1
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Simonazzi C, Natali L, Valmaggia L, Rowlands K, Meregalli V, Rabarbari E, De Luca Comandini A, Favaro A, Fontana F, Treasure J, Cardi V. Food-related aversion in a female sample of people with anorexia nervosa: Cognitive-behavioural correlates, somatic and subjective anxiety, and early experiences. Appetite 2023; 180:106366. [PMID: 36356912 DOI: 10.1016/j.appet.2022.106366] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/11/2022] [Accepted: 11/05/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Food-related anxiety and avoidance are key features of anorexia nervosa, and among the most arduous maintaining processes to address in treatment. This study gathered information on the behavioural and cognitive correlates of food-related anxiety, including their associations with early experiences of aversive learning related to food, and more general anxiety. METHODS One-hundred and forty-four patients with anorexia nervosa were recruited from clinical services in Italy. They completed online questionnaires to assess food-related anxiety, eating disorder psychopathology, eating disorder safety behaviours and threat cognitions, early experience of aversive learning related to food, and somatic anxiety. RESULTS Experiences of food-related aversive learning were recalled by the majority of the sample (87.86%), with negative psychological consequences following eating being the most often reported (75%). Safety behaviours and threat cognitions related to the consequences of eating were also reported (14.29%-87.86%, and 36.43-90% respectively, depending on the behaviour/cognition). Eating disorder psychopathology was predicted by both somatic anxiety and negative psychological consequences following eating, whereas self-reported food anxiety was only predicted by somatic anxiety. CONCLUSION Findings validate an anxiety-based model of anorexia nervosa which establishes the role of safety behaviours, threat cognitions, early aversive learning experiences, and anxiety in the psychopathology of the illness. Exposure-based interventions have the potential to target these factors, and inhibit food-related fear.
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Affiliation(s)
| | - Ludovica Natali
- University of Padova, Department of General Psychology, Padova, Italy.
| | - Lucia Valmaggia
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, SE5 8AF, United Kingdom; South London and Maudsley NHS Foundation Trust, London, BR3 3BX, United Kingdom; KU Leuven, Department of Psychiatry, Belgium.
| | - Katie Rowlands
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, SE5 8AF, United Kingdom.
| | - Valentina Meregalli
- University of Padova, Department of Neuroscience, Padova, Italy; University of Padova, Padova Neuroscience Center, Padova, Italy.
| | - Elisa Rabarbari
- University of Padova, Department of General Psychology, Padova, Italy.
| | | | - Angela Favaro
- University of Padova, Department of Neuroscience, Padova, Italy; University of Padova, Padova Neuroscience Center, Padova, Italy.
| | - Francesca Fontana
- Centro Provinciale di Treviso per i Disturbi del Comportamento Alimentare, Aulss2 Marca Trevigiana, Treviso, Italy.
| | - Janet Treasure
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, SE5 8AF, United Kingdom.
| | - Valentina Cardi
- University of Padova, Department of General Psychology, Padova, Italy; King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, SE5 8AF, United Kingdom.
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2
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Christensen RE, Lewis M. The Development of Disgust and Its Relationship to Adolescent Psychosocial Functioning. Child Psychiatry Hum Dev 2022; 53:1309-1318. [PMID: 34164758 DOI: 10.1007/s10578-021-01208-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 11/28/2022]
Abstract
Experiences of excessive disgust have been implicated in several psychopathologies. Research, however, has rarely examined disgust and its role in psychosocial functioning from a developmental standpoint. This study examines the relationship between disgust expression in early life and subsequent adolescent psychosocial functioning. Data from 165 children were collected as part of a longitudinal study. Disgust propensity in infancy and childhood was assessed using a facial expressivity task and food aversion task, respectively. Adolescent psychosocial functioning was measured through several self-report measures. Results suggest that there exists a degree of consistency in disgust expression within the first year of life, and that childhood disgust propensity may be related to impairment in early adolescent psychosocial functioning. These findings highlight the potential importance of identifying early disgust expression as a marker for later psychopathology.
