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Jeune SC, Graziano P, Campa A, Coccia CC. The causal associations between interoception, self-regulation, non-purposeful eating behaviors, and weight status in college women: a longitudinal cross-lagged model analysis. Psychol Health 2024:1-18. [PMID: 38712828 DOI: 10.1080/08870446.2024.2352062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/30/2024] [Indexed: 05/08/2024]
Abstract
AIMS Excessive weight gain has led to increased obesity and mortality risk among college students. Issues with maintaining a healthy weight may be attributed to poor internal awareness and unhealthy eating behaviors. The study's purpose was to determine the longitudinal effects among interoception, self-regulation, nonpurposeful eating behaviors, and weight status (BMI) among college women. METHODS Data from 103 females were collected via Qualtrics over 3 timepoints (T1, T2, T3) during an academic semester. Repeated measures ANOVA and cross-lagged model analyses were used. Significant changes were found in interoceptive responsiveness, external, and uncontrolled eating throughout 3 timepoints. RESULTS Longitudinally, significant causal effects were found among the study measures. Among all models, higher interoceptive responsiveness (T1) predicted increased self-regulation (T2). Higher non-purposeful eating behaviors (T1) predicted reduced self-regulation (T2). Higher BMI (T1) predicted reduced non-purposeful eating behaviors (T2), however higher BMI (T2) predicted increased non-purposeful eating (T3) and reduced interoceptive responsiveness (T3). Significant causal effects were found within each non-purposeful eating behavior models. CONCLUSION Overall, the research study provided foundational evidence of the importance of self-regulatory skills to help prevent unhealthy eating behaviors and increased weight status in college women. Future interventions educating college women to become more internally aware and better self-regulate are needed.
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Affiliation(s)
- Shanté C Jeune
- Department of Health Sciences, University of Central Florida, Orlando, FL, USA
| | - Paulo Graziano
- Department of Psychology, Florida International University, Miami, FL, USA
| | - Adriana Campa
- Department of Dietetics and Nutrition, Florida International University, Miami, FL, USA
| | - Catherine C Coccia
- Department of Dietetics and Nutrition, Florida International University, Miami, FL, USA
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Zhu Y, Yin L, Liu Q, Guan Y, Nie S, Zhu Y, Mo F. Tryptophan metabolic pathway plays a key role in the stress-induced emotional eating. Curr Res Food Sci 2024; 8:100754. [PMID: 38736909 PMCID: PMC11087915 DOI: 10.1016/j.crfs.2024.100754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/20/2024] [Accepted: 04/25/2024] [Indexed: 05/14/2024] Open
Abstract
Chronic stress disrupts the emotional and energetic balance, which may lead to abnormal behaviors such as binge eating. This overeating behavior alleviating the negative emotions is called emotional eating, which may exacerbate emotional instability and lead to obesity. It is a complex and multifaceted process that has not yet been fully understood. In this study, we constructed an animal model of chronic mild stress (CMS)-induced emotional eating. The emotional eating mice were treated with tryptophan for 21 days to reveal the key role of tryptophan. Furthermore, serum-targeted metabolomics, immunohistochemical staining, qPCR and ELISA were performed. The results showed that CMS led to the binge eating behavior, accompanied by the disturbed intestinal tryptophan-derived serotonin (5-hydroxytryptamine; 5-HT) metabolic pathways. Then we found that tryptophan supplementation improved depression and anxiety-like behaviors as well as abnormal eating behaviors. Tryptophan supplementation improved the abnormal expression of appetite regulators (e.g., AgRP, OX1R, MC4R), and tryptophan supplementation also increased the tryptophan hydroxylase 2 (tph2) and 5-HT receptors in the hypothalamus of CMS mice, which indicates that the 5-HT metabolic pathway influences feeding behavior. In vitro experiments confirmed that 5-HT supplementation ameliorated corticosterone-induced aberrant expression of appetite regulators, such as AgRP and OX1R, in the hypothalamic cell line. In conclusion, our findings revealed that the tryptophan-derived 5-HT pathway plays an important role in emotional eating, especially in providing targeted therapy for stress-induced obesity.
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Affiliation(s)
- Ying Zhu
- College of Food Science and Technology, Shanghai Ocean University, Shanghai 201306, China
- Department of Naval Nutrition and Food Hygiene, Naval Medical University, Shanghai 200433, China
| | - Lifeng Yin
- College of Food Science and Technology, Shanghai Ocean University, Shanghai 201306, China
- Department of Naval Nutrition and Food Hygiene, Naval Medical University, Shanghai 200433, China
| | - Qing Liu
- Department of Naval Nutrition and Food Hygiene, Naval Medical University, Shanghai 200433, China
- Shanghai Key Laboratory of Nautical Medicine and Translation of Drugs and Medical Devices, The First Affiliated Hospital of Naval Medical University, Shanghai 200433, China
| | - Yaoxing Guan
- College of Food Science and Technology, Shanghai Ocean University, Shanghai 201306, China
- Department of Naval Nutrition and Food Hygiene, Naval Medical University, Shanghai 200433, China
| | - Shuang Nie
- Department of Naval Nutrition and Food Hygiene, Naval Medical University, Shanghai 200433, China
- Shanghai Key Laboratory of Nautical Medicine and Translation of Drugs and Medical Devices, The First Affiliated Hospital of Naval Medical University, Shanghai 200433, China
| | - Yongheng Zhu
- College of Food Science and Technology, Shanghai Ocean University, Shanghai 201306, China
| | - Fengfeng Mo
- Department of Naval Nutrition and Food Hygiene, Naval Medical University, Shanghai 200433, China
- Shanghai Key Laboratory of Nautical Medicine and Translation of Drugs and Medical Devices, The First Affiliated Hospital of Naval Medical University, Shanghai 200433, China
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Grunewald W, Waitz-Kudla SN, Levinson CA, Brown TA, Smith AR. Development and Psychometric Validation of the Body Trust Scale. Assessment 2024:10731911231225200. [PMID: 38311906 DOI: 10.1177/10731911231225200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Interoception (e.g., abilities to recognize/attend to internal sensations) is robustly associated with psychopathology. One form of interoception, body trust, is relevant for the development of disordered eating and suicidal thoughts/behaviors. However, measures of body trust are narrow, despite research suggesting body trust is multifaceted. The aim of this study was to develop a comprehensive measure of body trust: The Body Trust Scale (BTS). 479 U.S. adults completed self-report surveys containing the BTS and psychopathology measures. Exploratory and confirmatory factor analyses revealed a three-factor structure: Comfort with One's Body, Physical Attractiveness, and Comfort with Internal Sensations. Factors showed strong construct, convergent, and divergent validity, as well as moderate predictive validity for suicidal thoughts/non-suicidal self-injury. Furthermore, factors showed strong internal consistency, test-retest reliability, and were invariant across the gender binary. The BTS can be used in research and clinical settings to understand how specific facets of body trust relate to psychopathology.
