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Ladwig G, Tanck JA, Quittkat HL, Vocks S. Risks and benefits of social media trends: The influence of "fitspiration", "body positivity", and text-based "body neutrality" on body dissatisfaction and affect in women with and without eating disorders. Body Image 2024; 50:101749. [PMID: 38850713 DOI: 10.1016/j.bodyim.2024.101749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 04/30/2024] [Accepted: 05/28/2024] [Indexed: 06/10/2024]
Abstract
This online experimental study investigates the effects of the social media trends "fitspiration" (images of thin-muscular women promoting health and fitness), "body positivity" (images of larger female bodies motivating women to love their bodies), and "body neutrality" (illustrations encouraging women to appreciate the body's functions) on body dissatisfaction and affect in women with and without eating disorders (ED). Women with (n = 172) and women without ED (n = 210) were randomly assigned to the conditions "fitspiration", "body positivity", and text-based "body neutrality", each comprising the presentation of 30 Instagram posts. Before and after viewing the posts, participants answered state questionnaires on body dissatisfaction and affect. The results revealed that body dissatisfaction increased after viewing "fitspiration" images and decreased after viewing "body positivity" and text-based "body neutrality" posts. Positive affect decreased following exposure to "fitspiration" and text-based "body neutrality" but remained unchanged following "body positivity". Negative affect decreased following "body positivity" and text-based "body neutrality" content but did not change following exposure to "fitspiration". There was no differential effect on women with versus without ED. This study demonstrates harmful effects of "fitspiration" on body image and affect, indicating the need for prevention programs for both women with and without ED.
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Affiliation(s)
- Gritt Ladwig
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Osnabrück University, Osnabrück, Germany.
| | - Julia A Tanck
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Osnabrück University, Osnabrück, Germany
| | - Hannah L Quittkat
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Osnabrück University, Osnabrück, Germany
| | - Silja Vocks
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Osnabrück University, Osnabrück, Germany
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Mikhail ME, Burt SA, Neale MC, Keel PK, Katzman DK, Klump KL. Changes in affect longitudinally mediate associations between emotion regulation strategy use and disordered eating. Int J Eat Disord 2024; 57:1181-1191. [PMID: 38332591 DOI: 10.1002/eat.24162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 01/26/2024] [Accepted: 01/26/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Trait-level emotion regulation (ER) difficulties are associated with eating disorders (EDs) transdiagnostically. However, little research has examined whether within-person fluctuations in ER longitudinally predict ED behaviors in daily life or the mechanisms of ER effects. Investigating daily ER could help us better understand why people experience ED behaviors at a given time. We examined whether day-to-day changes in adaptive (e.g., cognitive reappraisal) and maladaptive (e.g., rumination) ER longitudinally predicted core ED behaviors (binge eating, purging, dieting) and whether changes in affect mediated effects. METHOD Female participants (N = 688) ages 15-30 from the Michigan State University Twin Registry reported their adaptive and maladaptive ER use, negative affect (NA), positive affect (PA), binge eating, purging, and dieting on 49 consecutive days. Using structural equation modeling, we examined whether within-person fluctuations in ER predicted same- and next-day ED behaviors and whether changes in affect mediated longitudinal ER effects. RESULTS Greater maladaptive ER predicted increased likelihood of same-day binge eating and next-day binge eating and purging. The association between maladaptive ER and next-day binge eating and purging was mediated by increased next-day NA. In contrast, dieting was more closely related to changes in PA. Adaptive ER did not predict reduced likelihood of any ED behavior. CONCLUSIONS Maladaptive ER may longitudinally increase risk for binge eating and purging by amplifying NA. Interventions focused on decreasing maladaptive ER and subsequent NA might help disrupt binge eating-purging cycles. Conversely, results add to evidence that PA fluctuations may play a unique role in maintaining restrictive behaviors. PUBLIC SIGNIFICANCE Little is known about how daily changes in emotion regulation may impact disordered eating. We found that maladaptive emotion regulation (e.g., rumination) was associated with a higher likelihood of binge eating and purging on the next day because it predicted increased next-day negative affect. In contrast, dieting was more closely tied to fluctuations in positive affect. Targeting daily emotion regulation and affective processes may help disrupt cycles of disordered eating.
