Empirical scrutiny of a familiar narrative: sense of control in anorexia nervosa

Family accommodation in PTSD: Proposed considerations and distinctions from the established transdiagnostic literature

Accommodation is widely documented and studied among internalizing disorders; however, the conceptualization and study of accommodation in the context of posttraumatic stress disorder (PTSD) is relatively nascent. PTSD entails many diagnostic criteria-including exposure to a distinct Criterion A event, emotional numbing, and anger-that may uniquely influence accommodation and merit special consideration. Our aim was to review the impact of accommodation in PTSD, compare and contrast accommodation in PTSD to other disorders with a strong empirical evidence base regarding accommodation, and highlight considerations unique to PTSD and associated implications for accommodation. We conclude by providing considerations for future research and practice.

Eating disorders, disordered eating, and body image research in New Zealand: a scoping review

BACKGROUND

The prevention and treatment of eating disorders relies on an extensive body of research that includes various foci and methodologies. This scoping review identified relevant studies of eating disorders, body image, and disordered eating with New Zealand samples; charted the methodologies, sample characteristics, and findings reported; and identified several gaps that should be addressed by further research.

METHODS

Using scoping review methodology, two databases were searched for studies examining eating disorders, disordered eating, or body image with New Zealand samples. Snowball methods were further used to identify additional relevant articles that did not appear in initial searches. Two independent reviewers screened the titles and abstracts of 473 records. Full text assessment of the remaining 251 records resulted in 148 peer-reviewed articles being identified as eligible for the final review. A search of institutional databases yielded 106 Masters and Doctoral theses for assessment, with a total of 47 theses being identified as eligible for the final review. The included studies were classified by methodology, and the extracted information included the study foci, data collected, sample size, demographic information, and key findings.

RESULTS

The eligible studies examined a variety of eating disorder categories including binge-eating disorder, bulimia nervosa, and anorexia nervosa, in addition to disordered eating behaviours and body image in nonclinical or community samples. Methodologies included treatment trials, secondary analysis of existing datasets, non-treatment experimental interventions, cross-sectional observation, case-control studies, qualitative and mixed-methods studies, and case studies or series. Across all of the studies, questionnaire and interview data were most commonly utilised. A wide range of sample sizes were evident, and studies often reported all-female or mostly-female participants, with minimal inclusion of males and gender minorities. There was also an underrepresentation of minority ethnicities in many studies, highlighting the need for future research to increase diversity within samples.

CONCLUSION

This study provides a comprehensive and detailed overview of research into eating disorders and body image in New Zealand, while highlighting important considerations for both local and international research.

Real-Life Self-Control Conflicts in Anorexia Nervosa: An Ecological Momentary Assessment Investigation

Background

Individuals with anorexia nervosa (AN) are often thought to show heightened self-control and increased ability to inhibit desires. In addition to inhibitory self-control, antecedent-focused strategies (e.g., cognitive reconstrual—the re-evaluation of tempting situations) might contribute to disorder maintenance and enable disorder-typical, maladaptive behaviors.

Methods

Over a period of 14 days, 40 acutely underweight young female patients with anorexia nervosa (AN) and 40 healthy control (HC) participants reported their affect and behavior in self-control situations via ecological momentary assessment during inpatient treatment (AN) and everyday life (HC). Data were analyzed via hierarchical analyses (linear and logistic modeling).

Results

Conflict strength had a significantly lower impact on self-control success in AN compared to HC. While AN and HC did not generally differ in the number or strength of self-control conflicts or in the percentage of self-control success, AN reported self-controlled behavior to be less dependent on conflict strength.

Conclusions

While patients with AN were not generally more successful at self-control, they appeared to resolve self-control conflicts more effectively. These findings suggest that the magnitude of self-control conflicts has comparatively little impact on individuals with AN, possibly due to the use of antecedent-focused strategies. If confirmed, cognitive-behavioral therapy might focus on and help patients to exploit these alternative self-control strategies in the battle against their illness.

