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Rossi AA, Pietrabissa G, Castelnuovo G, Mannarini S. Cognitive restraint, uncontrolled eating, and emotional eating. The Italian version of the Three Factor Eating Questionnaire-Revised 18 (TFEQ-R-18): a three-step validation study. Eat Weight Disord 2024; 29:16. [PMID: 38402372 PMCID: PMC10894126 DOI: 10.1007/s40519-024-01642-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/29/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND The Three Factor Eating Questionnaire-Revised 18 (TFEQ-R-18) is an extensively used questionnaire to measure three transdiagnostic features of eating behavior: cognitive restraint, uncontrolled eating, and emotional eating. OBJECTIVE This research aims to investigate the psychometric properties of the Italian version of the TFEQ-R-18 in three large community samples. METHOD Cross-sectional research designs were employed. In Study 1 (N = 537), an exploratory graph analysis (EGA) was used to examine item clustering within the TFEQ-R-18. In Study 2 (N = 645), a confirmatory factor analysis (CFA) was conducted to test its structural validity. In Study 3 (N = 346), a MANOVA was employed assessing mean differences across eating disorders (e.g., anorexia nervosa, bulimia nervosa, binge eating disorder). RESULTS In Study 1, the EGA accurately identified the three original dimensions of the TFEQ-R-18. Study 2 showed that the Italian TFEQ-R-18 has good fit indexes (CFI = 0.989, RMSEA = 0.064; 90% CI [0.058, 0.070], SRMR = 0.062), and possesses robust psychometric properties. Study 3 reveals distinct, statistically significant differences among eating disorders. CONCLUSION The TFEQ-R-18 proves to be a concise and precise tool for measuring transdiagnostic eating behaviors. Its applicability in the Italian context, supported by robust psychometric properties, suggests its utility for both research and clinical purposes. The findings affirm its potential to inform interventions aimed at enhancing psychological health. LEVEL OF EVIDENCE Level V, descriptive study.
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Affiliation(s)
- Alessandro Alberto Rossi
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padua, Italy.
- Center for Intervention and Research on Family studies - CIRF, Department FISPPA, University of Padova, Padua, Italy.
| | - Giada Pietrabissa
- Clinical Psychology Research Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Dipartimento di Psicologia, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Gianluca Castelnuovo
- Clinical Psychology Research Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Dipartimento di Psicologia, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Stefania Mannarini
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padua, Italy
- Center for Intervention and Research on Family studies - CIRF, Department FISPPA, University of Padova, Padua, Italy
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2
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Russell H, Aouad P, Le A, Marks P, Maloney D, Touyz S, Maguire S. Psychotherapies for eating disorders: findings from a rapid review. J Eat Disord 2023; 11:175. [PMID: 37794513 PMCID: PMC10548609 DOI: 10.1186/s40337-023-00886-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 09/11/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Psychotherapy is considered central to the effective treatment of eating disorders-focusing on behavioural, psychological, and social factors that contribute to the illness. Research indicates psychotherapeutic interventions out-perform placebo, waitlist, and/or other treatments; but, outcomes vary with room for major improvement. Thus, this review aims to (1) establish and consolidate knowledge on efficacious eating disorder psychotherapies; (2) highlight select emerging psychotherapeutic interventions; and (3) identify knowledge gaps to better inform future treatment research and development. METHODS The current review forms part of a series of Rapid Reviews published in a special issue in the Journal of Eating Disorders to inform the development of the Australian-government-funded National Eating Disorder Research and Translation Strategy 2021-2031. Three databases were searched for studies published between 2009 and 2023, published in English, and comprising high-level evidence studies (meta-analyses, systematic reviews, moderately sized randomised controlled studies, moderately sized controlled-cohort studies, and population studies). Data pertaining to psychotherapies for eating disorders were synthesised and outlined in the current paper. RESULTS 281 studies met inclusion criteria. Behavioural therapies were most commonly studied, with cognitive-behavioural and family-based therapies being the most researched; and thus, having the largest evidence-base for treating anorexia nervosa, bulimia nervosa, and binge eating disorder. Other therapies, such as interpersonal and dialectical behaviour therapies also demonstrated positive treatment outcomes. Emerging evidence supports specific use of Acceptance and Commitment; Integrative Cognitive Affective; Exposure; Mindfulness; and Emotionally-Focused therapies; however further research is needed to determine their efficacy. Similarly, growing support for self-help, group, and computer/internet-based therapeutic modalities was noted. Psychotherapies for avoidant/restrictive food intake disorder; other, and unspecified feeding and eating disorders were lacking evidence. CONCLUSIONS Currently, clinical practice is largely supported by research indicating that behavioural and cognitive-behavioural psychotherapies are most effective for the treatment of eating disorders. However, the efficacy of psychotherapeutic interventions varies across studies, highlighting the need for investment and expansion of research into enhanced variants and novel psychotherapies to improve illness outcomes. There is also a pressing need for investigation into the whole range of eating disorder presentations and populations, to determine the most effective interventions.
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Affiliation(s)
- Haley Russell
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
| | - Phillip Aouad
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia.
| | - Anvi Le
- Healthcare Management Advisors, Melbourne, Australia
| | - Peta Marks
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
| | - Danielle Maloney
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
- Sydney Local Health District, New South Wales Health, Sydney, Australia
| | - Stephen Touyz
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
| | - Sarah Maguire
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
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Rossi AA, Pietrabissa G, Tagliagambe A, Scuderi A, Montecchiani L, Castelnuovo G, Mannarini S, Dalla Ragione L. Many Facets of Eating Disorders: Profiling Key Psychological Features of Anorexia Nervosa and Binge Eating Disorder. Behav Sci (Basel) 2023; 13:bs13030276. [PMID: 36975300 PMCID: PMC10045239 DOI: 10.3390/bs13030276] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/08/2023] [Accepted: 03/17/2023] [Indexed: 03/29/2023] Open
Abstract
Objective. The present study employs a profile analysis to identify and compare psychological features and core eating disorder (ED) symptoms in clinical samples of patients with anorexia nervosa (AN) and binge eating disorder (BED) and the general population (GP). Methods. A sample comprising 421 participants (142 patients with AN; 139 patients with BED; and 140 participants from the GP) was surveyed with the Eating Disorder Inventory-3 (EDI-3). Individuals with AN and BED were recruited and tested during their first week of a multidisciplinary inpatient program for weight loss and rehabilitation at the 'Rete DCA USL Umbria 1' (Eating Disorders Services), Italy. Results. The findings suggest distinct patterns of symptom presentation between the three samples across all the EDI-3 dimensions-with both the AN and BED groups scoring significantly higher than the GP. Patients with AN registered greater scores in all the psychological trait scales and the drive for thinness ED-specific dimension of the EDI-3 compared with their BED counterpart-which, instead, scored higher in the bulimia and body dissatisfaction subscales. These data support the transdiagnostic nature of the main risk factors for the onset and maintenance of EDs-which would vary in severity levels-and the existence of disease-specific pathways giving rise to AN and BED. Conclusion. This study for the first time compares patients with AN and BED with a non-clinical sample on main ED psychological features. This might inform classification approaches and could have important implications for the development of prevention and early intervention programs.
