Pathoplasticity of bulimic features and interpersonal problems

Interpersonal Problem Profiles of Personality and Psychopathology Constructs in Chinese Undergraduates and Offenders

The interpersonal problem circumplex is extensively used in the field as an assessment framework for understanding the interpersonal implications of a range of personality and psychopathology constructs. The vast majority of this large literature has been conducted in Western convenience and clinical samples. We computed interpersonal problem structural summary parameters for a range of personality and psychopathology variables in two Chinese offender samples (N = 424 and N = 555) and one undergraduate sample (N = 511) to test how well findings from Western samples generalize to Chinese undergraduates and offenders. The results showed that findings in Western samples generalized reasonably well to Chinese young adult and forensic contexts, although the interpersonal profiles of external variables were less specific in Chinese samples. Compared with undergraduates, interpersonal distress has stronger associations with the mental health of offenders. This study further elaborates the interpersonal correlates of individual differences in personality and psychopathology across cultures and assessment contexts, and it also extends the literature examining interpersonal problems in forensic settings.

Personality Heterogeneity in Adolescents With Disruptive Behavior Disorders1

We first confirmed adolescents diagnosed with disruptive behavior disorders (oppositional defiant, conduct disorder; n = 158) had lower constraint and higher negative emotionality, and greater psychiatric comorbidity and psychosocial dysfunction, relative to adolescents without (n = 755), in a population-based sample enriched for externalizing psychopathology (mean age = 17.90 years; 52% female). We then explored whether different personality types, defined by patterns of personality identified via latent profile analysis, were differently associated with clinical features in adolescents with a disruptive behavior disorder diagnosis. Four distinct personality types ("disinhibited," "high distress," "low distress," "positive") were meaningfully different from one another. Results highlight personality heterogeneity as a means of identifying individuals at greatest risk for the most deleterious forms of externalizing psychopathology.

The latent structure of interpersonal problems: Validity of dimensional, categorical, and hybrid models

Interpersonal problems are key transdiagnostic constructs in psychopathology. In the past, investigators have neglected the importance of operationalizing interpersonal problems according to their latent structure by using divergent representations of the construct: (a) computing scores for severity, agency, and communion (“dimensional approach”), (b) classifying persons into subgroups with respect to their interpersonal profile (“categorical approach”). This hinders cumulative research on interpersonal problems, because findings cannot be integrated both from a conceptual and a statistical point of view. We provide a comprehensive evaluation of interpersonal problems by enlisting several large samples (Ns = 5,400, 491, 656, and 712) to estimate a set of latent variable candidate models, covering the spectrum of purely dimensional (i.e., confirmatory factor analysis using Gaussian and nonnormal latent t-distributions), hybrid (i.e., semiparametric factor analysis), and purely categorical approaches (latent class analysis). Statistical models were compared with regard to their structural validity, as evaluated by model fit (corrected Akaike’s information criterion and the Bayesian information criterion), and their concurrent validity, as defined by the models’ ability to predict relevant external variables. Across samples, the fully dimensional model performed best in terms of model fit, prediction, robustness, and parsimony. We found scant evidence that categorical and hybrid models provide incremental value for understanding interpersonal problems. Our results indicate that the latent structure of interpersonal problems is best represented by continuous dimensions, especially when one allows for nonnormal latent distributions.

This study suggests that interpersonal problems are best characterized by continuous differences in severity and interpersonal style (i.e., agency and communion), and not by “types” of people.

Patients with Binge Eating Disorder and Obesity have qualitatively different interpersonal characteristics: Results from an Interpersonal Circumplex study

BACKGROUND

Patients with Binge Eating Disorder (BED) and obesity experience distressing relationships, which could trigger negative affect and over-eating. To date no studies compared the interpersonal profiles and prototypicality of both groups using the Interpersonal Circumplex.

METHOD

A sample of 177 patients with BED (mean age: 41.0 ± 12.5 years; 11.3% males), 321 obese non-BED adults (mean age: 44.5 ± 13.4 years; 28% males), and 108 normal weight adults (mean age: 37.3 ± 9.6 years; 52.77% males) completed the Inventory of Interpersonal Problems (IIP-32), and scales of binge eating and psychological distress at one time-point.

