653 PMCID: PMC8891090 DOI: 10.1016/j.bodyim.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 01/17/2022] [Accepted: 01/17/2022] [Indexed: 10/19/2022]
Abstract
The purpose of this study was to examine relations between interpersonal stress and momentary shape and weight concerns among pre-adolescent and early adolescent boys and girls with overweight/obesity, using ecological momentary assessment (EMA). We also aimed to determine whether interpersonal stress was differentially related to shape/weight concerns in boys versus girls. Forty youth, ages 8-14 years (53% female), with overweight or obesity reported their state-level shape/weight concerns and negative affect and their recent interpersonal stress (i.e., stress experienced since the last EMA assessment) multiple times a day, for two weeks. Results indicated that interpersonal stress predicted shape/weight concerns in girls but was not related to shape/weight concerns in boys. At the between-person level, higher overall feelings of loneliness and social rejection and a higher overall desire for more friends predicted higher average levels of shape/weight concerns. At the within-person level, higher momentary ratings of loneliness, social rejection, and desire for more friends predicted lower shape/weight concerns. These data suggest that the tendency to experience interpersonal stress may be more detrimental to body satisfaction for girls with overweight/obesity than for boys with overweight/obesity. Interventions that focus on reducing interpersonal stress may be effective in ameliorating shape/weight concerns in girls with overweight/obesity.
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Affiliation(s)
| | | | | | | | - Scott G. Engel
- Sanford Research,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine & Health Sciences
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6
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Chan CY, Lee AM, Koh YW, Lam SK, Lee CP, Leung KY, Tang CSK. Associations of body dissatisfaction with anxiety and depression in the pregnancy and postpartum periods: A longitudinal study. J Affect Disord 2020; 263:582-592. [PMID: 31744745 DOI: 10.1016/j.jad.2019.11.032] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/27/2019] [Accepted: 11/09/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pregnancy is a time of increasing vulnerability to the development of body dissatisfaction, anxiety, and depression. The present study aims to examine associations of body dissatisfaction with anxiety and depression at the following points: 6 months before pregnancy (retrospective report); in the first, second, and third trimesters of pregnancy; and up to 6 weeks postpartum. METHODS A prospective longitudinal design with a quantitative approach was adopted. A consecutive sample of 1,371 Chinese pregnant women in Hong Kong was assessed using standardized instruments at four time points. RESULTS A mixed-effects model with repeated measures revealed that body dissatisfaction and depression symptoms changed across different stages of pregnancy. Hierarchical multiple regressions showed that, after adjusting for the identified risk factors, body dissatisfaction before and during pregnancy were positively associated with antenatal anxiety and depression symptoms. Concurrent body dissatisfaction was positively associated with postpartum depression symptoms. LIMITATIONS There was a high attrition rate in the follow-up assessments. Antenatal anxiety symptoms were assessed using the scale for general anxiety, which may not adequately capture the experience of anxiety among pregnant women. CONCLUSIONS Primary healthcare practitioners should be made aware of body dissatisfaction among pregnant women in order to facilitate early intervention for anxiety and depression, because untreated psychological disturbance during pregnancy may persist into the postpartum period.
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Affiliation(s)
- Chui Yi Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong, China; The Felizberta Lo Padilla Tong School of Social Sciences, Caritas Institute of Higher Education, Hong Kong, China
| | - Antoinette Marie Lee
- Department of Psychiatry, The University of Hong Kong, Hong Kong, China; Department of Psychology, The University of Hong Kong, Hong Kong, China.
| | - Yee Woen Koh
- Department of Psychiatry, The University of Hong Kong, Hong Kong, China; Centre of Family and Population Research, The National University of Singapore, Singapore City, Singapore
| | - Siu Keung Lam
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong, China
| | - Chin Peng Lee
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong, China
| | - Kwok Yin Leung
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong, China
| | - Catherine So Kum Tang
- Department of Psychology, The National University of Singapore, Singapore City, Singapore
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7
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Austin JL, Serier KN, Sarafin RE, Smith JE. Body dissatisfaction predicts poor behavioral weight loss treatment adherence in overweight Mexican American women. Body Image 2017; 23:155-161. [PMID: 29035748 DOI: 10.1016/j.bodyim.2017.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 08/10/2017] [Accepted: 08/15/2017] [Indexed: 11/24/2022]
Abstract
Poor adherence poses a major barrier to the success of behavioral weight loss (BWL) programs, particularly for overweight Mexican American women. Given the high prevalence and costs of overweight/obesity, factors that contribute to attendance and adherence problems should be identified, especially in ethnic minority populations. The current study examined the role of pre-treatment body dissatisfaction and depression in predicting attendance and adherence in a BWL intervention. Ninety-nine overweight/obese Mexican American women enrolled in the intervention and completed baseline measures. Eighty-one of the women attended at least one treatment session and provided measures of dietary and physical activity adherence. Simultaneous linear regression analyses suggested that although higher levels of body dissatisfaction and depression each played unique roles in predicting poorer attendance, only body dissatisfaction predicted adherence. Specifically, higher body dissatisfaction predicted poorer treatment adherence. Findings highlight the importance of addressing body dissatisfaction early in BWL treatment to increase attendance and adherence.
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Affiliation(s)
- Julia L Austin
- University of New Mexico, Department of Psychology, MSC03 2220, Albuquerque, NM 87131, United States
| | - Kelsey N Serier
- University of New Mexico, Department of Psychology, MSC03 2220, Albuquerque, NM 87131, United States
| | - Ruth E Sarafin
- University of New Mexico, Department of Psychology, MSC03 2220, Albuquerque, NM 87131, United States
| | - Jane Ellen Smith
- University of New Mexico, Department of Psychology, MSC03 2220, Albuquerque, NM 87131, United States.
