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Wilkinson ML, Trainor C, Lampe E, Presseller EK, Juarascio A. Cannabis use and binge eating: Examining the relationship between cannabis use and clinical severity among adults with binge eating. Exp Clin Psychopharmacol 2024; 32:392-397. [PMID: 38236224 PMCID: PMC11253108 DOI: 10.1037/pha0000706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Cannabis use is prevalent among individuals with binge eating (BE; i.e., the inability to control eating behavior). Yet, only two studies to date (both over 20 years old) have tested if cannabis use relates to clinical severity among BE samples. Characterizing the relationship between cannabis use, eating disorder (ED) severity, and other psychiatric symptoms in BE samples is necessary for informing screening and clinical recommendations. The present study characterized cannabis use among adults with BE and tested between-group and within-group relationships between cannabis use and eating disorder symptoms, alcohol consumption and symptoms, and depression symptoms. Participants (N = 165) were treatment-seeking adults with at least once weekly BE in the past 3 months who completed clinical interviews and self-report measures before treatment. Over 23% of participants reported cannabis use in the past 3 months, with most persons using cannabis reported using "once or twice" or "monthly." Most persons using cannabis reported cannabis-related symptoms. Persons using cannabis reported significantly greater alcohol consumption and were more likely to report alcohol-related symptoms compared to persons not using cannabis. No associations were observed between cannabis use, eating disorder symptoms, and depressions symptoms. These findings indicate that a notable subset of patients with BE use cannabis and experience cannabis-related problems, and that cannabis and alcohol use may be related for these individuals. Considering legal and sociocultural shifts in cannabis availability and prevalence, results from the present study support screening for cannabis and alcohol use patterns in patients with BE. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
| | - Claire Trainor
- Department of Psychological and Brain Sciences, Drexel University
| | - Elizabeth Lampe
- Department of Psychological and Brain Sciences, Drexel University
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Sonnenblick RM, Wilkinson ML, Manasse SM, Juarascio AS. Does hopelessness predict treatment outcomes in adults with binge-spectrum eating disorders? Eat Disord 2024; 32:426-438. [PMID: 38335315 PMCID: PMC11178463 DOI: 10.1080/10640266.2024.2312725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
Using data from 165 adult participants who enrolled in four studies of cognitive-behavioral therapy (CBT) for binge-spectrum eating disorders (EDs), this secondary analysis examined 1) whether pretreatment hopelessness predicted posttreatment eating pathology, loss-of-control (LOC) eating frequency, and purging frequency; 2) whether treatment had an indirect effect on those outcomes through change in hopelessness; and 3) whether treatment had an indirect effect on hopelessness through those ED measures. The Eating Disorder Examination was used to assess overall eating pathology, LOC frequency, and purging frequency. Hopelessness was measured with one item from the Beck Depression Inventory-II. Regression models showed that pretreatment hopelessness predicted posttreatment LOC eating frequency but not overall eating pathology or purging frequency. Single-group tests of indirect effects showed no effect of reduction in hopelessness on reduction in ED symptoms, but there was an effect of reduction in ED symptoms on reduction in hopelessness.
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Affiliation(s)
- Ross M. Sonnenblick
- Department of Psychological and Brain Sciences, Drexel University, 3201 Chestnut St. Philadelphia, PA 19104, USA
- Center for Weight, Eating, and Lifestyle Science (WELL Center), Drexel University, 3201 Chestnut St. Philadelphia, PA 19104, USA
| | - Megan L. Wilkinson
- Department of Psychological and Brain Sciences, Drexel University, 3201 Chestnut St. Philadelphia, PA 19104, USA
- Center for Weight, Eating, and Lifestyle Science (WELL Center), Drexel University, 3201 Chestnut St. Philadelphia, PA 19104, USA
| | - Stephanie M. Manasse
- Department of Psychological and Brain Sciences, Drexel University, 3201 Chestnut St. Philadelphia, PA 19104, USA
- Center for Weight, Eating, and Lifestyle Science (WELL Center), Drexel University, 3201 Chestnut St. Philadelphia, PA 19104, USA
| | - Adrienne S. Juarascio
- Department of Psychological and Brain Sciences, Drexel University, 3201 Chestnut St. Philadelphia, PA 19104, USA
- Center for Weight, Eating, and Lifestyle Science (WELL Center), Drexel University, 3201 Chestnut St. Philadelphia, PA 19104, USA