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Lin XX, Chen YH, Wang YZ, Sun YB, Wang N, Luo F, Wang JY. Soreness Reminds Me of Grief: Patients With Chronic Pain Show Less Differentiated Representations of Emotional Feelings and Bodily States. THE JOURNAL OF PAIN 2024; 25:557-569. [PMID: 37742906 DOI: 10.1016/j.jpain.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/31/2023] [Accepted: 09/12/2023] [Indexed: 09/26/2023]
Abstract
People experience similarities between emotional feelings and bodily states on a daily basis, but both the magnitude and pervasiveness of this experiential similarity vary across individuals. Inspired by previous findings that chronic pain (CP) is characterized by strengthened pain-affect coupling and reduced interoceptive accuracy, we conducted 2 cross-sectional studies to examine whether patients with CP would exhibit less differentiated perception and mental representation of emotional feelings and bodily states. In study 1 (N = 500), patients with CP and healthy controls (HCs) completed a self-report questionnaire that asked explicitly about the perceived similarity between 5 basic emotion categories and a series of bodily states. In study 2 (N = 73), a specially designed false memory test was administered to examine whether patients with CP would have reduced differentiation of concepts of negative emotion and somatic distress. We found that patients with CP perceived greater and more pervasive similarities between emotional feelings and bodily states, as indicated by higher questionnaire scores and denser, less specialized bipartite emotion-body networks, both associated with lower subjective interoceptive accuracy. Furthermore, patients with CP formed false memories of negative emotion words (eg, grief) more readily than HCs after memorizing somatic distress words (eg, soreness), as if they represented negative emotion and somatic distress as a single, enmeshed semantic category. Our findings extend previous literature by demonstrating reduced discrimination between emotional and bodily experiences in CP that is not restricted to pain-related emotional and sensory experiences and may be related to a fundamentally less differentiated interoception. PERSPECTIVES: This study shows that patients with chronic pain have a profoundly less differentiated perception and implicit conceptualization of emotional feelings and bodily states, which appears to be associated with altered interoception. These findings may provide new perspectives on why they often experience a stronger pain-affect coupling.
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Affiliation(s)
- Xiao-Xiao Lin
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, PR China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China
| | - Ya-Hong Chen
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, PR China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China
| | - Yu-Zheng Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, PR China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China
| | - Ya-Bin Sun
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, PR China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China
| | - Ning Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, PR China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China
| | - Fei Luo
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, PR China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China
| | - Jin-Yan Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, PR China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China
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Schueler J, Philip SR, Vitus D, Engler S, Fields SA. Group differences in binge eating, impulsivity, and intuitive and mindful eating among intermittent fasters and non-fasters. Appetite 2023; 182:106416. [PMID: 36526039 DOI: 10.1016/j.appet.2022.106416] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022]
Abstract
Intermittent fasting (IF) is an increasingly popular diet involving short-term fasting and/or caloric restriction. While published research highlights physiological effects (e.g., weight, body fat) of IF, hardly any research has examined its associations with psychological factors. This study aimed to investigate the relationship between IF and binge eating, impulsivity, intuitive eating, and mindful eating. An undergraduate sample (N = 298) was recruited through a large southwestern university psychology subject pool. The sample was divided into three groups based on IF status: Current IF (n = 70), Past IF (n = 48), and No IF (n = 182). Current IF was negatively associated with lack of perseverance (e.g., "I generally like to see things through to the end"; p < .01) and intuitive eating (p < .05), varying by subscale, compared to the other groups. Notably, Past-IF, but not Current IF, participants were more likely to binge eat than individuals who reported never fasting (p = .03). These findings add credence to the rapidly developing area of research suggesting IF is associated with increased disordered eating behaviors. Notably, the findings from this study are limited due to the lack of diversity sample, such that generalizations can only be made toward White, middle-to-high income, college students. Future longitudinal studies are needed to test the directionality of these relationships.
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Affiliation(s)
- Jordan Schueler
- Department of Psychological & Brain Sciences, Texas A&M University, College Station, TX, USA.
| | - Samantha R Philip
- Department of Psychological & Brain Sciences, Texas A&M University, College Station, TX, USA.
| | - Darya Vitus
- Department of Psychological & Brain Sciences, Texas A&M University, College Station, TX, USA.
| | - Solangia Engler
- Department of Psychological & Brain Sciences, Texas A&M University, College Station, TX, USA.
| | - Sherecce A Fields
- Department of Psychological & Brain Sciences, Texas A&M University, College Station, TX, USA.
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6
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Dakanalis A, Mentzelou M, Papadopoulou SK, Papandreou D, Spanoudaki M, Vasios GK, Pavlidou E, Mantzorou M, Giaginis C. The Association of Emotional Eating with Overweight/Obesity, Depression, Anxiety/Stress, and Dietary Patterns: A Review of the Current Clinical Evidence. Nutrients 2023; 15:nu15051173. [PMID: 36904172 PMCID: PMC10005347 DOI: 10.3390/nu15051173] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 03/03/2023] Open
Abstract
(1) Background: Emotional eating is considered as the propensity to eat in response to emotions. It is considered as a critical risk factor for recurrent weight gain. Such overeating is able to affect general health due to excess energy intake and mental health. So far, there is still considerable controversy on the effect of the emotional eating concept. The objective of this study is to summarize and evaluate the interconnections among emotional eating and overweight/obesity, depression, anxiety/stress, and dietary patterns; (2) Methods: This is a thorough review of the reported associations among emotional eating and overweight/obesity, depression, anxiety/stress, and dietary patterns. We compressively searched the most precise scientific online databases, e.g., PubMed, Scopus, Web of Science and Google Scholar to obtain the most up-to-date data from clinical studies in humans from the last ten years (2013-2023) using critical and representative keywords. Several inclusion and exclusion criteria were applied for scrutinizing only longitudinal, cross-sectional, descriptive, and prospective clinical studies in Caucasian populations; (3) Results: The currently available findings suggest that overeating/obesity and unhealthy eating behaviors (e.g., fast food consumption) are associated with emotional eating. Moreover, the increase in depressive symptoms seems to be related with more emotional eating. Psychological distress is also related with a greater risk for emotional eating. However, the most common limitations are the small sample size and their lack of diversity. In addition, a cross-sectional study was performed in the majority of them; (4) Conclusions: Finding coping mechanisms for the negative emotions and nutrition education can prevent the prevalence of emotional eating. Future studies should further explain the underlying mechanisms of the interconnections among emotional eating and overweight/obesity, depression, anxiety/stress, and dietary patterns.
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Affiliation(s)
- Antonios Dakanalis
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- Correspondence: (A.D.); (C.G.)
| | - Maria Mentzelou
- Department of Food Science and Nutrition, School of Environment, University of Aegean, 81400 Myrina, Greece
| | - Souzana K. Papadopoulou
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece
| | - Dimitrios Papandreou
- Department of Health Sciences, College of Natural and Health Sciences, Zayed University, Abu Dhabi P.O. Box 144534, United Arab Emirates
| | - Maria Spanoudaki
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece
- Clinical Dietetics & Nutrition Department of 424 General Military Hospital, New Efkarpia Ring Road, 56429 Thessaloniki, Greece
| | - Georgios K. Vasios
- Department of Food Science and Nutrition, School of Environment, University of Aegean, 81400 Myrina, Greece
| | - Eleni Pavlidou
- Department of Food Science and Nutrition, School of Environment, University of Aegean, 81400 Myrina, Greece
| | - Maria Mantzorou
- Department of Food Science and Nutrition, School of Environment, University of Aegean, 81400 Myrina, Greece
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, School of Environment, University of Aegean, 81400 Myrina, Greece
- Correspondence: (A.D.); (C.G.)
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7
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Cheng D, Wei M. Modified Dual Pathway Model for Binge Eating: The Role of Emotion Dysregulation. COUNSELING PSYCHOLOGIST 2022. [DOI: 10.1177/00110000221077936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We tested a modification of the dual pathway model using two sequential mediators between body dissatisfaction and binge eating: restricted eating and difficulties in emotion regulation replacing negative affect. A total of 435 college students completed an online survey. Results from path analyses indicated that the relationship between body dissatisfaction and binge eating was not mediated by restricted eating for neither women nor men. However, this relationship was mediated first by restricted eating and then by difficulties in emotion regulation for women only. Moreover, this relationship was mediated by difficulties in emotion regulation for both women and men. A post hoc analysis indicated that the above mediation results were still significant after adding negative affect into the model. No mediations through negative affect were significant. Clinical implications include the conceptualization and intervention of eating concerns within an emotion dysregulation framework.