Sense of agency during and following recovery from anorexia nervosa

The need to feel in control is central to anorexia nervosa (AN). The sense of control in AN has only been studied through self-report. This study investigated whether implicit sense of control (sense of agency; SoA) differs across AN patients, recovered AN (RAN) patients and healthy controls (HC). Furthermore, we assessed whether state anxiety is influenced by negative emotional states. SoA was measured with the intentional binding task (IB) and state-anxiety levels through a questionnaire. We did not find any evidence of differences in SoA between groups. Furthermore, state anxiety was not a significant predictor of SoA. Further research into SoA in AN should focus on other features of the SoA that are not targeted by the IB task.

Enduring value of perfectionism and maturity fears for predicting eating disorder maintenance over 10-, 20-, and 30-year follow-up

OBJECTIVE

The Eating Disorder Inventory provides a theoretically informed multidimensional assessment of eating disorder symptoms and associated psychological factors widely used to examine the development and maintenance of eating disorders. Yet, mixed findings for some factors raise questions about whether their prognostic value varies as a function of duration of follow-up or type of eating pathology studied.

METHOD

The current study compared prognostic value of perfectionism, maturity fears, and interpersonal distrust as predictors of restrictive versus bulimic symptom patterns at 10-, 20-, and 30-year follow-up in N = 127 individuals diagnosed with eating disorders at baseline. Multivariable regression analyses and statistical comparison of effect sizes were used.

RESULTS

Drive for Thinness at 10- and 30-year follow-up was predicted by higher Perfectionism and higher Maturity Fears at baseline. Baseline Maturity Fears also predicted higher Drive for Thinness at 20-year follow-up and higher Bulimia at 10- and 20-year follow-up. Interpersonal Distrust did not demonstrate prognostic significance in multivariable models. Comparisons of effect sizes support that some differences in statistical significance reflect differences in prognostic value of psychological factors.

DISCUSSION

Both duration of follow-up and type of pathology impact the predictive value of psychological factors and have important implications for understanding illness maintenance. Findings support the utility of targeting Perfectionism for restrictive symptoms. Developing interventions focused on Maturity Fears may provide a novel approach to reducing both restrictive and bulimic symptoms.

Health beliefs, behaviors, and symptoms associated with orthorexia nervosa

PURPOSE

This research explored whether symptoms of orthorexia nervosa (ON), a condition involving obsessive thoughts and compulsive behaviors regarding healthy eating, are associated with differences pertaining to use of nutritional supplements and complementary and alternative medicine (CAM) techniques, to health locus of control, and to symptoms of poor physical health.

METHOD

An anonymous online survey assessing the variables above was completed by college students at a university in the southern United States: 47 in the ON symptoms group, 50 in the healthy-eating control group, and 83 in the normal-eating control group.

RESULTS

Compared to both control groups, the ON symptoms group reported greater supplement use and CAM participation, more reasons for these behaviors for the purpose of improving psychological health (i.e., to increase energy, enhance focus, and improve mood), and greater symptoms associated with poor physical health. None of the groups differed on internal or external health locus of control.

CONCLUSION

For those with ON, "healthy" eating behaviors are accompanied by other health behaviors that include supplement use and CAM activities. However, despite their goal of achieving perfect health, these individuals experience diminished physical health with symptoms that may be related to their severe dietary restrictions.

LEVEL OF EVIDENCE

Level V, descriptive cross-sectional study.

How newly diagnosed HIV-positive men who have sex with men look at HIV/AIDS - validation of the Chinese version of the revised illness perception questionnaire

Background

Newly diagnosed HIV-positive men who have sex with men (MSM) are an important subgroup in HIV intervention. How newly diagnosed HIV-positive MSM look at HIV/AIDS is consequential and is potentially associated with their risk behaviors and mental health problems. Illness representation has been used to define patients’ beliefs and expectations on an illness, and the revised Illness Perception Questionnaire (IPQ-R) has been developed to measure illness representations. This study aims to examine the psychometric properties of the IPQ-R among newly diagnosed HIV-positive MSM and to investigate their views towards HIV/AIDS.