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Affiliation(s)
- Alessandro Alberto Rossi
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padua, 35131 Padua, Italy
- Interdepartmental Center for Family Research, University of Padua, 35131 Padua, Italy
| | - Giada Pietrabissa
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy
- Clinical Psychology Research Laboratory, Ospedale San Giuseppe, IRCCS Istituto Auxologico Italiano, 28824 Verbania, Italy
| | | | | | | | - Gianluca Castelnuovo
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy
- Clinical Psychology Research Laboratory, Ospedale San Giuseppe, IRCCS Istituto Auxologico Italiano, 28824 Verbania, Italy
| | - Stefania Mannarini
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padua, 35131 Padua, Italy
- Interdepartmental Center for Family Research, University of Padua, 35131 Padua, Italy
| | - Laura Dalla Ragione
- Eating Disorders Services-USL N1 "Palazzo Francisci", 06059 Todi, Italy
- Food Science and Human Nutrition Unit, University Campus Biomedico of Rome, 00128 Rome, Italy
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4
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Liu S, Fuller-Tyszkiewicz M, Eddy S, Liu X, Portingale J, Giles S, Krug I. The Effects of Appearance-Based Comments and Non-Appearance-Based Evaluations on Body Dissatisfaction and Disordered Eating Urges: An Ecological Momentary Assessment Study. Behav Ther 2022; 53:807-818. [PMID: 35987540 DOI: 10.1016/j.beth.2022.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 01/09/2022] [Accepted: 01/11/2022] [Indexed: 11/26/2022]
Abstract
The current study used ecological momentary assessment (EMA) to investigate whether appearance-based comments, social and performance-based evaluations affected levels of body dissatisfaction (BD) and urges to engage in disordered eating behaviors (DE) throughout daily life. A total of 620 participants completed a baseline questionnaire assessing sociodemographic variables. Participants then downloaded a mobile app which alerted them to complete short surveys assessing their levels of BD, DE urges, and experiences of receiving comments and evaluations six times per day for 7 days. Negative appearance-based comments predicted greater levels of state BD, while positive appearance comments predicted lower levels of state BD. Negative social and performance-based evaluations predicted an increase in state BD, while positive evaluations predicted a decrease in this outcome variable. No significant predictor was found for the DE urge outcomes. The present findings suggest that receiving negative and positive feedback in various domains of one's life may predict opposite outcomes for body image. However, these effects do not necessarily associate with urges to engage in DE in a nonclinical population.
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Measuring perfectionism, impulsivity, self-esteem and social anxiety: Cross-national study in emerging adults from eight countries. Body Image 2020; 35:265-278. [PMID: 33126133 DOI: 10.1016/j.bodyim.2020.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 08/29/2020] [Accepted: 09/30/2020] [Indexed: 12/19/2022]
Abstract
This study assessed the measurement invariance of selected self-report measures of perfectionism, impulsivity, self-esteem and social anxiety in samples of emerging adults from eight different countries. Participants (N = 6272) completed the Multidimensional Perfectionism Scale (MPS), the UPPS-P Impulsive Behavior Scale, the 5-item Rosenberg Self-Esteem Scale (5-item RSES) and the Social Interaction Anxiety Scale (SIAS-6). Multigroup confirmatory factor analysis was run to examine cross-measure equivalence. Evidence for structural invariance was found for all questionnaires, while weak invariance was supported only for the 5-item RSES and the SIAS-6, and a partial weak invariance was found for the MPS and the UPPS-P. No measure achieved strong invariance. Strict invariance was achieved for the 5-item RSES, whereas only a partial strict invariance was supported for the MPS, UPPS-P and SIAS-6. These results suggest that perfectionism, impulsivity, self-esteem, and social anxiety are subjected to linguistic/cultural influence as well as to the effects of socio-demographic variables and can be evaluated by using the selected measures in eight different countries worldwide - but results should be interpreted with caution.
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6
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Personality and eating and weight disorders: an open research challenge. Eat Weight Disord 2018; 23:143-147. [PMID: 29177759 DOI: 10.1007/s40519-017-0463-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 11/08/2017] [Indexed: 10/18/2022] Open
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Dakanalis A, Colmegna F, Zanetti MA, Di Giacomo E, Riva G, Clerici M. Evaluation of the DSM-5 Severity Specifier for Bulimia Nervosa in Treatment-Seeking Youth. Child Psychiatry Hum Dev 2018; 49:137-145. [PMID: 28510006 DOI: 10.1007/s10578-017-0735-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A new severity specifier for bulimia nervosa (BN), based on the frequency of inappropriate weight compensatory behaviours (e.g., laxative misuse, self-induced vomiting, fasting, diuretic misuse, and excessive exercise), has been added to the most recent (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a means of addressing variability and heterogeneity in the severity of the disorder. While existing research provides support for the DSM-5 severity specifier for BN in adult patients, evidence for its validity and clinical utility in youth is currently lacking. To address this gap, data from 272 treatment-seeking adolescents with DSM-5 BN (94.2% female, M age = 15.3 years, SD 1.7) were analysed to examine whether these patients, sub-grouped based on the DSM-5 severity definitions, would show meaningful differences in a broad range of clinical variables and demographic and physical characteristics. Analyses revealed that participants categorized with mild, moderate, severe, and extreme severity of BN significantly differed from each other in 15 variables regarding eating disorder pathological features and putative maintenance factors (i.e., core low self-esteem, perfectionism, social appearance anxiety, body surveillance, and mood intolerance), health-related quality of life and comorbid psychiatric (i.e., affective and anxiety) disorders (large effect sizes). Between-group differences in demographics, body mass index, or age-of-BN onset were not observed. Collectively, our findings provide support for the utility of the frequency of inappropriate weight compensatory behaviours as a severity indicator for BN and suggest that age-at-onset of BN is probably more disorder- than severity-dependent. Implications for future research are outlined.
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Affiliation(s)
- Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy. .,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
| | | | | | - Ester Di Giacomo
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Laboratory, Istituto Auxologico Italiano, Milan, Italy.,Department of Psychology, Catholic University, Milan, Italy
| | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy.,Department of Mental Health, San Gerardo Hospital, Monza, Italy
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8
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Dakanalis A, Zanetti MA, Colmegna F, Riva G, Clerici M. Classifying binge eating-disordered adolescents based on severity levels. J Adolesc 2018; 62:47-54. [DOI: 10.1016/j.adolescence.2017.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 10/04/2017] [Accepted: 10/09/2017] [Indexed: 11/25/2022]
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9
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Dakanalis A, Gaudio S, Riva G, Clerici M. Severity of bulimia nervosa and its impact on treatment outcome. Eat Weight Disord 2017; 22:727-729. [PMID: 28744624 DOI: 10.1007/s40519-017-0422-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 07/18/2017] [Indexed: 11/25/2022] Open
Affiliation(s)
- Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy.