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Affiliation(s)
- Davelle Cheng
- Department of Psychology, Iowa State University, Ames, IA, USA
| | - Meifen Wei
- Department of Psychology, Iowa State University, Ames, IA, USA
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Munsch S, Forrer F, Naas A, Mueller V, Rubo M, Hannoun F, Mugellini E. Correlates of interpersonal emotion regulation problems in Loss of Control eating (LOC) in youth: study protocol of the combined online and App based questionnaire, laboratory and randomized controlled online intervention i-BEAT trial. BMC Psychol 2021; 9:193. [PMID: 34895337 PMCID: PMC8666071 DOI: 10.1186/s40359-021-00690-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/22/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Binge Eating Disorder (BED) represents a common eating disorder associated with marked health impairments. A subclinical variant, loss of control eating (LOC) is prevalent in youth. LOC is associated with similar mental distress as full-blown BED, increases the risk to develop a BED and promotes continuous weight gain. The etiology of LOC is not yet fully understood and specialized treatment for youth is scarce. METHODS The i-BEAT study includes a cross-sectional and longitudinal online questionnaire study (N = 600), an App based daily-life approach and a laboratory virtual reality study in N = 60 youths (14-24 years) with and without LOC as well as a controlled randomized online treatment trial to investigate the feasibility, acceptance and efficacy of a CBT and an interpersonal emotion regulation module for youth (N = 120). The primary outcomes include self-reported as well as measured (heart rate variability, gaze behavior, reaction times in stop signal task) associations between emotion regulation problems (such as dealing with RS), psychological impairment and binge eating in a healthy control group and youth with LOC. Secondary outcomes encompass general eating disorder pathology, social anxiety, body mass index, hyperscanning behavior and therapists' rating of patients' condition pre and post treatment. Epigenetic correlates of RS are assessed in healthy controls and youth with LOC and explored before and after treatment. DISCUSSION The expected findings will specify the role of interpersonal emotion regulation problems such as coping with the experience of social exclusion and rejection sensitivity (RS) in LOC and clarify, whether including a training to cope with RS adds to the efficacy of a cognitive behavioral treatment (CBT). TRIAL REGISTRATION German Clinical Trial Register: DRKS00023706. Registered 27 November 2020, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023706.
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Affiliation(s)
- Simone Munsch
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Fribourg, Rue P.-A.-de-Faucigny 2, 1700 Fribourg, Switzerland
| | - Felicitas Forrer
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Fribourg, Rue P.-A.-de-Faucigny 2, 1700 Fribourg, Switzerland
| | - Adrian Naas
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Fribourg, Rue P.-A.-de-Faucigny 2, 1700 Fribourg, Switzerland
| | - Verena Mueller
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Fribourg, Rue P.-A.-de-Faucigny 2, 1700 Fribourg, Switzerland
| | - Marius Rubo
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Fribourg, Rue P.-A.-de-Faucigny 2, 1700 Fribourg, Switzerland
| | - Fouad Hannoun
- Technology for Human Well-Being Institute (HumanTech), University of Applied Sciences of Western Switzerland, Boulevard de Pérolles 80, Fribourg, Switzerland
| | - Elena Mugellini
- Technology for Human Well-Being Institute (HumanTech), University of Applied Sciences of Western Switzerland, Boulevard de Pérolles 80, Fribourg, Switzerland
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9
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Cella S, Cipriano A, Aprea C, Cotrufo P. Risk factors for binge eating severity among adolescent girls and boys. A structural equation modeling approach. Appetite 2021; 169:105825. [PMID: 34826528 DOI: 10.1016/j.appet.2021.105825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 09/29/2021] [Accepted: 11/21/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Parental bonding, low self-esteem, emotion dysregulation, and eating style are correlated with each other and are associated with binge eating among adolescents. However, no studies have yet examined all these variables simultaneously. In the current study, the independent and combined influences of such constructs on binge eating were tested with structural equation modeling. METHOD A sample of 973 students aged between 12 and 16 (M = 14.17, SD = 1.25) years was screened by means of self-report measures assessing parental bonding, self-esteem, emotion dysregulation, eating styles and binge eating severity. RESULTS Self-esteem (β = -0.205) and eating styles (emotional β = 0.313, external β = 0.133, and restrained β = 0.178) had a direct effect on binge eating severity. The model (χ2(22) = 57.679; RMSEA = 0.041; CFI = 0.987; TLI = 0.949; SRMR = 0.024) revealed that the paths from both maternal and paternal care and maternal overprotection to binge eating were mediated through low self-esteem, emotion dysregulation and each eating style, explaining 35% of the variance. DISCUSSION Findings provide support for a comprehensive theoretical-based model of risk factors for binge eating and suggest the possible mechanisms through which the quality of early parental relationships contribute to developing dysfunctional eating patterns. Treatment and prevention efforts should improve self-esteem and emphasize emotion regulation capabilities.
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Affiliation(s)
- Stefania Cella
- Observatory on Eating Disorders, Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy.
| | - Annarosa Cipriano
- Observatory on Eating Disorders, Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Cristina Aprea
- Observatory on Eating Disorders, Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Paolo Cotrufo
- Observatory on Eating Disorders, Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
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10
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Towards a Comprehensive Understanding of Body Image: Integrating Positive Body Image, Embodiment and Self-Compassion. Psychol Belg 2021; 61:248-261. [PMID: 34394951 PMCID: PMC8323527 DOI: 10.5334/pb.1057] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 07/12/2021] [Indexed: 11/25/2022] Open
Abstract
Body image (BI) disturbance is a relevant factor in the etiology and treatment of eating disorders (ED). Although progress has been made in recent decades in understanding BI and its relationship with ED, the efficacy of BI disturbance prevention and intervention programs is still limited. In order to reach deeper understanding of BI disturbance and clarify the interactions between some protective and risk factors related to this construct, we carried out a literature review on some specific BI-related factors that so far have been analyzed independently. We specifically examined positive and negative BI; embodiment and its role in the development of positive and negative BI; and self-compassion as a protective factor that promotes positive embodiment (vs. disembodiment) and protection against body shame. We conclude that integrating the available evidence on these factors into BI models may be used to enhance our understanding of BI and improve the efficacy of prevention and intervention programs to help fight negative BI (by reducing body shame and disembodiment) and promote positive BI (by increasing self-compassion and positive embodiment).
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11
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Pearce AL, Brick TR, Masterson T, Adise S, Fearnbach SN, Stein W, English L, Tanofsky-Kraff M, Keller KL. Using association rules mining to characterize loss of control eating in childhood. Appetite 2021; 163:105236. [PMID: 33798619 DOI: 10.1016/j.appet.2021.105236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/02/2021] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
Childhood loss of control (LOC)-eating, the perceived inability to stop or control eating, is associated with increased risk for binge-eating disorder and obesity. However, the correlates of LOC-eating in childhood remain unclear. A secondary analysis of 177, 7-12-year-old children from five laboratory feeding studies was performed to investigate potential family (e.g., frequency of meals together, feeding practices), parental (e.g., education, weight status), and child (e.g., weight status, appetite traits) correlates of LOC-eating. Association rules mining (ARM1), a data-driven approach, was used to examine all characteristics that were common across studies to identify which were associated with LOC-eating. Results showed LOC-eating was characterized by a combination of child appetitive behaviors and parental feeding practices. In particular, LOC-eating was associated with low parental pressure to eat in combination with a high propensity to want to eat all the time and frequent refusal or dislike of novel foods. This pattern of both food approach (i.e., wanting to eat all the time) and avoidant behaviors (i.e., food fussiness) highlights the need for more research to characterize the complex patterns of appetitive traits associated with LOC-eating. In contrast, the absence of LOC-eating was associated with a low propensity to want to eat all the time, greater family income, and infrequent emotional overeating. Therefore, propensity to want to eat all the time, a single question from the Children's Eating Behavior Questionnaire, characterized both the presence and absence of LOC-eating, highlighting the need for more research to determine if this question captures clinically relevant individual differences. Future studies addressing these questions will advance our understanding of pediatric LOC-eating and may lead to interventions to reduce risk for more severe eating disorder symptomology.