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8
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Rivière J, Douilliez C. Perfectionism, rumination, and gender are related to symptoms of eating disorders: A moderated mediation model. PERSONALITY AND INDIVIDUAL DIFFERENCES 2017. [DOI: 10.1016/j.paid.2017.04.041] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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9
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Trauma in relation to psychological characteristics in women with eating disorders. CURRENT ISSUES IN PERSONALITY PSYCHOLOGY 2017. [DOI: 10.5114/cipp.2017.67047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
<b>Background</b><br />
The aim of the article was to present the results of the author’s own study that sought relationships between having experienced psychological trauma and the psychological characteristics of people with eating disorders. The basic research question was the following: To what degree are the traumatic events experienced by females with various types of eating disorders related to these females’ psychological characteristics? <br />
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<b>Participants and procedure</b><br />
The sample comprised 120 females with eating disorders: 30 females aged between 20 and 26 diagnosed with bulimia nervosa, 31 females diagnosed with binge-eating disorder and 59 females aged between 20 and 26 diagnosed with anorexia nervosa. The research was carried out in the years 2007-2012 in outpatient clinics treating neuroses and eating disorders and mental health outpatient clinics in Poland. The study employed a clinical and psychometric (i.e., questionnaires for measuring psychological characteristics) approach.<br />
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<b>Results</b><br />
Statistical analysis confirmed the existence of significant differences between the females with eating disorders who have experienced relational trauma(s) in their lives (particularly in their childhood and adolescence) and those who did not reveal such experience. The females with anorexia and bulimia who have also experienced psychological, physical or sexual violence revealed a significantly different, higher level of bulimic thinking and tendencies for excessively uncontrolled, impulsive behaviors towards food and nutrition (i.e., vomit-provoking and other forms of body purgation, e.g. using purgative drugs and others) than did females with no relational trauma experience.<br />
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<b>Conclusions</b><br />
The frequency of relational trauma occurrence was significantly higher for females with bulimia and bulimic anorexia. For females with restrictive anorexia and binge-eating disorder, no significantly frequent occurrence of trauma was observed. <br />
Diagnosing the occurrence of relational trauma in patients’ histories is a key element that should be involved in the process of psychotherapy for people with eating disorders.
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10
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Muehlenkamp JJ, Saris-Baglama RN. Self-Objectification and Its Psychological Outcomes for College Women. PSYCHOLOGY OF WOMEN QUARTERLY 2016. [DOI: 10.1111/1471-6402.t01-1-00076] [Citation(s) in RCA: 147] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The objectification of women by our society can become internalized by women, resulting in negative psychological outcomes. Using Fredrickson and Roberts' (1997) objectification theory, we tested a model of the relationships between self-objectification and disordered eating and depressive symptoms in a sample of undergraduate women ( n = 384). One postulate of self-objectification theory is that self-objectification can lead to a lack of internal awareness, which may mediate the relationship between self-objectification and restrictive eating, bulimic, and depressive symptoms. Results of structural equation modeling suggest that self-objectification has a direct relationship to restrictive eating, bulimic, and depressive symptoms. The mediational role of internal awareness was relevant for depressive symptoms but not for restrictive eating or bulimic symptoms. Depressive symptoms did, however, mediate the relationship between self-objectification and bulimic symptoms. The relevance of our findings to the understanding of objectification theory are discussed and future areas of research recommended.
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11
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Sampasa-Kanyinga H, Chaput JP, Hamilton HA. Use of social networking sites and perception and intentions regarding body weight among adolescents. Obes Sci Pract 2016; 2:32-39. [PMID: 27812377 PMCID: PMC5066653 DOI: 10.1002/osp4.26] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 11/30/2015] [Accepted: 12/02/2015] [Indexed: 11/24/2022] Open
Abstract
Objective Social networking sites (SNSs) not only offer users an opportunity to link with others but also allow individuals to compare themselves with other users. However, the link between the use of SNSs and the dissatisfaction with body weight is largely unknown. We investigated the associations between the use of SNSs and the perception of body weight and related behaviours among adolescent men and women. Methods The study sample consisted of 4,468 (48.5% women) 11–19‐year‐old Canadian students in grades 7 to 12 who participated in the 2013 Ontario Student Drug Use and Health Survey. Results Overall, 54.6% of students reported using SNSs for 2 h or less per day, 28.0% reported using them for more than 2 h d−1 and 17.4% reported infrequent or no use of SNSs (reference category). After adjustment for covariates, results showed that adolescent women who use SNSs for more than 2 h d−1 had greater odds of dissatisfaction with body weight (odds ratio = 2.02; 95% confidence interval [CI]: 1.30–3.16). More specifically, they were more likely to perceive themselves as overweight (relative risk ratio [RRR] = 2.20; 95% CI: 1.34−3.60) compared with those who reported infrequent or no use of SNSs. Conversely, men who use SNSs for 2 h or less per day presented a lower risk for perceiving themselves as overweight (RRR = 0.68; 95% CI: 0.47−0.98) but not those who use SNSs for more than 2 h d−1. Women who use SNSs for more than 2 h d−1 reported a greater likelihood of trying to lose weight (RRR = 2.52; 95% CI: 1.62−3.90). Conclusions Our results showed that heavy use of SNSs is associated with dissatisfaction with body weight in adolescent women.