RESULTS

Compared to normal weight and obese participants, those with BED reported higher levels of interpersonal problems on all circumplex dimensions, except for Vindictive, with small to medium effects. All groups had highly prototypical profiles. Both obese and normal weight adults had very similar interpersonal profiles characterized by predominant friendly-dominant themes. On the contrary, those with BED had predominant friendly-submissive themes. Patients with BED reported significantly higher levels of psychological distress and binge eating severity, compared to the other two groups. Greater Domineering, Cold, Socially Inhibited and Non-Assertive scale scores, and lower Vindictive scale scores significantly predicted higher binge eating and psychological distress, regardless of group membership.

DISCUSSION

Findings lend support to an interpersonal model of binge eating and to the presence of qualitative differences between patients with obesity and BED. Finally, results suggest some strategies for the clinical management of BED focused on non-assertion and problems with experiences and expression of anger.

Validation of the Inventory of Interpersonal Problems (IIP-64): a comparison of Swedish female outpatients with anorexia nervosa or bulimia nervosa and controls

AIM

The aim of the study was to explore the psychometric properties of the Inventory of Interpersonal Problems (IIP-64) and to compare levels of interpersonal distress in Swedish female outpatients with anorexia nervosa or bulimia nervosa with age- and gender-matched controls.

METHODS

Totally, 401 participants were included; anorexia nervosa (n = 74), bulimia nervosa (n = 85) and controls (n = 242). All participants completed the IIP-64. The eating disorder (ED) patients also filled out the Eating Disorder Inventory-2/3 (EDI).

RESULTS

Internal consistency of IIP-64 was acceptable to high. Principal component analyses with varimax rotation of the IIP-64 subscales confirmed the circumplex structure with two underlying orthogonal dimensions; affiliation and dominance. Significant correlations between EDI-3 composite scales ineffectiveness and interpersonal problems and IIP-64 were found. ED patients reported higher levels of interpersonal distress than controls on all but one subscale (intrusive/needy).

CONCLUSIONS

IIP-64 can be considered to have acceptable to good reliability and validity in a Swedish ED sample. IIP-64 can be a useful complement in assessment of interpersonal problems in ED.

Do adverse childhood experiences predict adult interpersonal difficulties? The role of emotion dysregulation

Adverse childhood experiences (ACEs) are risk factors for interpersonal difficulties in adulthood, however the mechanism that underlies this association is unknown. The current study investigated the association of a wide range of ACEs with interpersonal difficulties in adulthood, and tested whether emotion dysregulation mediated the relationship between ACEs and interpersonal difficulties. Patients over the age of 18 were recruited from primary care clinics (N = 4006). Participants completed self-report questionnaires that assessed ACEs, emotion dysregulation, and interpersonal difficulties. Results indicated that, after controlling for a range of demographic variables, each type of ACE significantly predicted increased interpersonal difficulties and that cumulative ACEs predicted increased interpersonal difficulties, F(8, 3137) = 39.68, p < .001, R² = 0.09. Further, emotion dysregulation mediated the association between ACEs and interpersonal difficulties, B = 0.79, SE = 0.09, 95% CI [0.64, 0.97]. These findings emphasize the role of childhood adversity on interpersonal functioning in adulthood, and highlight emotion dysregulation as a mechanism by which this association occurs. Results have the potential to inform preventative and treatment efforts to improve adaptive outcomes among individuals with a history of childhood adversity.