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Affiliation(s)
- Alaina L Pearce
- Department of Nutritional Science, The Pennsylvania State University, University Park, PA, USA.
| | - Timothy R Brick
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | - Travis Masterson
- Department of Nutritional Science, The Pennsylvania State University, University Park, PA, USA
| | - Shana Adise
- Department of Psychiatry, University of Vermont, USA
| | | | - Wendy Stein
- Department of Nutritional Science, The Pennsylvania State University, University Park, PA, USA
| | | | | | - Kathleen L Keller
- Department of Nutritional Science, The Pennsylvania State University, University Park, PA, USA; Department of Food Science, The Pennsylvania State University, University Park, PA, USA
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12
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Wu YT, Huang DH, Hsu TH, Hong FY. Children’s stress, negative emotions, emotional eating, and eating disorders: A moderated mediation model. JOURNAL OF PSYCHOLOGY IN AFRICA 2020. [DOI: 10.1080/14330237.2020.1821319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Yao-Teng Wu
- Graduate Institute of Biotechnology, Da-Yeh University, Changhua, Taiwan
| | - Der-Hsiang Huang
- Graduate Institute of Professional Development in Education, Da-Yeh University, Changhua, Taiwan
| | - Tai-Hao Hsu
- Graduate Institute of Biotechnology, Da-Yeh University, Changhua, Taiwan
| | - Fu-Yuan Hong
- Graduate Institute of Professional Development in Education, Da-Yeh University, Changhua, Taiwan
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13
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Thomas R, Siliquini R, Hillegers MH, Jansen PW. The association of adverse life events with children's emotional overeating and restrained eating in a population-based cohort. Int J Eat Disord 2020; 53:1709-1718. [PMID: 32702148 PMCID: PMC7589411 DOI: 10.1002/eat.23351] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Life adversities are recognized risk factors for eating disorders, in adolescents and adults, but whether such adversities are also associated with particular eating behaviors earlier in life is still unclear. Our aim was to assess whether experiencing adverse life events in early childhood is associated with emotional overeating and restrained eating at age 10. METHODS Emotional overeating and restrained eating were assessed in 4,653 10-years-old children using the mother-reported Children's Eating Behavior Questionnaire and Dutch Eating Behavior Questionnaire. Mothers also reported on 24 different life events during childhood, those with moderate or severe impact being categorized as adverse life events. Regression analyses were performed to investigate relationships between adverse life events and eating behaviors in the total sample. RESULTS Adjusted for covariates, adverse life events were associated with more emotional overeating and restrained eating in children (p-values for trend <.01). Specifically, mothers who reported that their child experienced 3+ adverse life events, also reported significantly higher emotional overeating (B = 0.20; 95% confidence interval [CI], 0.06-0.33) and restrained eating (B = 0.21; 95% CI, 0.08-0.33) in their children relative to children who did not experience adverse life events. These results did not differ by sex. DISCUSSION Our results based on mother-reported data suggest that children's experiences of life adversities are associated with emotional overeating and restrained eating at age 10 years. We recommend future prospective studies using multi-informant assessments of both adverse life events and eating behaviors to further describe the nature and developmental course of this relationship.
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Affiliation(s)
- Robin Thomas
- Department of Child and Adolescent Psychiatry/PsychologyErasmus MC‐University Medical CenterRotterdamThe Netherlands,Department of Public HealthUniversity of TorinoTorinoItaly
| | | | - Manon H. Hillegers
- Department of Child and Adolescent Psychiatry/PsychologyErasmus MC‐University Medical CenterRotterdamThe Netherlands
| | - Pauline W. Jansen
- Department of Child and Adolescent Psychiatry/PsychologyErasmus MC‐University Medical CenterRotterdamThe Netherlands,Department of Psychology, Education, and Child StudiesErasmus University RotterdamRotterdamThe Netherlands
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14
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" eLoriCorps Immersive Body Rating Scale": Exploring the Assessment of Body Image Disturbances from Allocentric and Egocentric Perspectives. J Clin Med 2020; 9:jcm9092926. [PMID: 32927847 PMCID: PMC7564525 DOI: 10.3390/jcm9092926] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 12/27/2022] Open
Abstract
The first objective of this study was to test the convergent and discriminant validity between the “eLoriCorps Immersive Body Rating Scale” and the traditional paper-based figure rating scale (FRS). The second objective was to explore the contribution of the egocentric virtual reality (VR) perspective of eLoriCorps to understanding body image disturbances (BIDs). The sample consisted of 53 female and 13 male adults. Body size dissatisfaction, body size distortion, perceived body size, and ideal body size were assessed. Overall, outcomes showed good agreement between allocentric perspectives as measured via VR and the FRS. The egocentric VR perspective produced different results compared to both the allocentric VR perspective and the FRS. This difference revealed discriminant validity and suggested that eLoricorps’ egocentric VR perspective might assess something different from the traditional conception of body dissatisfaction, which an allocentric VR perspective generally assesses. Finally, the egocentric VR perspective in assessing BIDs deserves to be studied more extensively to explore the possibility of finding two types of body image distortion: (a) an egocentric perceptual body distortion, referring to internal body sensation affected by intra-individual changes, and (b) an allocentric perceptual body distortion, referring to external body benchmarks constructed by inter-individual comparison occurring in a given cultural context.
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15
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The role of thin-idealization in associations between body dissatisfaction, dieting, and eating pathology: A moderated mediation analysis. CURRENT PSYCHOLOGY 2020. [DOI: 10.1007/s12144-017-9776-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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16
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Todd J, Aspell JE, Barron D, Swami V. An exploration of the associations between facets of interoceptive awareness and body image in adolescents. Body Image 2019; 31:171-180. [PMID: 31654981 DOI: 10.1016/j.bodyim.2019.10.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 10/06/2019] [Accepted: 10/06/2019] [Indexed: 11/17/2022]
Abstract
Previous research suggests that lower interoceptive awareness is associated with more negative body image during adolescence. However, studies have not distinguished between adaptive and maladaptive modes of attention toward interoceptive signals, and relationships between interoceptive awareness and positive body image remain unexplored. To address these issues, a sample of 265 British adolescents (140 girls, 125 boys) aged 13-16 years completed measures of interoceptive awareness, body appreciation, functionality appreciation, body pride, body shame, and body surveillance. Correlational analyses broadly indicated that greater interoceptive awareness was significantly associated with more positive body image. Multiple regressions revealed significant predictive relationships between interoceptive awareness and all facets of body image in both girls and boys, except body surveillance, which was not statistically significant for girls. At the univariate level, the interoceptive awareness facets of Attention Regulation, Body Listening, Self-Regulation, and Trusting emerged as significant predictors for at least one facet of positive body image, whilst the Noticing and Emotional Awareness facets did not. These findings broadly align with previous research with adults, which has indicated that the way interoceptive stimuli are appraised and responded to might be more closely associated with facets of body image than the tendency to notice interoceptive stimuli.