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Affiliation(s)
| | - J-P Chaput
- Healthy Active Living and Obesity Research Group Children's Hospital of Eastern Ontario Research Institute Ottawa Ontario Canada; Department of Paediatrics, Faculty of Medicine University of Ottawa Ottawa Ontario Canada
| | - H A Hamilton
- Centre for Addiction and Mental Health Toronto Ontario Canada; Dalla Lana School of Public Health University of Toronto Toronto Ontario Canada
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12
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Choi Y, Choi E, Shin D, Park SM, Lee K. The Association between Body Weight Misperception and Psychosocial Factors in Korean Adult Women Less than 65 Years Old with Normal Weight. J Korean Med Sci 2015; 30:1558-66. [PMID: 26538998 PMCID: PMC4630470 DOI: 10.3346/jkms.2015.30.11.1558] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 07/29/2015] [Indexed: 01/09/2023] Open
Abstract
With society's increasing interest in weight control and body weight, we investigated the association between psychological factors and body image misperception in different age groups of adult Korean women with a normal weight. On a total of 4,600 women from the Korea National Health and Nutrition Examination Survey 2007-2009, a self-report questionnaire was used to assess body weight perception and 3 psychological factors: self-rated health status, stress recognition, and depressed mood. Through logistic regression analysis, a poor self-rated health status (P = 0.001) and a higher recognition of stress (P = 0.001) were significantly associated with body image misperception and this significance remained after controlling for several sociodemographic (Model 1: adjusted odds ratio [aOR], 1.62; 95% confidence interval [CI], 1.31-2.00), health behavior and psychological factors (Model 2: aOR, 1.59; 95% CI, 1.29-1.96; Model 3: aOR, 1.36; 95% CI, 1.01-1.84). Especially, highly stressed middle-aged (50-64 yr) women were more likely to have body image misperception (Model 2: aOR, 2.85; 95% CI, 1.30-6.26). However, the correlation between depressed mood and self-reported body weight was inconsistent between different age groups. In conclusion, self-rated health status and a high recognition rate of severe stress were related to body weight misperception which could suggest tailored intervention to adult women especially women in younger age or low self-rated health status or a high recognition rate of severe stress.
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Affiliation(s)
- Yoonhee Choi
- Department of Applied Life Chemistry, Seoul National University College of Agriculture and Life Science, Seoul, Korea
| | - Eunjoo Choi
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Doosup Shin
- Department of Education and Research, Seoul National University Hospital, Seoul, Korea
| | - Sang Min Park
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kiheon Lee
- Department of Family Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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13
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Abstract
Health is regulated by homeostasis, a property of all living things. Homeostasis maintains equilibrium at set-points using feedback loops for optimum functioning of the organism. Imbalances in homeostasis causing overweight and obesity are evident in more than 1 billion people. In a new theory, homeostatic obesity imbalance is attributed to a hypothesized 'Circle of Discontent', a system of feedback loops linking weight gain, body dissatisfaction, negative affect and over-consumption. The Circle of Discontent theory is consistent with an extensive evidence base. A four-armed strategy to halt the obesity epidemic consists of (1) putting a stop to victim-blaming, stigma and discrimination; (2) devalorizing the thin-ideal; (3) reducing consumption of energy-dense, low-nutrient foods and drinks; and (4) improving access to plant-based diets. If fully implemented, interventions designed to restore homeostasis have the potential to halt the obesity epidemic.
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Affiliation(s)
- David F Marks
- Editor, Journal of Health Psychology and Health Psychology Open
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14
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Keating L, Tasca GA, Bissada H. Pre-treatment attachment anxiety predicts change in depressive symptoms in women who complete day hospital treatment for anorexia and bulimia nervosa. Psychol Psychother 2015; 88:54-70. [PMID: 24715589 DOI: 10.1111/papt.12028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 02/17/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Individuals with eating disorders are prone to depressive symptoms. This study examines whether depressive symptoms can change in women who complete intensive day treatment for anorexia and bulimia nervosa (BN), and whether these changes are associated with pre-treatment attachment insecurity. DESIGN Participants were 141 women with anorexia nervosa restricting type (n = 24), anorexia nervosa binge purge type (n = 30), and BN (n = 87) who completed a day hospital treatment programme for eating disorders. They completed a pre-treatment self-report measure of attachment, and a pre-treatment and post-treatment self-report measure of depressive symptoms. RESULTS Participants experienced significant reductions in depressive symptoms at post-treatment. Eating disorder diagnosis was not related to these improvements. However, participants lower in attachment anxiety experienced significantly greater improvement in depressive symptoms than those who were higher in attachment anxiety. CONCLUSIONS These results suggest that clinicians may tailor eating disorders treatments to patients' attachment patterns and focus on their pre-occupation with relationships and affect regulation to improve depressive symptoms. PRACTITIONER POINTS That depressive symptoms can decrease in women who complete day hospital treatment for anorexia and BN. That improvements in depressive symptoms do not vary according to eating disorder diagnosis in these women. That patients who complete treatment and who have higher attachment anxiety experience less improvements in depressive symptoms compared to those lower in attachment anxiety. That clinicians may attend to aspects of attachment anxiety, such as need for approval and up-regulation of emotions, to improve depressive symptoms in female patients with eating disorders.
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Affiliation(s)
- Leah Keating
- Department of Psychology, York University, Toronto, Canada
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15
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Abstract
Health is regulated by homeostasis, a property of all living things. Homeostasis maintains equilibrium at set-points using feedback loops for optimum functioning of the organism. Imbalances in homeostasis causing overweight and obesity are evident in more than 1 billion people. In a new theory, homeostatic obesity imbalance is attributed to a hypothesized 'Circle of Discontent', a system of feedback loops linking weight gain, body dissatisfaction, negative affect and over-consumption. The Circle of Discontent theory is consistent with an extensive evidence base. A four-armed strategy to halt the obesity epidemic consists of (1) putting a stop to victim-blaming, stigma and discrimination; (2) devalorizing the thin-ideal; (3) reducing consumption of energy-dense, low-nutrient foods and drinks; and (4) improving access to plant-based diets. If fully implemented, interventions designed to restore homeostasis have the potential to halt the obesity epidemic.