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Affiliation(s)
| | - Michael Lewis
- Institute for the Study of Child Development, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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3
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Manasse SM, Lampe EW, Srivastava P, Payne-Reichert A, Mason TB, Juarascio AS. Momentary associations between fear of weight gain and dietary restriction among individuals with binge-spectrum eating disorders. Int J Eat Disord 2022; 55:541-552. [PMID: 35088433 PMCID: PMC9377790 DOI: 10.1002/eat.23686] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 01/17/2022] [Accepted: 01/17/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Fear of weight gain (FOWG) is increasingly implicated in the maintenance of binge-spectrum eating disorders (EDs; e.g., bulimia nervosa [BN], binge-eating disorder [BED]) through the pathway of increased dietary restriction. However, particularly in binge-spectrum EDs, research is nascent and based on retrospective self-report. To improve treatment outcomes, it is critical to better understand the momentary relations between FOWG and dietary restriction. METHOD Sixty-seven adults with binge spectrum EDs completed a 7-14-day ecological momentary assessment protocol that included items regarding FOWG, ED behaviors, and types of dietary restriction (e.g., attempted restraint vs. actual restriction) several times per day. Multilevel models were used to evaluate reciprocal associations between FOWG and dietary restriction, and to evaluate the indirect of effects of dietary restriction on the relation between FOWG and binge eating. RESULTS While main effects were not statistically significant, ED presentation significantly moderated the association between increases in FOWG at time1 and both attempted and actual avoidance of enjoyable foods at time2 such that those with BN-spectrum EDs were more likely to avoid enjoyable foods following increased FOWG compared to those with BED-spectrum EDs. Engagement in restriction at time1 was not associated with decreased FOWG at time2. DISCUSSION Prospective associations between FOWG and restriction suggest that individuals with BN may be more likely to restrict their eating following increased FOWG. These findings suggest FOWG may be an important target for future treatments.
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Affiliation(s)
- Stephanie M Manasse
- Center for Weight Eating and Lifestyle Science (WELL Center), Drexel University, Philadelphia, Pennsylvania, USA
| | - Elizabeth W Lampe
- Center for Weight Eating and Lifestyle Science (WELL Center), Drexel University, Philadelphia, Pennsylvania, USA
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania, USA
| | - Paakhi Srivastava
- Center for Weight Eating and Lifestyle Science (WELL Center), Drexel University, Philadelphia, Pennsylvania, USA
| | - Adam Payne-Reichert
- Center for Weight Eating and Lifestyle Science (WELL Center), Drexel University, Philadelphia, Pennsylvania, USA
| | - Tyler B Mason
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Adrienne S Juarascio
- Center for Weight Eating and Lifestyle Science (WELL Center), Drexel University, Philadelphia, Pennsylvania, USA
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania, USA
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4
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Kim YK, Di Martino JM, Nicholas J, Rivera-Cancel A, Wildes JE, Marcus MD, Sapiro G, Zucker N. Parent strategies for expanding food variety: Reflections of 19,239 adults with symptoms of Avoidant/Restrictive Food Intake Disorder. Int J Eat Disord 2022; 55:108-119. [PMID: 34761436 PMCID: PMC8841112 DOI: 10.1002/eat.23639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 10/13/2021] [Accepted: 10/13/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To characterize helpful parent feeding strategies using reflections on childhood eating experiences of adults with symptoms of Avoidant/Restrictive Food Intake Disorder (ARFID). METHOD We explored a unique text-based dataset gathered from a population of N = 19,239 self-identified adult "picky eaters." The sample included adults with symptoms of ARFID as evidenced by marked interference in psychosocial functioning, weight loss/sustained low weight, and/or nutritional deficiency (likely ARFID), and non-ARFID participants. We leveraged state-of-the-art natural language processing (NLP) methods to classify feeding strategies that were perceived as helpful or not helpful. The best classifiers that distinguished helpful approaches were further analyzed using qualitative coding according to a grounded theory approach. RESULTS NLP reliably and accurately classified the perceived helpfulness of caregivers' feeding strategies (82%) and provided information about features of helpful parent strategies using recollections of adults with varying degrees of food avoidance. Strategies perceived as forceful were regarded as not helpful. Positive and encouraging strategies were perceived as helpful in improving attitudes toward food and minimizing social discomfort around eating. Although food variety improved, adults still struggled with a degree of avoidance/restriction. DISCUSSION Adults perceived that positive parent feeding strategies were helpful even though they continued to experience some degree of food avoidance. Creating a positive emotional context surrounding food and eating with others may help to eliminate psychosocial impairment and increase food approach in those with severe food avoidance. Nevertheless, additional tools to optimize parent strategies and improve individuals' capacity to incorporate avoided foods and cope with challenging eating situations are needed.