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Affiliation(s)
- Megan E Mikhail
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | - S Alexandra Burt
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | - Michael C Neale
- Department of Psychiatry, Human Genetics, and Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Pamela K Keel
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Debra K Katzman
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Kelly L Klump
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
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3
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Haynos AF, Anderson LM, Askew AJ, Liu C, Venables K, Craske MG, Peterson CB. A randomized, controlled pilot study of positive affect treatment adapted for anorexia nervosa. Int J Eat Disord 2024; 57:1253-1259. [PMID: 37811810 PMCID: PMC11001784 DOI: 10.1002/eat.24071] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/09/2023] [Accepted: 09/23/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE Novel treatments for adults with anorexia nervosa (AN) are sorely needed. Although psychological interventions have been developed for AN, none have been identified as superior to one another or nonspecific treatments. Common comorbidities (e.g., mood and anxiety disorders) are rarely targeted in AN treatments, possibly impairing long-term clinical improvement. AN is associated with reward processing dysfunctions paralleling those identified in affective disorders; however, few treatments directly target these processes. METHOD We adapted Positive Affect Treatment, a neuroscience-informed behavioral treatment developed for affective disorders, to the treatment of AN (PAT-AN). Adults with AN (N = 20) were randomized to 20 weeks of PAT-AN or waitlist to investigate the feasibility, acceptability, preliminary efficacy, and target engagement (on reward mechanisms) of PAT-AN. RESULTS PAT-AN demonstrated strong retention (100%) and acceptability ratings (M = 5.67-5.95 on a 7-point scale). BMI (p = .006) and eating disorder symptoms (p < .001) improved over PAT-AN sessions. The PAT-AN group showed medium to large pre-to-post-treatment improvements in BMI, eating disorder symptoms and impairment, depressive and anxiety symptoms, and some reward indices (ds = .56-.87); changes were largely sustained at 3-month follow-up. Waitlist showed negligible changes (ds < .20) on nearly all measures. DISCUSSION PAT-AN holds promise as an innovative treatment with capability to simultaneously improve eating disorder symptoms, affective symptoms, and underlying reward mechanisms. Findings should be interpreted cautiously due to small sample size and permitted concurrent enrollment in other treatments. Future, larger-scale research is warranted to establish the efficacy of PAT-AN. PUBLIC SIGNIFICANCE This study provided a preliminary evaluation of Positive Affect Treatment for anorexia nervosa (PAT-AN), a novel, neuroscience-informed treatment aimed at increasing rewarding life experiences outside of one's eating disorder. Initial results suggest that PAT-AN is considered acceptable and may alleviate eating disorder, depressive, and anxiety symptoms. Therefore, this study presents promising data on a treatment that may hold potential for improving the lives of individuals with this disorder.
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Affiliation(s)
- Ann F. Haynos
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN
| | - Lisa M. Anderson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN
| | - Autumn J. Askew
- San Diego State University/University of California, San Diego, San Diego, CA
| | - Chassidie Liu
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN
| | - Kira Venables
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Michelle G. Craske
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | - Carol B. Peterson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN
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Dougherty EN, Bottera AR, Haedt-Matt AA, Wildes JE. Reconceptualizing emotion regulation and coping strategy usage in eating disorders research: The utility of a regulatory flexibility framework. Int J Eat Disord 2023; 56:1835-1841. [PMID: 37465948 PMCID: PMC10592414 DOI: 10.1002/eat.24027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/20/2023]
Abstract
Emotion regulation and coping strategies are often conceptualized in eating disorder (ED) research as inherently adaptive or maladaptive, and successful regulation is often defined as greater overall use of adaptive strategies. However, recent empirical work outside of the field of EDs challenges this categorical conceptualization of strategies, demonstrating that adaptiveness is determined by the ability to flexibly implement and adjust strategies based on contextual demands (i.e., regulatory flexibility). Despite evidence that emotion regulation and coping strategies are best conceptualized in terms of flexibility in the broader literature, few ED studies have adopted this model. We review the current conceptual framework of emotion regulation and coping strategies used in ED research and present regulatory flexibility as an alternative approach to conceptualizing these strategies. The lack of research on regulatory flexibility among individuals with EDs limits our understanding of the role of emotion regulation and coping difficulties in ED risk and maintenance. Adopting a regulatory flexibility model of strategies in EDs may extend knowledge of the role of emotion regulation difficulties in the development and maintenance of EDs. We highlight the potential utility of investigating regulatory flexibility and present recommendations for future research on regulatory flexibility in EDs. PUBLIC SIGNIFICANCE STATEMENT: Research on emotion regulation and coping strategy usage in eating disorders often view regulatory strategies as inherently adaptive or maladaptive. However, recent studies support defining strategies in terms of flexibility. Adopting a regulatory flexibility model of strategies in eating disorders research may advance knowledge of the role of emotion regulation difficulties in the development and maintenance of eating disorders, ultimately enhancing prevention and treatment efforts.
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Affiliation(s)
- Elizabeth N Dougherty
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA
| | - Angeline R Bottera
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA
| | - Alissa A Haedt-Matt
- Department of Psychology, Illinois Institute of Technology, Chicago, Illinois, USA
| | - Jennifer E Wildes
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA
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Flynn RL, Massion TA, Kosmas JA, Smith SR, Mastronardi CN, Graham AK. Positive affect dysregulation and its relation to binge eating size and frequency. Front Psychol 2023; 14:1146549. [PMID: 37284471 PMCID: PMC10239925 DOI: 10.3389/fpsyg.2023.1146549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/02/2023] [Indexed: 06/08/2023] Open
Abstract
Negative affect is an established predictor of binge eating, yet less is known about positive affect. Low positive affect has been theorized to increase binge eating, but a better understanding is needed on the relationship between positive affect and binge eating frequency and size. Participants were 182 treatment-seeking adults (76% self-identified as female; 45% self-identified their race as Black and 40% as White; and 25% self-identified their ethnicity as Hispanic/Latino) with self-reported recurrent binge eating (≥12 binge episodes in the past 3 months). Participants completed the positive and negative affect schedule (PANAS) survey and the eating disorder examination to assess frequency of objective binge episodes (OBEs) and subjective binge episodes (SBEs) over the past 3 months. OBEs and SBEs also were combined to yield total binge episodes over the past 3 months. Independent t-tests and linear regression analyses were used to test associations between positive affect scores and binge episode size and frequencies, and to compare low versus higher positive affect on binge frequency. Additional exploratory models were conducted controlling for negative affect, identity characteristics, and socio-demographic variables. Lower positive affect was significantly associated with more frequent total binge episodes, but not OBEs and SBEs when assessed independently. Findings remained consistent when controlling for covariates and when comparing individuals with the lowest versus higher positive affect levels. Overall, results lend support to the theory that low positive affect is associated with binge eating. Increasing positive affect may be an important treatment consideration for those with recurrent binge eating.
