The Eating Disorder Diagnostic Scale: Psychometric Features Within a Clinical Population and a Cut-off Point to Differentiate Clinical Patients from Healthy Controls

Food approach and avoidance craving: A partial test of the Ambivalence Model of Craving

Accumulating evidence from both cross-sectional and cue-reactivity studies supports the application of the Ambivalence Model of Craving (AMC) from the substance use literature to food craving. The focus of this extant work has been on the association between the two dimensions of food craving (approach and avoidance) and disordered eating behaviors. The present study extended existing validity data by investigating approach and avoidance food craving profiles and their associations with 1) disordered eating behaviors and 2) thinness/restriction and eating expectancies - a risk factor for disordered eating that is explicitly described by the AMC. It was anticipated that food craving profiles would parallel those defined by the AMC (i.e., approach oriented, avoidance oriented, ambivalent, indifferent) and that profiles defined by high avoidance food craving would be higher in compensatory behaviors, restricting behaviors, and thinness/restriction expectancies, while those defined by high approach food craving would be higher in binge eating and eating expectancies. A sample of 407 undergraduate students (54% female, 47% non-Hispanic White; Mage = 21 years) reported demographics, food craving disordered eating behaviors, and thinness/restriction and eating expectancies via an anonymous online survey. Latent profile analysis was used to test hypotheses. Hypotheses were partially supported. Four profiles were identified, but similar levels of approach and avoidance food craving were observed in each profile, with the intensity of the cravings increasing across the four profiles. Endorsement of disordered eating behaviors and expectancies also increased in intensity across the profiles. Findings suggest an additive, rather than interactive, effect of food craving.

Impact of parenthood on eating pathology in young adults

OBJECTIVE

Few studies investigated parenthood as a predictor of eating pathology in young adulthood. We studied the association between parenthood, in the first year after becoming a parent and beyond, and eating pathology. Furthermore, we examined whether moving in together with a partner affected this association.

METHOD

This study used data of four measurement waves from TRAILS (Tracking Adolescents' Individual Lives Survey), a Dutch community cohort study (N = 2229) from preadolescence into young adulthood. The Eating Disorder Diagnostic Scale (EDDS), a measure to assess eating pathology, was assessed at ages 22, 26, and 29. Risk for eating disorder was assessed at age 19. Pregnant participants were excluded.

RESULTS

Parenthood was not associated with an increase of eating pathology in the first year after becoming a parent and beyond. Instead, parents were more likely to report being free from eating pathology symptoms compared to childless individuals (OR 2.07, 95% CI: 1.11-3.84). Among those who reported experiencing at least one eating problem, parenthood was not associated with the number of eating problems. Moving in together with a partner did not alter the association between parenthood and eating problems and neither did this association differ between males and females.

DISCUSSION

Parenthood in young adulthood was associated with a decreased risk of having eating pathology.

PUBLIC SIGNIFICANCE STATEMENT

In this longitudinal study among young adults, parenthood was not associated with the development of eating pathology.

Examining compulsive exercise as a risk factor for eating disorder symptoms in first-year college students using a latent change score modeling approach

OBJECTIVE

Research suggests that both compulsive exercise and eating disordered behaviors increase during college. Despite strong cross-sectional associations between compulsive exercise and eating disorders, it is unknown if compulsive exercise is a variable risk factor for eating disorders or simply a correlate. It was hypothesized that increases in compulsive exercise would significantly and prospectively predict increases in overall number of eating disorder symptoms over the study period.

METHOD

A total of 265 first year college students who did not meet criteria for a full or subthreshold eating disorder diagnosis at Time 1 (age M = 18.15; SD = 0.42; 122 female [46%] at Time 1) completed reports of compulsive exercise and eating disorder symptoms via online questionnaires at four timepoints over the 9-month 2021-2022 academic year (76% retention rate). Hypotheses were tested using a bivariate latent change score model.

RESULTS

Hypotheses were not supported. Change in compulsive exercise did not predict change in number of eating disorder symptoms. Change in number of eating disorder symptoms also did not predict change in compulsive exercise.

CONCLUSIONS

Compulsive exercise did not emerge as a variable risk factor for the development of eating disorder symptoms among first year college students. The relationship between these behaviors should be investigated at different developmental timepoints, such as early adolescence, and potential third variables that may explain the observed co-occurrence should be explored.

PUBLIC SIGNIFICANCE

This study investigated whether increases in compulsive exercise predicted increases in number of eating disorder symptoms among first year college students. Compulsive exercise did not significantly predict number of eating disorder symptoms. Additional research is warranted to clarify the relationship between compulsive exercise and eating disorder symptoms.

Low Overlap and High Heterogeneity Across Common Measures of Eating Disorder Pathology: A Content Analysis

This study evaluated symptoms assessed in common measures of eating disorder pathology and tested overlap to evaluate the extent to which measures may be interchangeable. Six measures were included: Bulimia Test-Revised, Eating Attitudes Test-26, Eating Disorder Diagnostic Scale, Eating Disorder Examination Questionnaire, Eating Pathology Symptoms Inventory, and Questionnaire for Eating Disorder Diagnoses. Content overlap was quantitatively estimated using the Jaccard Index. Mean overlap was low (.195), likely due to the wide range of symptoms (87) assessed. The mean overlap of each measure with all others was .117 - .267, and the overlap among individual measures was .083 - .382. Implications of low overlap among measures include variable characterization of eating disorder phenotypes and the risk for lower generalizability of findings due to measurement variability.

Transgender individuals are at higher risk for suicidal ideation and preparation than cisgender individuals in substance use treatment

Introduction

This study describes the differences and similarities in mental health, substance use, and substance use treatment outcomes between people presenting for SUD treatment who identified as transgender and those who identified as cisgender men or women.

Methods

We compared 64 individuals who self-identified as transgender and presented for SUD treatment to samples of cisgender men and women (separately) matched based on propensity scores which were created based on sociodemographic factors known to influence both the nature of substance use and patterns of treatment engagement including age, education, race, stable housing, and employment status. Comparisons were made using χ2 tests and t-tests in over 150 variables collected at treatment intake regarding physical and mental health, substance use patterns, events that led to treatment, reasons for seeking treatment, and treatment outcomes.

Results

The transgender sample endorsed six of the seven suicide-related items more often than at least one of the cisgender-matched samples. Furthermore, the transgender sample remained in treatment significantly longer (M = 32.3, SD = 22.2) than the cisgender male sample (M = 19.5, SD = 26.1, t = 2.17, p = 0.03).

Discussion

This study is a first step into understanding gender minority population experiences during SUD treatment. While there was no significant difference between the cisgender and transgender samples on most variables, there was an elevated prevalence of suicidal ideation and behaviors in the transgender sample, which warrants further investigation.

The complex interplay between psychosocial and biological factors in pregorexia nervosa - a rapid review

The importance of detecting eating disorders (EDs) during pregnancy cannot be overemphasized, because of the major negative effects this pathology has on both maternal and fetal health. Based on a rapid review including primary and secondary reports, PN may still be considered an elusive diagnosis entity, that partially overlaps with other EDs, either well-defined, like anorexia nervosa, or still in search of their own diagnosis criteria, like orthorexia nervosa. Neurochemical and hormonal factors, psychological and social mechanisms, along with lifestyle changes create a very complex framework for clinicians interested in defining the typical features of pregorexia nervosa (PN). The personal history of EDs is considered one of the most important risk factors for PN. The core diagnostic criteria for this entity are, so far, lack of gaining weight during pregnancy, an excessive focus on counting calories and/or intense physical exercising with a secondary decrease of interest in the fetus's health, lack of acceptance of the change in body shape during pregnancy, and pathological attention for own body image. Regarding the treatment of PN, nutritional and psychosocial interventions are recommended but no specific therapeutic strategies for this disorder have been detected in the literature. Psychotherapy is considered the main intervention for pregnant women with associated EDs and mood disorders, as the pharmacological agents could have teratogenic effects or insufficient data to support their safety in this population. In conclusion, taking into consideration the methodological limitations of a rapid review, data supporting the existence of PN were found, mainly regarding tentative diagnostic criteria, risk factors, and pathophysiological aspects. These data, corroborated with the importance of preserving optimal mental health in a vulnerable population, e.g., pregnant women, justify the need for further research focused on finding specific diagnostic criteria and targeted therapeutic approaches.