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
| | - Santino Gaudio
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Laboratory, IRCSS Istituto Auxologico Italiano, Milan, Italy
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy
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10
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Risk and maintenance factors for young women's DSM-5 eating disorders. Arch Womens Ment Health 2017; 20:721-731. [PMID: 28733894 DOI: 10.1007/s00737-017-0761-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 07/11/2017] [Indexed: 01/22/2023]
Abstract
Recent research with young women attending colleges, who are at the average age of eating disorder (ED) onset, established that the ED symptoms are not only prevalent but also relatively stable over the college period. Nonetheless, our knowledge regarding the course and modifiable factors associated with both the onset and maintenance of diagnosable (DSM-5) EDs in this population is limited. The objective of this report was to address these key research gaps. Data were examined from 2713 women who completed assessments of potential vulnerability factors and EDs in the autumn semester of the first (baseline) and fourth (follow-up) college years. A total of 13.1% of the sample met DSM-5 criteria for an ED diagnosis at baseline. At 4-year follow-up, 7.6% of the sample met DSM-5 criteria for an ED, with 67.5% of these cases representing women who had maintained an ED diagnosis from baseline, and 32.5% representing new onset EDs. Elevated appearance-ideal internalization, body dissatisfaction, self-objectification, dieting, and negative affectivity at baseline as well as changes in these factors between assessments all predicted onset and maintenance of DSM-5 EDs at 4-year follow-up. Self-objectification (thinking about and monitoring the body's appearance from an external observer's perspective) was the largest contributor to both ED onset and maintenance. In addition to enhancing our knowledge about the course of young women's (DSM-5) EDs during college, this work highlights potentially similar psychological foci for prevention and treatment efforts. Implications for improving existing preventive and treatment approaches are outlined.
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11
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Dakanalis A, Bartoli F, Caslini M, Crocamo C, Zanetti MA, Riva G, Clerici M, Carrà G. Validity and clinical utility of the DSM-5 severity specifier for bulimia nervosa: results from a multisite sample of patients who received evidence-based treatment. Eur Arch Psychiatry Clin Neurosci 2017; 267:823-829. [PMID: 27435722 DOI: 10.1007/s00406-016-0712-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 07/10/2016] [Indexed: 02/06/2023]
Abstract
A new "severity specifier" for bulimia nervosa (BN), based on the frequency of inappropriate weight compensatory behaviours (IWCBs), was added to the DSM-5 as a means of documenting heterogeneity and variability in the severity of the disorder. Yet, evidence for its validity in clinical populations, including prognostic significance for treatment outcome, is currently lacking. Existing data from 281 treatment-seeking patients with DSM-5 BN, who received the best available treatment for their disorder (manual-based cognitive behavioural therapy; CBT) in an outpatient setting, were re-analysed to examine whether these patients subgrouped based on the DSM-5 severity levels would show meaningful and consistent differences on (a) a range of clinical variables assessed at pre-treatment and (b) post-treatment abstinence from IWCBs. Results highlight that the mild, moderate, severe, and extreme severity groups were statistically distinguishable on 22 variables assessed at pre-treatment regarding eating disorder pathological features, maintenance factors of BN, associated (current) and lifetime psychopathology, social maladjustment and illness-specific functional impairment, and abstinence outcome. Mood intolerance, a maintenance factor of BN but external to eating disorder pathological features (typically addressed within CBT), emerged as the primary clinical variable distinguishing the severity groups showing a differential treatment response. Overall, the findings speak to the concurrent and predictive validity of the new DSM-5 severity criterion for BN and are important because a common benchmark informing patients, clinicians, and researchers about severity of the disorder and allowing severity fluctuation and patient's progress to be tracked does not exist so far. Implications for future research are outlined.
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Affiliation(s)
- Antonios Dakanalis
- Department of Brain and Behavioral Sciences, University of Pavia, P.Za Botta 11, 27100, Pavia, Italy. .,Department of Medicine and Surgery Translational, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy.
| | - Francesco Bartoli
- Department of Medicine and Surgery Translational, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Manuela Caslini
- Department of Medicine and Surgery Translational, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Cristina Crocamo
- Department of Medicine and Surgery Translational, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Maria Assunta Zanetti
- Department of Brain and Behavioral Sciences, University of Pavia, P.Za Botta 11, 27100, Pavia, Italy
| | - Giuseppe Riva
- Department of Psychology, Catholic University, Largo Gemelli 1, 20123, Milan, Italy.,Applied Technology for Neuro-Psychology Laboratory, Istituto Auxologico Italiano, IRCCS, Via Ariosto 13, 20145, Milan, Italy
| | - Massimo Clerici
- Department of Medicine and Surgery Translational, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery Translational, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy.,Division of Psychiatry, Faculty of Brain Sciences, University College of London, Gower Street, London, WC1E 6BT, UK
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12
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Cornelissen KK, McCarty K, Cornelissen PL, Tovée MJ. Body size estimation in women with anorexia nervosa and healthy controls using 3D avatars. Sci Rep 2017; 7:15773. [PMID: 29150646 PMCID: PMC5693901 DOI: 10.1038/s41598-017-15339-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 10/16/2017] [Indexed: 01/22/2023] Open
Abstract
A core feature of anorexia nervosa is an over-estimation of body size. However, quantifying this over-estimation has been problematic as existing methodologies introduce a series of artefacts and inaccuracies in the stimuli used for judgements of body size. To overcome these problems, we have: (i) taken 3D scans of 15 women who have symptoms of anorexia (referred to henceforth as anorexia spectrum disorders, ANSD) and 15 healthy control women, (ii) used a 3D modelling package to build avatars from the scans, (iii) manipulated the body shapes of these avatars to reflect biometrically accurate, continuous changes in body mass index (BMI), (iv) used these personalized avatars as stimuli to allow the women to estimate their body size. The results show that women who are currently receiving treatment for ANSD show an over-estimation of body size which rapidly increases as their own BMI increases. By contrast, the women acting as healthy controls can accurately estimate their body size irrespective of their own BMI. This study demonstrates the viability of combining 3D scanning and CGI techniques to create personalised realistic avatars of individual patients to directly assess their body image perception.
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Affiliation(s)
- Katri K Cornelissen
- Department of Psychology, Northumbria University, Newcastle Upon Tyne, NE1 8ST, United Kingdom
| | - Kristofor McCarty
- Department of Psychology, Northumbria University, Newcastle Upon Tyne, NE1 8ST, United Kingdom
| | - Piers L Cornelissen
- Department of Psychology, Northumbria University, Newcastle Upon Tyne, NE1 8ST, United Kingdom
| | - Martin J Tovée
- School of Psychology, Lincoln University, Lincoln, LN6 7TS, United Kingdom.