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Affiliation(s)
- Rebecca L. Flynn
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Thomas A. Massion
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jacqueline A. Kosmas
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Shannon R. Smith
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Carli N. Mastronardi
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Andrea K. Graham
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Santos BM, Haynos AF. Difficulties with positive emotion regulation in anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2023. [PMID: 36854860 DOI: 10.1002/erv.2973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/17/2023] [Accepted: 02/06/2023] [Indexed: 03/02/2023]
Abstract
Individuals with anorexia nervosa (AN) have well-documented difficulties regulating negative emotions, but less is known about positive emotion regulation in this population. To address this gap, we compared responses on the Difficulties in Emotion Regulation Scale-Positive questionnaire and the traditional DERS questionnaire (measuring negative affect dysregulation) between females with AN (n = 30) and demographically-matched controls without an eating disorder history (NC; n = 30) and examined relations between positive emotion regulation and clinical symptoms. Results indicated that individuals with AN demonstrated greater difficulty regulating negative (p < 0.001, d = 2.75) and positive (p < 0.001, d = 1.08) emotions compared to NC participants. Specifically, the AN group reported heightened positive emotion nonacceptance (p = 0.004, d = 0.78) and impulsivity (p = 0.003, d = 0.81). Greater positive emotion nonacceptance was associated with higher anxiety (p = 0.015) and depression (p = 0.022) among individuals with AN. Unexpectedly, more positive emotion impulsivity was associated with less restrictive eating in AN (p < 0.001). Findings were largely maintained even after controlling for negative emotion dysregulation and psychotropic medication use. The results suggest that reducing shame related to positive emotions could improve mood in AN; alternatively, relinquishing control when experiencing positive emotion could reduce restriction. More research is warranted on positive emotion regulation as a treatment target for AN.
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Affiliation(s)
- Bolade M Santos
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ann F Haynos
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
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Romano KA, Heron KE, Ferguson G, Scott SB. Emotion word use patterns and eating disorder symptoms: Considering the circumplex model of affect and basic emotions theory. Int J Eat Disord 2023; 56:464-469. [PMID: 36571239 PMCID: PMC9898121 DOI: 10.1002/eat.23879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 12/06/2022] [Accepted: 12/09/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE No prior research has examined whether the types of emotion words individuals use to describe their affective experiences cluster along affective dimensions inherent within leading affect theories, or how such emotion word use maps onto eating disorder (ED) symptoms. METHOD To address these gaps, latent profile analysis was used to empirically-identify groups of young adults (N = 352) by how often they use emotion words characterized by the circumplex model of affect's valence-arousal dimensions and basic emotions theory's basic versus complex emotion word categorizations. Auxiliary analyses examined differences in groups' ED symptoms (binge eating, purging, restricting, excessive exercising, muscle building, body dissatisfaction, and cognitive restraint). RESULTS The 5-profile valence-arousal model and 4-profile basic-complex model were the best-fitting theoretically-supported solutions. Valence-arousal profiles with greater negative affect valence generally exhibited worse ED pathology than others, whereas profiles with greater positive affect valence produced inconsistent risk- and protective-factor relations with distinct ED symptoms. Basic-complex profiles characterized by frequent use of both basic and complex emotion words generally had the greatest ED severity, and profiles with greater basic emotion word use exhibited elevated binge eating. DISCUSSION Individual-differences in young adults' emotion word use patterns, versus sample-level averages only, warrant further consideration in ED prevention and research. PUBLIC SIGNIFICANCE The present findings suggest that young adults differ in the types of words they use to describe their emotional experiences, and that these unique emotion word use patterns are linked to distinct eating disorder symptoms. These sources of variation warrant further consideration in eating disorders prevention efforts and future research seeking to advance affect-based eating disorders theories.
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Affiliation(s)
- Kelly A. Romano
- Virginia Consortium Program in Clinical Psychology, 555 Park Avenue, Norfolk, VA 23504, USA
| | - Kristin E. Heron
- Virginia Consortium Program in Clinical Psychology, 555 Park Avenue, Norfolk, VA 23504, USA
- Old Dominion University, 250 Mills Godwin Building, Norfolk, VA 23529, USA
| | - Giselle Ferguson
- Stony Brook University, 100 Nicolls Road, Stony Brook, NY 11794, USA
| | - Stacey B. Scott
- Stony Brook University, 100 Nicolls Road, Stony Brook, NY 11794, USA
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Breiner CE, Scharmer C, Zon C, Anderson D. The moderating role of self-compassion on the relationship between emotion-focused impulsivity and dietary restraint in a diverse undergraduate sample. Eat Behav 2022; 46:101650. [PMID: 35760018 DOI: 10.1016/j.eatbeh.2022.101650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 05/11/2022] [Accepted: 06/15/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE High levels of emotion-focused impulsivity (e.g., negative urgency) are significantly related to disordered eating behaviors, including dietary restraint. The objective of the current study was to understand the moderating role of self-compassion between emotion-focused impulsivity and dietary restraint in a diverse undergraduate sample. We hypothesized that high levels of self-compassion would protect individuals with high levels of emotion-focused impulsivity from engaging in high levels of dietary restraint. METHOD Participants (n = 607, Mage = 18.8, 63 % female, 45.3 % White) completed the UPPS-P, Eating Disorder Examination Questionnaire, and the Self-Compassion Questionnaire as part of a larger study examining eating behaviors in college students. RESULTS Negative urgency, but not positive urgency, was related to dietary restraint. Self-compassion moderated the relationship between both forms of impulsivity and dietary restraint, such that individuals with high emotion-focused impulsivity and high self-compassion had lower dietary restraint than individuals who had high emotion-focused impulsivity and low self-compassion. DISCUSSION Emotion-focused urgency is a risk factor for dietary restraint; both factors are highly correlated with more severe eating pathology, such as binging and purging behaviors. Self-compassion may buffer against the risk of emotion-focused impulsivity on engaging in dietary restraint behaviors in a community sample, which may inform our understanding of preventative interventions against eating pathology. These results should be replicated in clinical populations and across eating disorder diagnoses.