Clinical characterization of patients with bipolar disorder and a history of asthma: An exploratory study

INTRODUCTION

Bipolar disorder (BD) and asthma are leading causes of morbidity in the US and frequently co-occur.

OBJECTIVES

We evaluated the clinical features and comorbidities of patients with BD and a history of asthma.

METHODS

In a cross-sectional analysis from the Mayo Clinic Bipolar Biobank, we explored the clinical characteristics of the BD and an asthma phenotype and fitted a multivariable regression model to identify risk factors for asthma.

RESULTS

A total of 721 individuals with BD were included. From these, 140 (19%) had a history of asthma. In a multivariable model only sex and evening chronotype were significant predictors of asthma with the odds ratios and 95% confidence intervals being 1.65 (1.00, 2.72; p=0.05) and 1.99 (1.25, 3.17; p < 0.01), respectively. Individuals with asthma had higher odds of having other medical comorbidities after adjusting for age, sex, and site including hypertension (OR = 2.29 (95% CI 1.42, 3.71); p < 0.01), fibromyalgia (2.29 (1.16, 4.51); p=0.02), obstructive sleep apnea (2.03 (1.18, 3.50); p=0.01), migraine (1.98 (1.31, 3.00); p < 0.01), osteoarthritis (2.08 (1.20, 3.61); p < 0.01), and COPD (2.80 (1.14, 6.84); p=0.02). Finally, individuals currently on lithium were less likely to have a history of asthma (0.48 (0.32, 0.71); p < 0.01).

CONCLUSION

A history of asthma is common among patients with BD and is associated with being female and having an evening chronotype, as well as with increased odds of having other medical comorbidities. A lower likelihood of a history of asthma among those currently on lithium is an intriguing finding with potential clinical implications that warrants further study.

Beyond Binge Eating: The Impact of Implicit Biases in Healthcare on Youth with Disordered Eating and Obesity

(1) Background: Obesity and eating disorders (ED) can coexist resulting in worse health outcomes. Youth with ED are more likely to have obesity relative to peers with a healthy weight. Pediatric providers deliver first-line care to children and youth of all sizes and body shapes from infancy to adolescents. As healthcare providers (HCPs), we bring biases into our practice. Learning to recognize and address these biases is needed to provide the best care for youth with obesity. (2) Purpose: This paper aims to summarize the literature regarding the prevalence of ED beyond binge eating in youth with obesity and discuss how the intersection of weight, gender, and racial biases impact the assessment, diagnosis, and treatment of ED. We provide recommendations for practice and considerations for research and policy. (3) Conclusions: The assessment and treatment of ED and disordered eating behaviors (DEBs) in youth with obesity is complex and requires a holistic approach. This approach begins with identifying and understanding how one's implicit biases impact care. Providing care from a patient-centers lens, which considers how the intersection of multiple stigmatized identities increases the risk for DEBs in youth with obesity may improve long-term health outcomes.

Disordered eating is related to deficits in emotional processing: A correlational study with a subclinical sample

BACKGROUND

Both clinical and non-clinical levels of disordered eating behaviours have been associated with deficits in emotional processing.

METHODS

Through a correlational design, the present study examined the relationship between different types of disordered eating behaviours and various forms of emotional processing. N = 209 female undergraduate participants completed self-report measures of disordered eating behaviours, perceived emotion intensity, emotion regulation skills, and self-compassion. Four groups of participants were identified based on self-reported disordered eating behaviours: a healthy control group (n = 90), dieting group (n = 22), binging group (n = 59), and binging/purging group (n = 38).

RESULTS

Greater severity of disordered eating was associated with greater emotional processing deficits including greater perceived emotion intensity, greater emotion regulation difficulties, and diminished self-compassion. Emotion regulation skills mediated the relationship between emotion intensity and disordered eating behaviours. A continuum of emotional processing deficits was observed wherein the healthy control group exhibited the fewest emotional processing deficits, and these deficits became increasingly severe among the dieting group, binging group, and binging/purging group, respectively. Each disordered eating type was associated with a specific profile of emotional processing difficulties.

LIMITATIONS

This study examined a subclinical sample of only female participants.

CONCLUSIONS

Findings bear clinical importance for the prevention, treatment, and understanding of disordered eating behaviours.

Change in body image flexibility and correspondence with outcomes in a digital early intervention for eating disorders based on acceptance and commitment therapy

Body image flexibility (BIF) has been suggested as a transdiagnostic process of change in eating disorder (ED) interventions, but data remain sparse. The current study examined the relationship between BIF and treatment effects in a randomized controlled trial comparing a digital ACT-based intervention to a waitlist control for early ED intervention. Women and girls with elevated Weight Concern Scale (WCS) scores were randomized to either the ACT intervention or a waitlist control. Linear regression models were used to examine the impact of treatment on WCS scores controlling for age and body-mass index and BIF was examined as a mediator of change. Change in BIF was also examined as a predictor of Eating Disorder Examination-Questionnaire (EDE-Q) global scores at 1-month in the ACT condition. ACT participants had greater reductions in WCS scores, an effect partially mediated by BIF and concentrated almost entirely in the ACT condition. Increased BIF from baseline to end-of-treatment also predicted lower EDE-Q scores at 1-month post-intervention. The current study suggests additional research exploring BIF as a process of change in EDs is warranted and could expand understanding of how treatment works or treatment options. Additional studies with more frequent, complete and concordant assessments between groups are needed.

The relationship between individual symptom connectivity and global eating disorder symptom severity

BACKGROUND

The network approach has emerged as a useful framework for conceptualizing and investigating psychopathology, including eating disorders. Network connectivity, that is, the density of the connections among network nodes, has been somewhat neglected despite its theoretical relevance. As predicted by network theory, symptom connectivity would be distinct but related to symptom severity and may be a useful clinical indicator of psychopathology as stronger and/or more diffuse connections among symptoms offer more avenues for symptom activation. This study aimed to investigate the relationship between moment-by-moment individual-level symptom connectivity and global levels of symptom severity in the context of eating disorder symptoms and experiences.

METHODS

A sample of 58 female undergraduate college students, mean (SD) age = 20.5 (3.1) provided data on eating disorder symptoms eight times a day over the course of 10 days. Network analyses were used to calculate the eating disorder symptoms network connectivity for each participant. In addition, participants completed survey of self-report measures of eating disorder symptom severity and trait mindfulness and body image flexibility.

RESULTS

Analyses revealed a moderate, positive relationship between individual network connectivity and eating disorder symptom severity. In addition, symptom connectivity predicted unique variance of symptom severity even after controlling for other clinically-relevant variables.

CONCLUSIONS

Individual-level network connectivity may be an important dimension of psychopathology and further work exploring the role of network connectivity is warranted.

PUBLIC SIGNIFICANCE

These findings suggest that symptom severity and the extent to which different eating disorder symptoms are connected are related but different dimensions. Investigating how these different dimensions play a role in eating disorder pathology could help to better understand and treat these disorders.

Coping in adolescents: A mediator between stress and disordered eating

BACKGROUND

Adolescence is a developmental period that can place individuals at heightened risk of engaging in disordered eating patterns. Stress and coping have been included as etiological factors of eating pathology, yet the mechanism of this relationship in adolescent males and females remains understudied.

AIMS

This study investigated the role of coping as a mediator in the stress-disordered eating relationship in a sample of adolescents.