Method

A total of 225 newly diagnosed HIV-positive MSM completed the Chinese version of IPQ-R. Both confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) were applied to examine the factor structure of IPQ-R.

Results

CFA showed a poor goodness of fit to the original factor structure of IPQ-R. EFA of the IPQ-R revealed 7 factors, including Emotional Response, Treatment Control, Timeline-acute/chronic, Illness Coherence, Consequence, Personal Control and Helplessness. Cronbach’s alpha showed acceptable internal consistency for the derived factors, except the Personal Control (0.61) and Helplessness (0.55). Person correlation coefficients demonstrated that the derived factors of IPQ-R had significant associations with the outcome variables (depression and posttraumatic growth). The scores of the Emotional Response, Consequence, Treatment Control, Personal Control, Timeline-acute/chronic and Illness Coherence were above the midpoint, and the score of the Helplessness was below the midpoint.

Conclusion

Both similarities and differences were found when the IPQ-R is applied to newly diagnosed HIV-positive MSM. The IPQ-R can be used with some refinements in future studies. Newly diagnosed HIV-positive MSM have a relatively high level of negative perceptions towards HIV/AIDS in both cognitive and emotional aspects.

An examination of the relationships between acculturative stress, perceived discrimination, and eating disorder symptoms among ethnic minority college students

Empirical evidence suggests the importance of considering acculturative stress and perceived discrimination in understanding the mental health of ethnic minority groups, including their eating behaviors and associated psychopathology. The current study examined the effect of acculturative stress and perceived discrimination on eating disorder symptoms among ethnic minority undergraduate students. A total of 187 ethnic minority undergraduate students (41.2% men) completed this cross-sectional study by completing self-report questionnaires on a secure online system. Regression analyses revealed a main effect of acculturative stress on eating concern, shape concern, weight concern, drive for thinness, and bulimia but not restraint or body dissatisfaction. Gender moderated the effect of acculturative stress on drive for muscularity, suggesting that this effect was only significant in women, but not men. The main effect of perceived discrimination was significant for restraint, eating concern, shape concern, weight concern, and drive for muscularity but not drive for thinness, bulimia, or body dissatisfaction. Acculturative stress and perceived discrimination are important factors to consider in understanding the development and maintenance of eating disorder symptoms among ethnic minority populations. Targeting these two factors may improve the effectiveness of intervention programs for eating disorder symptoms among ethnic minority undergraduate students.

A Self-determination Theory Approach to the Study of Body Image Concerns, Self-presentation and Self-perceptions in a Sample of Aerobic Instructors

This study examined motivational predictors of body image concerns, self-presentation and self-perceptions using Self-determination Theory as a guiding framework. Aerobic instructors ( N = 149) completed questionnaires measuring general need satisfaction, exercise motivational regulations, body image concerns, social physique anxiety and self-perceptions. Introjected regulation predicted all outcome variables in the expected direction. Intrinsic motivation positively predicted physical self-worth. Further, autonomy need satisfaction negatively predicted body image concerns. Finally, differences existed in need satisfaction, introjected regulation, self-perceptions and social physique anxiety between those at risk of developing eating disorders and those not at risk. The results underline the importance of overall and exercise-specific feelings of self-determination in dealing with body image concerns and low self-perceptions of aerobics instructors.

Multi-dimensional self-esteem and magnitude of change in the treatment of anorexia nervosa

Self-esteem improvement is one of the main targets of inpatient eating disorder programmes. The present study sought to examine multi-dimensional self-esteem and magnitude of change in eating psychopathology among adults participating in a specialist inpatient treatment programme for anorexia nervosa. A standardised assessment battery, including multi-dimensional measures of eating psychopathology and self-esteem, was completed pre- and post-treatment for 60 participants (all white Scottish female, mean age=25.63 years). Statistical analyses indicated that self-esteem improved with eating psychopathology and weight over the course of treatment, but that improvements were domain-specific and small in size. Global self-esteem was not predictive of treatment outcome. Dimensions of self-esteem at baseline (Lovability and Moral Self-approval), however, were predictive of magnitude of change in dimensions of eating psychopathology (Shape and Weight Concern). Magnitude of change in Self-Control and Lovability dimensions were predictive of magnitude of change in eating psychopathology (Global, Dietary Restraint, and Shape Concern). The results of this study demonstrate that the relationship between self-esteem and eating disorder is far from straightforward, and suggest that future research and interventions should focus less exclusively on self-esteem as a uni-dimensional psychological construct.

