Dissatisfaction versus over-evaluation in a general population sample of women

Empirical Investigation of Different Factor Structures for the Eating Disorder Examination-Questionnaire in Adult Women With Anorexia Nervosa

The Eating Disorder Examination-Questionnaire (EDE-Q) is a widely used self-report measure of eating pathology. Despite widespread use, investigations of its factor structure have proved inconclusive and rarely supported the "original" interpretation. The current study evaluates several proposed factor solutions of the EDE-Q using latent variable analysis in a sample of adult women with anorexia nervosa (AN). A total of 804 patients from a specialist treatment center in the United States participated in the study. Confirmatory factor analysis was conducted on 22 EDE-Q items assessing attitudinal features of eating pathology. Findings suggested that three full-item versions (none of which was the "original" interpretation) fit the data adequately, with a brief, seven-item version showing excellent fit. The study is one of the first to examine this within a sample of women with AN and provides an empirical foundation for how best to use the EDE-Q among clinical and research participants with AN. Findings suggest that the "original" factor structure lacks structural validity in women with AN. Its use should generally be discouraged, and future work on screening and treatment outcomes might consider the EDE-Q7.

Peer Academic Supports for Success (PASS) for College Students with Mental Illness: Open Trial

Increasing numbers of college students have serious mental health conditions, but their dropout rates are high and debt accrual is common. A well-specified intervention that colleges can directly offer their undergraduates with serious mental health conditions that sustains their academic persistence is greatly needed. The Peer Academic Supports for Success (PASS) coaching model was developed to address this need. This study’s goal was to conduct an open trial of the initial PASS model to test the feasibility of the model and research methods in preparation for more rigorous testing. Ten college juniors and seniors, with and without lived mental health experience, were hired, trained, and supervised to be PASS peer coaches. Twelve undergraduate students with academically impairing mental health conditions served as study participants and received PASS. Student data were collected at baseline and two semesters post baseline. Intervention feasibility data were assessed through coach report. Results indicate PASS can be delivered with fidelity by peer coaches, can attract and retain students, and is safe. Results also suggest that PASS has significant effects on most of the targeted proximal outcomes. The PASS findings are promising as a college-based intervention to support young adult students with mental health conditions.

Physical and Emotional Intimate Partner Violence and Women's Health in the First Year After Childbirth: An Australian Pregnancy Cohort Study

Intimate partner violence (IPV) can comprise physical, sexual, and emotional abuse, and is a widespread public health concern. Despite increasing recognition that women experience different types of IPV, the majority of research has focused on physical IPV. The present study aims to examine associations between different types of IPV (physical, emotional, physical, and emotional) and women's mental, physical, and sexual health by analyzing longitudinal data from a prospective pregnancy cohort of 1,507 first-time mothers in Melbourne, Australia. Questionnaires included validated measures of physical and mental health (Short Form Health Survey, Edinburgh Postnatal Depression Scale) and IPV (Composite Abuse Scale). Emotional IPV alone was the most commonly reported type of IPV (n = 128, 9.5%), followed by both physical and emotional IPV (n = 76, 5.7%), and then physical IPV alone (n = 30, 2.2%). Women reporting emotional IPV or physical and emotional IPV had increased odds of poor health compared with women reporting no IPV. Experience of physical and emotional IPV was most strongly associated with mental health issues, including depressive symptoms (adjusted odds ratio [OR] 4.6, 95% confidence interval [CI] = [2.9, 7.1]) and self-reported anxiety (adjusted OR 2.9, 95% CI = [1.9, 4.4]). Experience of emotional IPV alone was associated with poor mental health as well as physical factors, including poor general physical health (adjusted OR 1.9, 95% CI = [1.2, 3.1]), and pain during sex (adjusted OR 1.8, 95% CI = [1.2, 2.7]). Increased odds of poor body image were also observed for women reporting emotional IPV alone and physical and emotional IPV. These findings highlight the need for greater awareness of the diversity in women's experiences of IPV among health care providers. This includes understanding the prevalence of emotional IPV among new mothers, and the range of health problems that are more common for women experiencing IPV.

Distinctiveness and significance of body dissatisfaction and overvaluation among Latinx/Hispanic and White men and women

OBJECTIVE

To examine the distinctiveness and significance of two body image constructs, dissatisfaction with weight and shape and overvaluation of weight and shape, with respect to eating disorder psychopathology, weight, and depression in White and Latinx/Hispanic men and women.