DEMOGRAPHICS/SETTINGS

Participants included 2262 grade 7-12 students from a larger cross-sectional study entitled, Research on Eating and Adolescent Lifestyles (REAL).

METHODOLOGY/ANALYSES

Participants completed measures of perceived stress, life stressors, coping style, and disordered eating. Multiple mediator models of coping were analyzed to examine the extent to which coping mediated the stress-disordered eating relationship, for males and females separately.

FINDINGS

Emotion-oriented coping was a significant partial mediator in the relationship between stress (perceived stress, life stressors) and disordered eating in male and female adolescents. Findings suggest adolescents experiencing high stress tend to engage in emotion-oriented coping, which may lead to greater levels of disordered eating.

IMPLICATIONS

Interventions targeting effective coping strategies for dealing with different stress types may prevent youth from disordered eating, thus reducing their risk of eating disorders during a vulnerable period in development.

Screening for eating disorders across genders in college students: Initial validation of the brief assessment of stress and eating

Given that eating disorders (EDs) are relatively common in college populations, it is important to have reliable and valid tools to identify students so that they can be referred to evidence-based care. Although research supports the psychometric properties of existing ED screens for identifying cases of EDs, most studies have been conducted in samples of young white-majority women or have not reported the psychometric properties of the screening tool in men.

OBJECTIVE

The purpose of the current study was to validate a brief, 10-item screening tool for the identification of EDs-the brief assessment of stress and eating (BASE).

METHOD

Participants were college students (N = 596; 68.2% cisgender women) from a large Midwestern university who completed the BASE and SCOFF. The Eating Disorders Diagnostic Survey was used to generate DSM-5 ED diagnoses. We evaluated area under the curve (AUC) for both receiver operating curves (ROC) and precision-recall curves (PRC).

RESULTS

Both the BASE and SCOFF performed significantly better than chance at identifying probable EDs in cisgender women (BASE AUC: ROC = .787, PRC = .633, sensitivity = .733, specificity = .697; SCOFF AUC: ROC = .810, PRC = .684, sensitivity = .793, specificity = .701). However, the BASE (AUC: ROC = .821, PRC = .605, sensitivity = .966, specificity = .495) significantly outperformed the SCOFF (AUC: ROC = .710, PRC = .354, sensitivity = .828, specificity = .514) for identifying probable EDs in cisgender college men.

DISCUSSION

The BASE is appropriate for student healthcare and college research settings. Because the BASE outperforms the SCOFF in college men, results from the current study are expected to contribute to improved identification of EDs on college campuses.

PUBLIC SIGNIFICANCE

The BASE is a new screening tool to identify eating disorders. The BASE performed as well as, if not better than, the SCOFF (particularly in men). Given the need for brief, psychometrically strong, and unbiased ED screening tools in college students, the current study helps address an unmet student healthcare need that we expect will contribute to improved identification of EDs on college campuses.

The development and validation of the Conscious Objectification Questionnaire

OBJECTIVE

Self-objectification is linked to disordered eating (DE) behaviors in women. However, the awareness of objectification by the self and others, not just the objectifying experiences themselves, may be differentially related to DE. The proposed study examines the development and validity of the Conscious Objectification Questionnaire (COQ), which seeks to evaluate awareness of objectification by others and intentional self-objectification.

METHOD

In Study 1, 24 participants who identify as women (≥18 years) will provide qualitative feedback on COQ items, and survey items will be updated based on participant feedback. In Study 2, separate participants will complete the COQ and questionnaires assessing DE, self-objectification, and mental health correlates. Exploratory factor analyses will be conducted on the COQ, and reliability and convergent and divergent validity will be assessed.

RESULTS

Results will clarify whether the COQ is a reliable and valid instrument that measures the distinct construct of awareness of objectification.

DISCUSSION

If proven psychometrically sound, the COQ may be useful for future research on the link between awareness of objectification and disordered eating.

PUBLIC SIGNIFICANCE

The novel Conscious Objectification Questionnaire (COQ) assesses the degree to which women recognize and act upon being objectified. The COQ will be reviewed by self-objectification experts and pilot participants before being psychometrically evaluated with data from a larger sample. The COQ is expected to differentially relate to disordered eating above and beyond existing self-objectification measures and accurately represent the distinct construct of conscious awareness of societal and self-objectification.

The association between negative body talk and body shame on disordered eating symptoms among college students

Negative body talk (NBT), defined as negative communication about one's body, is associated with disordered eating, yet factors that may enhance these effects are understudied. Using objectification theory as a framework, NBT may reflect a vocal manifestation of self-objectification and endorsement of body shame may enhance the association between NBT and disordered eating. Given relatively consistent NBT and objectification theory-based conclusions across male and female college samples, the current study hypothesized that for college students high in body shame, NBT would be more strongly associated with disordered eating than for those low in body shame. A total of 849 college students (77.4 % female) completed measures of NBT (sex-specific), body shame, and eating disorder symptoms. Negative binomial regressions tested hypotheses separately by sex. Moderation results identified that the association between NBT and eating disorder symptoms was stronger for females reporting lower body shame compared to higher body shame. Among males, only significant main effects of NBT and body shame were observed. Body image and disordered eating preventive interventions may benefit from targeting NBT and/or body shame in males and females, and college females reporting lower body shame may be at greatest risk for the negative impact of NBT.

Motivation to change predicts naturalistic changes in binge eating and purging, but not fasting or driven exercise among individuals with eating disorders

We examined the naturalistic relations between motivation to change and change in four specific eating disorder (ED) behaviors-binge eating (BE), purging, fasting, and driven exercise-in a community-based sample of individuals with EDs over two consecutive 6-week periods. We conducted cross-lagged generalized estimating equations using the transtheoretical model's four stages of change to predict changes in the ED behaviors 6 weeks later. Individuals reported lower pre-contemplation for behaviors typically associated with more distress (e.g., BE, purging) than they did for behaviors associated with less distress (e.g., fasting and driven exercise). Action predicted decreases in BE and purging frequencies but not fasting or driven exercise frequencies. Naturalistic relations between ED behavior severity/frequency and motivation to change these features can be detected over 6-week intervals; that is, attempts at change in individuals' natural environments can be successful over relatively brief periods of time, especially when individuals experience the motivation to change these features. The process of motivation to change ED behaviors is not linear, and our study highlights the movement between stages of change among individuals with EDs. Future research is needed to examine how much of the observed changes are sustained.

A feasibility study of the delivery of online brief cognitive-behavioral therapy (CBT-T) for eating disorder pathology in the workplace

OBJECTIVE

CBT-T is a brief (10 sessions) version of cognitive behavioral therapy for non-underweight eating disorders. This report describes the protocol for a single center, single group, feasibility trial of online CBT-T in the workplace as an alternative to the health-service setting. By offering mental health services for eating disorders in the workplace, greater accessibility and increased help-seeking behaviors could be achieved.

METHOD

Treatment will be delivered online over 10 weeks and offered to employees based on self-referral rather than meeting diagnostic criteria, making treatment available to employees with sub-threshold eating disorder symptoms.

RESULTS

Assessments will be conducted at baseline, mid-treatment (week 4), posttreatment (week 10) and at follow-up (1 month and 3 months posttreatment). For the primary outcome, measures will include recruitment, attrition and attendance data using pre-set benchmarks to determine high, medium or low feasibility and acceptability. Qualitative participant experiences data will be analyzed using thematic analysis. Impact on work engagement and effect sizes will be determined from secondary outcome measures; the latter enabling sample size calculations for future study.

DISCUSSION

These pilot data will provide insights to recruitment, acceptability, effectiveness and viability of a future fully powered clinical trial of online CBT-T in the workplace.

