The mediating role of self-criticism, experiential avoidance and negative urgency on the relationship between ED-related symptoms and difficulties in emotion regulation

A meta-analysis of disordered eating and its association with self-criticism and self-compassion

OBJECTIVE

Future treatments for eating disorders (ED) need to be enhanced by targeting maintaining mechanisms. Literature suggests self-criticism and self-critical perfectionism act as key mechanisms exacerbating ED, and self-compassion protects against self-criticism. This meta-analysis examines associations between self-criticism and self-critical perfectionism on disordered eating (DE), and reviews how self-compassion and self-criticism relate to each other with respect to DE.

METHOD

Searches across three databases yielded 135 studies across 42,952 participants. Heterogeneity, publication bias, and quality assessments were analyzed. Moderation analyses between self-criticism measures, self-compassion measures, between clinical and nonclinical samples, and between cross-sectional and experimental studies were also conducted.

RESULTS

Random-effects models showed a medium positive link between self-criticism and DE (r = .37), and 10 subgroups pertaining to various measures of self-criticism utilized in literature showed small to large positive links with DE (r = .20-.52). Preliminary evidence also suggests negative relationships between self-compassion and DE (r = -.40 to -.43) and negative relationships between self-compassion and self-criticism (r = -.04 to -.88).

DISCUSSION

Greater levels of self-criticism is linked with greater levels of DE and reduced levels of self-compassion, suggesting a need to tackle self-criticism and nurture self-compassion in standard treatments for ED. Understanding these interactions better in conjunction with dismantling intervention studies can help develop more effective and efficient interventions targeting self-criticism and self-compassion for people with DE.

PUBLIC SIGNIFICANCE STATEMENT

Higher levels of self-criticism are linked with higher levels of DE and lower self-compassion. Self-compassion interventions could be more effective and efficient in reducing ED symptoms if self-criticism is tackled early in such treatments.

A neural network underlying cognitive strategies related to eating, weight and body image concerns

Concerns about food intake, weight and body shape can trigger negatively loaded emotions, which may prompt the use of cognitive strategies to regulate these emotional states. A novel fMRI task was developed to assess the neurobehavioral correlates of cognitive strategies related to eating, weight and body image concerns, such as self-criticism, avoidance, rumination, and self-reassurance. Fourteen healthy females were presented audio sentences referring to these conditions and instructed to repeat these internally while engaging their thoughts with the content of food or body images. Participants were asked to report the elicited emotion and rate their performance. All cognitive strategies recruited a network including the inferior and superior frontal gyri, orbitofrontal and anterior cingulate cortex, insula, and dorsal striatum. These brain regions are involved in emotional, reward and inhibitory control processing. Representational similarity analysis revealed distinct patterns of neural responses for each cognitive strategy. Additionally, self-report measures showed that self-criticism was positively associated with superior frontal gyrus (SFG) activation. Self-compassion scores were negatively correlated with activations in the insula and right putamen, while self-reassurance scores were negatively associated with activity in the orbitofrontal cortex. These findings identify a neural network underlying cognitive strategies related to eating, weight and body image concerns, where neurobehavioral correlation patterns depend on the cognitive strategy.

Factor structure and psychometric properties of a multicultural Spanish-language version of the Eating Disorder-15 in a nonclinical sample of Chilean women

OBJECTIVE

The Eating Disorder-15 (ED-15) is a brief measure developed for the routine assessment of eating disorder (EDs), despite its use in research settings having increased over the last few years. To assess the psychometric properties of the ED-15 in a nonclinical sample of Chilean women.

METHOD

A multicultural Spanish-language version was developed through combined translation techniques. University female students (N = 380) (M_age 22.32, SD = 2.48) were recruited through social media. After providing their informed consent, participants completed a battery of questionnaires online.

RESULTS

A bi-factor model replicating the bi-factor structure and providing support for the general factor showed the best fit to the data. Moderate-to-strong correlations with measures of EDs, physical comparison, body appreciation, social physique anxiety, and depressive symptoms are presented as evidence of concurrent and convergent validity. Items analyses revealed strong correlations between manifest variables, their correspondent latent variable and the general factor (r_s  = .60 to .89, ps < .001). Additionally, current findings provide support for the internal consistency of the scale (Cronbach's alpha and Omega values were ≥ .80) and test-retest reliability (ICCs = .84 to .89, ps < .001).

DISCUSSION

Like previous findings, the current study provides validity to the original bi-factor structure of the ED-15 and additional validity to a general factor. The availability of this multicultural Spanish-language version would provide session-by-session assessment, providing crucial information throughout treatment. Also, the availability of the current measure would contribute to further research efforts in a yet understudied population such as Hispanic women.

PUBLIC SIGNIFICANCE

The Eating Disorder-15 (ED-15) is a promising measure meant to assess session-by-session change for clinical and research purposes. The availability of a Multicultural Spanish language version of the ED-15 allows for routine clinical assessment and represents a contribution for research efforts in a yet understudied populations such as Hispanic women.