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Affiliation(s)
| | | | - Caitlyn Zon
- University at Albany, State University of New York, Albany, NY, USA
| | - Drew Anderson
- University at Albany, State University of New York, Albany, NY, USA
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Malet-Karas A, Bernard D, Piet E, Bertin E. Disordered eating as a repercussion of sexual assault: a consequence to consider. Eat Weight Disord 2022; 27:2095-2106. [PMID: 35015284 DOI: 10.1007/s40519-021-01356-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/28/2021] [Indexed: 12/17/2022] Open
Abstract
PURPOSE This study aims at clarifying the links between sexual violence and disordered eating (DE). METHODS In a sample of 12,638 victims of self-reported sexual violence, we analyzed the situation of 546 victims that declared having developed DE. We assessed the characteristics of the assault (age, type of aggression) and the medical consequences (PTSD, depression, suicide attempts, anxiety disorders, etc.). RESULTS DE prevalence was 4.3% in the victim sample. The age of the first assault in DE victims was significantly lower than that of the whole population (12 years vs 16 years for median; p < 0.001). A much higher prevalence of sexual assault consequences was present in victims developing DE with odd ratios (OR) for: self-mutilation (OR = 11.5 [8.29-15.95], p < 0.001); depression (OR = 5.7 [4.81-6.86], p < 0.001); self-medication (OR = 5.3 [3.86-7.19], p < 0.001); suicide attempts (OR = 4.5 [3.59-5.67], p < 0.001); post-traumatic stress disorder (OR = 3.8 [2.99-4.78], p < 0.001); anxiety troubles (OR = 5.2 [4.11-6.47], p < 0.001); alcoholism (OR = 4.0 [2.81-5.58], p < 0.001). CONCLUSION This study confirms the link between DE and sexual violence, especially in childhood, leading to severe psychological consequences. In this context, DE should be envisaged as a coping strategy accompanying emotional dysregulation due to traumatic events, and be treated as such. LEVEL OF EVIDENCE Level IV: Evidence obtained from multiple time series analysis such as case studies.
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Affiliation(s)
| | - Delphine Bernard
- Association "Le Regard du Miroir", 5 Boulevard Foch BP 62732, 51100, Reims, France
| | - Emmanuelle Piet
- Association "Collectif féministe contre le viol (CFCV)", Paris, France
| | - Eric Bertin
- Clinical Nutrition Transversal Unit (UTNC) of Reims University Hospital and Performance, Health, Metrology, Society Laboratory (PSMS, EA 7507) of Reims Champagne-Ardenne University, Reims, France.
- Hôpital Robert Debré, Unité 63 Nutrition, 45 rue Cognacq Jay, 51092, Reims, France.
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Atchison A, Zickgraf HF. Orthorexia nervosa and eating disorder behaviors: A systematic review of the literature. Appetite 2022; 177:106134. [PMID: 35750289 DOI: 10.1016/j.appet.2022.106134] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 05/13/2022] [Accepted: 06/08/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Orthorexia nervosa (ON) involves obsessive thoughts about healthy eating and distress related to this obsession. There is still dispute over whether ON should be considered on the obsessive-compulsive spectrum, the eating disorder (ED) spectrum, or as its own disorder. Based on current research, orthorexic behaviors seem to be closely related to eating disorder behaviors. However, given the range of instruments used to measure ED and ON, and the lack of consistency in the specific ED domains explored, a review of the current literature is warranted. OBJECTIVE The objective of this study was to review the literature relating ON and ED symptoms in an effort to understand the nature of their relationship, and to identify ED symptom domains most closely related to ON. METHODS A search was conducted on PubMed, Science Direct, and Web of Science using the term "orthorexia" and at least one of the following: "anorexia nervosa," "bulimia nervosa," "eating disorder," "arfid," "restrictive," "body image," "weight concern," "shape concern." After exclusion criteria were applied, 42 articles were included in the review. RESULTS The results indicated that ON is consistently related to both trait and disordered restrictive eating symptoms of anorexia nervosa, and weight control motivations for food choice. However, ON was less consistently related to binge-spectrum eating disorder symptoms, emotional eating, uncontrolled eating, or body dissatisfaction/shape and weight concerns. CONCLUSION The finding that ON symptoms are related to restraint and weight loss efforts, but not to body dissatisfaction or dysregulated eating suggests that ON may represent a distinct ED.