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13
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Raykos BC, McEvoy PM, Fursland A. Socializing problems and low self-esteem enhance interpersonal models of eating disorders: Evidence from a clinical sample. Int J Eat Disord 2017. [PMID: 28649729 DOI: 10.1002/eat.22740] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The present study evaluated the relative clinical validity of two interpersonal models of the maintenance of eating disorders, IPT-ED (Rieger et al., ) and the interpersonal model of binge eating (Wilfley, MacKenzie, Welch, Ayres, & Weissman, ; Wilfley, Pike, & Striegel-Moore, ). While both models propose an indirect relationship between interpersonal problems and eating disorder symptoms via negative affect, IPT-ED specifies negative social evaluation as the key interpersonal problem, and places greater emphasis on the role of low self-esteem as an intermediate variable between negative social evaluation and eating pathology. METHOD Treatment-seeking individuals (N = 306) with a diagnosed eating disorder completed measures of socializing problems, generic interpersonal problems, self-esteem, eating disorder symptoms, and negative affect (depression and anxiety). Structural equation models were run for both models. RESULTS Consistent with IPT-ED, a significant indirect pathway was found from socializing problems to eating disorder symptoms via low self-esteem and anxiety symptoms. There was also a direct pathway from low self-esteem to eating disorder symptoms. Using a socializing problems factor in the model resulted in a significantly better fit than a generic interpersonal problems factor. Inconsistent with both interpersonal models, the direct pathway from socializing problems to eating disorder symptoms was not supported. DISCUSSION Interpersonal models that included self-esteem and focused on socializing problems (rather than generic interpersonal problems) explained more variance in eating disorder symptoms. Future experimental, prospective, and treatment studies are required to strengthen the case that these pathways are causal.
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Affiliation(s)
| | - Peter M McEvoy
- Centre for Clinical Interventions, Perth, Australia
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Anthea Fursland
- Centre for Clinical Interventions, Perth, Australia
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia
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14
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What about the assessment of personality disturbance in adolescents with eating disorders? Eat Weight Disord 2017; 22:551-552. [PMID: 28217819 DOI: 10.1007/s40519-017-0368-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 01/30/2017] [Indexed: 10/20/2022] Open
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15
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Dakanalis A, Clerici M. The nature of the association between binge-eating severity and metabolic syndrome. Eat Weight Disord 2017; 22:553-554. [PMID: 28405909 DOI: 10.1007/s40519-017-0386-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 03/25/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy. .,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
| | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy
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16
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Dakanalis A, Riva G, Gaudio S, Clerici M. Cognitive-behavioral or psychodynamic therapy for people with bulimia nervosa. Eat Weight Disord 2017; 22:555-556. [PMID: 28674751 DOI: 10.1007/s40519-017-0412-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 06/18/2017] [Indexed: 11/29/2022] Open
Affiliation(s)
- Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy. .,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Laboratory, IRCSS Istituto Auxologico Italiano, Milan, Italy.,Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Santino Gaudio
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
| | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy
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17
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Abstract
Binge eating is a distressing symptom common to bulimia nervosa (BN), anorexia nervosa binge/purge subtype (AN-BP) and binge-eating disorder (BED). Over the last 40 years, many attempts have been made to conceptualise this symptom in terms of its antecedents, function, triggers, consequences, and maintaining factors. Cognitive theories of binge eating have evolved as new evidence has emerged. This literature review summarises the main and most influential cognitive models of binge eating across different eating disorder presentations. Many theories have examined binge eating in the context of restriction or compensatory behaviours, as is often observed in cases of BN. Few theories have examined binge eating as it occurs in BED specifically. The long-term efficacy of cognitive behavioural therapy (CBT) treatment based on these models leaves much to be desired, and indicates that there may be maintaining factors of binge eating not addressed in the typical CBT treatment for eating disorders. More recent cognitive models of binge eating propose possible maintaining beliefs, but further study is required to validate these models. Suggestions for future research are presented.
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18
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Ferrer-García M, Gutiérrez-Maldonado J, Pla-Sanjuanelo J, Vilalta-Abella F, Riva G, Clerici M, Ribas-Sabaté J, Andreu-Gracia A, Fernandez-Aranda F, Forcano L, Riesco N, Sánchez I, Escandón-Nagel N, Gomez-Tricio O, Tena V, Dakanalis A. A Randomised Controlled Comparison of Second-Level Treatment Approaches for Treatment-Resistant Adults with Bulimia Nervosa and Binge Eating Disorder: Assessing the Benefits of Virtual Reality Cue Exposure Therapy. EUROPEAN EATING DISORDERS REVIEW 2017; 25:479-490. [PMID: 28804985 DOI: 10.1002/erv.2538] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 06/25/2017] [Accepted: 07/10/2017] [Indexed: 12/22/2022]
Abstract
A question that arises from the literature on therapy is whether second-level treatment is effective for patients with recurrent binge eating who fail first-level treatment. It has been shown that subjects who do not stop binge eating after an initial structured cognitive-behavioural treatment (CBT) programme benefit from additional CBT (A-CBT) sessions; however, it has been suggested that these resistant patients would benefit even more from cue exposure therapy (CET) targeting features associated with poor response (e.g. urge to binge in response to a cue and anxiety experienced in the presence of binge-related cues). We assessed the effectiveness of virtual reality-CET as a second-level treatment strategy for 64 patients with bulimia nervosa and binge eating disorder who had been treated with limited results after using a structured CBT programme, in comparison with A-CBT. The significant differences observed between the two groups at post-treatment in dimensional (behavioural and attitudinal features, anxiety, food craving) and categorical (abstinence rates) outcomes highlighted the superiority of virtual reality-CET over A-CBT. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Marta Ferrer-García
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Spain
| | | | - Joana Pla-Sanjuanelo
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Spain
| | | | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Italy
| | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano Bicocca, Italy
| | - Joan Ribas-Sabaté
- Department of Psychiatry and Mental Health, Igualada General Hospital, Spain
| | | | - Fernando Fernandez-Aranda
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN)-ISCIII, Spain
| | - Laura Forcano
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN)-ISCIII, Spain
| | - Nadine Riesco
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN)-ISCIII, Spain
| | - Isabel Sánchez
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN)-ISCIII, Spain
| | | | | | | | - Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano Bicocca, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Italy
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19
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Dakanalis A, Colmegna F, Riva G, Clerici M. Validity and utility of the DSM-5 severity specifier for binge-eating disorder. Int J Eat Disord 2017; 50:917-923. [PMID: 28245061 DOI: 10.1002/eat.22696] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 02/06/2017] [Accepted: 02/10/2017] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To test both the concurrent and predictive significance of the new DSM-5 severity specifier for binge-eating disorder (BED) in adult outpatients. METHOD Existing data from 195 adults with DSM-5 BED who received evidence-based treatment (manual-based cognitive-behavioral therapy) in an outpatient setting were re-analysed to examine whether these patients sub-grouped according to the DSM-5 severity levels, defined by the frequency of binge-eating (BE) episodes, would show meaningful differences in a range of variables of clinical interest assessed at pre-treatment and end-of treatment abstinence from BE. RESULTS Participants categorized with mild (33.3% of the sample), moderate (35.4%), severe (15.9%), and extreme (15.4%) severity of BED, based on their pre-treatment clinician-rated frequency of BE episodes, differed significantly from each other in physical characteristics (body mass index) and another sixteen variables of clinical interest assessed at pre-treatment regarding eating disorder psychopathology and putative maintenance factors, lifetime and current psychiatric disorder comorbidity, general psychiatric distress, and psychosocial impairment. The four DSM-5 severity groups were statistically indistinguishable in demographics or age-of-BED onset. However, significant between-group differences were observed in the treatment outcome, i.e., abstinence from BE, achieved by 98.5%, 66.7%, 38.7% and 6.7% of participants categorized with mild, moderate, severe, and extreme severity respectively. The outcome analyses repeated in the completer sample (n = 187) yielded the same pattern of the aforementioned intent-to-treat (N = 195) results. DISCUSSION The findings provide support for the severity specifier for BED introduced in the DSM-5 as a means of addressing within-group variability in severity.