Adolescent sense of control: a downward extension of the Shapiro Control Inventory to pre- and early adolescents

The most commonly used measures of perceived control for young adolescents are dated, psychometrically flawed, or focused on particular domains. To address the need for a general purpose measure of control for this age range, the overall sense of control (OSOC) and the domains of control (DOC) subscales of the Shapiro Control Inventory (D. H. Shapiro, 1994), designed for use with adults, were modified. Exploratory factor analyses suggested that the adapted OSOC and DOC scales consisted of internally consistent 1-factor structures, accounting for 32% and 29% of the variance, respectively. In Study 1, results from 310 preadolescents (9-13 years old) indicated that a higher sense of control was related to lower stress, OSOC, r(308) = -.52, p < .001; DOC, r(308) = -.23, p < .001; and depression, OSOC, r(308) = -.63, p < .001; DOC, r(308) = -.33, p < .001. In study 2, results from 195 adolescents (11-15 years old) showed that a higher sense of control was associated with lower stress, r(193) = -.55, p < .001, and depression, r(193) = -.60, p < .001, concurrently. The results suggest that these 2 revised measures of adolescent perceived control exhibited good content and predictive validities.

Understanding the relationships between body esteem, risk for anorexia nervosa, and domain-dependent decision-making impulsivity in a college sample

Impulsivity has been suggested to interact with low body esteem to elevate risk for anorexia nervosa. Discounting tasks are unique tools for examining impulsivity. Female college students (N=139) at varying levels of body esteem and risk for anorexia nervosa responded to discounting scenarios depicting opportunities to lose/gain weight and to worsen/improve complexion. Multiple regression analyses were used to examine the relationships between impulsivity and risk for anorexia nervosa and body esteem in four disorder-relevant decision-making contexts. Results indicated that lower decision-making impulsivity predicted lower body esteem levels when the outcome of the task was framed as an opportunity to lose weight. It is suggested that greater self-control regarding weight-loss in women with low body esteem may be problematic, placing them at higher risk for eating- and weight-related problems. Results reiterate the need for continued attention to fostering healthy body esteem and weight-control patterns in women on college campuses.

Social information-processing and coping in adolescent females diagnosed with an eating disorder: toward a greater understanding of control

The objective of this study was to examine differences in social information-processing and coping strategies between adolescent females in treatment for an eating disorder and asymptomatic peers. Adolescent females in treatment for an eating disorder (n = 50) were compared to asymptomatic control participants (n = 59) on a measure of social information-processing. Participants were presented with 4 hypothetical, ambiguous social dilemmas in which the intent of a peer provocateur was unclear. Questions followed each dilemma assessing intent attributions, the participant's emotional reaction, the intensity of the emotion, and coping strategies. The participants in treatment for an eating disorder were significantly more likely to perceive hostile intent from a peer provocateur, reported a greater intensity of negative emotions, and identified a significantly greater number of avoidant coping strategies. Specifically, the eating disorder group identified significantly more intrapunitive avoidant coping strategies that reflect maladaptive and self-destructive means of coping with distressing events. Results indicate social cognitive processing biases and maladaptive coping strategies may be instrumental in perceived loss of control and influence the development/maintenance of eating disorders.

Disgust sensitivity and anorexia nervosa

BACKGROUND

Previous studies found inconsistent differences in disgust sensitivity between patients with a variety of eating disorders and normal controls.