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Affiliation(s)
- Anna Atchison
- University of South Alabama, Department of Psychology, Mobile, AL, 36688, USA.
| | - Hana F Zickgraf
- University of South Alabama, Department of Psychology, Mobile, AL, 36688, USA
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Bronstein MV, Everaert J, Kummerfeld E, Haynos AF, Vinogradov S. Biased and inflexible interpretations of ambiguous social situations: Associations with eating disorder symptoms and socioemotional functioning. Int J Eat Disord 2022; 55:518-529. [PMID: 35132668 PMCID: PMC9392902 DOI: 10.1002/eat.23688] [Citation(s) in RCA: 3] [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: 10/06/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Research indicates that difficulties across multiple socioemotional functioning domains (e.g., social emotion expression/regulation, response to social elicitors of emotion) and negatively biased interpretations of ambiguous social situations may affect eating disorder symptoms. The impact of inflexible interpretations of social situations on eating disorder symptoms is less clear. The present study therefore examined relations between inflexible and biased social interpretations, socioemotional functioning, and eating disorder symptoms. METHOD A total of 310 participants from the general population, recruited from an online crowdsourcing platform, completed measures of socioemotional functioning (e.g., rejection sensitivity, negative social exchange), eating disorder symptoms, and positive and negative interpretation bias and inflexibility on a single measurement occasion. RESULTS Socioemotional functioning impairments (Pillai's trace = 0.11, p < .001), but not negative (β = .07, p = .162) or positive (β = -.01, p = .804) interpretation bias or inflexible interpretations (β = .04, p = .446), were associated with eating disorder symptoms in multiple regression models. In network analyses controlling statistically for multiple markers of socioemotional functioning, eating disorder symptoms were directly associated with negative (but not positive) interpretation bias. Inflexible interpretations were indirectly linked to symptoms via co-dampening of positive emotions. Exploratory causal discovery analyses suggested that several socioemotional functioning variables (social anxiety, depression, negative social exchange) may cause eating disorder symptoms. CONCLUSIONS Consistent with cognitive-interpersonal models of disordered eating, our results suggest that less accurate (biased, inflexible) interpretations of social information contribute to patterns of cognition (anxious anticipation of rejection) and emotion regulation (down-regulation of positive social emotion) thought to encourage disordered eating. PUBLIC SIGNIFICANCE This study suggests that less accurate interpretations of ambiguous social information encourage anxious anticipation of rejection and downregulation of positive social emotions, both of which are thought to promote eating disorder symptoms. Knowledge provided by this study about the likely relations between interpretive processes, social/emotional functioning, and eating disorder symptoms may help inform treatments for eating disorders, particularly those that attempt to modify patterns of interpretation.
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Affiliation(s)
- Michael V. Bronstein
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jonas Everaert
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Research Group of Quantitative Psychology and Individual Differences, KU Leuven, Leuven, Belgium
| | - Erich Kummerfeld
- Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ann F. Haynos
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sophia Vinogradov
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, USA
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Dolan SC, Khindri R, Franko DL, Thomas JJ, Reilly EE, Eddy KT. Anhedonia in eating disorders: A meta-analysis and systematic review. Int J Eat Disord 2022; 55:161-175. [PMID: 34811779 DOI: 10.1002/eat.23645] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/11/2021] [Accepted: 11/11/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Anhedonia, or loss of pleasure, is related to deficits in reward processing across a variety of psychiatric disorders. In light of research suggesting abnormal reward processing in eating disorders (EDs), the study of anhedonia in EDs may yield important insights into the role of reward in eating pathology. This meta-analysis and review aimed to provide both a quantitative and qualitative synthesis of the existing literature on this topic. METHOD We conducted this research (or these meta-analyses) according to PRISMA guidelines. We searched four databases for both peer-reviewed and unpublished literature, and included studies only if a self-report or clinical interview measure of anhedonia was administered to a sample with an ED diagnosis. RESULTS We included 21 studies in the systematic review, and 10 studies in two meta-analyses that compared anhedonia between ED and control samples (n = 9 studies) and within different ED diagnoses (n = 5 studies). Meta-analyses revealed that anhedonia was significantly higher in ED groups compared to healthy controls, but there was no significant difference in anhedonia between ED diagnostic groups. A qualitative review of the literature also suggested that anhedonia may be correlated with increased ED symptom severity. DISCUSSION Findings indicated that anhedonia is elevated in EDs and may be a relevant treatment target. Future research should examine how self-reported anhedonia may correlate with components of reward processing in EDs in order to improve theoretical models as well as targeted interventions.
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Affiliation(s)
- Sarah C Dolan
- Department of Psychology, Hofstra University, Hempstead, New York, USA
| | - Ruchika Khindri
- Department of Psychology, Hofstra University, Hempstead, New York, USA
| | - Debra L Franko
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Applied Psychology, Northeastern University, Boston, Massachusetts, USA
| | - Jennifer J Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Erin E Reilly
- Department of Psychology, Hofstra University, Hempstead, New York, USA
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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13
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Coniglio KA, Cooper M, Selby EA. Behavioral reinforcement of pathological exercise in anorexia nervosa. Int J Eat Disord 2022; 55:184-192. [PMID: 34626127 DOI: 10.1002/eat.23626] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/29/2021] [Accepted: 09/29/2021] [Indexed: 12/29/2022]
Abstract
Pathological exercise in anorexia nervosa (AN) is a harmful behavior associated with a chronic course and poor prognosis. To date, no comprehensive theoretical model exists to describe pathological exercise in the context of AN, and as such, few treatments are effective at promoting direct and sustained pathological exercise extinction. Using a framework put forth by Wise & Koob (2014), debating the relative importance of positive and negative reinforcement in substance use, we present three hypotheses of behavioral reinforcement of exercise, encompassing biological, psychological, and environmental influences. Specifically, we argue that exercise is positively reinforced through receipt of biological and behavioral rewards, negatively reinforced through avoidance of aversive emotions, and that these two systems work in tandem over time to engrain pathological exercise as a habit. We then present suggestions for testing each of these hypotheses as future directions for the field.