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Affiliation(s)
| | | | - Julia Nicholas
- Psychiatry and Behavioral Sciences, Duke University, USA
| | | | | | | | - Guillermo Sapiro
- Electrical and Computer Engineering, Duke University, USA,Computer Sciences, Duke University, USA,Biomedical Engineering, Duke University, USA,Mathematics, Duke University, USA
| | - Nancy Zucker
- Psychiatry and Behavioral Sciences, Duke University, USA,Psychology and Neuroscience, Duke University, USA
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5
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Chen B, Sun X, Xie F, Zhang M, Shen S, Chen Z, Yuan Y, Shi P, Qin X, Liu Y, Wang Y, Dai Q. Fear in the Chinese Population: Influential Patterns in the Early Stage of the COVID-19 Pandemic. Front Psychol 2021; 12:567364. [PMID: 34140908 PMCID: PMC8204111 DOI: 10.3389/fpsyg.2021.567364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 04/30/2021] [Indexed: 01/07/2023] Open
Abstract
Major global public health emergencies challenge public mental health. Negative emotions, and especially fear, may endanger social stability. To better cope with epidemics and pandemics, early emotional guidance should be provided based on an understanding of the status of public emotions in the given circumstances. From January 27 to February 11, 2020 (during which the cases of COVID-19 were increasing), a national online survey of the Chinese public was conducted. A total of 132,482 respondents completed a bespoke questionnaire, the Emotion Regulation Questionnaire, and the Berkeley Expressivity Questionnaire (BEQ). Results showed that at the early stage of the COVID-19 epidemic, 53.0% of the Chinese population reported varying degrees of fear, mostly mild. As seen from regression analysis, for individuals who were unmarried and with a relatively higher educational level, living in city or area with fewer confirmed cases, cognitive reappraisal, positive expressivity and negative inhibition were the protective factors of fear. For participants being of older age, female, a patient or medical staff member, risk perception, negative expressivity, positive impulse strength and negative impulse strength were the risk factors for fear. The levels of fear and avoidant behavior tendencies were risk factors for disturbed physical function. Structural equation modeling suggested that fear emotion had a mediation between risk perception and escape behavior and physical function disturbance. The findings help to reveal the public emotional status at the early stage of the pandemic based on a large Chinese sample, allowing targeting of the groups that most need emotional guidance under crisis. Findings also provide evidence of the need for psychological assistance in future major public health emergencies.
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Affiliation(s)
- Beijing Chen
- Department of Nursing Psychology, Army Medical University, Chongqing, China
| | - Xiaoxiao Sun
- Department of Nursing Psychology, Army Medical University, Chongqing, China
| | - Fei Xie
- Department of Nursing Psychology, Army Medical University, Chongqing, China
| | - Mengjia Zhang
- Department of Nursing Psychology, Army Medical University, Chongqing, China
| | - Sitong Shen
- Department of Nursing Psychology, Army Medical University, Chongqing, China
| | - Zhaohua Chen
- Department of Nursing Psychology, Army Medical University, Chongqing, China
| | - Yuan Yuan
- Department of Clinical Nursing, Southwest Hospital of Army Medical University, Chongqing, China
| | - Peixia Shi
- Department of Neurology, Xin Qiao Hospital of Army Medical University, Chongqing, China
| | - Xuemei Qin
- Department of Nursing Psychology, Army Medical University, Chongqing, China
| | - Yingzhe Liu
- Department of Neurology, The Hospital of 81st Group Army PLA, Zhang Jiakou, China
| | - Yuan Wang
- Department of Teaching and Research Support Center, Army Medical University, Chongqing, China
| | - Qin Dai
- Department of Nursing Psychology, Army Medical University, Chongqing, China,*Correspondence: Qin Dai,
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6
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Anderson LM, Berg H, Brown TA, Menzel J, Reilly EE. The Role of Disgust in Eating Disorders. Curr Psychiatry Rep 2021; 23:4. [PMID: 33404776 PMCID: PMC7895454 DOI: 10.1007/s11920-020-01217-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW In current review, we evaluate the current literature examining the role of disgust in eating disorders (EDs), and provide a theoretical model designed to inform the study and treatment of disgust-based symptoms in EDs. RECENT FINDINGS Findings from this review suggest that aberrant disgust-conditioning processes represent promising but understudied mechanisms that may contribute to the risk and maintenance of core eating disorder (ED) psychopathology. In addition, preliminary evidence supports the use of interventions designed to target aversive disgust cues and disrupt maladaptive disgust-based conditioning that may maintain eating pathology. However, experimental studies designed to elucidate the role of disgust and aversive learning processes remain limited. Disgust is a promising risk and maintenance factor in EDs. Future systematic investigation is needed to examine disgust-based processes at a mechanistic level in order to better understand the links between disgust, avoidance behaviors, and EDs. Further investigation of the mechanistic role of disgust in EDs is warranted.