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Affiliation(s)
- Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan/Monza, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Fabrizia Colmegna
- Mental Health Department, San Gerardo Monza Health and Social Care Trust, Monza, Italy
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Laboratory, Istituto Auxologico Italiano, Milan, Italy.,Department of Psychology, Catholic University, Milan, Italy
| | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan/Monza, Italy.,Mental Health Department, San Gerardo Monza Health and Social Care Trust, Monza, Italy
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20
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Wade S, Byrne S, Allen K. Enhanced cognitive behavioral therapy for eating disorders adapted for a group setting. Int J Eat Disord 2017; 50:863-872. [PMID: 28489288 DOI: 10.1002/eat.22723] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 03/21/2017] [Accepted: 04/15/2017] [Indexed: 01/17/2023]
Abstract
OBJECTIVE This randomized control trial is an evaluation of the effectiveness of enhanced cognitive behavioral treatment (CBT-E) for eating disorders adapted for a group setting. The study aimed to examine the effects of group CBT-E on eating disorder psychopathology and additional maintaining pathology. METHOD A transdiagnostic sample of individuals with eating disorders with a BMI ≥ 18 kg/m2 (N = 40) were randomized to an immediate-start or delayed-start condition so as to compare therapeutic effects of group CBT-E with a waitlist control. Global Eating Disorder Examination Questionnaire (EDE-Q) scores, BMI, and measures of Clinical Perfectionism, Self-Esteem, Interpersonal Difficulties, and Mood Intolerance were measured across the 8-week control period, throughout the group treatment and at 3-months post-treatment. RESULTS Over 70% of those who entered the trial completed treatment. The first eight weeks of group CBT-E were more effective at reducing Global EDE-Q scores than no treatment (waitlist control). By post-treatment, good outcome (a Global EDE-Q within 1 SD of Australian community norms plus BMI ≥ 18.5) was achieved by 67.9% of treatment completers and 66.7% of the total sample. Symptom abstinence within the previous month was reported by 14.3% of treatment completers and 10.3% of the total sample. Significant reductions in Clinical Perfectionism, Self-Esteem, Interpersonal Difficulties, and Mood Intolerance were also observed. DISCUSSION This study demonstrated that a group version of CBT-E can be effective at reducing eating disorder psychopathology in a transdiagnostic sample of individuals with eating disorders. Group CBT-E could provide a means of increasing availability of evidence-based treatment for eating disorders.
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Affiliation(s)
- Stephanie Wade
- School of Psychology, University of Western Australia, Perth, Australia
| | - Sue Byrne
- School of Psychology, University of Western Australia, Perth, Australia
| | - Karina Allen
- School of Psychology, University of Western Australia, Perth, Australia.,Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom.,The Eating Disorders Service, Maudsley Hospital, South London & Maudsley NHS Foundation Trust, London, United Kingdom
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21
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Dakanalis A, Riva G, Serino S, Colmegna F, Clerici M. Classifying Adults with Binge Eating Disorder Based on Severity Levels. EUROPEAN EATING DISORDERS REVIEW 2017; 25:268-274. [DOI: 10.1002/erv.2518] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/18/2017] [Accepted: 03/20/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Antonios Dakanalis
- University of Milan-Bicocca, Milan/Monza and University of Pavia; Pavia Italy
| | - Giuseppe Riva
- Istituto Auxologico Italiano; Milan and Catholic University; Milan Italy
| | | | | | - Massimo Clerici
- University of Milan-Bicocca, Milan/Monza and San Gerardo Hospital; Monza Italy
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22
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Testing the DSM-5 severity indicator for bulimia nervosa in a treatment-seeking sample. Eat Weight Disord 2017; 22:161-167. [PMID: 27650858 DOI: 10.1007/s40519-016-0324-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 09/12/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE This study tested the new DSM-5 severity criterion for bulimia nervosa (BN) based on the frequency of inappropriate weight compensatory behaviors in a treatment-seeking sample. METHODS Participants were 345 adults with DSM-5 BN presenting for treatment. They were sub-grouped based on DSM-5 severity levels and compared on a range of variables of clinical interest and demographics. RESULTS Based on DSM-5 severity definitions, 27.2 % of the sample was categorized with mild, 26.1 % with moderate, 24.9 % with severe, and 21.8 % with extreme severity of BN. Analyses revealed that the four (mild, moderate, severe, and extreme) severity groups of BN significantly differed from each other in eating disordered and body-related attitudes and behaviors, factors involved in the maintenance process of the disorder, comorbid psychiatric disorders, psychological distress, and psychosocial impairment (medium-to-large effect sizes). No significant between-group differences were observed in demographics, body mass index, or at the age when BN first occurred, lending some credence to recent suggestions that age-at-onset of BN may be more a disorder- than a severity-dependent variable. CONCLUSIONS Collectively, our findings provide support for the severity indicator for BN introduced in the DSM-5 as a means of addressing heterogeneity and variability in the severity of the disorder.