The Italian Version of the Inventory of Interpersonal Problems (IIP-32): Psychometric Properties and Factor Structure in Clinical and Non-clinical Groups

All versions of the Inventory of Interpersonal Problems (IIP) are broadly used to measure people's interpersonal functioning. The aims of the current study are: (a) to examine the psychometric properties and factor structure of the Italian version of the Inventory of Interpersonal Problems—short version (IIP-32); and (b) to evaluate its associations with core symptoms of different eating disorders. One thousand two hundred and twenty three participants (n = 623 non-clinical and n = 600 clinical participants with eating disorders and obesity) filled out the Inventory of Interpersonal Problems—short version (IIP-32) along with measures of self-esteem (Rosenberg Self-Esteem Scale, RSES), psychological functioning (Outcome Questionnaire, OQ-45), and eating disorders (Eating Disorder Inventory, EDI-3). The present study examined the eight-factor structure of the IIP-32 with Confirmatory Factor Analysis (CFA) and Exploratory Structural Equation Modeling (ESEM). ESEM was also used to test the measurement invariance of the IIP-32 across clinical and non-clinical groups. It was found that CFA had unsatisfactory model fit, whereas the corresponding ESEM solution provided a better fit to the observed data. However, six target factor loadings tend to be modest, and ten items showed cross-loadings higher than 0.30. The configural and metric invariance as well as the scalar and partial strict invariance of the IIP-32 were supported across clinical and non-clinical groups. The internal consistency of the IIP-32 was acceptable and the construct validity was confirmed by significant correlations between IIP-32, RSES, and OQ-45. Furthermore, overall interpersonal difficulties were consistently associated with core eating disorder symptoms, whereas interpersonal styles that reflect the inability to form close relationships, social awkwardness, the inability to be assertive, and a tendency to self-sacrificing were positively associated with general psychological maladjustment. Although further validation of the Italian version of the IIP-32 is needed to support these findings, the results on its cross-cultural validity are promising.

Patient baseline interpersonal problems as moderators of outcome in two psychotherapies for bulimia nervosa

Objective: We tested an aptitude by treatment interaction; namely, whether patients' baseline interpersonal problems moderated the comparative efficacy of cognitive-behavioral therapy (CBT) vs. interpersonal psychotherapy (IPT) for bulimia nervosa (BN). Method: Data derived from a randomized-controlled trial. Patients reported on their interpersonal problems at baseline; purge frequency at baseline, midtreatment, and posttreatment; and global eating disorder severity at baseline and posttreatment. We estimated the rate of change in purge frequency across therapy, and the likelihood of attaining clinically meaningful improvement (recovery) in global eating disorder severity by posttreatment. We then tested the interpersonal problem by treatment interactions as predictors of both outcomes. Results: Patients with more baseline overly communal/friendly problems showed steeper reduction in likelihood of purging when treated with CBT vs. IPT. Patients with more problems of being under communal/cold had similar reductions in likelihood of purging across both treatments. Patients with more baseline problems of being overly agentic were more likely to recover when treated with IPT vs. CBT, whereas patients with more problems of being under agentic were more likely to recover when treated with CBT vs. IPT. Conclusions: Interpersonal problems related to communion and agency may inform treatment fit among two empirically supported therapies for BN.

Interpersonal problems across levels of the psychopathology hierarchy

We examined the relationship between psychopathology and interpersonal problems in a sample of 825 clinical and community participants. Sixteen psychiatric diagnoses and five transdiagnostic dimensions were examined in relation to self-reported interpersonal problems. The structural summary method was used with the Inventory of Interpersonal Problems Circumplex Scales to examine interpersonal problem profiles for each diagnosis and dimension. We built a structural model of mental disorders including factors corresponding to detachment (avoidant personality, social phobia, major depression), internalizing (dependent personality, borderline personality, panic disorder, posttraumatic stress, major depression), disinhibition (antisocial personality, drug dependence, alcohol dependence, borderline personality), dominance (histrionic personality, narcissistic personality, paranoid personality), and compulsivity (obsessive-compulsive personality). All dimensions showed good interpersonal prototypicality (e.g., detachment was defined by a socially avoidant/nonassertive interpersonal profile) except for internalizing, which was diffusely associated with elevated interpersonal distress. The findings for individual disorders were largely consistent with the dimension that each disorder loaded on, with the exception of the internalizing and dominance disorders, which were interpersonally heterogeneous. These results replicate previous findings and provide novel insights into social dysfunction in psychopathology by wedding the power of hierarchical (i.e., dimensional) modeling and interpersonal circumplex assessment.