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Singh S, Gorrell S, Matheson BE, Reilly EE, Lock JD, Le Grange D. Testing associations between assessments of cognitive flexibility and eating disorder symptoms in adolescent bulimia nervosa. Int J Eat Disord 2024. [PMID: 38840408 DOI: 10.1002/eat.24235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVE Cognitive rigidity, or difficulty adapting to changing demands, is commonly observed in anorexia nervosa. Less is known, however, about cognitive flexibility (CF) in bulimia nervosa (BN) and, particularly, adolescence. Clarifying this relation and best assessment practices may guide informed clinical decision-making. The current study compared how two measures of CF (i.e., Wisconsin Card Sort Task [WCST] and Trail Making Task [TMT]) relate to BN symptoms among adolescents. METHODS Data from a subsample (n = 78) of adolescents with BN were analyzed. Linear and hurdle regressions were used to compare the effects of WCST perseverative errors and TMT performance on Eating Disorder Examination Global Scores, objective binge episodes, and self-induced vomiting episodes (SVEs) at baseline and end-of-treatment (EOT). RESULTS Neither CF measure associated with baseline BN symptoms. TMT performance positively associated with the likelihood of engaging in SVEs at EOT (𝛽 = 0.47, p = 0.01, 95% confidence interval [CI] = [0.11-0.84]) and, among adolescents who endorsed ≥1 SVE at EOT, WCST perseverative errors (𝛽 = 0.05, p = 0.005, 95% CI = [0.01-0.08]) positively associated with SVE frequency at EOT. DISCUSSION The overall lack of associations between CF and outcomes suggests that cognitive rigidity may not be as relevant to the clinical profile of adolescent BN as for anorexia nervosa. In the few significant associations that emerged, the WCST and TMT uniquely predicted the severity of vomiting at EOT in this sample. Given the lack of CF deficits, future work should aim to test the role of other executive functions (e.g., impulsivity), in addition to CF, to determine which deficits are present in adolescent BN and may predict outcomes. PUBLIC SIGNIFICANCE Patients with eating disorders often have difficulties thinking flexibly, which may interfere with their recovery. We tested two ways of measuring flexible thinking in adolescents with BN. Overall, flexible thinking was not associated with symptom-level outcomes. However, less flexible thinking at the start of treatment predicted self-induced vomiting at EOT. If findings are replicable, then assessing and addressing flexible thinking could improve outcomes for adolescents with BN.
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Affiliation(s)
- Simar Singh
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Brittany E Matheson
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California, USA
| | - Erin E Reilly
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - James D Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago (Emeritus), Chicago, Illinois, USA
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Dougherty EN, Wildes JE, Haedt-Matt AA. The role of habit in maintaining binge/purge behaviors: An ecological momentary assessment study. Int J Eat Disord 2024; 57:1160-1171. [PMID: 37776547 PMCID: PMC10980597 DOI: 10.1002/eat.24070] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVE Individuals with eating disorders transdiagnostically engage in binge eating (BE) and/or purging, despite life-threatening consequences. Little is known about factors that contribute to the persistence of these behaviors. This study explored whether habitual control over binge/purge (B/P) spectrum behaviors contributes to symptom persistence and whether negative reinforcement via reductions in negative affect is less influential in maintaining B/P behaviors that are under habitual control and are persistent. METHOD Women with BE and/or purging (N = 81) completed self-report measures assessing habit strength of BE and purging. Then, they completed a 14-day ecological momentary assessment (EMA) protocol during which they completed measures of negative affect, BE, and purging multiple times per day. RESULTS Habitual control over purging was associated with a greater frequency of purging during the EMA period. However, habitual control over BE was not associated with the severity of loss of control eating or the frequency of BE episodes. Habitual control did not moderate temporal relations between negative affect and B/P behaviors during the EMA period. However, exploratory analyses revealed that individuals with a longer duration of BE and greater habitual control over BE showed a less pronounced reduction in negative affect following BE. DISCUSSION Overall, these findings suggest that purging may be maintained by habitual stimulus-response learning. In addition, they support the possibility that reduction in negative affect may play a less prominent role in maintaining BE that is habitual and persistent. PUBLIC SIGNIFICANCE This study investigated whether habit contributes to the persistence of symptoms in women with binge/purge spectrum behaviors and whether negative reinforcement via reductions in negative affect is less influential in maintaining binge/purge behaviors that are under habitual control. The findings suggest that purging may be maintained through habit. This supports the potential utility of habit reversal interventions to decrease habitual purging.