METHODS

Participants were White (n = 1,941) and Latinx/Hispanic (n = 568) adults living in the United States who completed an online battery of established measures of body image, eating disorder psychopathology and behaviors, and depression.

RESULTS

Two body image constructs, dissatisfaction with weight and shape and overvaluation of weight and shape, were related to each other but showed some important distinctions in their associations with eating- and weight-related variables. Significantly greater proportions of White than Latinx/Hispanic individuals reported co-occurring dissatisfaction and overvaluation, and significantly greater proportions of Latinx/Hispanic than White individuals reported dissatisfaction alone. Ethnicity moderated the association of dissatisfaction and overvaluation with body mass index (BMI), and the association of overvaluation with depression. Ethnicity also had a main effect on binge-eating frequency.

CONCLUSIONS

Dissatisfaction and overvaluation were distinct among both Latinx/Hispanic and White individuals. However, associations with eating- and weight-related variables varied between ethnicities, suggesting a need for further research on the influence of cultural variables on body image and eating disorder psychopathology.

People who overvalue appearance selectively attend to descriptors of the attractiveness ideal: Findings from an emotional Stroop task

OBJECTIVE

Attentional biases to stimuli related to stigmatized appearance are theorized to stem from appearance overvaluation, but little research has examined this link. As well, little research has examined whether appearance overvaluation is associated with biases toward stimuli that describe the attractiveness ideal. We addressed these gaps in the literature using the emotional Stroop task and tested whether appearance overvaluation is associated with an attentional bias for words that describe stigmatized appearance (e.g., fat, ugly, shabby), the attractiveness ideal (e.g., thin, beautiful, fashionable), or both.

METHOD AND RESULTS

In Study 1, a community sample of people (N = 86) completed measures of appearance overvaluation, body dissatisfaction, and body mass index (BMI) followed by an emotional Stroop task. Appearance overvaluation was associated with an attentional bias for attractiveness ideal words-not stigmatized appearance words. Results remained significant when controlling for participants' body dissatisfaction, BMI, and gender. Study 2 (N = 316) replicated these findings. Finally, an integrative data analysis that pooled the data of Studies 1 and 2 (N = 402) provided additional support for our general hypothesis that people who overvalue appearance display an attentional bias to stimuli related to the attractiveness ideal.

DISCUSSION

The results show a robust association between appearance overvaluation and selective attention for attractiveness ideal stimuli. Results are discussed in reference to theory and research on information processing in eating disorders. We also call for research to examine information processing of stimuli related to the attractiveness ideal among people with eating disorders and who place high importance on appearance for self-definition.

Body shape concerns across racial and ethnic groups among adults in the United States: More similarities than differences

This study evaluated the relationship between race/ethnicity and body shape concerns among adults in the U.S. and evaluated if this relationship varied by Body Mass Index (BMI) and gender. Data were collected from U.S. adults (N = 2,212) using a national online survey panel designed to approximate the US census data. Gender, age, race/ethnicity, BMI and body shape concerns (Body Shape Questionnaire) were assessed. Analysis of variance was utilized to evaluate the race/ethnicity and BSQ association and if the relationship varied by gender and BMI category. The sample (65 % White, 13 % Black/African American, 16 % Latino/Hispanic/Mexican American and 6 % Asian/Pacific Islander) was 50 % female; mean age of 44.2 years (SD = 16.8); BMI of 27.4 (SD = 6.7). A gender by BMI category interaction (p < .01) revealed no difference in BSQ scores by gender when BMI < 18, but higher BSQ scores among women for all other BMI groups. A main effect of race/ethnicity revealed BSQ scores were equally high across racial/ethnic groups, except individuals who identified as White (M = 42.0, SD = 19.7) reported higher BSQ than those identified as Asian/Pacific Islander (M = 37.4, SD = 17.4). Body shape concerns are common among US adults. Individuals of racial/ethnic minority status may experience similar gender- and BMI-related differences in body shape concerns as White individuals.

Racial differences in overeating, loss of control eating, and binge eating: Extending core tenets of the Cognitive Behavioral Theory of Eating Disorders

PURPOSE

The present study examined racial differences in associations among body dissatisfaction, body checking, and dietary restraint relative to overeating, loss of control eating, and binge eating outcomes among college women.