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Affiliation(s)
- David F Marks
- Editor, Journal of Health Psychology and Health Psychology Open
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16
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Shanmugam V, Jowett S, Meyer C. Eating psychopathology as a risk factor for depressive symptoms in a sample of British athletes. J Sports Sci 2014; 32:1587-95. [DOI: 10.1080/02640414.2014.912758] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Haedt-Matt AA, Zalta AK, Forbush KT, Keel PK. Experimental evidence that changes in mood cause changes in body dissatisfaction among undergraduate women. Body Image 2012; 9:216-20. [PMID: 22210105 PMCID: PMC3312938 DOI: 10.1016/j.bodyim.2011.11.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 11/23/2011] [Accepted: 11/25/2011] [Indexed: 11/18/2022]
Abstract
Previous research has found concurrent and prospective associations between negative mood and body dissatisfaction; however, only experimental research can establish causal relationships. This study utilized an experimental design to examine the influence of negative mood on body dissatisfaction. Undergraduate women were randomly assigned to an experimental or control condition. Participants in the experimental condition (n=21) completed a negative mood induction procedure. Participants in the control condition (n=24) completed a neutral mood procedure. All participants completed visual analog scales regarding their mood and satisfaction with weight and shape before and after each manipulation. Body dissatisfaction increased following the procedure for experimental but not control participants, suggesting that negative mood caused increased body dissatisfaction. In cultures that idealize thinness, body dissatisfaction may arise from funneling general feelings of dysphoria into more concrete and culturally meaningful negative feelings about the body.
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Affiliation(s)
| | - Alyson K. Zalta
- University of Pennsylvania, Department of Psychology, Philadelphia, PA, United States
| | - Kelsie T. Forbush
- Purdue University, Department of Psychological Sciences, West Lafayette, IN, United States
| | - Pamela K. Keel
- Florida State University, Department of Psychology, Tallahassee, FL, United States
- Correspondence concerning this article should be addressed to: Pamela K. Keel, Florida State University, Department of Psychology, 1107 W. Call St., Tallahassee, FL 32306, United States. Tel.: +1 850 645 9140; fax: +1 850 644 7739.
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18
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19
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Suisman JL, Burt SA, McGue M, Iacono WG, Klump KL. Parental divorce and disordered eating: an investigation of a gene-environment interaction. Int J Eat Disord 2011; 44:169-77. [PMID: 21312202 PMCID: PMC3058816 DOI: 10.1002/eat.20866] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/28/2010] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We investigated gene-environment interactions (GxE) for associations between parental divorce and disordered eating (DE). METHOD Participants were 1,810 female twins from the Michigan State University Twin Registry and the Minnesota Twin Family Study. The Minnesota Eating Behaviors Survey was used to assess DE. We tested for GxE by comparing the heritability of DE in twins from divorced versus intact families. It was hypothesized that divorce would moderate the heritability of DE, in that heritability would be higher in twins from divorced than twins from intact families. RESULTS As expected, the heritability of body dissatisfaction was significantly higher in twins from divorced than intact families. However, genetic influences were equal in twins from divorced and intact families for all other forms of DE. DISCUSSION Although divorce did not moderate heritability of most DE symptoms, future research should replicate GxEs for body dissatisfaction and identify factors underlying this unique relationship.
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Affiliation(s)
| | | | - Matt McGue
- University of Minnesota, Minneapolis, Minnesota
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21
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Holm-Denoma JM, Hankin BL. Perceived physical appearance mediates the rumination and bulimic symptom link in adolescent girls. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2010; 39:537-44. [PMID: 20589564 DOI: 10.1080/15374416.2010.486324] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The prospective relationship between initial rumination and subsequent bulimic symptoms, and vice versa, was examined, and possible mediators were tested in a community sample of 191 adolescent girls (M age = 14.5) at 3 different assessment time points. Path analyses indicated that Time 1 rumination predicted Time 3 bulimic symptoms, and vice versa. Physical appearance competence (but not social competence) mediated both relationships. The results suggest that specific cognitive mechanisms, such as rumination, may play an etiological role in the development of bulimic symptoms. This may be especially true for adolescent girls who exhibit low competence beliefs about their physical appearance.
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Sánchez-Villegas A, Pimenta AM, Beunza JJ, Guillen-Grima F, Toledo E, Martinez-Gonzalez MA. Childhood and young adult overweight/obesity and incidence of depression in the SUN project. Obesity (Silver Spring) 2010; 18:1443-8. [PMID: 19875985 DOI: 10.1038/oby.2009.375] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This study included 11,825 participants of a Spanish dynamic prospective cohort based on former students from University of Navarra, registered professionals from some Spanish provinces, and university graduates from other associations, followed-up for 6.1 years. We aimed to assess the association between childhood or young adult overweight/obesity and the risk of depression. Participants were asked to select which of nine figures most closely represented their body shape at ages 5 and 20 years. Childhood and young adult overweight/obesity was defined as those cases in which participants reported body shape corresponding to the figures 6-9 (more obese categories) at age 5 or 20, respectively. A subject was classified as incident case of depression if he/she was initially free of depression and reported physician-made diagnosis of depression and/or the use of antidepressant medication in at least one of biannual follow-up questionnaires. The association between childhood and young adult overweight/obesity and incidence of depression was estimated by multiple-adjusted hazard ratio (HR) and its 95% confidence interval (95% CI). Overweight/obesity at age 5 years predicted an increased risk for adult depression (HR = 1.50, 95% CI = 1.06-2.12), and a stronger association was observed at age 20 years ((HR = 2.22, 95% CI = 1.22-4.08), (subjects younger than 30 years at recruitment were excluded from this last analysis)). Childhood or young adult overweight/obesity was associated with elevated risk of adult depression. These results, if causal and confirmed in other prospective studies, support treating childhood and young adult overweight/obesity as part of comprehensive adult depression prevention efforts.