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Affiliation(s)
- Lisa M. Anderson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, 2450 Riverside Avenue South, F229, Minneapolis, MN 55454, USA
| | - Hannah Berg
- Department of Psychology, University of Minnesota, N218 Elliott Hall, 75 East River Road, Minneapolis, MN 55455, USA
| | - Tiffany A. Brown
- Department of Psychiatry, University of California - San Diego, 4510 Executive Drive, Suite 315, San Diego, CA 92121, USA
| | - Jessie Menzel
- Department of Psychiatry, University of California - San Diego, 4510 Executive Drive, Suite 315, San Diego, CA 92121, USA
| | - Erin E. Reilly
- Department of Psychology, Hofstra University, 210 Hauser Hall, Hempstead, NY 11549, USA
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7
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Bottera AR, Kambanis PE, De Young KP. The differential associations of shame and guilt with eating disorder behaviors. Eat Behav 2020; 39:101427. [PMID: 32896681 DOI: 10.1016/j.eatbeh.2020.101427] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 08/10/2020] [Accepted: 08/13/2020] [Indexed: 02/07/2023]
Abstract
Negative affect increases in the hours prior to binge eating (BE), suggesting individuals may use BE to attempt to alleviate experiences of aversive self-awareness, such as shame and guilt. Guilt involves feeling bad about ones behavior and may elicit reparative actions; shame involves feeling bad about oneself and is generally associated with maladaptive behavior. Distinguishing how shame and guilt differentially relate to specific eating disorder (ED) behaviors may inform our understanding of emotional antecedents of ED behaviors and lead to refined treatment and prevention targets. We aimed to distinguish shame and guilt as they relate to BE and self-induced vomiting (SIV). We hypothesized that: (a) shame-proneness and state shame would be uniquely associated with BE, as BE may be used to escape from experiences of shame, and (b) guilt-proneness and state guilt would be positively associated with SIV among individuals who binge eat, as SIV may be used as a reparative action for BE. Participants (N = 347) completed self-report measures assessing guilt, shame, and ED behaviors. Shame-proneness and state shame were uniquely associated with BE and the urge to binge eat, while guilt-proneness and state guilt were not. Contrary to our hypothesis, guilt-proneness and state guilt were not associated with SIV among those who binge eat or endorsed urges to binge eat. These findings suggest that shame and guilt are differentially related to ED behaviors and identify shame specifically as an emotion that may elicit BE. Future research is needed to identify temporal relations between shame and ED behaviors.
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Affiliation(s)
- Angeline R Bottera
- Department of Psychology, University of Wyoming, United States of America.
| | - P Evelyna Kambanis
- Department of Psychology, University of Wyoming, United States of America
| | - Kyle P De Young
- Department of Psychology, University of Wyoming, United States of America
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8
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Schaumberg K, Reilly EE, Gorrell S, Levinson CA, Farrell NR, Brown TA, Smith KM, Schaefer LM, Essayli JH, Haynos AF, Anderson LM. Conceptualizing eating disorder psychopathology using an anxiety disorders framework: Evidence and implications for exposure-based clinical research. Clin Psychol Rev 2020; 83:101952. [PMID: 33221621 DOI: 10.1016/j.cpr.2020.101952] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 11/09/2020] [Accepted: 11/09/2020] [Indexed: 12/13/2022]
Abstract
Eating disorders (EDs) and anxiety disorders (ADs) evidence shared risk and significant comorbidity. Recent advances in understanding of anxiety-based disorders may have direct application to research and treatment efforts for EDs. The current review presents an up-to-date, behavioral conceptualization of the overlap between anxiety-based disorders and EDs. We identify ways in which anxiety presents in EDs, consider differences between EDs and ADs relevant to treatment adaptions, discuss how exposure-based strategies may be adapted for use in ED treatment, and outline directions for future mechanistic, translational, and clinical ED research from this perspective. Important research directions include: simultaneous examination of the extent to which EDs are characterized by aberrant avoidance-, reward-, and/or habit-based neurobiological and behavioral processes; improvement in understanding of how nutritional status interacts with neurobiological characteristics of EDs; incorporation of a growing knowledge of biobehavioral signatures in ED treatment planning; development of more comprehensive exposure-based treatment approaches for EDs; testing whether certain exposure interventions for AD are appropriate for EDs; and improvement in clinician self-efficacy and ability to use exposure therapy for EDs.