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Affiliation(s)
- Jennifer Todd
- School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, UK.
| | - Jane E Aspell
- School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, UK
| | - David Barron
- Centre for Psychological Medicine, Perdana University, Serdang, Malaysia
| | - Viren Swami
- School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, UK; Centre for Psychological Medicine, Perdana University, Serdang, Malaysia
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17
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Rancourt D, Foster N, Bollepalli S, Fitterman-Harris HF, Powers MA, Clements M, Smith LB. Test of the modified dual pathway model of eating disorders in individuals with type 1 diabetes. Int J Eat Disord 2019; 52:630-642. [PMID: 30802993 DOI: 10.1002/eat.23054] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/11/2019] [Accepted: 02/12/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Adolescents and young adults with type 1 diabetes (T1D) demonstrate high rates of disordered eating behaviors (DEBs) and may experience physiological and psychological vulnerabilities not currently included in established risk models of DEBs. This study examined associations among constructs included in the recently proposed T1D-specific modified dual pathway model and examined age as a moderator of these associations. METHOD Participants included adolescents (n = 307; age M = 15.71, SD = 1.33), young adults (n = 313; age M = 21.20, SD = 2.10), and adults (n = 198; age M = 30.51, SD = 2.81) recruited via the T1D Exchange Clinic Registry. Data were collected from participants' medical records and from self-report questionnaires assessing dietary regimen, dietary restraint, body dissatisfaction, hunger/satiety, diabetes-specific negative affect, and DEBs. Multiple group path modeling was used to test hypotheses. RESULTS Approximately 31% of participants were at risk for an eating disorder. The original modified dual pathway model had poor model fit. The addition of three empirically defensible paths improved model fit. Diabetes-specific dietary regimen, diabetes-specific negative affect, and hunger/satiety disruption all were associated with DEBs. A fully varying multiple group model by age fit best; however, only the dietary restraint to DEBs pathway demonstrated a distinct pattern across age cohort, which attenuated from the adolescent to the adult cohort. DISCUSSION This study provides preliminary support for associations proposed in the modified dual pathway model and suggests potential for intervening on disease-specific risk factors of DEBs in a T1D population.
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Affiliation(s)
- Diana Rancourt
- Department of Psychology, University of South Florida, Tampa, Florida
| | | | - Sureka Bollepalli
- Department of Pediatrics, University of South Florida Diabetes Center, Tampa, Florida
| | | | - Margaret A Powers
- International Diabetes Center at Park Nicollet, Minneapolis, Minnesota
| | - Mark Clements
- Children's Mercy Hospital, University of Missouri-Kansas City, Kansas City, Missouri
| | - Laura B Smith
- Department of Pediatrics, University of South Florida Diabetes Center, Tampa, Florida
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18
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Forney KJ, Schwendler T, Ward RM. Examining similarities in eating pathology, negative affect, and perfectionism among peers: A social network analysis. Appetite 2019; 137:236-243. [PMID: 30872142 DOI: 10.1016/j.appet.2019.03.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/25/2019] [Accepted: 03/07/2019] [Indexed: 01/23/2023]
Abstract
Friends tend to be more similar than non-friends (i.e., exhibit homophily) in body image concerns and disordered eating behaviors. These similarities may be accounted for by similarities in eating disorder risk factors and correlates. The current study sought to replicate findings of homophily for eating pathology using social network analysis and to test if similarity in eating pathology is present above and beyond homophily for eating disorder risk factors and correlates. College students (n = 89) majoring in nutrition completed a social network assessment and measures of eating pathology (i.e., body dissatisfaction, binge eating, restricting, excessive exercise), negative affect, and perfectionism. Homophily for eating pathology, negative affect, and perfectionism were tested as predictors of friendship ties using exponential random graph modeling, adjusting for gender, year in school, and body mass index. Results did not support homophily for eating pathology. However, restricting was associated with a lower likelihood of friendship ties. Homophily was present for perfectionism, but not for negative affect. Results suggest that eating pathology may influence the propensity to form friendships and account for previous findings of homophily in the literature. Homophily for perfectionism may have also driven previous findings for homophily. More longitudinal work using social network analysis is needed to understand the role that personality plays in peer influences on eating pathology.
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Affiliation(s)
- K Jean Forney
- Department of Psychology, Florida State University, 1107 W Call St, Tallahassee, FL, 32306, USA; Department of Psychology, Ohio University, 200 Porter Hall, Athens, OH, 45701, USA.
| | - Teresa Schwendler
- Department of Kinesiology and Health, Miami University, 106 Phillips Hall, Oxford, OH, 45056, USA
| | - Rose Marie Ward
- Department of Kinesiology and Health, Miami University, 106 Phillips Hall, Oxford, OH, 45056, USA.
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19
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Hoffmann S, Warschburger P. Prospective relations among internalization of beauty ideals, body image concerns, and body change behaviors: Considering thinness and muscularity. Body Image 2019; 28:159-167. [PMID: 30731427 DOI: 10.1016/j.bodyim.2019.01.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 01/27/2019] [Accepted: 01/27/2019] [Indexed: 01/23/2023]
Abstract
Common models propose that the internalization of societal beauty ideals influences disordered eating behaviors and muscularity-oriented behaviors via body image concerns. However, previous studies addressing these pathways have been mainly cross-sectional and primarily included female samples. We investigated these pathways prospectively in male and female adolescents and young adults, examining two pathways: a 'weight/shape pathway,' linking thin-ideal internalization, weight/shape concern, and restrained eating, and a 'muscularity pathway,' linking athletic-ideal internalization, muscularity concern, and muscularity-oriented behavior. Across three time points, 973 participants from the German general population were assessed. Although the hypothesized pathways could not be supported in their complete temporal sequence, several hypothesized pathways occurred across two time points. Among others, weight/shape concern predicted restrained eating and the athletic ideal played a prominent role in the prediction of muscularity-oriented behavior in both genders.
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Affiliation(s)
- Svenja Hoffmann
- Department of Psychology, University of Potsdam, Karl-Liebknecht-Straße 24/25, 14476 Potsdam, Germany.
| | - Petra Warschburger
- Department of Psychology, University of Potsdam, Karl-Liebknecht-Straße 24/25, 14476 Potsdam, Germany.
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20
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Corno G, Serino S, Cipresso P, Baños RM, Riva G. Assessing the Relationship Between Attitudinal and Perceptual Component of Body Image Disturbance Using Virtual Reality. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2019; 21:679-686. [PMID: 30421995 DOI: 10.1089/cyber.2018.0340] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Body image disturbance (BID) affects quality of life even in the absence of clinically diagnosable eating pathology, and numerous studies have shown its crucial role in the emergence and maintenance of eating disorders. This study aimed at exploring attitudinal and perceptual components of BID using a novel virtual reality (VR)-based paradigm. A community sample of women (N = 27) recreated in VR their perceived body in both an allocentric (third-person view) and egocentric (first-person view) perspective. Specifically, women were able to choose between a wide range of three-dimensional bodies spanning body mass index 12.5-42.5 kg/m2. Attitudinal indexes of BID (body dissatisfaction, body uneasiness, and body image avoidance) were assessed through questionnaires. Attitudinal components predicted the perceptual BID only in the allocentric perspective. Specifically, overestimation was predicted by body image avoidance, while underestimation was predicted by body uneasiness. Furthermore, a common predictor of underestimation and overestimation was body dissatisfaction. In line with the allocentric lock hypothesis, the current results seem to confirm the presence of two different mechanisms underlying BID: one related to real-time perception-driven inputs (egocentric frame) and one related to abstract knowledge, beliefs, and attitudes related to a person's body (allocentric frame). These findings contribute to a better understanding of the nature and mechanisms underlying BID and provide additional evidence about the suitability of using VR for exploring and assessing body image-related components and disturbances.