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Affiliation(s)
- Almudena Sánchez-Villegas
- Department of Clinical Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
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Abstract
Anorexia nervosa and bulimia nervosa are primarily psychiatric disorders characterized by severe disturbances of eating behavior. Eating disorders are most prevalent in the Western culture where food is in abundance and female attractiveness is equated with thinness. Eating disorders are rare in countries like India. Despite a plethora of management options available to the mental health professionals, no major breakthrough has been achieved in recent years. Nutritional rehabilitation along with some form of re educative psychotherapy remains the mainstay of management of anorexia nervosa. In bulimia nervosa, both fluoxetine and cognitive behavior therapy have been found to be effective. Although the above-mentioned management options have been in use for decades, the active ingredient is still to be ascertained.
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Affiliation(s)
- Kaustav Chakraborty
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh -160 012, India
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Hirata E, Pilati R. Desenvolvimento e validação preliminar da Escala Situacional de Satisfação Corporal - ESSC. PSICO-USF 2010. [DOI: 10.1590/s1413-82712010000100002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
O objetivo deste estudo foi desenvolver e validar um instrumento de satisfação corporal situacional numa amostra de estudantes universitários brasileiros. A escala inclui itens de avaliação de partes e do corpo como um todo. Análises fatoriais exploratórias revelaram uma estrutura com quatro fatores; "partes inferiores" (α=0,72), "satisfação e músculo" (α=0,82), "partes externas" (α=0,65) e "insatisfação e gordura" (α=0,82). Seus 28 itens obtiveram cargas fatoriais variando entre 0,32 e 0,82. Análises adicionais indicaram que a escala foi sensível a características da amostra, como Índice de Massa Corporal e gênero, corroborando a literatura atual da área.
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Feminist Identity Attitudes, Negative Affect, and Eating Pathology in African American College Women. JOURNAL OF BLACK PSYCHOLOGY 2009. [DOI: 10.1177/0095798409353753] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
African American women are believed to have unique experiences related to eating pathology partially because of the intersection of gender and race in Western society. Investigations of negative affect and identity development as predictors of eating pathology in African American women have yielded mixed results; however, feminist identity development is yet to be examined as a predictor of eating problems in this group. Therefore, the current study investigated feminist identity attitudes, anxiety, and depression as predictors of eating pathology in 98 African American college women. Interestingly, most of the participants endorsed a “Synthesis” feminist identity style. However, negative affect emerged as the only significant predictor of eating pathology. These findings are congruent with previous research that supports significant relations between anxiety, depression, and eating disturbance in women.
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Clark A, Skouteris H, Wertheim EH, Paxton SJ, Milgrom J. The Relationship between Depression and Body Dissatisfaction across Pregnancy and the Postpartum. J Health Psychol 2009; 14:27-35. [DOI: 10.1177/1359105308097940] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The overall aim of this study was to examine the relationship between depression and body dissatisfaction across pregnancy and the first 12 months postpartum. During pregnancy, women's ( N = 116) perceived attractiveness and strength/fitness remained stable, while feeling fat and salience of weight/shape decreased in late pregnancy. During the postpartum, feeling fat and salience of weight/shape increased. Depression and body dissatisfaction scores were correlated with each other concurrently and across multiple time points. However, in baseline-controlled prospective analyses, only a model of greater depression late in pregnancy predicting body dissatisfaction at six weeks postpartum and feeling fat throughout the postpartum was supported.
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Pimenta AM, Sánchez-Villegas A, Bes-Rastrollo M, López CN, Martínez-González MÁ. Relationship between body image disturbance and incidence of depression: the SUN prospective cohort. BMC Public Health 2009; 9:1. [PMID: 19121216 PMCID: PMC2667175 DOI: 10.1186/1471-2458-9-1] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2008] [Accepted: 01/02/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Body image disturbance is an increasing problem in Western societies and is associated with a number of mental health outcomes including anorexia, bulimia, body dysmorphia, and depression. The aim of this study was to assess the association between body image disturbance and the incidence of depression. METHODS This study included 10,286 participants from a dynamic prospective cohort of Spanish university graduates, who were followed-up for a median period of 4.2 years (Seguimiento Universidad de Navarra - the SUN study). The key characteristic of the study is the permanently open recruitment that started in 1999. The baseline questionnaire included information about body mass index (BMI) and the nine figure schemes that were used to assess body size perception. These variables were grouped according to recommended classifications and the difference between BMI and body size perception was considered as a proxy of body image disturbance. A subject was classified as an incident case of depression if he/she was initially free of depression and reported a physician-made diagnosis of depression and/or the use of antidepressant medication in at least one of the follow-up questionnaires. The association between body image disturbance and the incidence of depression was estimated by calculating the multivariable adjusted Odds Ratio (OR) and its 95% Confidence Interval (95% CI), using logistic regression models. RESULTS The cumulative incidence of depression during follow-up in the cohort was 4.8%. Men who underestimated their body size had a high percentage of overweight and obesity (50.1% and 12.6%, respectively), whereas women who overestimated their body size had a high percentage of underweight (87.6%). The underestimation exhibited a negative association with the incidence of depression among women (OR: 0.72, 95% CI: 0.54 - 0.95), but this effect disappeared after adjusting for possible confounding variables. The proportion of participants who correctly perceived their body size was high (53.3%) and gross misperception was seldom found, with most cases selecting only one silhouette below (42.7%) or above (2.6%) their actual BMI. CONCLUSION We found no association between body image disturbance and subsequent depression in a cohort of university graduates in Spain.