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23
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Duarte C, Pinto-Gouveia J. Self-Defining Memories of Body Image Shame and Binge Eating in Men and Women: Body Image Shame and Self-Criticism in Adulthood as Mediating Mechanisms. SEX ROLES 2016. [DOI: 10.1007/s11199-016-0728-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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24
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Dakanalis A, Clerici M, Carrà G, Riva G. Dysfunctional bodily experiences in anorexia nervosa: where are we? Eat Weight Disord 2016; 21:731-732. [PMID: 27345845 DOI: 10.1007/s40519-016-0299-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 06/15/2016] [Indexed: 01/15/2023] Open
Affiliation(s)
- Antonios Dakanalis
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy. .,Department of Medicine and Surgery Translational, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy.
| | - Massimo Clerici
- Department of Medicine and Surgery Translational, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery Translational, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy.,Division of Psychiatry, Faculty of Brain Sciences, University College of London, London, UK
| | - Giuseppe Riva
- Department of Psychology, Catholic University, Milan, Italy.,Applied Technology for Neuro-Psychology Laboratory, Istituto Auxologico Italiano, IRCCS, Milan, Italy
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25
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Serino S, Dakanalis A. Bodily illusions and weight-related disorders: Clinical insights from experimental research. Ann Phys Rehabil Med 2016; 60:217-219. [PMID: 27887907 DOI: 10.1016/j.rehab.2016.10.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/10/2016] [Accepted: 10/21/2016] [Indexed: 01/08/2023]
Affiliation(s)
- Silvia Serino
- Università Cattolica del Sacro Cuore, Department of Psychology, Largo Gemelli, 1, 20100 Milan, Italy; IRCCS Istituto Auxologico Italiano, Applied Technology for Neuro-Psychology Lab, Via Magnasco, 2, 20149 Milan, Italy.
| | - Antonios Dakanalis
- University of Milano-Bicocca, Department of Medicine and Surgery, Via Cadore 48, 20900 Monza, Italy; University of Pavia, Department of Brain and Behavioral Sciences, Piazza Botta, 6, 27100 Pavia, Italy
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26
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Dakanalis A, Pla-Sanjuanelo J, Caslini M, Volpato C, Riva G, Clerici M, Carrà G. Predicting onset and maintenance of men's eating disorders. Int J Clin Health Psychol 2016; 16:247-255. [PMID: 30487868 PMCID: PMC6225078 DOI: 10.1016/j.ijchp.2016.05.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 05/09/2016] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND/OBJECTIVE Eating disorders (EDs) represent serious yet understudied mental health issues, particularly amongst young adult men attending colleges, who are at the average age of onset. Despite this and recent evidence that in young adult men the core ED symptoms are prevalent and remain relatively stable over the college period, little is known about factors associated with both the onset and maintenance of diagnosable EDs in this population. This work sought to address these research gaps. METHOD Logistic regression analyses were conducted using data from an on-going longitudinal study of eating and mental health issues to examine the influence of theoretically relevant factors in predicting the onset and maintenance of men's (DSM-5) EDs at 4-year follow-up (N = 2,507). RESULTS Body dissatisfaction, self-objectification, appearance-ideal internalization, dieting, and negative affectivity were all predictors of ED onset and maintenance. Self-objectification was the largest contributor to both ED onset and maintenance. CONCLUSIONS The findings highlight potentially similar psychosocial foci for prevention and treatment efforts. Implications for improving existing preventive and treatment approaches are discussed.
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Affiliation(s)
| | | | | | | | - Giuseppe Riva
- Catholic University of Milan, Italty
- Istituto Auxologico Italiano, Italy
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27
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Dakanalis A, Timko AC, Clerici M, Riva G, Carrà G. Objectified Body Consciousness (OBC) in Eating Psychopathology. Assessment 2016; 24:252-274. [DOI: 10.1177/1073191115602553] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Objectified body consciousness (OBC) appears to play a crucial role in eating and body-related disturbances, which typically emerge during adolescence. The 24-item OBC Scale (OBCS) has been employed in eating disorder (ED) research and school-based adolescent samples, but evidence for its psychometric proprieties exists only in adult (nonclinical) populations. We evaluated (a) the construct validity and reliability of the 24-item OBCS with data collected from 1,259 adolescent girls and boys from the community (Study 1) and 643 adolescents of both genders with an ED (Study 2) and (b) whether the instrument functions similarly and equivalently measures the underlying construct(s) across gender and samples (i.e., test of measurement equivalence/invariance; Study 3). Results upheld the three-factor structure and measurement equivalence/invariance of the 24-item OBCS across gender and samples. OBCS subscale scores were internally consistent and stable over a 4-week period. OBCS subscales discriminated community participants with high and low ED symptom levels with fair accuracy, as well as community participants from those with an ED. They were also associated with five constructs closely related to both OBC and ED psychopathology. Latent mean comparisons across samples and gender were performed and discussed. Implications and directions for future research are also outlined.
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Affiliation(s)
- Antonios Dakanalis
- University of Pavia, Pavia, Italy
- University of Milano-Bicocca, Milan, Italy
| | | | | | - Giuseppe Riva
- Istituto Auxologico Italiano, Milan, Italy
- Catholic University of Milan, Milan, Italy
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28
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Serino S, Scarpina F, Keizer A, Pedroli E, Dakanalis A, Castelnuovo G, Chirico A, Novelli M, Gaudio S, Riva G. A Novel Technique for Improving Bodily Experience in a Non-operable Super-Super Obesity Case. Front Psychol 2016; 7:837. [PMID: 27378965 PMCID: PMC4909741 DOI: 10.3389/fpsyg.2016.00837] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 05/18/2016] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The available clinical guidelines for super-super obese patients (i.e., with body mass index (BMI) > 60 kg/m(2)) that are not suitable for bariatric surgery mandate a palliative multidisciplinary treatment (i.e., production and maintenance of weight loss) provided in a center of excellence. However, the modality and the impact of this approach are still controversial. Moreover, it is not able to address the high level of body dissatisfaction and body distortions that are common among these patients. CLINICAL PRESENTATION We report the case of a non-operable super-super obesity - a 37 year old woman with a BMI of 62 kg/m(2) - receiving a specialized treatment for her obstructive sleep apnea. She entered a multidisciplinary program that promoted healthy behaviors, including physical activities and psychological intervention. To improve body dissatisfaction, which was linked to a significant multisensory impairment of body perception, she also entered a virtual reality (VR) body-swapping illusion protocol. At the end of the current investigation, the patient continued her multidisciplinary program, reporting an increase in the motivation for undertaking healthy behavior and a decrease in the anxiety feelings associated with her clinical condition. CONCLUSION This case provides preliminary evidence that both body dissatisfaction and body-size distortions of non-operable super-super obesity patients could be addressed by a VR body-swapping protocol, which is important because the palliative multidisciplinary treatment recommended for these patients is not able to address them. Interestingly, the use of a VR body-swapping illusion protocol seems to be able to improve not only the experience of the body in these patients but their motivation for change, too.