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Affiliation(s)
- Giulia Corno
- 1 Applied Technology for Neuro-Psychology Lab, I.R.C.C.S. Istituto Auxologico Italiano , Milan, Italy
| | - Silvia Serino
- 1 Applied Technology for Neuro-Psychology Lab, I.R.C.C.S. Istituto Auxologico Italiano , Milan, Italy .,2 Department of Psychology, Università Cattolica del Sacro Cuore , Milan, Italy
| | - Pietro Cipresso
- 1 Applied Technology for Neuro-Psychology Lab, I.R.C.C.S. Istituto Auxologico Italiano , Milan, Italy .,2 Department of Psychology, Università Cattolica del Sacro Cuore , Milan, Italy
| | - Rosa M Baños
- 3 Departamento Personalidad, Evaluación y Tratamientos Psicológicos, Universitat de Valencia , Valencia, Spain .,4 CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health , Madrid, Spain
| | - Giuseppe Riva
- 1 Applied Technology for Neuro-Psychology Lab, I.R.C.C.S. Istituto Auxologico Italiano , Milan, Italy .,2 Department of Psychology, Università Cattolica del Sacro Cuore , Milan, Italy
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21
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Black EB, Garratt M, Beccaria G, Mildred H, Kwan M. Body image as a predictor of nonsuicidal self-injury in women: A longitudinal study. Compr Psychiatry 2019; 88:83-89. [PMID: 30529911 DOI: 10.1016/j.comppsych.2018.11.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/19/2018] [Accepted: 11/21/2018] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES To determine whether Body Image Dissatisfaction (BID) predicted NonSuicidal Self-Injury (NSSI) cross-sectionally and longitudinally, independent of comorbidity between NSSI and Disordered Eating (DE). Another aim was to determine whether BID could predict number of NSSI methods present. METHOD Adult females completed measures of NSSI and DE (n = 283); and a longitudinal sample (n = 106) completed these measures again one year later. RESULTS BID was a small yet significant predictor of NSSI both cross-sectionally and longitudinally. Poorer BID significantly explained a greater number of NSSI methods cross-sectionally and longitudinally. CONCLUSIONS BID explains unique variance in NSSI (including increased number of methods), and is not a function of comorbidity with DE. This has the potential to influence theory, as well as inform early intervention initiatives for BID in females. Further research is required to determine other variables implicated in this relationship, as well as whether these findings are applicable to other groups such as adolescents and males.
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Affiliation(s)
- Emma B Black
- The University of Queensland, Australia; Deakin University, Australia.
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22
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Puccio F, Fuller-Tyszkiewicz M, Buck K, Krug I. Negative urgency and the dual pathway model of bulimic symptoms: A longitudinal analysis. EUROPEAN EATING DISORDERS REVIEW 2018; 27:34-48. [PMID: 30318838 DOI: 10.1002/erv.2647] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/29/2018] [Accepted: 09/16/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study extends the dual pathway model (DPM) of bulimic symptoms by considering the bidirectional effects amongst symptoms of depression, dietary restraint, and bulimia. We also assessed the influence of negative urgency, a personality construct associated with bulimic symptoms, on the DPM. METHOD Participants were 244 females (Mage = 23.77 years) from the general community. Variables pertinent to the DPM as well as negative urgency were assessed at baseline, and symptoms of depression, dietary restraint, and bulimia were reassessed at 1-month follow-up. RESULTS Excellent model fit was obtained once modifications were made to the DPM and the extended model that included negative urgency. Cross-sectional paths replicated the DPM as hypothesized, with the exception that time 1 (T1) body mass index failed to predict T1 body dissatisfaction. Although no bidirectional effects were observed, T1 depression predicted dietary restraint at time 2 (T2). Negative urgency was shown to provide incremental predictive utility of T1 pressure to be thin, T1 body dissatisfaction, and T1 and T2 depression. CONCLUSION Findings lend support to the DPM and suggest that depression might be a risk factor for later dietary restraint. The results are also consistent with the notion that negative urgency may be an independent risk factor for symptoms of bulimia. However, short-term longitudinal effects of these putative risk factors require further evaluation.
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Affiliation(s)
- Francis Puccio
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology, Deakin University, Geelong, Victoria, Australia.,Center for Social and Early Emotional Development, Deakin University, Geelong, Victoria, Australia
| | - Kimberly Buck
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Advance Care Planning Australia, Austin Health, Heidelberg, Victoria, Australia
| | - Isabel Krug
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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23
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An ecological momentary assessment of the effect of fasting during Ramadan on disordered eating behaviors. Appetite 2018; 127:44-51. [DOI: 10.1016/j.appet.2018.04.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 04/09/2018] [Accepted: 04/22/2018] [Indexed: 11/16/2022]
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24
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Riva G, Dakanalis A. Altered Processing and Integration of Multisensory Bodily Representations and Signals in Eating Disorders: A Possible Path Toward the Understanding of Their Underlying Causes. Front Hum Neurosci 2018; 12:49. [PMID: 29483865 PMCID: PMC5816057 DOI: 10.3389/fnhum.2018.00049] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 01/26/2018] [Indexed: 01/25/2023] Open
Abstract
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM V) eating problems are the clinical core of eating disorders (EDs). However, the importance of shape and weight overvaluation symptoms in these disorders underlines the critical role of the experience of the body in the etiology of EDs. This article suggests that the transdiagnostic centrality of these symptoms in individuals with EDs may reflect a deficit in the processing and integration of multisensory bodily representations and signals. Multisensory body integration is a critical cognitive and perceptual process, allowing the individual to protect and extend her/his boundaries at both the homeostatic and psychological levels. To achieve this goal the brain integrates sensory data arriving from real-time multiple sensory modalities and internal bodily information with predictions made using the stored information about the body from conceptual, perceptual, and episodic memory. In this view the emotional, visual, tactile, proprioceptive and interoceptive deficits reported by many authors in individuals with EDs may reflect a broader impairment in multisensory body integration that affects the individual's abilities: (a) to identify the relevant interoceptive signals that predict potential pleasant (or aversive) consequences; and (b) to modify/correct the autobiographical allocentric (observer view) memories of body related events (self-objectified memories). Based on this view, the article also proposes a strategy, based on new technologies (i.e., virtual reality and brain/body stimulation), for using crossmodal associations to reactivate and correct the multisensory body integration processes.
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Affiliation(s)
- Giuseppe Riva
- Centro Studi e Ricerche di Psicologia della Comunicazione, Università Cattolica del Sacro Cuore, Milan, Italy
- Applied Technology for Neuro-Psychology Laboratory, Istituto Auxologico Italiano (IRCCS), Milan, Italy
| | - Antonios Dakanalis
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Milan, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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25
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Goldschmidt AB, Lavender JM, Hipwell AE, Stepp SD, Keenan K. Examining Two Prevailing Models of Loss of Control Eating Among Community-Based Girls. Obesity (Silver Spring) 2018; 26:420-425. [PMID: 29280308 PMCID: PMC5783779 DOI: 10.1002/oby.22101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 11/28/2017] [Accepted: 11/28/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Cognitive-behavioral and interpersonal models of loss of control (LOC) eating have been underexplored in adolescents. METHODS By using data from community-based adolescent girls assessed annually over 4 years, the cognitive-behavioral (n = 416) and interpersonal (n = 418) models were examined by using a regression-based bootstrapping approach. RESULTS Body dissatisfaction at 14 years prospectively predicted LOC eating at 18 years, both directly (direct effect = -0.039; SE = 0.017; P = 0.02) and indirectly via dieting (indirect effect = -0.010; 95% CI: -0.022 to -0.003). Interpersonal functioning at 14 years was negatively associated with negative emotionality at 17 years, which, in turn, was prospectively associated with LOC eating at 18 years (indirect effect = 0.001; 95% CI: -0.001 to -0.0003); however, the direct association between age 14 interpersonal functioning and age 18 LOC eating was not significant (direct effect = -0.001; SE = 0.001; P = 0.47). CONCLUSIONS These findings support the cognitive-behavioral model, and partially support the interpersonal model, with the latter findings implying that over time, negative emotionality may promote LOC eating independent of the effects of prior social functioning. Prevention and early intervention efforts for LOC eating may benefit from integrating these theoretical frameworks.