Testing the cognitive-behavioural maintenance models across DSM-5 bulimic-type eating disorder diagnostic groups: a multi-centre study

The original cognitive-behavioural (CB) model of bulimia nervosa, which provided the basis for the widely used CB therapy, proposed that specific dysfunctional cognitions and behaviours maintain the disorder. However, amongst treatment completers, only 40-50 % have a full and lasting response. The enhanced CB model (CB-E), upon which the enhanced version of the CB treatment was based, extended the original approach by including four additional maintenance factors. This study evaluated and compared both CB models in a large clinical treatment seeking sample (N = 679), applying both DSM-IV and DSM-5 criteria for bulimic-type eating disorders. Application of the DSM-5 criteria reduced the number of cases of DSM-IV bulimic-type eating disorders not otherwise specified to 29.6 %. Structural equation modelling analysis indicated that (a) although both models provided a good fit to the data, the CB-E model accounted for a greater proportion of variance in eating-disordered behaviours than the original one, (b) interpersonal problems, clinical perfectionism and low self-esteem were indirectly associated with dietary restraint through over-evaluation of shape and weight, (c) interpersonal problems and mood intolerance were directly linked to binge eating, whereas restraint only indirectly affected binge eating through mood intolerance, suggesting that factors other than restraint may play a more critical role in the maintenance of binge eating. In terms of strength of the associations, differences across DSM-5 bulimic-type eating disorder diagnostic groups were not observed. The results are discussed with reference to theory and research, including neurobiological findings and recent hypotheses.

Negative affect, interpersonal perception, and binge eating behavior: An experience sampling study

OBJECTIVE

Etiological and maintenance models for disordered eating highlight the salience of negative affect and interpersonal dysfunction. This study employed a 14-day experience sampling procedure to assess the impact of negative affect and interpersonal perceptions on binge eating behavior.

METHOD

Young adult women (N = 40) with recurrent binge eating and significant clinical impairment recorded their mood, interpersonal behavior, and eating behaviors at six stratified semirandom intervals daily through the use of personal digital assistants.

RESULTS

Although momentary negative affect was associated with binge eating behavior, average levels of negative affect over the experience sampling period were not, and interpersonal problems moderated the relationship between negative affect and binge eating. Interpersonal problems also intensified the association between momentary interpersonal perceptions and binge eating behavior. Lagged analyses indicated that previous levels of negative affect and interpersonal style also influence binge eating.

DISCUSSION

The study findings suggest there may be important differences in how dispositional versus momentary experiences of negative affect are associated with binge eating. Results also highlight the importance of interpersonal problems for understanding relationships among negative affect, interpersonal perception, and binge eating behavior. These results offer several possibilities for attending to affective and interpersonal functioning in clinical practice.

Interaction effects in comorbid psychopathology

PURPOSE

Comorbidity in psychopathology is the norm. Despite some initial evidence, few studies have examined if the presence of comorbid conditions changes the expression of the pathology, either through increased severity of the syndrome(s) or by expanding to symptoms beyond the syndrome(s) (i.e., symptom overextension). The following report provides an illustration of interactive effects and overextension in comorbid pathology.

METHOD

A large pool of patients from a university hospital were assessed using SCID-I/P interviews. Of these, 230 patients diagnosed with major depressive disorder, social phobia, or both were included in the study.

RESULTS

Symptoms not belonging to either index condition (major depressive disorder or social phobia) reliably overextended in comorbid cases (odds ratios between 2.82 and 15.75).

CONCLUSIONS

Current research methodologies (e.g., structured interviews) do not allow for the examination of overextended symptoms. The authors make a call for future psychopathological research to search systematically for interactive effects by adopting more inclusive or flexible assessments.

Are there subtypes of panic disorder? An interpersonal perspective

OBJECTIVE

Panic disorder (PD) is associated with significant personal, social, and economic costs. However, little is known about specific interpersonal dysfunctions that characterize the PD population. The current study systematically examined these interpersonal dysfunctions.