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Affiliation(s)
- Silvia Serino
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, MilanItaly; Department of Psychology, Università Cattolica del Sacro Cuore, MilanItaly
| | - Federica Scarpina
- "Rita Levi Montalcini" Department of Neuroscience, University of Turin, TurinItaly; Psychology Research Laboratory, IRCCS Istituto Auxologico Italiano, Ospedale San Giuseppe, PiancavalloItaly
| | - Anouk Keizer
- Department of Experimental Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht Netherlands
| | - Elisa Pedroli
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan Italy
| | - Antonios Dakanalis
- Department of Brain and Behavioral Sciences, University of Pavia, PaviaItaly; Department of Surgery and Interdisciplinary Medicine, University of Milano-Bicocca, MilanItaly
| | - Gianluca Castelnuovo
- Department of Psychology, Università Cattolica del Sacro Cuore, MilanItaly; Psychology Research Laboratory, IRCCS Istituto Auxologico Italiano, Ospedale San Giuseppe, PiancavalloItaly
| | - Alice Chirico
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan Italy
| | - Margherita Novelli
- Psychology Research Laboratory, IRCCS Istituto Auxologico Italiano, Ospedale San Giuseppe, Piancavallo Italy
| | - Santino Gaudio
- Centre for Integrated Research, Area of Diagnostic Imaging, University Campus Bio-Medico, RomeItaly; Department of Neuroscience, Functional Pharmacology, Uppsala University, UppsalaSweden
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, MilanItaly; Department of Psychology, Università Cattolica del Sacro Cuore, MilanItaly
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29
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Dakanalis A, Clerici M, Caslini M, Gaudio S, Serino S, Riva G, Carrà G. Predictors of initiation and persistence of recurrent binge eating and inappropriate weight compensatory behaviors in college men. Int J Eat Disord 2016; 49:581-90. [PMID: 27062291 DOI: 10.1002/eat.22535] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 02/21/2016] [Accepted: 02/21/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The transition to college is considered as a risk period for the development of behavioral symptoms of eating disorders (BSEDs) and some evidence suggests that, amongst men, these symptoms occurring on a regular basis remain relatively stable over the college period. Nevertheless, little is known about factors associated with persistent engagement in and initiation of recurrent (or regular) binge eating and inappropriate weight compensatory behaviors in this population. The objective of this report was to address these research gaps. METHOD Data were examined from 2,555 male first-year college students who completed an assessment of potential vulnerability factors and BSEDs at the beginning of the autumn semester (baseline) and nine months later (end of the spring semester; follow-up). RESULTS Elevated negative affectivity, body dissatisfaction, self-objectification, and lower self-esteem at baseline were predictive of persistent engagement in regular binge eating and four compensatory behaviors (self-induced vomiting, laxative/diuretic abuse, fasting, exercise) at follow-up, as well as initiation of all these behaviors occurring regularly (i.e., at least weekly for 3 months). Self-objectification (thinking and monitoring the body's outward appearance from a third-person perspective) emerged as the largest contributor of both the initiation and persistence of all behavioral symptoms. DISCUSSION Data emphasize that the same psychological factors underlie initiation and persistence of recurrent BSEDs and should shape the focus of future interventions for college men. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:581-590).
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Affiliation(s)
- Antonios Dakanalis
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Department of Surgery and Interdisciplinary Medicine, University of Milan-Bicocca, Milan, Italy
| | - Massimo Clerici
- Department of Surgery and Interdisciplinary Medicine, University of Milan-Bicocca, Milan, Italy
| | - Manuela Caslini
- Department of Surgery and Interdisciplinary Medicine, University of Milan-Bicocca, Milan, Italy
| | - Santino Gaudio
- Centre for Integrated Research, University Campus Bio-Medico, Rome, Italy.,Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Silvia Serino
- Department of Psychology, Catholic University, Milan, Italy
| | - Giuseppe Riva
- Department of Psychology, Catholic University, Milan, Italy.,Applied Technology for Neuropsychology Laboratory, Istituto Auxologico Italiano, Milan, Italy
| | - Giuseppe Carrà
- Department of Surgery and Interdisciplinary Medicine, University of Milan-Bicocca, Milan, Italy.,Division of Psychiatry, Faculty of Brain Sciences, University College of London, London, United Kingdom
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30
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Dakanalis A, Timko A, Serino S, Riva G, Clerici M, Carrà G. Prospective Psychosocial Predictors of Onset and Cessation of Eating Pathology amongst College Women. EUROPEAN EATING DISORDERS REVIEW 2016; 24:251-6. [DOI: 10.1002/erv.2433] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 09/26/2015] [Accepted: 12/24/2015] [Indexed: 12/19/2022]
Affiliation(s)
- Antonios Dakanalis
- Department of Brain and Behavioral Sciences; University of Pavia; Italy
- Department of Surgery and Interdisciplinary Medicine; University of Milan-Bicocca; Italy
| | - Alix Timko
- Department of Child and Adolescent Psychiatry and Behavioral Sciences; Children's Hospital of Philadelphia; USA
| | - Silvia Serino
- Applied Technology for Neuro-Psychology Laboratory; Istituto Auxologico Italiano; Italy
| | - Giuseppe Riva
- Department of Psychology; Catholic University of Milan; Italy
- Applied Technology for Neuro-Psychology Laboratory; Istituto Auxologico Italiano; Italy
| | - Massimo Clerici
- Department of Surgery and Interdisciplinary Medicine; University of Milan-Bicocca; Italy
| | - Giuseppe Carrà
- Mental Health Sciences Unit, Faculty of Brain Sciences; University College London; UK
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31
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The Social Appearance Anxiety Scale in Italian Adolescent Populations: Construct Validation and Group Discrimination in Community and Clinical Eating Disorders Samples. Child Psychiatry Hum Dev 2016; 47:133-50. [PMID: 25976291 DOI: 10.1007/s10578-015-0551-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Anxiety in situations where one's overall appearance (including body shape) may be negatively evaluated is hypothesized to play a central role in Eating Disorders (EDs) and in their co-occurrence with Social Anxiety Disorder (SAD). Three studies were conducted among community (N = 1995) and clinical (N = 703) ED samples of 11- to 18-year-old Italian girls and boys to (a) evaluate the psychometric qualities and measurement equivalence/invariance (ME/I) of the Social Appearance Anxiety (SAA) Scale (SAAS) and (b) determine to what extent SAA or other situational domains of social anxiety related to EDs distinguish adolescents with an ED only from those with SAD. Results upheld the one-factor structure and ME/I of the SAAS across samples, gender, age categories, and diagnostic status (i.e., ED participants with and without comorbid SAD). The SAAS demonstrated high internal consistency and 3-week test-retest reliability. The strength of the inter-relationships between SAAS and measures of body image, teasing about appearance, ED symptoms, depression, social anxiety, avoidance, and distress, as well as the ability of SAAS to discriminate community adolescents with high and low levels of ED symptoms and community participants from ED participants provided construct validity evidence. Only SAA strongly differentiated adolescents with any ED from those with comorbid SAD (23.2 %). Latent mean comparisons across all study groups were performed and discussed.
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Serino S, Dakanalis A, Gaudio S, Carrà G, Cipresso P, Clerici M, Riva G. Out of body, out of space: Impaired reference frame processing in eating disorders. Psychiatry Res 2015; 230:732-4. [PMID: 26541204 DOI: 10.1016/j.psychres.2015.10.025] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 09/26/2015] [Accepted: 10/23/2015] [Indexed: 11/25/2022]
Abstract
A distorted body representation is a core symptom in eating disorders (EDs), though its mechanism is unclear. Allocentric lock theory, emphasising the role of reference frame processing in body image, suggests that ED patients may be (b)locked to an (allocentric) representation of their own body stored in long-term memory (e.g., my body is fat) that is not updated (modified) by the (real-time egocentric) perception-driven experience of the physical body. Employing a well-validated virtual reality-based procedure, relative to healthy controls, ED patients showed deficits in the ability to refer to and update a long-term stored (allocentric) representation with (egocentric) perceptual-driven inputs.