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Affiliation(s)
- Andrea B. Goldschmidt
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University/The Miriam Hospital, Providence, RI, USA
| | - Jason M. Lavender
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Alison E. Hipwell
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Stephanie D. Stepp
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kate Keenan
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
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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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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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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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Duarte C, Pinto-Gouveia J. The impact of early shame memories in Binge Eating Disorder: The mediator effect of current body image shame and cognitive fusion. Psychiatry Res 2017; 258:511-517. [PMID: 28890226 DOI: 10.1016/j.psychres.2017.08.086] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 06/28/2017] [Accepted: 08/25/2017] [Indexed: 10/18/2022]
Abstract
This study examined the phenomenology of shame experiences from childhood and adolescence in a sample of women with Binge Eating Disorder. Moreover, a path analysis was investigated testing whether the association between shame-related memories which are traumatic and central to identity, and binge eating symptoms' severity, is mediated by current external shame, body image shame and body image cognitive fusion. Participants in this study were 114 patients, who were assessed through the Eating Disorder Examination and the Shame Experiences Interview, and through self-report measures of external shame, body image shame, body image cognitive fusion and binge eating symptoms. Shame experiences where physical appearance was negatively commented or criticized by others were the most frequently recalled. A path analysis showed a good fit between the hypothesised mediational model and the data. The traumatic and centrality qualities of shame-related memories predicted current external shame, especially body image shame. Current shame feelings were associated with body image cognitive fusion, which, in turn, predicted levels of binge eating symptomatology. Findings support the relevance of addressing early shame-related memories and negative affective and self-evaluative experiences, namely related to body image, in the understanding and management of binge eating.
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Affiliation(s)
- Cristiana Duarte
- CINEICC - Cognitive and Behavioural Centre for Research and Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal.
| | - José Pinto-Gouveia
- CINEICC - Cognitive and Behavioural Centre for Research and Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal
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Eating behavior style predicts craving and anxiety experienced in food-related virtual environments by patients with eating disorders and healthy controls. Appetite 2017; 117:284-293. [DOI: 10.1016/j.appet.2017.07.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 06/22/2017] [Accepted: 07/10/2017] [Indexed: 12/26/2022]
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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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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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The dual-pathway model of binge eating: Is there a need for modification? Appetite 2017; 114:137-145. [DOI: 10.1016/j.appet.2017.03.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 11/22/2016] [Accepted: 03/20/2017] [Indexed: 01/19/2023]
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Cirasola A, Hillman S, Fonagy P, Chiesa M. Mapping the road from childhood adversity to personality disorder: The role of unresolved states of mind. Personal Ment Health 2017; 11:77-90. [PMID: 28101905 DOI: 10.1002/pmh.1365] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 12/01/2016] [Accepted: 12/12/2016] [Indexed: 11/10/2022]
Abstract
Childhood adversity has been found to be an important aetiological factor in the development of personality disorder (PD) in several studies. However, the role of disorganized attachment with unresolved mental states for traumatic experiences requires further investigation. This study explores the relationship between childhood adversities, unresolved states of mind, PD diagnosis and psychiatric distress. Two hundred forty-five adult participants, 124 from a clinical PD group and 121 non-psychiatric controls were assessed using the Structured Clinical Interview for DSM-IV, the Cassel Baseline Questionnaire, the Symptom Checklist-90-R and the Adult Attachment Interview, in order to ascertain presence of PD, childhood adversity, level of psychiatric distress and unresolved states of mind. Within the overall unresolved (U-overall) attachment category, a distinction was made between unresolved for abuse (U-abuse) and unresolved for loss (U-loss). The results indicated that childhood adversity was significantly associated with unresolved states of mind, as well as with overall PD diagnosis, paranoid PD, borderline PD, avoidant PD and psychiatric distress. Mediation analyses confirmed that U-overall and U-loss were significant mediators between childhood adversity and PD diagnoses, but surprisingly, U-abuse was not a significant mediator. The strength, limitations and clinical implications of the findings are discussed. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Antonella Cirasola
- Child Attachment and Psychological Therapies Research Unit, The Anna Freud Centre and University College London, London, UK
| | | | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Marco Chiesa
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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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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36
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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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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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38
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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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Abstract
Stigmatizing attitudes toward eating disorders (EDs) may lead to reduced treatment seeking. We aimed to estimate the prevalence of stigmatizing trends and beliefs related to anorexia nervosa (AN) and bulimia nervosa (BN), and the associations with the experiential knowledge of the problem, in a large sample of Italian undergraduates. A total of 2109 participants completed an online survey including questionnaires related to stigmatizing beliefs toward AN and BN, and personal contacts with people with EDs. Undergraduates reported almost overlapping low levels of stigmatizing trends for AN and BN, apart from personal responsibility and social distance. Those aged 18 to 25 and living with family held higher stigmatizing attitudes. Stigma was lower in underweight participants and in those (12%) reporting a previous ED diagnosis. Although not improving stigmatizing attitudes, 83% of the sample was familiar with people with an ED. Antistigma actions to increase awareness on EDs and to improve treatment-seeking behaviors are needed.
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40
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A revised examination of the dual pathway model for bulimic symptoms: The importance of social comparisons made on Facebook and sociotropy. COMPUTERS IN HUMAN BEHAVIOR 2016. [DOI: 10.1016/j.chb.2016.08.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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41
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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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Krug I, King RM, Youssef GJ, Sorabji A, Wertheim EH, Le Grange D, Hughes EK, Letcher P, Olsson CA. The effect of low parental warmth and low monitoring on disordered eating in mid-adolescence: Findings from the Australian Temperament Project. Appetite 2016; 105:232-41. [PMID: 27212673 DOI: 10.1016/j.appet.2016.05.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 05/13/2016] [Accepted: 05/15/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate the interactions between low parental warmth and monitoring at age 13-14 years and disordered eating attitudes and behaviours at age 15-16 years. METHOD Data on 1300 (667 females) adolescents and their parents were drawn from The Australian Temperament Project (ATP), a 30 year (15 wave) population based longitudinal study of social-emotional development. Parent participants completed surveys on parenting practices in late childhood, and adolescent participants reported disordered eating using the drive for thinness and bulimia subscales of the Eating Disorder Inventory (EDI) and an additional body dissatisfaction scale. Interaction was examined on the additive scale by estimating super-additive risk; i.e., risk in excess of the sum of individual risks. RESULTS For boys, neither parental warmth or monitoring, nor their interaction, was related to disordered eating. For girls, low parental warmth (alone) was associated with bulimic behaviours. In contrast, exposure to both low monitoring and warmth was associated with ∼3½-fold, ∼4-fold and ∼5-fold increases in the odds of reporting body dissatisfaction, drive for thinness and bulimia, respectively. For body dissatisfaction and drive for thinness, risk associated with joint exposure exceeded the sum of individual risks, suggesting an additive interaction between parenting styles. CONCLUSION Further investment in family-level interventions that focus on promoting parental monitoring behaviour and a warm parent-child relationship remain important strategies for preventing a range of disordered eating behaviours in adolescents.