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Affiliation(s)
- Adriano Marçal Pimenta
- Department of Maternal and Child Nursing and Public Health, Nursing School, Universidade Federal de Minas Gerais (UFMG), Avenida Alfredo Balena, 190. Belo Horizonte, Minas Gerais, CEP 30130-100, Brazil
| | - Almudena Sánchez-Villegas
- Department of Preventive Medicine and Public Health, Medical School, Clínica Universitaria/Universidad de Navarra (UNAV), Inrunlarrea, 1. Pamplona, Navarra, E 31080, Spain
- Department of Clinical Sciences, Medical School, Universidad de Las Palmas de Gran Canaria (ULPGC), PO BOX: 550, Las Palmas, Las Palmas de Gran Canaria, CP. 35080, Spain
| | - Maira Bes-Rastrollo
- Department of Preventive Medicine and Public Health, Medical School, Clínica Universitaria/Universidad de Navarra (UNAV), Inrunlarrea, 1. Pamplona, Navarra, E 31080, Spain
| | - Celeste Nicole López
- Harvard Medical School, Harvard University, 25 Shattuck Street, Boston, Massachusetts, 02115, USA
| | - Miguel Ángel Martínez-González
- Department of Preventive Medicine and Public Health, Medical School, Clínica Universitaria/Universidad de Navarra (UNAV), Inrunlarrea, 1. Pamplona, Navarra, E 31080, Spain
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Kim DS, Kim HS, Cho Y, Cho SI. The Effects of Actual and Perceived Body Weight on Unhealthy Weight Control Behaviors and Depressed Mood among Adult Women in Seoul, Korea. J Prev Med Public Health 2008; 41:323-30. [DOI: 10.3961/jpmph.2008.41.5.323] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Dong-Sik Kim
- School of Public Health, Seoul National University, Korea
- Institute of Health and Environment, Seoul National University, Korea
| | - Hyun-Sun Kim
- School of Public Health, Seoul National University, Korea
| | - Youngtae Cho
- School of Public Health, Seoul National University, Korea
- Institute of Health and Environment, Seoul National University, Korea
| | - Sung-Il Cho
- School of Public Health, Seoul National University, Korea
- Institute of Health and Environment, Seoul National University, Korea
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29
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Spindler A, Milos G. Links between eating disorder symptom severity and psychiatric comorbidity. Eat Behav 2007; 8:364-73. [PMID: 17606234 DOI: 10.1016/j.eatbeh.2006.11.012] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2006] [Revised: 10/25/2006] [Accepted: 11/09/2006] [Indexed: 11/16/2022]
Abstract
Patients with eating disorders (ED) frequently exhibit additional psychiatric disorders. This study aimed to examine whether psychiatric comorbidity in ED patients is associated with increased severity of ED symptoms in a sample of 277 women with a current ED (84 anorexia nervosa, 152 bulimia nervosa, 41 eating disorders not otherwise specified). Psychiatric comorbidity of Axes I and II was determined using the Structured Clinical Interview (SCID) for DSM-IV. Severity of ED-related symptoms was assessed using interviewer-rated scales from the Structured Interview for Anorexia and Bulimia Nervosa (SIAB). Affective and anxiety-related disorders of both axes were linked with increased intensity of weight- and appearance-related fears and concerns. Frequency of binge-eating and frequency of purging both were associated with Axis I anxiety disorders, substance-related disorders, and Cluster B personality disorders. Frequency of dieting was related to anxiety disorders on both axes. Multivariate analyses revealed that Axis I anxiety disorders were more closely linked with severity of ED symptoms than affective or substance-related disorders. The results showed that psychiatric comorbidity of both axes is linked with increased severity of ED symptoms and that there are associations between specific ED symptoms and specific forms of comorbidity.
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Affiliation(s)
- Anja Spindler
- Psychiatric Department, University Hospital, Culmannstrasse 8, CH-8091 Zürich, Switzerland.
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Abstract
OBJECTIVE The RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center systematically reviewed evidence on factors associated with outcomes among individuals with anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) and whether outcomes differed by sociodemographic characteristics. METHOD We searched electronic databases including MEDLINE and reviewed studies published from 1980 to September, 2005, in all languages against a priori inclusion/exclusion criteria and focused on eating, psychiatric or psychological, or biomarker outcomes. RESULTS At followup, individuals with AN were more likely than comparisons to be depressed, have Asperger's syndrome and autism spectrum disorders, and suffer from anxiety disorders including obsessive-compulsive disorders. Mortality risk was significantly higher than what would be expected in the population and the risk of suicide was particularly pronounced. The only consistent factor across studies relating to worse BN outcomes was depression. A substantial proportion of individuals continue to suffer from eating disorders over time but BN was not associated with increased mortality risk. Data were insufficient to draw conclusions concerning factors associated with BED outcomes. Across disorders, little to no data were available to compare results based on sociodemographic characteristics. CONCLUSION The strength of the bodies of literature was moderate for factors associated with AN and BN outcomes and weak for BED.
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Affiliation(s)
- Nancy D Berkman
- RTI International, Research Triangle Park, North Carolina, USA
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31
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Hilbert A, Tuschen–Caffier B. Body–Related Cognitions in Binge–Eating Disorder and Bulimia Nervosa. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2005. [DOI: 10.1521/jscp.2005.24.4.561] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ruuska J, Kaltiala-Heino R, Rantanen P, Koivisto AM. Are there differences in the attitudinal body image between adolescent anorexia nervosa and bulimia nervosa? Eat Weight Disord 2005; 10:98-106. [PMID: 16114223 DOI: 10.1007/bf03327531] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Body image dissatisfaction is as well a risk factor for eating disorders (ED) and a central feature of ED. The exact nature of body image in adolescent ED is still debated. This study examined attitudinal body image in adolescent anorexia nervosa (AN) and bulimia nervosa (BN), and the association of age, maturational timing, duration of eating disorder, actual weight and general psychological distress with the attitudinal body image in ED. METHODS The study group consisted of an outpatient clinical sample of adolescents attending for assessment because of eating disorders. The attitudinal body image of 57 adolescents (girls) aged 14-21 years was studied at the beginning of the treatment. The attitudes to body shape, body size, appearance, tone and femininity were studied by a Likert format scale and by the body dissatisfaction (BD) and drive for thinness scales (DT) from EDI-2 inventory. RESULTS Bulimics reported more body image dissatisfaction than anorectics. In multivariate analyses BN and higher general psychological distress had strong associations with body image dissatisfaction. Longer duration of ED and earlier menarche were also associated with negative body image. DISCUSSION Attitudinal body image differs between adolescent AN and BN. The psychological distress has a great impact on body image in ED, which should be taken into account in assessment and in treatment interventions.