METHOD

The present analyses included 194 patients with PD out of a sample of 201 who were randomized to cognitive-behavioral therapy, panic-focused psychodynamic psychotherapy, or applied relaxation training. Interpersonal dysfunction was measured with the Inventory of Interpersonal Problems-Circumplex (Horowitz, Alden, Wiggins, & Pincus, 2000).

RESULTS

Individuals with PD reported greater levels of interpersonal distress than that of a normative cohort (especially when PD was accompanied by agoraphobia), but lower than that of a cohort of patients with major depression. There was no single interpersonal profile that characterized PD patients. Symptom-based clusters (with vs. without agoraphobia) could not be discriminated on core or central interpersonal problems. Rather, as revealed by cluster analysis based on the pathoplasticity framework, there were 2 empirically derived interpersonal clusters among PD patients that were not accounted for by symptom severity and were opposite in nature: domineering-intrusive and nonassertive. The empirically derived interpersonal clusters appear to be of clinical utility in predicting alliance development throughout treatment: Although the domineering-intrusive cluster did not show any changes in the alliance throughout treatment, the nonassertive cluster showed a process of significant strengthening of the alliance.

CONCLUSIONS

Empirically derived interpersonal clusters in PD provide clinically useful and nonredundant information about individuals with PD.

Assessing Interpersonal Subtypes in Depression

The context-free diagnoses outlined by the Diagnostic and Statistical Manual of Mental Disorders might not provide enough information to represent the heterogeneity observed in depressed patients. Interpersonal factors have been linked to depression in a mutually influencing pathoplastic relationship where certain problems, like submissiveness, are related to symptom chronicity. This study evaluated interpersonal pathoplasticity in a range of depressive presentations. We examined archival data collected from 407 participants who met criteria for major depressive disorder (MDD), dysthymic disorder (DD), or subthreshold depression (sD). Latent profile analysis (LPA) identified 5 interpersonal subtypes (vindictive, intrusive, socially avoidant, exploitable, and cold). Apart from gender, the subtypes did not differ significantly on demographic characteristics, psychiatric comorbidity, or self-report depression severity. Socially avoidant participants were more likely to meet criteria for a clinical depression diagnosis (MDD or DD), whereas vindictive participants were more likely to have sD. Our results indicate that interpersonal problems could account for heterogeneity observed in depression.

Comprehensive examination of the trans-diagnostic cognitive behavioral model of eating disorders in males

The Trans-diagnostic Model (TM) of eating pathology describes how one or more of four hypothesized mechanisms (i.e., mood intolerance, core low self-esteem, clinical perfectionism and interpersonal difficulties) may interrelate with each other and with the core psychopathology of eating disorders (i.e., over-evaluation of weight and shape) to maintain the disordered behaviors. Although a cognitive behavioral treatment based on the TM has shown to be effective in treating eating disorders, the model itself has undergone only limited testing. This is the first study to both elaborate and test the validity of the TM in a large sample (N=605) of undergraduate men. Body mass index was controlled within structural equation modeling analyses. Although not all expected associations for the maintenance variables were significant, overall the validity of the model was supported. Concern about shape and weight directly led to exercise behaviors. There was a direct path from binge eating to exercise and other forms of compensatory behaviors (i.e., purging); but no significant path from restriction to binge eating. Of the maintaining factors, mood intolerance was the only maintaining variable directly linked to men's eating disorder symptoms. The other three maintaining factors of the TM indirectly impacted restriction through concerns about shape and weight, whereas only interpersonal difficulties predicted low self-esteem and binge eating. Potential implications for understanding and targeting eating disturbances in men are discussed.

Status update: maladaptive Facebook usage predicts increases in body dissatisfaction and bulimic symptoms

BACKGROUND

The current study examined the effects of online social evaluations and comparisons on body dissatisfaction and bulimic symptoms.

METHODS

We tested the effects of maladaptive Facebook usage (defined as the tendency to seek negative social evaluations and/or engage in social comparisons via Facebook) on body dissatisfaction and bulimic symptoms in a sample of 232 college females followed for approximately 4 weeks.