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Affiliation(s)
- Isabel Krug
- Melbourne School of Psychological Sciences, The University of Melbourne, Victorian Australia, 14-20 Blackwood Street, VIC, 3010, Melbourne, Australia.
| | - Ross M King
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - George J Youssef
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia; Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | - Anisha Sorabji
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Eleanor H Wertheim
- School of Psychology and Public Health, La Trobe University, Plenty Road & Kingsbury Drive, Melbourne, Bundoora, VIC, 3086, Australia
| | - Daniel Le Grange
- Department of Psychiatry and Department of Pediatrics, University of California, San Francisco, 3333 California Street, Box 0503, LH Suite 245, San Francisco, CA, 94143-0503, USA
| | - Elizabeth K Hughes
- Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, 50 Flemington Rd, Parkville, VIC, 3052, Australia; Department of Paediatrics, The University of Melbourne, The Royal Children's Hospital Melbourne, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | - Primrose Letcher
- Department of Paediatrics, The University of Melbourne, The Royal Children's Hospital Melbourne, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | - Craig A Olsson
- Melbourne School of Psychological Sciences, The University of Melbourne, Victorian Australia, 14-20 Blackwood Street, VIC, 3010, Melbourne, Australia; Centre for Social and Early Emotional Development, School of Psychology, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia; Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, 50 Flemington Rd, Parkville, VIC, 3052, Australia; Department of Paediatrics, The University of Melbourne, The Royal Children's Hospital Melbourne, 50 Flemington Rd, Parkville, VIC, 3052, Australia
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Applicability of the dual pathway model in normal and overweight binge eaters. Body Image 2016; 18:162-7. [PMID: 27479739 DOI: 10.1016/j.bodyim.2016.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 06/19/2016] [Accepted: 06/22/2016] [Indexed: 12/30/2022]
Abstract
Binge eating is a significant problem in both eating disordered and community populations alike. Extensive support exists for the dual pathway model of binge eating in both adolescent and adult clinical and nonclinical populations. However, the restrained eating pathway to binge eating in particular has failed to be confirmed in some studies. In particular, the dual pathway model may not be applicable to overweight binge eaters. The current study examined the applicability of the dual pathway model in a sample of healthy and overweight binge eaters. A total of 260 (115 healthy weight; 145 overweight or obese) adult binge eaters completed an online survey. Mediation analyses indicated support for both the dietary restraint and negative affect pathways in the healthy weight sample but only the latter pathway was supported in the overweight sample. Therefore, the full dual pathway model may only be applicable to healthy weight binge eaters.
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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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45
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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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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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Pennesi JL, Wade TD. A systematic review of the existing models of disordered eating: Do they inform the development of effective interventions? Clin Psychol Rev 2016; 43:175-92. [PMID: 26781985 DOI: 10.1016/j.cpr.2015.12.004] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 11/09/2015] [Accepted: 12/20/2015] [Indexed: 12/21/2022]
Abstract
Despite significant advances in the development of prevention and treatment interventions for eating disorders and disordered eating over the last decade, there still remains a pressing need to develop more effective interventions. In line with the 2008 Medical Research Council (MRC) evaluation framework from the United Kingdom for the development and evaluation of complex interventions to improve health, the development of sound theory is a necessary precursor to the development of effective interventions. The aim of the current review was to identify the existing models for disordered eating and to identify those models which have helped inform the development of interventions for disordered eating. In addition, we examine the variables that most commonly appear across these models, in terms of future implications for the development of interventions for disordered eating. While an extensive range of theoretical models for the development of disordered eating were identified (N=54), only ten (18.5%) had progressed beyond mere description and to the development of interventions that have been evaluated. It is recommended that future work examines whether interventions in eating disorders increase in efficacy when developed in line with theoretical considerations, that initiation of new models gives way to further development of existing models, and that there be greater utilisation of intervention studies to inform the development of theory.
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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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Disentangling the Association Between Child Abuse and Eating Disorders: A Systematic Review and Meta-Analysis. Psychosom Med 2016; 78:79-90. [PMID: 26461853 DOI: 10.1097/psy.0000000000000233] [Citation(s) in RCA: 175] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The aim of this systematic review and meta-analysis was to estimate the association between distinct types of child abuse--sexual (CSA), physical (CPA), and emotional (CEA)--and different eating disorders (EDs). METHODS Electronic databases were searched through January 2014. Studies reporting rates of CSA, CPA, and CEA in people with anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED), as compared with individuals without EDs, were included. Pooled analyses were based on odds ratios (ORs), with relevant 95% confidence intervals (CIs), weighting each study with inverse variance models with random effects. Risk of publication bias was estimated. RESULTS Thirty-two of 1714 studies assessed for eligibility met the inclusion criteria, involving more than 14,000 individuals. The association between EDs and any child abuse showed a random-effects pooled OR of 3.21 (95% CI = 2.29-4.51, p < .001) with moderate heterogeneity (I2 = 57.2%, p = .005), whereas for CSA, this was 1.92 (95% CI = 1.13-3.28, p = .017), 2.73 (95% CI = 1.96-3.79, p < .001), and 2.31 (95% CI = 1.66-3.20, p < .001), for AN, BN, and BED, respectively. However, adjusting for publication bias, the estimate for CSA and AN was not significant (OR = 1.06, 95% CI = 0.59-1.88, p = .85). Although CPA was associated with AN, BN, and BED, CEA was associated just with BN and BED. CONCLUSIONS BN and BED are associated with childhood abuse, whereas AN shows mixed results. Individuals with similar trauma should be monitored for early recognition of EDs. TRIAL REGISTRATION The protocol was registered in PROSPERO (an international prospective register of systematic reviews) with the reference number CRD42014007360.
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Dakanalis A, Carrà G, Calogero R, Zanetti MA, Gaudio S, Caccialanza R, Riva G, Clerici M. Testing the cognitive-behavioural maintenance models across DSM-5 bulimic-type eating disorder diagnostic groups: a multi-centre study. Eur Arch Psychiatry Clin Neurosci 2015; 265:663-76. [PMID: 25416408 DOI: 10.1007/s00406-014-0560-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 11/07/2014] [Indexed: 12/23/2022]
Abstract
The original cognitive-behavioural (CB) model of bulimia nervosa, which provided the basis for the widely used CB therapy, proposed that specific dysfunctional cognitions and behaviours maintain the disorder. However, amongst treatment completers, only 40-50 % have a full and lasting response. The enhanced CB model (CB-E), upon which the enhanced version of the CB treatment was based, extended the original approach by including four additional maintenance factors. This study evaluated and compared both CB models in a large clinical treatment seeking sample (N = 679), applying both DSM-IV and DSM-5 criteria for bulimic-type eating disorders. Application of the DSM-5 criteria reduced the number of cases of DSM-IV bulimic-type eating disorders not otherwise specified to 29.6 %. Structural equation modelling analysis indicated that (a) although both models provided a good fit to the data, the CB-E model accounted for a greater proportion of variance in eating-disordered behaviours than the original one, (b) interpersonal problems, clinical perfectionism and low self-esteem were indirectly associated with dietary restraint through over-evaluation of shape and weight, (c) interpersonal problems and mood intolerance were directly linked to binge eating, whereas restraint only indirectly affected binge eating through mood intolerance, suggesting that factors other than restraint may play a more critical role in the maintenance of binge eating. In terms of strength of the associations, differences across DSM-5 bulimic-type eating disorder diagnostic groups were not observed. The results are discussed with reference to theory and research, including neurobiological findings and recent hypotheses.
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Affiliation(s)
- Antonios Dakanalis
- Department of Brain and Behavioral Sciences, University of Pavia, P.za Botta 11, 27100, Pavia, Italy.
| | - Giuseppe Carrà
- Division of Psychiatry, Faculty of Brain Sciences, University College of London, Gower Street, London, WC1E 6BT, UK
| | - Rachel Calogero
- School of Psychology, University of Kent, Canterbury, Kent, CT2 7NZ, UK
| | - Maria Assunta Zanetti
- Department of Brain and Behavioral Sciences, University of Pavia, P.za Botta 11, 27100, Pavia, Italy
| | - Santino Gaudio
- Centre for Integrated Research, Area of Diagnostic Imaging, University "Campus Bio-Medico di Roma", Via Pietro Tacchini 24, 00197, Rome, Italy
| | - Riccardo Caccialanza
- Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 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 Neurosciences and Biomedical Technologies, University of Milano-Bicocca, Medical School, Via Cadore, 48, 20052, Monza, Italy
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