AIM

The objective of this study was to compare disgust sensitivity between a larger and more specific sample of anorexia nervosa (AN) patients and control subjects.

METHOD

We compared the scores on the 'disgust sensitivity scale' of AN patients (N = 62) and control subjects (N = 62) using a multivariate analysis of variance. All subjects were women.

RESULTS

AN patients scored consistently higher on all domains of disgust sensitivity. This difference was significant for six of eight disgust domains. The largest significant difference between the groups was on the domains food and magical thinking.

CONCLUSION

Our findings elaborate on previous findings and are in line with recent neurological findings suggesting that disgust and insular impairments are associated with AN. Clinical implications of our findings are discussed.

An examination of the factor structure of the Revised Illness Perception Questionnaire modified for adults with mild traumatic brain injury

OBJECTIVE

Factors influencing outcome after mild traumatic brain injury (MTBI) remain poorly understood. In other health conditions patient illness perceptions have been associated with outcome and have provided targets for effective interventions. These have not been systematically explored in MTBI and identifying reliable and valid measures of illness perceptions in MTBI is a first step before such concepts can be explored in clinical and research settings.

METHOD

This study investigated the factor structure and internal consistency reliability of the Illness Perceptions Questionnaire-Revised (IPQ-R) modified for MTBI in a sample of 147 adults recruited within 3 months of injury.

RESULTS

The results demonstrated a close replication of the original factor structure although there were notable exceptions likely to be specific to MTBI and potentially other acutely injured populations. Final scales showed good internal consistency although factors relating to causal attribution were less so.

CONCLUSION

The IPQ-R (MTBI) provides an acceptable measure of key components of injury perceptions after MTBI. Minor refinements appear required if this measure is to make a contribution to research and clinical practice in injury-based populations such as MTBI.

Self-liking and self-competence: relationship to symptoms of anorexia nervosa

Self-esteem has been hypothesised to play a pivotal role in the development and treatment, and outcome of anorexia nervosa (AN). Though this relationship is typically investigated by considering self-esteem as a unitary construct, research suggests that this comprises of two related but distinct components of self-liking and self-competence. This study investigates the association between self-liking, self-competence, and symptomatology of AN through the course of a defined treatment episode in 77 women. Self-liking was significantly associated with laxative abuse. Self-competence was significantly associated with elevated ineffectiveness, perfectionism and interpersonal distrust. Although self-competence and eating disturbance severity significantly improved over the treatment episode, one in three participants reported a reduced self-like or self-competence. Changes in both self-competence and self-liking at the end of treatment was associated with changes in drive for thinness. Such findings have implications for treatment models concerned with improving self-esteem.

Eating disorders across two cultures: does the expression of psychological control vary?

OBJECTIVE

Because both the expression of eating disorder (ED) symptoms and preferred psychological control styles may be affected by culture, the purpose of the present study was to examine whether the expression of psychological control in women with EDs varies across two cultures.

METHOD

North European Australian and Chinese Singaporean women (n = 117) with anorexia nervosa (n = 36), bulimia nervosa (n = 13) and eating disorders not otherwise specified (n = 3), and without an ED (n = 65) recruited in Australia and Singapore completed a multidimensional inventory assessing sense of control, domains of control, preferred means by which to gain control, and motivation for control.

RESULTS

Although the normative control profile for each culture differed slightly, control profiles among those with an ED were very similar across both cultures. However, the directionality and extent of specific aspects of control pathology associated with the presence of an ED differed across cultures. North European Australians with an ED were much more deviant from the cultural norm than their Chinese Singaporean ED counterparts in relation to overall sense of control, methods of gaining control, and control in the domain of body. Chinese Singaporean woman with an ED were much more deviant from the cultural norm than their North European Australian ED counterparts in the domain of control over impulses.

CONCLUSIONS

Having an ED powerfully distorts psychological control irrespective of culture. However the degree, directionality, and form of the displacement from normal control styles is also culture dependent. This has implications for treatments that attempt to redress or correct control issues in people with an ED in other cultures.