RESULTS

Results provided evidence that maladaptive Facebook usage significantly predicted increases in bulimic symptoms and episodes of over-eating approximately four weeks later. Body dissatisfaction was found to fully mediate the relationship between maladaptive Facebook usage and increases in over-eating episodes, whereas body dissatisfaction partially mediated the relationship between maladaptive Facebook usage and increases in bulimic symptoms more broadly.

LIMITATIONS

Limitations include the use of a novel measure of maladaptive Facebook usage due to the absence of an existing measure and a non-clinical sample.

CONCLUSIONS

The results of this study suggest that reducing maladaptive Facebook usage may be a fruitful target for interventions aimed at reducing body dissatisfaction and symptoms of eating pathology.

Alternative methods of classifying eating disorders: models incorporating comorbid psychopathology and associated features

There is increasing recognition of the limitations of current approaches to psychiatric classification. Nowhere is this more apparent than in the eating disorders (EDs). Several alternative methods of classifying EDs have been proposed, which can be divided into two major groups: 1) those that have classified individuals on the basis of disordered eating symptoms; and, 2) those that have classified individuals on the basis of comorbid psychopathology and associated features. Several reviews have addressed symptom-based approaches to ED classification, but we are aware of no paper that has critically examined comorbidity-based systems. Thus, in this paper, we review models of classifying EDs that incorporate information about comorbid psychopathology and associated features. Early approaches are described first, followed by more recent scholarly contributions to comorbidity-based ED classification. Importantly, several areas of overlap among the classification schemes are identified that may have implications for future research. In particular, we note similarities between early models and newer studies in the salience of impulsivity, compulsivity, distress, and inhibition versus risk taking. Finally, we close with directions for future work, with an emphasis on neurobiologically-informed research to elucidate basic behavioral and neuropsychological correlates of comorbidity-based ED classes, as well as implications for treatment.

The role of interpersonal functioning in the maintenance of eating psychopathology: a systematic review and testable model

This review aims to systematically evaluate the empirical literature relating to the interpersonal functioning of those with eating disorder psychopathology and presents a preliminary model to help the formulation of patients' problems. Following a thorough literature search, 35 papers were included in this systematic review. The vast majority of studies indicate a strong association between eating psychopathology and certain maladaptive personality traits. The origins of social anxiety and poor social support that have been described as maintaining eating disorders appear to differ according to diagnostic groups. Interpersonal difficulties in people with restrictive behaviors such as anorexia appear to be related to the avoidance of expressing feelings to others and to giving priority to other people's feeling over their own. While interpersonal difficulties in patients with bulimia nervosa appear to be more related to interpersonal distrust and negative interaction and conflict with others. These concepts are presented in a preliminary model of interpersonal functioning in the eating disorders.

Subtypes in bulimia nervosa: the role of eating disorder symptomatology, negative affect, and interpersonal functioning

BACKGROUND

The aim of the study was to investigate whether patients with bulimia nervosa (BN) could be subdivided into clinically meaningful groups reflecting the complex patterns of eating disorder symptoms and personality characteristics that face the clinician.

METHODS

Seventy patients diagnosed with BN using the Eating Disorder Examination were assessed with measures of negative affect, attachment patterns, and interpersonal problems. An exploratory hierarchical cluster analysis was performed.

RESULTS

The study found two main subtypes differing primarily in terms of symptom severity and level of negative affect, but these subtypes were further subdivided into four clinically relevant subtypes: A dietary restraint/negative affect/high symptomatic group, an emotionally overcontrolled group, a low dietary restraint/emotionally underregulated group, and a high functioning/securely attached group.

CONCLUSIONS

The study indicates that cluster-analytic studies, including a broad range of instruments measuring eating disorder symptoms as well as negative affect, relational patterns, and other personality characteristics, may contribute to an integration of previously suggested models of subtypes in BN.