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Affiliation(s)
- J Ruuska
- Tampere School of Public Health, Tampere Medical School, University of Tampere, Finland.
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Barry DT, Grilo CM, Masheb RM. Comparison of patients with bulimia nervosa, obese patients with binge eating disorder, and nonobese patients with binge eating disorder. J Nerv Ment Dis 2003; 191:589-94. [PMID: 14504568 DOI: 10.1097/01.nmd.0000087185.95446.65] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study compared patients with bulimia nervosa (BN), obese patients with binge eating disorder (BED), and nonobese patients with BED. One hundred sixty-two adult women consecutively evaluated for outpatient clinical trials who met DSM-IV criteria for BN, purging type (N = 46) or for BED (N = 79 obese and N = 37 nonobese) were compared using the Eating Disorder Inventory (EDI). The three groups differed significantly on two (drive for thinness and body dissatisfaction) of the three eating-related scales and on all five of the general personality scales of the EDI. When age and depression level were controlled, findings for the eating-related scales did not change, whereas four of the five general personality scales were no longer significant. Post hoc analyses revealed that the BN group and the nonobese BED group had significantly higher drive for thinness than the obese BED group. The nonobese and the obese BED groups did not differ from each other in any area (other than drive for thinness), including body dissatisfaction. The nonobese and the obese BED groups had significantly lower maturity features than the BN group. Our findings suggest that when the effects of age and depression levels are controlled, treatment-seeking women with BN and BED are generally similar. Certain differences that do exist between women with BN and BED are associated with obesity status (drive for thinness), whereas others are associated with diagnosis (body dissatisfaction, maturity fears).
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Affiliation(s)
- Declan T Barry
- Department of Psychiatry, Yale Psyquiatric Research at Congress Place, Yale University School of Medicine, New Haven, CT 06519, USA
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Cogley CB, Keel PK. Requiring remission of undue influence of weight and shape on self-evaluation in the definition of recovery for bulimia nervosa. Int J Eat Disord 2003; 34:200-10. [PMID: 12898556 DOI: 10.1002/eat.10187] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The current study evaluated the concurrent validity of requiring remission of undue influence of weight and shape on self-evaluation (undue influence) in defining recovery from bulimia nervosa (BN). METHODS Three groups completed the Beck Depression Inventory, the Mood and Anxiety Symptom Questionnaire, the Body Shape Questionnaire, and the Social Adjustment Scale: 31 women were fully recovered from BN (FR), 28 women had no behavioral symptoms of BN (partially recovered [PR]), and 59 matched non-eating-disordered controls (MC). RESULTS The PR group had more pathologic scores on depression, anxiety, body dissatisfaction, and social adjustment compared with both the FR and MC groups, which did not differ from each other. DISCUSSION These findings suggest that including remission of cognitive symptoms in a standardized definition of recovery may prove to be clinically useful in establishing reliable prognostic indicators. Future research should evaluate the role played by cognitive symptoms in triggering relapse.
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Affiliation(s)
- Catherine B Cogley
- Department of Psychology, Harvard University, Cambridge, Massachusetts 02138, USA
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Lokken K, Ferraro FR, Kirchner T, Bowling M. Gender differences in body size dissatisfaction among individuals with low, medium, or high levels of body focus. THE JOURNAL OF GENERAL PSYCHOLOGY 2003; 130:305-10. [PMID: 12926515 DOI: 10.1080/00221300309601161] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The authors designed the present study to test whether women reported higher levels of body dissatisfaction than did men even when the 2 genders were matched on a measure of degree of body focus. Sixty undergraduates (30 men, 30 women) were screened on attention-to-body-shape scores and divided into high, medium, and low body-shape-focus groups. The participants also completed questionnaires that provided information on age, education, vocabulary ability, levels of depression, and body-image assessment. The groups did not differ (ps > .05) on age, education, vocabulary ability, or levels of depression. However, women in all 3 body-shape-focus categories indicated a larger discrepancy between their real vs. ideal body images (p < .01) than did the men. In the high-body-focus group, there was an 11:1ratio between women's and men's reported real-ideal body-shape discrepancies. Women showed greater body dissatisfaction than did men, even when the genders were matched on a measure of body focus.
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Affiliation(s)
- Kristine Lokken
- Department of Psychology, University of North Dakota, Grand Forks 58202-8380, USA
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Girodo M. Actual and possible body-image self-schemas in young women with bulimic tendencies. Percept Mot Skills 2003; 96:1123-32. [PMID: 12929764 DOI: 10.2466/pms.2003.96.3c.1123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To examine whether information about body image is processed and cognitively organized around a self-concept, two experiments analyzed reaction time and memory for 48 young women with bulimic tendencies. Information was self-referencing to body shape vs trait words and information processing of adjectives referenced to "I dream of" and "I am afraid of" facets of self. Bulimic subjects encoded "fat" adjectives faster when these words were referenced to the present self. Reaction times were also faster to both "thin" and "fat" adjectives when these words were self-referenced to an "I dream of" and to an "I am afraid of" self, respectively. Processing of body-image information depended on which facet of self was activated rather than on the denotative meaning of the stimulus words. Memory for thin and fat adjectives was not related to preoccupation with body image or to which facet of the self was invoked. Findings suggest that an actual body-image schema and a possible body-image schema could coexist for bulimic persons. Such coexistence is necessary for a theory which posits knowledge structures might be dynamically related.
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Affiliation(s)
- Michel Girodo
- School of Psychology, University of Ottawa, ON, Canada.