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Affiliation(s)
- Silvia Serino
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Via Magnasco 2, 20149 Milan, Italy.
| | - Antonios Dakanalis
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Department of Surgery and Interdisciplinary Medicine, University of Milano-Bicocca, Milan, Italy
| | - Santino Gaudio
- Centre for Integrated Research-Area of Diagnostic Imaging, University Campus Bio-Medico, Rome, Italy
| | - Giuseppe Carrà
- Division of Psychiatry, Faculty of Brain Sciences, University College of London, London, UK
| | - Pietro Cipresso
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Via Magnasco 2, 20149 Milan, Italy
| | - Massimo Clerici
- Department of Surgery and Interdisciplinary Medicine, University of Milano-Bicocca, Milan, Italy
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Via Magnasco 2, 20149 Milan, Italy; Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
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Reich-Erkelenz D, Schmitt A, Falkai P. Unravelling basic mechanisms in addiction and neuropsychiatric disorders. Eur Arch Psychiatry Clin Neurosci 2015; 265:633-5. [PMID: 26459020 DOI: 10.1007/s00406-015-0645-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Daniela Reich-Erkelenz
- Institute of Psychiatric Phenomics and Genomics, Ludwig-Maximilians-University Munich, Nußbaumstr. 7, 80336, Munich, Germany
| | - Andrea Schmitt
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Nußbaumstr. 7, 80336, Munich, Germany.
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Nußbaumstr. 7, 80336, Munich, Germany
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Dakanalis A, Clerici M, Carrà G. Narcissistic Vulnerability and Grandiosity as Mediators Between Insecure Attachment and Future Eating Disordered Behaviors: A Prospective Analysis of Over 2,000 Freshmen. J Clin Psychol 2015; 72:279-92. [PMID: 26613236 DOI: 10.1002/jclp.22237] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE This study aimed to build on existing literature by examining the potential mediating role of two variants of narcissism (grandiosity and vulnerability) in explaining part of the underlying mechanism by which insecure (avoidant and anxiety) attachment affects behavioral elements of eating pathology (dieting and bulimic behaviors). METHOD Longitudinal data collected from 2,055 freshman college students (52.2% women; mean age 18.34 years) were analysed using a latent variable structural equation modelling approach, controlling for initial levels of the endogenous (i.e., dependent) latent variables and holding body mass index, anxiety, stress, depression, and self-esteem levels as time-varying covariates. RESULTS The effect of attachment anxiety on future bulimic behaviors was fully mediated through vulnerable narcissism (i.e., no significant direct link between attachment anxiety and bulimic behaviors), whereas grandiose narcissism fully mediated the association between attachment avoidance and future dieting behaviors. Dieting also predicted future bulimic behaviors and served as an additional (full) mediator between grandiose narcissism and bulimic behaviors. Differences in the strength of these associations across gender were not observed, and all indirect effects were statistically significant. CONCLUSION Overall, the findings (a) seem to support the theoretical postulations linking different insecure attachment experiences to different narcissistic tendencies, (b) imply that specific insecure attachment patterns may pass through different mediating pathways (narcissistic grandiosity and vulnerability) to specific behavioral elements of eating pathology (dieting and bulimic behaviors) regardless of gender, and (c) suggest that individuals with high grandiose narcissistic levels may not be protected from bulimic behaviors as previously indicated.
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Dakanalis A, Carrà G, Calogero R, Fida R, Clerici M, Zanetti MA, Riva G. The developmental effects of media-ideal internalization and self-objectification processes on adolescents' negative body-feelings, dietary restraint, and binge eating. Eur Child Adolesc Psychiatry 2015; 24:997-1010. [PMID: 25416025 DOI: 10.1007/s00787-014-0649-1] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 11/07/2014] [Indexed: 12/23/2022]
Abstract
Despite accumulated experimental evidence of the negative effects of exposure to media-idealized images, the degree to which body image, and eating related disturbances are caused by media portrayals of gendered beauty ideals remains controversial. On the basis of the most up-to-date meta-analysis of experimental studies indicating that media-idealized images have the most harmful and substantial impact on vulnerable individuals regardless of gender (i.e., "internalizers" and "self-objectifiers"), the current longitudinal study examined the direct and mediated links posited in objectification theory among media-ideal internalization, self-objectification, shame and anxiety surrounding the body and appearance, dietary restraint, and binge eating. Data collected from 685 adolescents aged between 14 and 15 at baseline (47 % males), who were interviewed and completed standardized measures annually over a 3-year period, were analyzed using a structural equation modeling approach. Results indicated that media-ideal internalization predicted later thinking and scrutinizing of one's body from an external observer's standpoint (or self-objectification), which then predicted later negative emotional experiences related to one's body and appearance. In turn, these negative emotional experiences predicted subsequent dietary restraint and binge eating, and each of these core features of eating disorders influenced each other. Differences in the strength of these associations across gender were not observed, and all indirect effects were significant. The study provides valuable information about how the cultural values embodied by gendered beauty ideals negatively influence adolescents' feelings, thoughts and behaviors regarding their own body, and on the complex processes involved in disordered eating. Practical implications are discussed.
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Affiliation(s)
- Antonios Dakanalis
- Department of Brain and Behavioral Sciences, University of Pavia, P.za Botta 11, 27100, Pavia, Italy,
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Dakanalis A, Carrà G, Timko A, Volpato C, Pla-Sanjuanelo J, Zanetti A, Clerici M, Riva G. Mechanisms of influence of body checking on binge eating. Int J Clin Health Psychol 2015; 15:93-104. [PMID: 30487826 PMCID: PMC6224801 DOI: 10.1016/j.ijchp.2015.03.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 03/13/2015] [Indexed: 01/02/2023] Open
Abstract
Despite the theorized role of body checking behaviours in the maintenance process of binge eating, the mechanisms by which they may impact binge eating remain unclear. Using objectification model of eating pathology as a theoretical framework, the authors examined the potential intervening roles of body shame, appearance anxiety, and dietary restraint in the pathway between body checking and binge eating. Data collected from a large sample of treatment-seeking people with Bulimic-type Eating Disorders (N = 801) were analysed trough structural equation modelling. Results showed that, regardless of specific DSM-5 diagnostic categories, body checking behaviours were indirectly associated with binge eating and dietary restraint through body shame and appearance anxiety, whereas dietary restraint was directly linked to binge eating. The findings have clinical utility as they contribute to gaining insight into how critical scrutiny of one's body may act in several indirect ways to affect binge eating. We discuss practical implications of the findings.
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Affiliation(s)
| | | | - Alix Timko
- Children's Hospital of Philadelphia, USA
| | | | | | | | | | - Giuseppe Riva
- Catholic University of Milan and Istituto Auxologico Italiano, Italy
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