METHOD

Young adult women (N = 903) at three Mid-Atlantic US institutions completed measures assessing negative body image and eating pathology via an online survey. Structural equation modeling was used to test a model examining associations among body dissatisfaction, body checking, dietary restraint, and disinhibited eating behaviors. Multigroup analyses examined whether these associations differed for women who identified as White (n = 432) versus Black (n = 359).

RESULTS

More frequent body checking explained associations between elevated body dissatisfaction and more frequent use of all three disinhibited eating outcomes for White and Black women, whereas restraint solely mediated an association between body dissatisfaction and overeating. The assessed constructs generally operated in a similar manner across racial groups. However, stronger associations among body dissatisfaction, restraint, and overeating, and between body checking and loss of control eating were identified for women who identified as White versus Black.

CONCLUSIONS

Eating disorder programming efforts targeting body checking behavior may prove useful in decreasing White and Black women's disinhibited eating.

The relative importance of dissatisfaction, overvaluation and preoccupation with weight and shape for predicting onset of disordered eating behaviors and depressive symptoms over 15 years

OBJECTIVE

The aim of this study was to examine the relative importance of dissatisfaction, overvaluation, and preoccupation with body weight and shape in predicting increases in disordered eating behaviors and depressive symptoms from adolescence through to early adulthood.

METHOD

The study involved 1,830 participants (60% female) who completed the Project EAT survey during adolescence (mean age = 14.90 years, SD = 1.65 years) and again, 15 years later, in early adulthood. Participants provided assessments of dissatisfaction, overvaluation and preoccupation with weight and shape, as well as disordered eating and depressive symptoms at both time points.

RESULTS

The three aspects of body image had distinct patterns of association with the outcomes both concurrently and longitudinally. Dissatisfaction predicted depressive symptoms as well as a wide range of disordered eating outcomes, including dieting, unhealthy weight control behaviors (UWCBs), and binge eating, particularly in female participants. Preoccupation was associated with all of these disordered eating behaviors (but not with depressive symptoms) and was notably the strongest predictor of dieting and UWCBs in female participants. Overvaluation was associated with both disordered eating and depressive symptoms, although typically was a less potent predictor of difficulties than the other aspects of body image.

DISCUSSION

Dissatisfaction, overvaluation, and preoccupation are related but make distinct contributions to clinically significant outcomes. Models of eating disorders should move beyond focusing exclusively on dissatisfaction or overvaluation toward a broader conceptualisation of body image. Findings from this study particularly suggest the importance of considering preoccupation with weight and shape.

Different Facets of Body Image Disturbance in Binge Eating Disorder: A Review

The goal of the present review is to give an overview of the current findings on various facets of body image disturbance in Binge Eating Disorder such as body dissatisfaction, overconcern with weight and shape, body-related checking and avoidance behavior, misperception of body size, and body-related cognitive bias. In addition, treatments for a disturbed body image in BED and evidence of body image disturbance in youth with binge eating are reviewed. The results show that a disturbed body image in BED is present in the form of overconcern with weight and shape. Furthermore, there are hints that body dissatisfaction, as well as body-related checking and avoidance behavior, are also impaired. Research concerning misperception of body size in BED has been neglected so far, but first findings show that individuals with BED rate their own body shape rather accurately. Furthermore, there are first hints that body-related cognitive biases are present in individuals with BED. Moreover, in children and adolescents, there are first hints that body dissatisfaction, as well as shape and weight concerns, seem to be associated with loss of control and binge eating. Treatments aimed directly at the convertibility of a disturbed body image in BED have revealed encouraging outcomes. In conclusion, body image disturbance seems to occur in BED, and first studies show that it can be treated effectively.

The importance of body image concerns in overweight and normal weight individuals with binge eating disorder

Body image concerns in binge eating disorder (BED) have been examined almost exclusively in overweight individuals with BED. The current study extends past research by including overweight and normal weight BED and non-BED groups to assess the multifactorial construct of body image using subscales of the Eating Disorder Examination 16.0 (EDE-16.0) and a Body Comparison Task. Independent of weight status and when controlling for age and race, women with BED are distinguished from those without BED by significantly greater overvaluation of shape and weight on the EDE-16.0 and significantly reduced weight satisfaction after a Body Comparison Task. Both BED diagnosis and weight status were independently associated with Weight Concern and Shape Concern subscales on the EDE-16.0. Taken together, these data provide further support for the consideration of body image concerns in the diagnostic criteria for BED.