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37
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Walker L, Timmerman GM, Kim M, Sterling B. Relationships between body image and depressive symptoms during postpartum in ethnically diverse, low income women. Women Health 2003; 36:101-21. [PMID: 12539795 DOI: 10.1300/j013v36n03_07] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this study was to examine body image, depressive symptoms, and their interrelationship at post-delivery and at 6 weeks postpartum in a triethnic sample of low income new mothers. Data for this study were drawn from the Austin New Mothers Study. Participants were 76 Anglo/White, 72 African American, and 135 Hispanic new mothers who were participating in Medicaid, at least 18 years old, free of medical risk factors, and delivered at term. Body image was measured by the Body Cathexis Scale (BCS) and depressive symptoms by the Center for Epidemiologic Studies Depression Scale (CES-D). The leading areas of body dissatisfaction in postpartum were similar across ethnic groups. At 6 weeks postpartum Anglo women had the highest number of body image components perceived negatively, whereas African-American women had the least. In the overall sample, body image attitudes were significantly related to depressive symptoms in correlational (r's .19 to .34) and regression analyses. In addition, African American ethnicity was associated in regression analyses with higher depressive symptoms. Neither African American nor Hispanic ethnicity significantly moderated the relationship between body image attitudes and depressive symptoms in tests of interactions. Marital/partnered status and income level were related to depressive symptoms at both time points. In addition, being a woman with a parity of II was associated with higher depressive symptoms at 6 weeks postpartum. Although addition of these personal variables increased the percent of variance accounted for, body image attitudes continued to be significant predictors of depressive symptoms.
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Affiliation(s)
- Lorraine Walker
- University of Texas at Austin, School of Nursing, 1700 Red River Street, Austin, TX 78701-1499, USA
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38
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Matz PE, Foster GD, Faith MS, Wadden TA. Correlates of body image dissatisfaction among overweight women seeking weight loss. J Consult Clin Psychol 2002. [PMID: 12182267 DOI: 10.1037/0022-006x.70.4.1040] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Predictors of body image dissatisfaction (BID) among obese people are poorly understood. In 79 obese women seeking weight reduction, associations with BID of self-esteem, youth teasing, adult teasing, and internalization of sociocultural appearance standards (ISAS) were studied. Analyses revealed that only self-esteem, adult teasing, and ISAS predicted BID. Results highlight the importance of adulthood self-esteem and interpersonal-cultural context--rather than childhood experiences--in predicting adulthood BID.
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Affiliation(s)
- Patty E Matz
- Cornell Cognitive Therapy Clinic, Weill Medical College, Cornell University, New York, New York 10021, USA.
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39
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Abstract
Competitive female athletes may have higher risk of eating disorders (ED) than recreational athletes, in part because low body fat may be advantageous in sports. However, women who participate in sports or physical activities might also do this for weight reduction, altering body shape, and for other food related reasons. This study was conducted to evaluate the association between hours of leisure time physical activity (PA) and prevalence of ED, and whether the association between the Eating Disorders Inventory (EDI) scales and ED, as classified by the Survey of Eating Disorders (SED), was the same among women with high vs. low physical activity levels. The community-based study sample consisted of 898 female students aged 18-50 years. Subjects filled out the EDI, the SED, and a questionnaire concerning physical activity and demographic data. Physical activity was not associated with increased risk of having a SED-defined diagnosis of an ED or of having an EDI score greater than 40, which is sometimes used to define women at risk for having an eating disorder. Women with a SED-defined ED had higher scores on all subscales of the EDI, but did not differ with respect to age, BMI or hours of weekly activity. The strongest predictors of having a SED-defined ED were body mass index (BMI), two EDI scales, drive of thinness and Bulimia Nervosa, with no differences between the two PA groups. Among women with a SED-defined ED, those with more than 5 h weekly PA did not differ from others with respect to scoring on the EDI or BMI. Results suggest that hours of physical activity may not increase risk of developing ED. Effective interventions are needed to help the growing numbers of persons with body-image and eating difficulties. For some, moderate physical training might be helpful.
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Affiliation(s)
- Liv Berit Augestad
- Department of Sport Sciences, Faculty of Social Sciences and Technology Management, Norwegian University of Science and Technology, N-7491 Trondheim, Norway.
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Anderson CB, Carter FA, McIntosh VV, Joyce PR, Bulik CM. Self-harm and suicide attempts in individuals with bulimia nervosa. Eat Disord 2002; 10:227-43. [PMID: 16864266 DOI: 10.1002/erv.472] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Self-harm has been identified as a clinical feature in at least a subgroup of women with bulimia nervosa. We explored how women with bulimia who engage in self-harming behaviors differ from women with bulimia without self-harming behaviors and from women with bulimia who attempt suicide with lethal intent. We compared features of the eating disorder, Axis I and II comorbidity, and Eating Disorder Inventory and Temperament and Character Inventory (TCI) scores across 19 women with bulimia who engaged in self-harming behaviors, 28 women with bulimia who reported suicide attempts with lethal intent, and 105 women with bulimia with no self-harming or suicidal behaviors. Women with bulimia nervosa and self-harm behaviors reported significantly more laxative abuse and drug abuse in general. Bulimic women with suicide attempts had the highest rates of overall comorbidity across the three groups. Individuals with self-harm scored significantly higher on the self-transcendence scale of the TCI. Bulimic women with self-harming behaviors appear to engage in more drug taking behavior--both associated with the eating disorder (laxatives) and in terms of illicit drug use. Overall, the highest rates of Axis I and Axis II comorbidity were associated with individuals with suicide attempts. High scores on self-transcendence may signal a greater sense of dissociation and disconnectedness in bulimic women who self-harm.
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Affiliation(s)
- Charles B Anderson
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond 23298-0126, USA
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Women's Health LiteratureWatch. JOURNAL OF WOMEN'S HEALTH & GENDER-BASED MEDICINE 2001; 10:821-6. [PMID: 11703895 DOI: 10.1089/15246090152636587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
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