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Affiliation(s)
- Kathryn A Coniglio
- Department of Psychology, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Marita Cooper
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Edward A Selby
- Department of Psychology, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
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14
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Abstract
Anhedonia is frequently observed among individuals with eating disorders (ED), though its relevance to ED pathology and clinical outcomes remain poorly understood. This chapter will present the latest findings regarding anhedonia in ED, with the majority of data available for anorexia nervosa (AN) and bulimia nervosa (BN). We consider anhedonia from the mechanistic lens of altered reward processing, with attention given to subjective experience, neurotransmitter function, neural correlates, and cognitive performance corresponding to distinct components of reward (i.e., liking, wanting, and learning). Findings from animal models are also highlighted. The chapter concludes with a discussion of implications for treatment and future directions aimed at better understanding anhedonia in ED.
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Affiliation(s)
- Susan M Murray
- Department of Psychiatry, University of California San Diego, UCSD Eating Disorders Center for Treatment and Research, San Diego, CA, USA
| | - Carina S Brown
- Department of Psychiatry, University of California San Diego, UCSD Eating Disorders Center for Treatment and Research, San Diego, CA, USA
| | - Walter H Kaye
- Department of Psychiatry, University of California San Diego, UCSD Eating Disorders Center for Treatment and Research, San Diego, CA, USA
| | - Christina E Wierenga
- Department of Psychiatry, University of California San Diego, UCSD Eating Disorders Center for Treatment and Research, San Diego, CA, USA.
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15
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Abstract
Abstract
Purpose of Review
Anhedonia is a transdiagnostic symptom comprising reduced subjective reward or pleasure. Anhedonia influences subjective anticipation and in-the-moment experiences. This review draws together affective learning and engagement evidence for anhedonia affecting subjective experiences of social environments.
Recent Findings
While social engagement is diminished consistently, subjective appraisals of social contexts vary across different mental health disorders. Low positive affect during social experiences or stimuli is reported in PTSD, mood, schizophrenia, and anxiety disorders. Diminished neural reward networks underpin the anticipation of social experiences in ADHD, schizophrenia spectrum, and autistic spectrum disorders. Multiple theories exist to explain how anhedonia might interfere with social environments.
Summary
Anhedonia is a barrier to engagement, motivation, and enjoyment of social contexts. While many studies characterize experiences during social contexts, learning theories provide the most promise for developing targeted interventions.
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16
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Wong VZ, Christian C, Hunt RA, Levinson CA. Network investigation of eating disorder symptoms and positive and negative affect in a clinical eating disorder sample. Int J Eat Disord 2021; 54:1202-1212. [PMID: 33819357 DOI: 10.1002/eat.23511] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/24/2021] [Accepted: 03/24/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Growing literature suggests that emotions influence the maintenance of eating disorder (ED) symptoms. However, most research has studied the relationship between ED symptoms and affect broadly (i.e., negative affect [NA], positive affect [PA]), rather than examining models comprised of multiple specific affective states (e.g., upset, proud). METHOD The current study (N = 196 individuals with EDs) used network analysis to examine the most interconnected (i.e., central) NA and PA states in EDs and test the complex associations between specific NA, PA, and ED symptoms. We estimated two networks: one with affective states only and another with affective states and ED symptoms. RESULTS Feeling distressed, afraid, attentive, and determined were the most central symptoms in the affect-only network. ED symptoms related to overvaluation of weight and shape, including affect-based ED symptoms (i.e., guilt about eating), were central in the network of affect and ED symptoms. Guilt about eating and shame were central bridge symptoms across affect and ED symptom clusters, meaning that they were each strongly connected across clusters, and may represent important pathways among affect and ED symptoms. DISCUSSION Limitations include the cross-sectional and between-person nature of these analyses, from which we cannot derive causal or within-persons processes. Clinical interventions that target central and bridge symptoms (e.g., fear, shame) may disrupt the reinforcing cycle of NA in EDs that may contribute to ED behaviors. Future research should examine relationships among affective states and ED symptoms in longitudinal and intraindividual network models to develop more effective treatments for EDs.
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Affiliation(s)
- Valerie Z Wong
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Caroline Christian
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Rowan A Hunt
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Cheri A Levinson
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA
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17
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Melles H, Spix M, Jansen A. Avoidance in Anorexia Nervosa: Towards a research agenda. Physiol Behav 2021; 238:113478. [PMID: 34058219 DOI: 10.1016/j.physbeh.2021.113478] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 05/15/2021] [Accepted: 05/26/2021] [Indexed: 01/27/2023]
Abstract
Anorexia Nervosa is a severe and disabling mental disorder and a huge challenge to treat. Intense fears of e.g., food, eating, weight gain and social evaluation are core features of anorexia nervosa and obstacles during treatment. The perceived threats trigger avoidance and safety behaviors like highly restrictive eating, strict eating rules, vomiting and body checking, to minimize feared outcomes. The role of avoidance in anorexia nervosa is however hardly studied experimentally. In the present article, the focus is on a new transdiagnostic research agenda featuring both basic and clinical experimental research into avoidance as a most important mechanism maintaining the eating disorder. Avoidance learning and the generalization of learned avoidance behaviors are discussed, as well as safety behaviors and the need for inhibitory learning as a treatment target during exposure therapy.