Disentangling body image: The relative associations of overvaluation, dissatisfaction, and preoccupation with psychological distress and eating disorder behaviors in male and female adolescents

OBJECTIVE

The distinctiveness and relative clinical significance of overvaluation, dissatisfaction, and preoccupation with body weight/shape remains inconclusive. This study sought to add to the evidence by testing associations between these three body image constructs and indicators of clinical significance.

METHOD

Male and female secondary students (N = 1,666) aged 12-18 years completed a survey that included measures of dissatisfaction with, overvaluation of, and preoccupation with weight/shape, psychological distress, eating disorder behaviors, and basic demographic information. Conditional process analysis was employed to test the independent and mediating effects of overvaluation, dissatisfaction, and preoccupation on distress, dietary restraint, and objective binge eating.

RESULTS

Overvaluation, dissatisfaction, and preoccupation were highly correlated (r = 0.47-0.84). In girls, preoccupation demonstrated the strongest independent and mediating effects on distress, dietary restraint, and binge eating; whereas neither the direct or indirect effects of dissatisfaction on distress and overvaluation on binge eating were significant. Among boys however, the direct and indirect effects of overvaluation, dissatisfaction, and preoccupation on distress and eating disorder behaviors were relatively equal.

DISCUSSION

Preoccupation with weight/shape may be particularly clinically significant in girls, whereas all constructs of body image disturbance may be equally clinically significant in boys. The findings are consistent with the view that these constructs, while closely related, are distinct. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:118-126).

Perceived psychosocial impairment associated with eating disorder features: responses to a mental health literacy intervention

BACKGROUND

Whether and to what extent young adults are aware of the adverse impact of eating disorder features (EDF) on psychosocial functioning is unclear, although such awareness may affect the experience and behavior of sufferers. The aim of the current study was to examine young adults' perceptions of psychosocial impairment associated with EDF, and the potential effect on these perceptions of an eating disorders "mental health literacy" (ED-MHL) intervention.

METHODS

Undergraduate students (male: n = 35; female: n = 141) completed self-report questionnaires prior to, immediately following, and 3 months after completion of a 3-h ED-MHL intervention. Perceived psychosocial impairment associated with EDF-binge eating, purging, extreme dietary restriction, overvaluation of weight/shape, and excessive exercise-was assessed at each time point.

RESULTS

At all 3 time points, EDF were considered to have a 'slightly negative' to 'very negative' impact on psychosocial functioning. Prior to the intervention, binge eating, purging and extreme dietary restriction were generally considered to have a greater negative impact than excessive exercise and overvaluation of weight/shape. Three months after the ED-MHL intervention, participants reported greater perceived impairment associated with excessive exercise and overvaluation; while perceptions of psychosocial impairment associated with binge eating, purging and dietary restriction remained largely unchanged. Females perceived greater impairment associated with EDF than males did immediately after the intervention, but not at the 3-month follow-up.

CONCLUSIONS

The adverse effects on psychosocial functioning of binge eating, purging and extreme dietary restriction appear to be readily recognized by young people. Awareness of the adverse effects of excessive exercise and overvaluation may be poorer, but amenable to improvement by means of a relatively simple intervention. These features may warrant particular attention in health promotion programs.

Quality of life impairment associated with body dissatisfaction in a general population sample of women

Background

In order to elucidate the individual and community health burden of body dissatisfaction (BD), we examined impairment in quality of life associated with BD in a large, general population sample of women.

Methods

Self-report measures of BD, health-related quality of life (SF-12 Physical and Mental Component Summary scales) and subjective quality of life (WHOQOL-BREF Psychological Functioning and Social Relationships subscales) were completed by 5,255 Australian women aged 18 to 42 years.

Results

Most participants (86.9%) reported some level of dissatisfaction with their weight or shape and more than one third (39.4%) reported moderate to marked dissatisfaction. Higher levels of BD were associated with poorer quality of life for all items of both quality of life measures, the degree of impairment being proportional to the degree of BD. Associations were strongest for items tapping mental health and psychosocial functioning, although greater BD was associated with substantially increased risk of impairment in certain aspects of physical health even when controlling for body weight. Post-hoc analysis indicated that the observed associations between BD and quality of life impairment were not accounted for by an association between BD and eating disorder symptoms.