PUBLIC SIGNIFICANCE STATEMENT

This study will present feasibility data from an eating disorders intervention (online CBT-T) using the workplace as an alternative to the healthcare setting to recruit and treat workers. Recruitment will be based on self-reported eating and weight concerns rather than diagnosis potentially enabling treatment to employees who have not previously sought help. The data will also provide insights to recruitment, acceptability, effectiveness, and future viability of CBT-T in the workplace.

The role of rumination and positive beliefs about rumination in eating pathology

PURPOSE

General and eating disorder (ED)-specific ruminations have been identified as key factors that may contribute to eating pathology. Positive beliefs about rumination (e.g., "Ruminating helps me to prevent future mistakes") may impact this association. However, the effect of positive beliefs about rumination on the links between rumination and ED symptom severity has not been investigated. This study sought to clarify relations between rumination and ED symptom severity and to evaluate the potential moderating effect of positive beliefs about rumination on these associations.

METHODS

During a laboratory visit, undergraduate participants (N = 473, M_Age = 18.90 ± 2.27, M_BMI = 23.45 kg/m² ± 4.31, 54.8% female) completed an online battery of questionnaires assessing general and ED-specific ruminative processes (e.g., brooding, reflection), positive beliefs about rumination, and global ED symptoms. Hierarchical multiple regression analyses assessed the unique contributions of specific ruminative processes, and the moderating effect of positive beliefs on associations between ruminative processes and ED symptom severity.

RESULTS

Hierarchical multiple regression results suggest that, after controlling for gender and BMI, ED-specific brooding, b = 1.32, SE = 0.13, β = 0.46, p < 0.0001, and reflection, b = 1.44, SE = 0.33, β = 0.19, p < 0.0001, accounted for unique variance in ED symptom severity. Moderation model results indicate that, at low levels of general reflection, b = - 0.06, SE = 0.02, β = - 0.51, p = 0.003, and ED-specific reflection, b = - 0.15, SE = 0.03, β = - 0.59, p < 0.0001, increased positive beliefs about rumination were associated with greater ED symptom severity.

CONCLUSION

Findings suggest ED-specific rumination accounts for ED symptom severity above and beyond general rumination, and that rumination-related expectancies influence the association between reflection and ED symptom severity.

LEVEL OF EVIDENCE

Level III, evidence obtained from a well-designed cohort study.

The prevalence and nutritional status of adolescent Saudi girls with disordered eating

This study on adolescents was intended to assess the prevalence of disordered eating attitudes and the nutritional status of adolescent girls in Saudi Arabia. Disordered eating attitudes and behaviour were assessed using the EAT-26. The type of eating disorder (ED) was determined using Diagnostic statistical manual of mental disorders, fifth edition. The nutritional status of the adolescent girls was determined by measuring their weight and height twice using standard protocols. The BMI-for-age and height-for-age were defined using WHO growth charts. Comparisons between adolescent girls with and without EDs were conducted using SPSS version 26. Eating disorders (EDs) were prevalent among 10⋅2 % of these girls. Other specified feeding or EDs were the most prevalent ED (7⋅6 %), followed by unspecified feeding or eating disorder (2⋅4 %). Anorexia nervosa was common among 0⋅3 % of the girls. The eating disordered adolescents were either overweight (7⋅7 %), obese (10⋅3 %), stunted (7⋅7 %) or severely stunted (2⋅6 %). ANOVA revealed that the BMI-for-age was influenced by age (P = 0⋅028), the type of ED (P = 0⋅019) and the EAT-26 (P < 0⋅0001). Pearson's correlation showed that the EAT-26 score increased significantly with the BMI (r 0⋅22, P = 0⋅0001), height (r 0⋅12, P = 0⋅019) and weight (r 0⋅22, P = 0⋅0001). The early detection of EDs among adolescents is highly recommended to reduce the risk associated with future impaired health status. Nutrition professionals must target adolescents, teachers and parents and provide nutritional education about the early signs and symptoms of ED and the benefits of following a healthy dietary pattern.

Revisiting the bipolar disorder with migraine phenotype: Clinical features and comorbidity

INTRODUCTION

To evaluate the prevalence and clinical correlates of lifetime migraine among patients with bipolar disorder (BD).

METHODS

In a cross-sectional study, we evaluated 721 adults with BD from the Mayo Clinic Bipolar Disorder Biobank and compared clinical correlates of those with and without a lifetime history of migraine. A structured clinical interview (DSM-IV) and a clinician-assessed questionnaire were utilized to establish a BD diagnosis, lifetime history of migraine, and clinical correlates.

RESULTS

Two hundred and seven (29%) BD patients had a lifetime history of migraine. BD patients with migraine were younger and more likely to be female as compared to those without migraine (p values <0.01). In a multivariate logistic regression model, younger age (OR=0.98, p<0.01), female sex (OR=2.02, p<0.01), higher shape/weight concern (OR=1.04, p=0.02), greater anxiety disorder comorbidities (OR=1.24, p<0.01), and evening chronotype (OR=1.65, p=0.03) were associated with migraine. In separate regression models for each general medical comorbidity (controlled for age, sex, and site), migraines were significantly associated with fibromyalgia (OR=3.17, p<0.01), psoriasis (OR=2.65, p=0.03), and asthma (OR=2.0, p<0.01). Participants with migraine were receiving ADHD medication (OR=1.53, p=0.05) or compounds associated with weight loss (OR=1.53, p=0.02) at higher rates compared to those without migraine.

LIMITATIONS

Study design precludes determination of causality. Migraine subtypes and features were not assessed.

CONCLUSIONS

Migraine prevalence is high in BD and is associated with a more severe clinical burden that includes increased comorbidity with pain and inflammatory conditions. Further study of the BD-migraine phenotype may provide insight into common underlying neurobiological mechanisms.

Eating Disorder Symptomatology Among Adolescents Presenting for Bariatric Surgery Candidacy: Examining Differences by Sex and Racial Minority Status

BACKGROUND

Research on adolescent bariatric surgery candidates is limited by insufficient inclusion of ethnic minorities and males, and lack of consideration of the full spectrum of disordered eating behaviors (i.e., restriction, compensatory behaviors [e.g., purging], overeating/binge eating behaviors).

OBJECTIVES

The current study investigated differences in the full range of disordered eating behaviors across sex and ethnicity among adolescents seeking bariatric surgery.

SETTING

Teaching hospital, United States.

METHODS

Data were collected using retrospective chart review of 79 adolescent bariatric surgery candidates (59% female, 46.8% Hispanic, M_BMI = 50.2, SD_BMI = 10.0, M_age = 17.3, SD_age = 2.02) who had completed the self-reported Eating Disorder Diagnostic Scale for DSM-5 at intake.

RESULTS

Approximately 33% of study participants met self-reported criteria for an eating disorder, with 35% endorsing binge eating behaviors and 50% endorsing compensatory behaviors. Few differences in behavior frequencies were observed across sex or racial/ethnic status.

CONCLUSIONS

Findings underscore the importance of assessing the full spectrum of disordered eating behaviors among adolescent bariatric surgery candidates.

Risk factors in preadolescent boys and girls for the development of eating pathology in young adulthood

OBJECTIVE

Despite a growing literature on potential risk factors for eating disorders, longitudinal research starting before adolescence is scarce, and little is known about risk factors in males. We investigated risk factors in preadolescent boys and girls for the development of eating pathology in adolescence and young adulthood.

METHOD

This study is part of TRAILS (TRacking Adolescents' Individual Lives Survey), a Dutch population-based cohort study (N = 2,229) from preadolescence into adulthood. Potential risk factors were measured at age 11, based on self-report, reports of one of the parents, and records of the Preventive Child Healthcare. Variables included sociodemographic variables, pregnancy and perinatal factors, eating- and weight-related factors, psychological functioning, stressful experiences and family factors. At age 19, two-stage screening including interviews by eating disorder experts was used to examine the prevalence of eating disorders. At age 22 and 26, eating pathology was assessed by the Eating Disorder Diagnostic Scale.