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Affiliation(s)
- Hanna Melles
- Clinical Psychological Science, Maastricht University, the Netherlands
| | - Michelle Spix
- Clinical Psychological Science, Maastricht University, the Netherlands
| | - Anita Jansen
- Clinical Psychological Science, Maastricht University, the Netherlands.
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18
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Haynos AF, Anderson LM, Askew AJ, Craske MG, Peterson CB. Adapting a neuroscience-informed intervention to alter reward mechanisms of anorexia nervosa: a novel direction for future research. J Eat Disord 2021; 9:63. [PMID: 34039415 PMCID: PMC8152047 DOI: 10.1186/s40337-021-00417-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/04/2021] [Indexed: 01/16/2023] Open
Abstract
Accumulating psychobiological data implicate reward disturbances in the persistence of anorexia nervosa (AN). Evidence suggests that individuals with AN demonstrate decision-making deficits similar to those with mood and anxiety disorders that cause them to under-respond to many conventionally rewarding experiences (e.g., eating, interacting socially). In contrast, unlike individuals with other psychiatric disorders, individuals with AN simultaneously over-respond to rewards associated with eating-disorder behaviors (e.g., restrictive eating, exercising). This pattern of reward processing likely perpetuates eating-disorder symptoms, as the rewards derived from eating-disorder behaviors provide temporary relief from the anhedonia associated with limited responsivity to other rewards. Positive Affect Treatment (PAT) is a cognitive-behavioral intervention designed to target reward deficits that contribute to anhedonia in mood and anxiety disorders, including problems with reward anticipation, experiencing, and learning. PAT has been found to promote reward responsivity and clinical improvement in mood and anxiety disorders. This manuscript will: (1) present empirical evidence supporting the promise of PAT as an intervention for AN; (2) highlight nuances in the maintaining processes of AN that necessitate adaptations of PAT for this population; and (3) suggest future directions in research on PAT and other reward-based treatments that aim to enhance clinical outcomes for AN.
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Affiliation(s)
- Ann F Haynos
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, 2450 Riverside Ave., Minneapolis, MN, 55454, USA.
| | - Lisa M Anderson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, 2450 Riverside Ave., Minneapolis, MN, 55454, USA
| | - Autumn J Askew
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, 2450 Riverside Ave., Minneapolis, MN, 55454, USA
| | - Michelle G Craske
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Carol B Peterson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, 2450 Riverside Ave., Minneapolis, MN, 55454, USA
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19
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Essayli JH, Webster AE, Quaill MA, Zickgraf HF, Lane-Loney SE. Do individuals with eating disorders dislike exposure therapy? Attitudes from children, adults, and parents toward exposure therapy and other treatments for eating disorders. Int J Eat Disord 2021; 54:606-614. [PMID: 33521983 DOI: 10.1002/eat.23468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/29/2020] [Accepted: 12/29/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Exposure therapy appears underutilized in the treatment of eating disorders (EDs), perhaps due to clinicians' concerns that patients will dislike exposure therapy. The present study aims to investigate the attitudes of child patients, adult patients, and parents of child patients with EDs toward exposure therapy relative to four other treatments for EDs. METHOD A questionnaire was administered to patients and parents (N = 126) upon admission to a partial hospitalization program for EDs. Participants read vignettes describing five different treatments for EDs, and answered questions assessing attitudes about each treatment. RESULTS At admission, participants reported the most favorable attitudes toward cognitive therapy, and the least favorable attitudes toward psychiatric medication. Exposure therapy generally received similar scores as interpersonal and expressive art therapy, and was perceived as significantly more preferable and effective in the long-term than psychiatric medication. Relative to child and adult patients, parents reported greater preferences for all treatments except medication, and perceived all treatments as more credible except medication and art therapy. Preliminary findings from a subset of participants who also completed the questionnaire at discharge indicated that positive attitudes toward exposure therapy increased over the course of treatment. DISCUSSION Individuals with EDs and their parents may enter treatment with particularly favorable views toward cognitive therapy, and do not appear to have strong attitudes toward exposure therapy one way or the other. Clinicians' concerns that patients with EDs will dislike exposure therapy may be largely unfounded.
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Affiliation(s)
- Jamal H Essayli
- Penn State College of Medicine, Department of Pediatrics, Hershey, Pennsylvania, USA.,Penn State College of Medicine, Department of Psychiatry and Behavioral Health, Hershey, Pennsylvania, USA
| | - Aiyana E Webster
- Department of Psychology, University of South Florida, Tampa, Florida, USA
| | - Marlana A Quaill
- Morgridge College of Education, Department of Teaching and Learning Sciences, University of Denver, Denver, Colorado, USA
| | - Hana F Zickgraf
- Department of Psychology, University of South Alabama, Mobile, Alabama, USA
| | - Susan E Lane-Loney
- Penn State College of Medicine, Department of Pediatrics, Hershey, Pennsylvania, USA.,Penn State College of Medicine, Department of Psychiatry and Behavioral Health, Hershey, Pennsylvania, USA
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20
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Dreier MJ, Coniglio K, Selby EA. Mapping features of pathological exercise using hierarchical-dimensional modeling. Int J Eat Disord 2021; 54:422-432. [PMID: 33185893 DOI: 10.1002/eat.23406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/23/2020] [Accepted: 10/24/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Pathological exercise is common among those with eating disorders and has typically been characterized as excessive, compulsive, or compensatory in nature. Little is known about how pathological exercise is associated with other eating disorder behaviors or personality traits, or whether these associations differ between men and women. METHOD We used hierarchical dimensional modeling in three samples, including college women (N = 205), women with eating psychopathology (N = 268), and college men (N = 235), to examine latent associations between pathological exercise and eating disorder psychopathology, namely compulsivity, emotion regulation, and body dissatisfaction. RESULTS Using Goldberg's (2006) "bass-ackwards" method, we identified separate 10-factor solutions (women) or an 11-factor solution (men). A distinct muscle building factor arose in the three-factor solution for men, and it also notably arose in the six- and eight-factor solutions for community and college women, respectively, highlighting an important understudied motivation factor in both healthy and pathological exercise. Each solution accounted for 64.8% (college women), 51.9% (women with eating psychopathology), and 43.9% (college men) of the variance in excessive exercise, respectively. DISCUSSION Findings indicate that pathological exercise is associated with different psychological traits (e.g., poor emotion regulation, compulsivity) across populations, and such differences may necessitate unique treatment approaches tailored accordingly.