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Affiliation(s)
| | | | - Sasha Gorrell
- University of California, San Francisco, United States of America
| | - Cheri A Levinson
- University of Louisville, Department of Psychological & Brain Sciences, United States of America
| | | | - Tiffany A Brown
- University of California, San Diego, United States of America
| | - Kathryn M Smith
- Sanford Health, United States of America; University of Southern California, United States of America
| | | | | | - Ann F Haynos
- University of Minnesota, United States of America
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9
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Rodgers RF, Lombardo C, Cerolini S, Franko DL, Omori M, Fuller‐Tyszkiewicz M, Linardon J, Courtet P, Guillaume S. The impact of the COVID-19 pandemic on eating disorder risk and symptoms. Int J Eat Disord 2020; 53:1166-1170. [PMID: 32476175 PMCID: PMC7300468 DOI: 10.1002/eat.23318] [Citation(s) in RCA: 272] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/17/2020] [Accepted: 05/17/2020] [Indexed: 12/12/2022]
Abstract
The current COVID-19 pandemic has created a global context likely to increase eating disorder (ED) risk and symptoms, decrease factors that protect against EDs, and exacerbate barriers to care. Three pathways exist by which this pandemic may exacerbate ED risk. One, the disruptions to daily routines and constraints to outdoor activities may increase weight and shape concerns, and negatively impact eating, exercise, and sleeping patterns, which may in turn increase ED risk and symptoms. Relatedly, the pandemic and accompanying social restrictions may deprive individuals of social support and adaptive coping strategies, thereby potentially elevating ED risk and symptoms by removing protective factors. Two, increased exposure to ED-specific or anxiety-provoking media, as well as increased reliance on video conferencing, may increase ED risk and symptoms. Three, fears of contagion may increase ED symptoms specifically related to health concerns, or by the pursuit of restrictive diets focused on increasing immunity. In addition, elevated rates of stress and negative affect due to the pandemic and social isolation may also contribute to increasing risk. Evaluating and assessing these factors are key to better understanding the impact of the pandemic on ED risk and recovery and to inform resource dissemination and targets.
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Affiliation(s)
- Rachel F. Rodgers
- APPEAR, Department of Applied PsychologyNortheastern UniversityBostonMassachusettsUSA,Department of Psychiatric Emergency & Acute Care Lapeyronie Hospital, CHRU MontpellierMontpellierFrance,Department of PsychologySapienza University of RomeRomeItaly
| | | | - Silvia Cerolini
- Department of PsychologySapienza University of RomeRomeItaly
| | - Debra L. Franko
- APPEAR, Department of Applied PsychologyNortheastern UniversityBostonMassachusettsUSA
| | - Mika Omori
- Department of PsychologyOchanomizu UniversityTokyoJapan
| | | | - Jake Linardon
- School of PsychologyDeakin UniversityMelbourneVictoriaAustralia
| | - Philippe Courtet
- Department of Psychiatric Emergency & Acute Care Lapeyronie Hospital, CHRU MontpellierMontpellierFrance
| | - Sebastien Guillaume
- Department of Psychiatric Emergency & Acute Care Lapeyronie Hospital, CHRU MontpellierMontpellierFrance
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10
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Harris AA, Romer AL, Hanna EK, Keeling LA, LaBar KS, Sinnott-Armstrong W, Strauman TJ, Wagner HR, Marcus MD, Zucker NL. The central role of disgust in disorders of food avoidance. Int J Eat Disord 2019; 52:543-553. [PMID: 30801767 PMCID: PMC6759364 DOI: 10.1002/eat.23047] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 01/03/2019] [Accepted: 01/29/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Individuals with extreme food avoidance such as Avoidant Restrictive Food Intake Disorder (ARFID) experience impairing physical and mental health consequences from nutrition of insufficient variety or/and quantity. Identifying mechanisms contributing to food avoidance is essential to develop effective interventions. Anxiety figures prominently in theoretical models of food avoidance; however, there is limited evidence that repeated exposures to foods increases approach behavior in ARFID. Studying disgust, and relationships between disgust and anxiety, may offer novel insights, as disgust is functionally associated with avoidance of contamination from pathogens (as may