RESULTS

Preadolescent anxious distress and high weight were associated with eating pathology in adolescence and young adulthood in both boys and girls. Overeating in preadolescence was found to be a prodromal symptom of eating disorders during late adolescence. No evidence was found for sex-specific risk factors.

DISCUSSION

Anxious preadolescents with high weight are at increased risk for the development of eating pathology later on. Clinicians should be aware of eating disorder symptoms - like overeating - in this high-risk group of children, and could consider an early intervention to prevent the development of full-blown eating disorders.

An exploratory examination of internalized weight stigma in a sample living with food insecurity

Internalized weight stigma (IWS) is associated with various health concerns, regardless of body size. One weakness of existing IWS research is that it largely lacks diverse study populations. One recent exception, however, found increasing IWS was associated with higher levels of food insecurity (FI) in a low-income, majority Latinx sample. Using the same sample (N = 530), the present study further explored levels of IWS as compared to documented (mostly White/European) samples; we also investigated IWS in relation to three dichotomous eating disorder (ED) outcomes (e.g., any/no vomiting). Finally, based on previous qualitative findings regarding dietary restraint in the most severe level of FI, we explored the independent contribution of dietary restraint and IWS to cross-sectional risk of ED pathology. Results indicated that individuals living with FI experience IWS at concerning levels. Additionally, IWS played a small yet significant role in cross-sectional risk for ED pathology regardless of FI severity, while dietary restraint contributed to independent risk only in those with the most severe FI. Findings suggest that IWS is prevalent in this marginalized population, associated with ED pathology, and that the effect of dietary restraint on risk for ED pathology appears to uniquely impact those living with severe FI.

Registered report: Initial development and validation of the eating disorders safety behavior scale

Anxiety and eating disorders (EDs) often co-occur, prompting calls to explore anxiety-related maintenance processes in ED samples. Safety behaviors, which function to prevent a feared outcome from occurring or to reduce anxiety associated with a feared stimulus, are observed across anxiety disorders and, along with overt avoidance behaviors, are an important target in treatment. Data suggest that individuals with EDs also engage in safety behaviors. However, no existing assessments provide a comprehensive measure of eating-disorder-specific overt avoidance and safety behaviors. The goal of this Stage 1 Registered Report is to develop a comprehensive self-report measure of ED-specific safety behaviors. In Study 1, we will recruit 50 women with EDs to complete the scale and provide feedback on the response scale. Feedback from these participants will be used to refine the measure. In Study 2, we will evaluate the psychometric properties of the measure in a large sample of women with EDs (n dependent on the size of measurement) and a community sample without current or a history of ED symptoms. We will explore the measure factor structure, known-groups validity by comparing scores from women with EDs to healthy controls, internal consistency, and convergent and divergent validity with other psychological instruments.

Body image and body change behaviors associated with orthorexia symptoms in males

In recent years, Orthorexia Nervosa has received increasing attention as a form of restrictive disordered eating driven by concerns related to "healthy eating" as opposed to weight and shape concerns. To date, however, data on the correlates of orthorexia in men are lacking, particularly pertaining to the relationship between orthorexia and muscularity-related dimensions. A sample of 103 (M_age = 19.84) male college students completed an online questionnaire reporting on orthorexia symptoms, eating pathology, drive for muscularity, exercise dependence, and internalization of the thin and athletic ideals. Correlational analyses and linear regression models were used to explore relationships between orthorexia and variables of interest. Findings revealed positive relationships between high levels of orthorexia symptoms and eating pathology, exercise dependence, thin and athletic internalization, and behavioral dimensions of drive for muscularity. The results of this study extend our understanding of the correlates of orthorexia symptoms among young men and highlight their association with other dimensions of eating pathology as well as dysfunctional exercise. In addition, concerns related to healthiness may overlap with muscularity-related concerns, perhaps due to the conflation between health and muscular appearance in social constructions of male body ideals.

Heightened affective response to perturbation of respiratory but not pain signals in eating, mood, and anxiety disorders

Several studies have recently suggested that an abnormal processing of respiratory interoceptive and nociceptive (painful) stimuli may contribute to eating disorder (ED) pathophysiology. Mood and anxiety disorders (MA) are also characterized by abnormal respiratory symptoms, and show substantial comorbidity with ED. However, no studies have examined both respiratory and pain processing simultaneously within ED and MA. The present study systematically evaluated responses to perturbations of respiratory and nociceptive signals across the levels of physiology, behavior, and symptom report in a transdiagnostic ED sample (n = 51) that was individually matched to MA individuals (n = 51) and healthy comparisons (HC; n = 51). Participants underwent an inspiratory breath-holding challenge as a probe of respiratory interoception and a cold pressor challenge as a probe of pain processing. We expected both clinical groups to report greater stress and fear in response to respiratory and nociceptive perturbation than HCs, in the absence of differential physiological and behavioral responses. During breath-holding, both the ED and MA groups reported significantly more stress, feelings of suffocation, and suffocation fear than HC, with the ED group reporting the most severe symptoms. Moreover, anxiety sensitivity was related to suffocation fear only in the ED group. The heightened affective responses in the current study occurred in the absence of group differences in behavioral (breath hold duration, cold pressor duration) and physiological (end-tidal carbon dioxide, end-tidal oxygen, heart rate, skin conductance) responses. Against our expectations, there were no group differences in the response to cold pain stimulation. A matched-subgroup analysis focusing on individuals with anorexia nervosa (n = 30) produced similar results. These findings underscore the presence of abnormal respiratory interoception in MA and suggest that hyperreactivity to respiratory signals may be a potentially overlooked clinical feature of ED.

Benefits of yoga in the treatment of eating disorders: Results of a randomized controlled trial

Yoga has begun to be incorporated into the treatment of eating disorders despite limited empirical support for this practice. The purpose of this study was to investigate the efficacy of incorporating Yoga into the treatment of eating disorders. This preliminary randomized controlled trial investigated the benefits of participating in an eight-week Kripalu Yoga program for 53 women with symptoms of bulimia nervosa and binge eating disorder. Compared to waitlist controls, Yoga participants experienced decreases in binge eating frequency, emotional regulation difficulties and self-criticism, and increases in self-compassion. Yoga participants also experienced increases in state mindfulness skills across the eight weeks of the Yoga program. While these results are encouraging and suggest Yoga may have a valuable role to play in the treatment of eating disorders, it is important to stress their tentative nature. Further research, adopting a more rigorous design, is needed to address the limitations of the present study and expand on these findings.

Evening chronotype, disordered eating behavior, and poor dietary habits in bipolar disorder

OBJECTIVE

Our aim was to evaluate the relationship between evening chronotype, a proxy marker of circadian system dysfunction, and disordered eating behavior and poor dietary habits in individuals with bipolar disorder (BD).

METHODS

In this cross-sectional study, we evaluated 783 adults with BD. Chronotype was determined using item 5 from the reduced Morningness-Eveningness Questionnaire. The Eating Disorder Diagnostic Scale (EDDS) and the Rapid Eating Assessment for Participants-Shortened Version (REAP-S) were used to assess disordered eating behavior and dietary habits respectively. General linear models and logistic regression models were utilized to evaluate differences between chronotype groups.

RESULTS

Two hundred and eight (27%) BD participants self-identified as having evening chronotypes. Compared to non-evening types, evening types were younger (P < 0.01) and, after controlling for age, had higher mean EDDS composite z-scores (P < 0.01); higher rates of binge-eating (BE) behavior (P = 0.04), bulimia nervosa (P < 0.01), and nocturnal eating binges (P < 0.01); and a higher body mass index (P = 0.04). Compared to non-evening types, evening chronotypes had a lower REAP-S overall score (P < 0.01) and scored lower on the 'healthy foods' and 'avoidance of unhealthy food' factors. Evening types also skipped breakfast more often (P < 0.01), ate less fruit (P = 0.02) and vegetables (P = 0.04), and consumed more fried foods (P < 0.01), unhealthy snacks (P = 0.02), and soft drinks (P = 0.01).