Examining the interpersonal model of binge eating and loss of control over eating in women

OBJECTIVE

This study examined the interpersonal model of binge eating (Wilfley et al., Interpersonal Psychotherapy for Group, New York: Basic Books, 2000; Wilfley et al., Arch Gen Psychiatry, 8, 713-721, 2002; Elliott et al., Behav Res Ther, 48, 424-428, 2010) which posits that interpersonal problems lead to negative affect which, in turn, triggers disordered eating.

METHOD

The model was tested using data from 350 women obtained via an internet assessment method. Analyses examined direct and indirect effects, via depressive/negative affect, of interpersonal problems, including domains of affiliation and dominance on loss of control over eating, binge eating, and eating disorder psychopathology.

RESULTS

Interpersonal problems showed significant effects on binge eating and eating disorder psychopathology that were statistically mediated by depressive/negative affect. Affiliation showed significant effects on binge eating and eating disorder psychopathology with low affiliation effects statistically mediated by depressive/negative affect and high affiliation effects independent of depressive/negative affect.

DISCUSSION

These findings support the interpersonal model of binge eating and highlight the importance of examining specific types of interpersonal problems in understanding heterogeneity of individuals with eating disorder psychopathology.

Testing a maintenance model for eating disorders in a sample seeking treatment at a tertiary care center: a structural equation modeling approach

Fairburn et al (Fairburn, CG, Cooper, Z, Shafran, R. Behav Res Ther 2003;41:509-528) proposed additional maintenance mechanisms (ie, interpersonal difficulties, mood intolerance, low self-esteem, and perfectionism) for some individuals with eating disorders in addition to core eating disorder psychopathology (ie, overevaluation of eating, weight, and shape and their control). This is the first study to both elaborate and test this maintenance model as a structural model. Adults seeking treatment of an eating disorder (N = 1451) at a specialized tertiary care center were included in this cross-sectional study. In the first part of the study, diagnostically heterogeneous participants (n = 406) were randomly selected to test a structural model based on the maintenance model. In the second part of the study, remaining participants (n = 1045) were grouped according to eating disorder diagnosis to test for invariance of the structural paths of the final model across diagnoses. Overall, the structural model with core and additional mechanisms fit the data well and, with 1 exception, represented maintenance processes for each of the diagnostic groups. Treatment models based on both core and additional maintenance factors for those seeking therapy at a specialized tertiary care center may result in improved treatment outcomes for these patients with eating disorders.

The association among interpersonal problems, binge behaviors, and self-esteem, in the assessment of obese individuals

OBJECTIVES

Although disordered eating has been assumed to be associated with interpersonal problems, there is a lack of research regarding the relationship between interpersonal problems and obesity. This study explored associations among self-esteem, binge behaviors, and interpersonal problems in obese individuals, by contrasting obese persons with overweight persons, and to investigate whether body mass index (BMI), binge behaviors, and self-esteem predict interpersonal problems in obese individuals.

METHODS

A group of nonobese overweight people (n = 65; BMI range, 25-29.9 kg/m²) and a group of obese people (n = 78; BMI >35 kg/m²) were selected from 224 people attending a mental health care service specializing in eating disorders in Palermo (Italy). Seventy-eight percent of participants were female. All participants filled in the following measures: the Inventory of Interpersonal problems-short version, the Binge Eating Scale, and the Rosenberg Self-esteem Scale.

RESULTS

The findings showed that 4 domains of interpersonal problems were associated with binge behaviors and self-esteem in obese participants. Moreover, the relationship between binge behaviors and interpersonal problems was partially mediated by self-esteem.

CONCLUSIONS

Given the poor prognosis for the long-term management of obesity, it could be important for clinicians to carefully assess patients' interpersonal functioning and its relationship to self-esteem and binge behaviors, especially with respect to treatment-seeking obese patients.