occur via ingestion) and is largely resistant to extinction. METHOD This exploratory, cross-sectional study included data from 1,644 adults who completed an online questionnaire. Participant responses were used to measure ARFID classification, picky eating, sensory sensitivity, disgust, and anxiety. Structural equation modeling tested a measurement model of latent disgust and anxiety factors as measured by self-reported frequency of disgust and anxiety reactions. Mediational models were used to explore causal ordering. RESULTS A latent disgust factor was more strongly related to severity of picky eating (B ≈ 0.4) and ARFID classification (B ≈ 0.6) than the latent anxiety factor (B ≈ 0.1). Disgust partially mediated the association between anxiety and picky eating and fully mediated the association between anxiety and ARFID. Models testing the reverse causal ordering demonstrated poorer fit. Findings suggest anxiety may be associated with food avoidance in part due to increased disgust. CONCLUSIONS Disgust may play a prominent role in food avoidance. Findings may inform novel approaches to treatment.
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Affiliation(s)
| | | | | | | | - Kevin S. LaBar
- Department of Psychology and Neuroscience, Duke
University
| | - Walter Sinnott-Armstrong
- Department of Psychology and Neuroscience, Duke
University,Department of Philosophy, Duke University
| | | | - H. Ryan Wagner
- Department of Psychiatry and Behavioral Sciences, Duke
University School of Medicine
| | - Marsha D. Marcus
- Department of Psychiatry, University of Pittsburgh School
of Medicine
| | - Nancy L. Zucker
- Department of Psychology and Neuroscience, Duke
University,Department of Psychiatry and Behavioral Sciences, Duke
University School of Medicine
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11
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Agüera Z, Paslakis G, Munguía L, Sánchez I, Granero R, Sánchez-González J, Steward T, Jiménez-Murcia S, Fernández-Aranda F. Gender-Related Patterns of Emotion Regulation among Patients with Eating Disorders. J Clin Med 2019; 8:jcm8020161. [PMID: 30717125 PMCID: PMC6406611 DOI: 10.3390/jcm8020161] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 01/23/2019] [Accepted: 01/28/2019] [Indexed: 12/22/2022] Open
Abstract
Difficulties in emotion regulation (ER) are common in females with eating disorders (ED). However, no study to date has analyzed ER in males with ED. In the study at hand, we assessed ER in males with ED and compared results to both females with ED and healthy controls (HC). We also examined associations between ER difficulties, personality, and psychopathology. A total of 62 males with ED were compared with 656 females with ED, as well as 78 male and 286 female HC. ER was assessed by means of the Difficulties in Emotion Regulation Scale (DERS). We found that males and females with ED showed greater ER difficulties compared to HC. Pronounced general psychopathology was a shared factor associated with higher ER difficulties in both males and females with ED. However, whereas higher novelty seeking, higher cooperativeness, lower reward dependence, and lower self-directedness were related to higher ER difficulties in females with ED, lower persistence was associated with ER difficulties in males with ED. In sum, males and females with ED show similar ER difficulties, yet they are distinct in how ER deficits relate to specific personality traits. Research on strategies promoting ER in the treatment of males with ED is warranted.
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Affiliation(s)
- Zaida Agüera
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
- Department of Public Health, Mental Health and Maternal-Child Nursing, School of Nursing, University of Barcelona, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
| | - Georgios Paslakis
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
| | - Lucero Munguía
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
| | - Isabel Sánchez
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
| | - Roser Granero
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
- Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain.
| | - Jessica Sánchez-González
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
| | - Trevor Steward
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
| | - Susana Jiménez-Murcia
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
| | - Fernando Fernández-Aranda
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
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