CONCLUSIONS

Our findings suggest that the circadian system plays a role in the disordered eating and unhealthy dietary behaviors observed in BD patients. The circadian system may therefore represent a therapeutic target in BD-associated morbidity that warrants further investigation.

A bifactor analysis of the Weight Bias Internalization Scale: What are we really measuring?

Internalized weight stigma (IWS) has been linked with disordered eating behavior, both directly, and as a mediator of the relationship between experienced weight stigma and maladaptive coping. However, the construct of IWS is highly correlated with the related constructs of body image and global self-esteem, and the three constructs may better be represented by underlying trait self-judgment. This overlap is not generally accounted for in existing studies. The present study investigated the shared variance between self-esteem, body image, and IWS in an international sample of higher-weight individuals. Bifactor analysis confirmed that the intermediary role of IWS in the relationship between experienced stigma and self-reported eating behavior was largely accounted for by aspects of body image and global self-esteem. Greater conceptual clarity in the study of IWS is needed to understand the mechanisms via which societal weight stigma impacts on individuals' self-directed judgments and downstream health-related behaviors.

Temperament in preadolescence is associated with weight and eating pathology in young adulthood

OBJECTIVE

Few longitudinal studies have investigated the role of temperament traits on weight and eating problems thus far. We investigated whether temperament in preadolescence influences body weight and the development of eating pathology in adolescence and young adulthood.

METHOD

This study used data from TRAILS (Tracking Adolescents' Individual Lives Survey), a Dutch community cohort study (N = 2,230) from preadolescence into adulthood. At age 11, the temperament dimensions negative affectivity and effortful control were measured with the Early Adolescent Temperament Questionnaire-Revised. Body mass index (BMI) was measured at all assessment waves. At age 19, the prevalence of eating disorders was investigated by two-stage screening including interviews by eating disorder experts. At age 22 and 26, the Eating Disorder Diagnostic Scale was used to assess the level of eating pathology.

RESULTS

Higher negative affectivity in preadolescence was associated with higher BMI and eating pathology in young adulthood. Lower effortful control in preadolescence was found to be a risk factor for the development of obesity in young adulthood. No association was found between effortful control in preadolescence and eating pathology in later life.

DISCUSSION

Both negative affectivity and effortful control play a role in the development of weight or eating problems during adolescence.

Prevalence and correlates of eating disorders in greek-cypriot adolescents and young adults

The present study aimed to explore the prevalence rates of eating disorders among Greek-Cypriot adolescents and young adults and examine the role of the following variables in relation to eating disorder risk: gender, age, dieting, exercise and present-ideal weight discrepancy. One thousand and eighty-one middle, high school and university students responded to self-reported measures assessing eating disorders, weight-related concerns and behaviors. Prevalence estimates were 26% for high eating disorder risk and 14.98% for subthreshold eating disorders symptoms while 12% of participants met criteria of an eating disorder diagnosis. Multivariate logistic regression confirmed well-established predictors for eating disorder risk including present to ideal weight discrepancy which had a differential effect on risk in adolescents (i.e., 6-10 kg) and young adults (11+kg). This is the first study to provide prevalence rates of the entire eating pathology spectrum among Greek-Cypriot youth. Results are discussed in terms of their implications in the development of age-specific screening tools and prevention programs.

Linking Pavlovian Disgust Conditioning and Eating Disorder Symptoms: An Analogue Study

Although the experience of disgust is commonly endorsed among women with eating disorders, it remains unclear how to best model this emotion in relation to disordered eating. The present study sought to identify potential disgust conditioning abnormalities that may underlie the development of eating disorder symptoms. Individuals high and low in eating disorder symptoms (HED, n = 19; LED, n = 18) completed a Pavlovian conditioning procedure in which one neutral food item (conditioned stimulus; CS+) was followed by disgusting videos of individuals vomiting (unconditioned stimulus; US) and another neutral food item (CS-) was not reinforced with the disgusting video. Following this acquisition procedure, there was an extinction procedure in which both CSs were presented unreinforced. The results showed that ratings of disgust, fear, and willingness to eat the CS+ and CS- did not significantly vary as a function of the conditioning phase for the LED group. However, the HED group rated the CS+ as significantly more disgusting and fear inducing than the CS- after the acquisition phase and this pattern persisted after extinction. These conditioning effects were also observed to be significantly larger for disgust compared to fear. The HED group also reported being significantly less willing to eat the CS+ compared to the CS- after the acquisition phase and this pattern also persisted after extinction. In the full sample, only discriminant disgust responding after acquisition was associated with the amount of calorie consumption over the 24-hour period after conditioning. These findings suggest that eating disorder symptoms may result from a heightened proneness to associate disgusting outcomes with otherwise neutral food items. This pattern of disgust learning may reinforce food avoidance in eating disorders and appears to be difficult to fully unlearn.

Cognitive dissonance-based eating disorder prevention: pilot study of a cultural adaptation for the Orthodox Jewish community

The Body Project (BP) is a cognitive dissonance-based eating disorders (ED) prevention program that targets thin-ideal internalization and reduces ED risk factors and onset for higher-risk adolescent/young adult females. Although the more insular Orthodox Jewish communities reduce exposure to mainstream secular media, they are not immune to thin-ideal internalization and EDs. The present uncontrolled study evaluated the preliminary effects of a cultural adaptation of the BP for Orthodox Jewish girls. The modified manual improved fit with ultra-Orthodox Jewish norms, practices, and values. Eighty-nine 11th-graders in a private, all-female religious high school participated. ED risk factors and symptoms were assessed at baseline, end of 4-week intervention, and 6-month follow-up. Multi-level modeling showed that body dissatisfaction and negative affect significantly decreased across time. Findings demonstrate potential for the BP to be adapted for and implemented in cultural and religious communities wherein interactions with societal influences on thin-ideal internalization differ from dominant culture.

A screening tool for detecting eating disorder risk and diagnostic symptoms among college-age women

Objective: As eating disorders (EDs) often emerge during college, managing EDs would ideally integrate prevention and treatment. To achieve this goal, an efficient tool is needed that detects clinical symptoms and level of risk. This study evaluated the performance of a screen designed to identify individuals at risk for or with an ED. Participants: Five hundred forty-nine college-age women. Methods: Participants completed a screen and diagnostic interview. Results: Using parsimonious thresholds for ED diagnoses, screen sensitivity ranged from 0.90 (anorexia nervosa) to 0.55 (purging disorder). Specificity ranged from 0.99 (anorexia nervosa) to 0.78 (subthreshold binge eating disorder) compared to diagnostic interview. Moderate to high area under the curve values were observed. The screen had high sensitivity for detecting high risk. Conclusions: The screen identifies students at risk and has acceptable sensitivity and specificity for identifying most ED diagnoses. This tool is critical for establishing stepped care models for ED intervention.

Goal-directed versus outcome-based financial incentives for weight loss among low-income patients with obesity: rationale and design of the Financial Incentives foR Weight Reduction (FIReWoRk) randomised controlled trial

INTRODUCTION

Obesity is a major public health challenge and exacerbates economic disparities through employment discrimination and increased personal health expenditures. Financial incentives for weight management may intensify individuals' utilisation of evidence-based behavioural strategies while addressing obesity-related economic disparities in low-income populations. Trials have focused on testing incentives contingent on achieving weight loss outcomes. However, based on social cognitive and self-determination theories, providing incentives for achieving intermediate behavioural goals may be more sustainable than incentivising outcomes if they enhance an individual's skills and self-efficacy for maintaining long-term weight loss. The objective of this paper is to describe the rationale and design of the Financial Incentives foR Weight Reduction study, a randomised controlled trial to test the comparative effectiveness and cost-effectiveness of two financial incentive strategies for weight loss (goal directed vs outcome based) among low-income adults with obesity, as well as compared with the provision of health behaviour change resources alone.