Conclusions

In women, BD is associated with marked impairment in aspects of quality of life relating to mental health and psycho-social functioning and at least some aspects of physical health, independent of its association with body weight and eating disorder symptoms. Greater attention may need to be given to BD as a public health problem. The fact that BD is “normative” should not be taken to infer that it is benign.

Why no cognitive body image feature such as overvaluation of shape/weight in the binge eating disorder diagnosis?

OBJECTIVE

Undue influence of body shape or weight on self-evaluation--referred to as overvaluation--is considered a core feature across eating disorders, but is not a diagnostic requirement for binge eating disorder (BED). This article addresses the relevance of a feature reflecting disturbance in body image for the diagnosis of BED.

METHOD

The distinction between overvaluation of shape/weight and body dissatisfaction is discussed, and empirical research regarding the concurrent and predictive significance of overvaluation of shape/weight for BED is reviewed.

RESULTS

The literature suggests that overvaluation does not simply reflect concern or distress commensurate with excess weight, is reliably associated with greater severity of eating-related psychopathology and psychological distress, and has reliably shown negative prognostic significance.

DISCUSSION

Overvaluation of shape/weight warrants consideration as a diagnostic specifier for BED.

Eating disorder symptom trajectories in adolescence: effects of time, participant sex, and early adolescent depressive symptoms

BACKGROUND

Adolescence is a period of developmental risk for eating disorders and eating disorder symptoms. This study aimed to describe the prevalence and trajectory of five core eating disorder behaviours (binge eating, purging, fasting, following strict dietary rules, and hard exercise for weight control) and a continuous index of dietary restraint and eating, weight and shape concerns, in a cohort of male and female adolescents followed from 14 to 20 years. It also aimed to determine the effect of early adolescent depressive symptoms on the prevalence and trajectory of these different eating disorder symptoms. Participants (N = 1,383; 49% male) were drawn from the Western Australian Pregnancy Cohort (Raine) Study, a prospective cohort study that has followed participants from pre-birth to age 20 years. An adapted version of the Eating Disorder Examination-Questionnaire was used to assess eating disorder symptoms at ages 14, 17 and 20 years. The Beck Depression Inventory for Youth was used to assess depressive symptoms at age 14. Longitudinal changes in the prevalence of eating disorder symptoms were tested using generalised estimating equations and linear mixed models.

RESULTS

Symptom trajectories varied according to the eating disorder symptom studied, participant sex, and the presence of depressive symptoms in early adolescence. For males, eating disorder symptoms tended to be stable (for purging, fasting and hard exercise) or decreasing (for binge eating and global symptom scores) from 14 to 17 years, and then stable to 20 years. For females, fasting and global symptom scores increased from age 14 to peak in prevalence at age 17. Rates of binge eating in females were stable from age 14 to age 17 and increased significantly thereafter, whilst rates of purging and hard exercise increased from age 14 to age 17, and then remained elevated through to age 20. Depressive symptoms at age 14 impacted on eating disorder symptom trajectories in females, but not in males.

CONCLUSIONS

Prevention, screening and intervention initiatives for adolescent eating disorders need to be tailored to gender and age. Purging behaviour appears to be an important target for work with early to middle adolescent females.

Mental health impairment in underweight women: do body dissatisfaction and eating-disordered behavior play a role?

Background

We sought to evaluate the hypothesis that mental health impairment in underweight women, where this occurs, is due to an association between low body weight and elevated levels of body dissatisfaction and/or eating-disordered behaviour.

Methods

Subgroups of underweight and normal-weight women recruited from a large, general population sample were compared on measures of body dissatisfaction, eating-disordered behaviour and mental health.

Results

Underweight women had significantly greater impairment in mental health than normal-weight women, even after controlling for between-group differences in demographic characteristics and physical health. However, there was no evidence that higher levels of body dissatisfaction or eating-disordered behaviour accounted for this difference. Rather, underweight women had significantly lower levels of body dissatisfaction and eating-disordered behaviour than normal-weight women.

Conclusions

The findings suggest that mental health impairment in underweight women, where this occurs, is unlikely to be due to higher levels of body dissatisfaction or eating-disordered behaviour. Rather, lower levels of body dissatisfaction and eating-disordered behaviour among underweight women may counterbalance, to some extent, impairment due to other factors.