Interpersonal subtypes in social phobia: diagnostic and treatment implications

Interpersonal assessment may provide a clinically useful way to identify subtypes of social phobia. In this study, we examined evidence for interpersonal subtypes in a sample of 77 socially phobic outpatients. A cluster analysis based on the dimensions of dominance and love on the Inventory of Interpersonal Problems-Circumplex Scales (Alden, Wiggins, & Pincus, 1990) found 2 interpersonal subtypes of socially phobic patients. These subtypes did not differ on pretreatment global symptom severity as measured by the Brief Symptom Inventory (Derogatis, 1993) or diagnostic comorbidity but did exhibit differential responses to outpatient psychotherapy. Overall, friendly-submissive social phobia patients had significantly lower scores on measures of social anxiety and significantly higher scores on measures of well-being and satisfaction at posttreatment than cold-submissive social phobia patients. We discuss the results in terms of interpersonal theory and the clinical relevance of assessment of interpersonal functioning prior to beginning psychotherapy with socially phobic patients.

Personality heterogeneity in female adolescent inpatients with features of eating disorders

OBJECTIVE

This study examined evidence for personality variability in adolescents with eating disorder features in light of previous evidence that personality variability in adult women with eating disorder symptoms carries important clinical implications.

METHOD

Millon Adolescent Clinical Inventory personality data from adolescent girls with disturbed eating who were psychiatrically hospitalized were cluster analyzed, and resulting groups were compared in eating and comorbid psychopathology.

RESULTS

Three subgroups were identified among the 153 patients with eating disorder features: high functioning, internalizing, and externalizing. The internalizing group was marked by eating-related and mood dysfunction; the externalizing group by elevated eating and mood psychopathology as well as impulsivity, aggression, and substance use; and the high-functioning group by lower levels of psychopathology and relatively high self-esteem.

CONCLUSIONS

These findings converge with previous research using different personality models in adult samples and highlight the clinical use of considering personality heterogeneity among adolescent and adult women with disturbed eating.

Interpersonal problems in eating disorders

OBJECTIVE

Eating disorders are often chronic in nature and lead to a number of problems among which interpersonal issues are suggested to be central. Although research has shown that individuals with disturbed patterns of eating consistently report problems in social interactions, this study is unique in assessing a range of interpersonal problems among patients with all types of eating disorders before and after intensive hospital-based treatment.

METHOD

A total of 208 patients receiving a primary diagnosis of restrictive anorexia nervosa, bulimia nervosa, or anorexia nervosa of the binge/purging-subtype were included in the study. Eating pathology, symptom severity, and interpersonal patterns were examined before and after treatment.

RESULTS

Patients with eating disorders exhibited a generally nonassertive, submissive interpersonal style, with anorexic patients of the binge/purging-subtype reporting more difficulties with social inhibition and nonaffiliation. These patterns were found to change over the course of treatment with interpersonal problems at intake predictive of greater binge severity at discharge. Furthermore, issues of dominance and social avoidance predicted outcome for specific subgroups of patients.

DISCUSSION

Results underscore the importance of interpersonal problems in eating disorders and suggest that interpersonal patterns remain a focus of treatment and future research.

The utility of considering interpersonal problems in the assessment of bulimic features

Previous research suggests that heterogeneity in bulimic features can be explained in part by pathoplastic, or varying, interpersonal problems. The present study compared groups of women with bulimic features (N=110) defined by varying interpersonal problems (warm-dominant, warm-submissive, cold-submissive, or cold-dominant) with regard to comorbid psychopathology, personality characteristics, and the influences of dietary restraint and negative affectivity on bulimic psychopathology. As predicted, group differences were not explained by severity of eating-related pathology, socially desirable responding, or the interpretability of interpersonal profiles, although groups unexpectedly differed in depressive symptoms. The warm-submissive group had highest scores on adaptive personality characteristics, including, agreeableness, extraversion, and conscientiousness. As hypothesized, the influence of negative affect and dietary restraint on bulimic symptoms differed as a function of interpersonal style, perhaps suggesting that interpersonal problem heterogeneity may mark different etiological pathways for bulimic psychopathology. Finally, interpersonal problems incremented bulimic features in predicting depressive symptoms. Overall, these results highlight the added value of considering pathoplastic interpersonal problems in addition to clinical diagnoses in the assessment of eating disorders.