METHODS AND ANALYSIS

We are recruiting 795 adults, aged 18-70 years with a body mass index ≥30 kg/m2, from three primary care clinics serving residents of socioeconomically disadvantaged neighbourhoods in New York City and Los Angeles. All participants receive a 1-year commercial weight loss programme membership, self-monitoring tools (bathroom scale, food journal and Fitbit Alta HR), health education and monthly check-in visits. In addition to these resources, those in the two intervention groups can earn up to $750 over 6 months for: (1) participating in an intensive weight management programme, self-monitoring weight and diet and meeting physical activity guidelines (goal-directed arm); or (2) a ≥1.5% to ≥5% reduction in baseline weight (outcome-based arm). To maximise incentive efficacy, we incorporate concepts from behavioural economics, including immediacy of payments and framing feedback to elicit regret aversion. We will use generalised mixed effect models for repeated measures to examine intervention effects on weight at 6, 9 and 12 months.

ETHICS AND DISSEMINATION

Human research protection committees at New York University School of Medicine, University of California Los Angeles (UCLA) David Geffen School of Medicine and Olive-View-UCLA Medical Center granted ethics approval. We will disseminate the results of this research via peer-reviewed publications, conference presentations and meetings with stakeholders.

TRIAL REGISTRATION NUMBER

NCT03157713.

General and Eating Disorder Specific Flexibility: Development and Validation of the Eating Disorder Flexibility Index (EDFLIX) Questionnaire

Findings from studies investigating cognitive flexibility in eating disorders (EDs) are inconsistent, and although neuropsychological tests are commonly used to measure these skills, they may not be particularly effective in predicting everyday functioning. Also, extant studies have largely focused on flexibility in anorexia nervosa (AN), with assessments targeting general rather than specific flexibility, and cognitive, rather than behavioral flexibility. Knowledge regarding ED specific flexibility and flexibility in bulimia nervosa (BN) and binge eating disorder (BED) is still scarce. The aim of this study was to develop and validate a novel measure assessing general and ED specific flexibility in a diagnostically diverse sample, and in healthy controls (HCs). A sample of 207 adult individuals with EDs (55% AN, 29% BN, 16% BED) and 288 HCs responded to an online, 51-item, pilot questionnaire on ED specific and general flexibility. In addition, participants completed the shift subscale from the Behavior Rating Inventory of Executive Function Adult version (BRIEF-A), and the Eating Disorder Diagnostic Scale (EDDS). A principal component analysis (PCA) in the clinical sample yielded a 36-item, three-factor solution capturing general flexibility, flexibility related to food and exercise, and flexibility concerning body shape and weight. Results showed that the measure had good to excellent internal consistency, and good convergent validity. A confirmatory factor analysis (CFA) using data from HCs revealed good fit indexes, supporting the original factor solution. A receiver operating characteristics analysis (ROC) demonstrated excellent accuracy in distinguishing scores from those with and without EDs. A cutoff score of 136 yielded the most balanced sensitivity and specificity. Significant differences in general and ED specific flexibility were found between individuals with and without EDs. Overall, HCs achieved the highest flexibility scores, followed by those with BED, BN, and AN. In sum this novel measure, the Eating Disorder Flexibility Index (EDFLIX) questionnaire, was found to be reliable and valid in the assessment of cognitive and behavioral flexibility, with results offering support for the conceptual distinction between general and ED related flexibility. The study also provides strong evidence for the discriminant validity of the EDFLIX with results revealing significant differences in flexibility in people with and without EDs. In addition, significant differences in flexibility also emerged when comparing diagnostic groups, indicating the utility of the assessment instrument for classification purposes.

Factor analysis of the eating disorder diagnostic scale in individuals with bipolar disorder

PURPOSE

To examine the potential factor structure of the Eating Disorder Diagnostic Scale (EDDS) in a sample of individuals with bipolar disorder.

METHOD

Exploratory common factor analyses were conducted in a sample of 1031 people with bipolar disorder as defined by the Structured Clinical Interview for DSM-IV-TR.

RESULTS

Approximately 27% of participants had a comorbid eating disorder. Exploratory factor analysis yielded a 3 factor solution (i.e., shape/weight concerns; binge eating behaviors, compensatory behavior).

CONCLUSIONS

The 3-factor solution of the EDDS in a bipolar disorder sample is consistent with major eating disorder symptom domains. Future research is necessary to replicate these findings in eating disorder samples with diverse comorbid psychopathology.

A preliminary naturalistic clinical case series study of the feasibility and impact of interoceptive exposure for eating disorders

Recent literature suggests that individuals with eating disorders demonstrate altered interoceptive processing, which may relate to the maintenance of symptoms and thus represent a salient treatment target. Adopting treatment techniques effective for other conditions characterized by disturbed interoceptive processes (e.g., anxiety disorders) could aid in improving the outcomes of psychological interventions for eating disorders. The current investigation was a naturalistic case series (N = 4) that examined adjunctive interoceptive exposure (IE) for eating disorders, with an emphasis on evaluating the feasibility, acceptability, and impact of this intervention on anxiety sensitivity, interoceptive deficits, and eating disorder symptoms. Results suggested that all individuals who received 4 consecutive sessions of traditional and eating-disorder-specific IE exercises demonstrated decreases in interoceptive deficits and subjective distress. Results for anxiety sensitivity and eating disorder symptoms were encouraging yet more mixed. Findings also generally suggested that the intervention was feasible and acceptable, yet between-session practice compliance varied considerably among participants. Overall, we describe how IE may be used to target interoceptive deficits in eating disorders and provide preliminary evidence of how this may be accomplished within naturalistic intensive outpatient settings.

Estimation of a Relative Risk Effect Size when Using Continuous Outcomes Data: An Application of Methods in the Prevention of Major Depression and Eating Disorders

INTRODUCTION

The raw mean difference (RMD) and standardized mean difference (SMD) are continuous effect size measures that are not readily usable in decision-analytic models of health care interventions. This study compared the predictive performance of 3 methods by which continuous outcomes data collected using psychiatric rating scales can be used to calculate a relative risk (RR) effect size.

METHODS

Three methods to calculate RR effect sizes from continuous outcomes data are described: the RMD, SMD, and Cochrane conversion methods. Each conversion method was validated using data from randomized controlled trials (RCTs) examining the efficacy of interventions for the prevention of depression in youth (aged ≤17 years) and adults (aged ≥18 years) and the prevention of eating disorders in young women (aged ≤21 years). Validation analyses compared predicted RR effect sizes to actual RR effect sizes using scatterplots, correlation coefficients ( r), and simple linear regression. An applied analysis was also conducted to examine the impact of using each conversion method in a cost-effectiveness model.

RESULTS

The predictive performances of the RMD and Cochrane conversion methods were strong relative to the SMD conversion method when analyzing RCTs involving depression in adults (RMD: r = 0.89-0.90; Cochrane: r = 0.73; SMD: r = 0.41-0.67) and eating disorders in young women (RMD: r = 0.89; Cochrane: r = 0.96). Moderate predictive performances were observed across the 3 methods when analyzing RCTs involving depression in youth (RMD: r = 0.50; Cochrane: r = 0.47; SMD: r = 0.46-0.46). Negligible differences were observed between the 3 methods when applied to a cost-effectiveness model.

CONCLUSION

The RMD and Cochrane conversion methods are both valid methods for predicting RR effect sizes from continuous outcomes data. However, further validation and refinement are required before being applied more broadly.