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Affiliation(s)
- Melissa J Dreier
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kathryn Coniglio
- Department of Psychology, Rutgers University, Piscataway, New Jersey, USA
| | - Edward A Selby
- Department of Psychology, Rutgers University, Piscataway, New Jersey, USA
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21
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Mason TB, Smith KE, Anderson LM, Hazzard VM. Anhedonia, positive affect dysregulation, and risk and maintenance of binge-eating disorder. Int J Eat Disord 2021; 54:287-292. [PMID: 33295671 PMCID: PMC8673784 DOI: 10.1002/eat.23433] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 11/02/2020] [Accepted: 11/23/2020] [Indexed: 11/12/2022]
Abstract
Low positive affect has been identified as an antecedent of binge-eating episodes among individuals with binge-eating disorder (BED), yet positive affect has received far less attention in eating disorders research than its counterpart, negative affect. In this article, we argue that the low levels of positive affect which occur with anhedonia (i.e., loss of interest or pleasure in activities) may contribute to the onset and maintenance of BED. We introduce a theoretical model in which anhedonia increases the risk for BED through its interrelationships with dysregulated eating and weight gain, and we describe potential direct (e.g., reward-related processes) as well as indirect (e.g., influences on depressive symptoms and physical activity) pathways by which anhedonia may lead to adverse eating- and weight-related outcomes. We also propose a momentary maintenance model in which low positive affect and positive affect dysregulation occurring with anhedonia maintain binge eating directly and indirectly through maladaptive health behaviors, such as decreased physical activity, less healthy eating, and fewer social interactions, which in turn maintain anhedonia. We draw upon outside literature to present evidence that aligns with the proposed risk and maintenance models and conclude by outlining avenues for future research-including methodological/measurement, theoretical, and clinical research directions.
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Affiliation(s)
- Tyler B. Mason
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Kathryn E. Smith
- Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA
| | - Lisa M. Anderson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN
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22
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Weineck F, Hauke G, Lindemann H, Lachenmeir K, Schnebel A, Karačić M, Meule A, Voderholzer U, Pollatos O. Using bodily postures in the treatment of anorexia nervosa: Effects of power posing on interoception and affective states. EUROPEAN EATING DISORDERS REVIEW 2020; 29:216-231. [PMID: 33252788 DOI: 10.1002/erv.2813] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 11/03/2020] [Accepted: 11/13/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Power posing involves the adoption of an expansive bodily posture. This study examined whether power posing could benefit individuals with anorexia nervosa (AN) and women with normal weight in regards to interoceptive ability and affective states. METHOD Participants included 50 inpatients and outpatients with AN as well as 51 normal-weight women. Interoceptive accuracy (IAcc), measured by the heartbeat tracking task and interoceptive sensibility (IS), measured by confidence ratings, were assessed at baseline, after a single power posing session and after 1 week of daily training. Also, the short-term effects of power posing on subjective feelings of dominance, pleasantness, and arousal were investigated. RESULTS Both groups increased in their IAcc after one power posing session. Also, there was a significant main effect of time on feelings of dominance and pleasantness in the short-term. Women with AN displayed lower levels of IS, dominance, and pleasantness as well as higher levels of arousal than women without AN. DISCUSSION These findings suggest that power posing has the potential to increase IAcc, subjective feelings of power and pleasant affect in the short-term. Further research should investigate which mechanisms foster the effectiveness of this intervention to tailor it to the needs of women with AN.
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Affiliation(s)
- Felicitas Weineck
- Department of Clinical and Health Psychology, Ulm University, Ulm, Germany
| | - Gernot Hauke
- Department of Clinical and Health Psychology, Ulm University, Ulm, Germany
| | - Hanna Lindemann
- Department of Physical Medicine and Rehabilitation, Ludwig Maximilian University, Munich, Germany
| | - Karin Lachenmeir
- Treatment Center for Eating Disorders (TCE), Dritter Orden Hospital, Munich, Germany
| | | | | | - Adrian Meule
- Schön Klinik Roseneck, Prien am Chiemsee, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Ulrich Voderholzer
- Schön Klinik Roseneck, Prien am Chiemsee, Germany
- Department of Psychiatry and Psychotherapy, University Freiburg, Freiburg, Germany
| | - Olga Pollatos
- Department of Clinical and Health Psychology, Ulm University, Ulm, Germany
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