Traumatic event exposure associated with increased food insecurity and eating disorder pathology

OBJECTIVE

The primary aim was to investigate the association between food insecurity (FI) and eating disorders, which are nutrition-based public health problems, with traumatic event exposure in a low-income marginalized population. The study also investigated the association between traumatic event exposure, anxiety and weight stigma.

DESIGN

The study used self-report surveys in a cross-sectional design.

SETTING

Food pantries affiliated with the local food bank in a major US city.

SUBJECTS

Participants (n 503) consisted of clients presenting to food pantries. Participants were predominantly female (76·5 %), Latino/Hispanic (64·6 %) and low-income (59 % reported earning under $US 10 000 per year).

RESULTS

Results indicated that 55·7 % of participants had directly experienced a traumatic event; this increased to 61·6 % when witnessing was included. Higher levels of FI were associated with greater traumatic event exposure. Increased exposure to traumatic events correlated with worsened overall eating disorder pathology (r=-0·239), weight stigma (r=-0·151) and anxiety (r=-0·210).

CONCLUSIONS

The present study is the first to investigate the association of FI, eating disorders and trauma in a low-income marginalized population. Results indicate that exposure to traumatic events is common in this civilian population and that traumatic event exposure is associated with higher levels of FI and eating disorder pathology. Results indicate that further research is warranted given that traumatic event exposure, eating disorder pathology, weight stigma and anxiety may complicate effective delivery of public health interventions in those living with FI.

Self-esteem and peer-perceived social status in early adolescence and prediction of eating pathology in young adulthood

OBJECTIVE

Self-esteem is implied as a factor in the development of eating disorders. In adolescence peers have an increasing influence. Support for the role of self-esteem in eating disorders is ambiguous and little is known about the influence of social status as judged by others. The present study investigates whether self-esteem and peer status in early adolescence are associated with eating pathology in young adulthood.

METHOD

This study is part of TRAILS, a longitudinal cohort study on mental health and social development from preadolescence into adulthood. At age 11, participants completed the Self-Perception Profile for Children, assessing global self-esteem and self-perceptions regarding social acceptance, physical appearance, and academic competence. At age 13, peer status among classmates was assessed regarding likeability, physical attractiveness, academic performance, and popularity in a subsample of 1,007 participants. The Eating Disorder Diagnostic Scale was administered at age 22. The present study included peer-nominated participants with completed measures of self-perception at age 11 and eating pathology at age 22 (N = 732; 57.8% female).

RESULTS

In a combined model, self-perceived physical attractiveness at age 11 and peer popularity at age 13 were inversely correlated with eating pathology at 22 years, while likeability by peers at age 13 was positively related to eating pathology.

DISCUSSION

Both self-perceptions and peer status in early adolescence are significant predictors of eating pathology in young adults. Specific measures of self-esteem and peer-perceived status may be more relevant to the prediction of eating pathology than a global measure of self-esteem.

Bipolar disorder with binge eating behavior: a genome-wide association study implicates PRR5-ARHGAP8

Bipolar disorder (BD) is associated with binge eating behavior (BE), and both conditions are heritable. Previously, using data from the Genetic Association Information Network (GAIN) study of BD, we performed genome-wide association (GWA) analyses of BD with BE comorbidity. Here, utilizing data from the Mayo Clinic BD Biobank (969 BD cases, 777 controls), we performed a GWA analysis of a BD subtype defined by BE, and case-only analysis comparing BD subjects with and without BE. We then performed a meta-analysis of the Mayo and GAIN results. The meta-analysis provided genome-wide significant evidence of association between single nucleotide polymorphisms (SNPs) in PRR5-ARHGAP8 and BE in BD cases (rs726170 OR = 1.91, P = 3.05E-08). In the meta-analysis comparing cases with BD with comorbid BE vs. non-BD controls, a genome-wide significant association was observed at SNP rs111940429 in an intergenic region near PPP1R2P5 (p = 1.21E-08). PRR5-ARHGAP8 is a read-through transcript resulting in a fusion protein of PRR5 and ARHGAP8. PRR5 encodes a subunit of mTORC2, a serine/threonine kinase that participates in food intake regulation, while ARHGAP8 encodes a member of the RhoGAP family of proteins that mediate cross-talk between Rho GTPases and other signaling pathways. Without BE information in controls, it is not possible to determine whether the observed association reflects a risk factor for BE in general, risk for BE in individuals with BD, or risk of a subtype of BD with BE. The effect of PRR5-ARHGAP8 on BE risk thus warrants further investigation.

Eating disorders in premenstrual dysphoric disorder: a neuroendocrinological pathway to the pathogenesis and treatment of binge eating

BACKGROUND

This case report details the presentation, treatment and post-operative outcome of an adult female with co-occurring binge eating disorder and premenstrual dysphoric disorder (PMDD).

CASE PRESENTATION

The patient, self-presenting for treatment, reported having struggled with severe, debilitating physical and psychological PMDD symptoms for nearly a decade. After having taken part in a number of unsuccessful first- and second line treatments in primary and secondary care, the patient was referred to tertiary care at the Department of Gynecology at Oslo University Hospital in Norway. Chemical menopause using a gonadotropin-releasing hormone (GnRH) agonist was induced, predicting the desired response (i.e. resolution of PMDD symptoms) to bilateral salpingo-oophorectomy (BSO). At three- and six months post BSO follow-up, the patient reported complete resolution of all reported PMDD symptoms including marked increase in appetite (i.e. hyperphagia), specific food cravings and auxiliary binge eating.

CONCLUSIONS

To our knowledge, this is the first case documenting the recovery from an eating disorder following surgical ovarian suppression. Our findings lend supports to existing studies linking binge eating to hormonal changes in the mid-luteal phase of the menstrual cycle, and may help advance new treatment options for a selected, severely impaired group of females struggling with excessive appetite and binge eating due to fluctuations in ovarian activity.

Food insecurity and eating disorder pathology

OBJECTIVE

The primary aim of this study was to investigate eating disorder (ED) pathology in those living with food insecurity. A secondary aim was to investigate whether any-reason dietary restraint, weight self-stigma, and worry increased as level of food insecurity increased.

METHOD

Participants (N = 503) seeking food from food pantries completed questionnaires assessing level of food insecurity, demographics, ED pathology, dietary restraint, weight self-stigma, and worry.

RESULTS

Consistent with hypotheses, participants with the highest level of food insecurity (i.e., adults who reported having hungry children in their household) also endorsed significantly higher levels of binge eating, overall ED pathology, any-reason dietary restraint, weight self-stigma, and worry compared to participants with lower levels of food insecurity. Contrary to hypotheses, compensatory behaviors also increased as level of food insecurity worsened. Overall, 17% of those in the child hunger food insecurity group reported clinically significant ED pathology.

DISCUSSION

This is the first study to assess the full spectrum of ED pathology in a low-income, marginalized population with food insecurity. Given that food insecurity is a global concern, results from this study suggest that greater attention to the association between ED pathology and food insecurity is warranted by researchers around the world.

An Interactive, Graphical Tool for Retrospectively Assessing Symptom Frequency and Severity: An Illustration With Eating Disorder Behaviors, Body Weight, and Stress

There are few assessments that gather valid, highly detailed data on short-term (i.e., weekly) symptom frequency/severity retrospectively. In particular, methodologies that provide valid data for research investigating symptom changes are typically prospective, expensive, and burdensome. The purpose of this study was to evaluate a new interactive and graphical assessment tool for gathering detailed information about eating-related symptom frequency/severity retrospectively over a 3-month period. A mixed eating disorder sample ( N = 113) recruited from the community provided symptom data once weekly for 12 weeks and completed the Interactive, Graphical Assessment Tool (IGAT) assessing eating disorder symptoms on three occasions to determine the test-retest and concurrent validity of the IGAT. The IGAT performed marginally better than other measures for retrospective symptom frequency assessment in the eating disorders and did so at a greater level of detail than other available tools. Future research should evaluate the IGAT with other behaviors of interest.