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Affiliation(s)
- Elizabeth N Dougherty
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois, USA
| | - Jennifer E Wildes
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois, USA
| | - Alissa A Haedt-Matt
- Department of Psychology, Illinois Institute of Technology, Chicago, Illinois, USA
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Wilkinson ML, Boyajian LE, Juarascio AS. Characterizing alcohol-related disordered eating behaviors in adults with binge eating. Eat Weight Disord 2022; 27:3773-3779. [PMID: 36121559 DOI: 10.1007/s40519-022-01475-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/09/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Alcohol-related disordered eating behaviors (ADEBs; i.e., engagement in dietary restriction or excessive exercise before or after drinking alcohol to avoid weight gain) are associated with negative psychosocial and medical consequences. Previous research has primarily studied ADEBs among community samples. Individuals with clinically significant binge eating may also engage in ADEBs given high rates of alcohol use and inappropriate weight-control behaviors. The current study aimed to characterize the prevalence and psychological correlates (i.e., weight and shape concerns, alcohol consumption, binge eating frequency) of ADEBs among individuals with clinically significant binge eating. METHODS Participants were 166 treatment-seeking individuals who engaged in once weekly binge eating over the past three months. Participants completed a clinical interview to assess eating disorder symptoms and self-report measures of alcohol consumption patterns and ADEBs engagement. RESULTS Over one-fourth of participants endorsed at least one ADEBs in the past three months. Participants who endorsed ADEBs reported greater alcohol consumption than participants who drank alcohol but did not endorse ADEBs, after controlling for eating disorder diagnosis. Greater frequency of ADEBs was related to higher weight and shape concerns among individuals who endorsed ADEBs in the past three months. Presence of ADEBs and ADEBs frequency were not related to binge eating frequency. CONCLUSION Results suggest that clinicians treating individuals with binge eating who drink alcohol should screen for ADEBs and assess how ADEBs may contribute to an individual's eating pathology. Future research should assess the temporal relationship between alcohol use and ADEBs engagement, and study ADEBs in BN-spectrum samples. LEVEL OF EVIDENCE Level V, descriptive studies.
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Affiliation(s)
- Megan L Wilkinson
- Weight, Eating, and Lifestyle Sciences Center, Drexel University, 3201 Chestnut Street, Stratton 238, Philadelphia, PA, 19104, USA.
- Department of Psychological and Brain Sciences, Drexel University, 3201 Chestnut Street, Stratton 238, Philadelphia, PA, 19104, USA.
| | - Laura E Boyajian
- Weight, Eating, and Lifestyle Sciences Center, Drexel University, 3201 Chestnut Street, Stratton 238, Philadelphia, PA, 19104, USA
| | - Adrienne S Juarascio
- Weight, Eating, and Lifestyle Sciences Center, Drexel University, 3201 Chestnut Street, Stratton 238, Philadelphia, PA, 19104, USA
- Department of Psychological and Brain Sciences, Drexel University, 3201 Chestnut Street, Stratton 238, Philadelphia, PA, 19104, USA
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Reilly EE, Gorrell S, Brosof L, Lock J, Le Grange D. Characterizing changes in obsessive-compulsive symptoms over the course of treatment for adolescent bulimia nervosa. Int J Eat Disord 2022; 55:1342-1351. [PMID: 35861249 PMCID: PMC9869712 DOI: 10.1002/eat.23782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Data suggest that obsessive-compulsive (OC) symptoms are commonly observed in adolescents with eating disorders and predict poorer treatment response. Further, emerging data among adults suggest that changes in OC symptoms relate to changes in eating disorder symptoms across treatment. Given evidence that early invention decreases risk for protracted illness, evaluating processes that may relate to treatment response will be useful in increasing the effectiveness of existing interventions. Therefore, the current investigation explored changes in general and eating disorder-specific OC symptoms throughout family-based treatment (FBT) and cognitive behavioral therapy (CBT) for bulimia nervosa (BN), as well as associations among these changes and eating disorder outcomes at follow-up. METHOD Participants (N = 110) received 18 sessions of FBT or CBT and completed measurements of general and eating disorder-specific OC symptoms at baseline, end-of-treatment, and 6- and 12-month follow-up. RESULTS Multilevel models indicated that across both treatments, there was no change in general OC symptoms, whereas all eating disorder-related OC symptoms decreased over treatment and follow-up. Exploratory analyses indicated that lower severity in discharge eating-disorder-specific OC symptoms contributed to lower eating pathology at follow-up. DISCUSSION Together, findings support the efficacy of both FBT and CBT in helping to reduce eating disorder-specific OC symptoms and suggest that adjunctive intervention may be required for ameliorating general OC symptoms in this population. PUBLIC SIGNIFICANCE BN is associated with significant increases in mortality and societal cost, and there is a pressing need for innovations within available treatments for young people with this disorder. In the current study, we explore the extent to which existing evidence-based treatments for adolescent BN are effective in targeting obsessive-compulsive symptoms, a known predictor of treatment response and common co-morbidity in this population.
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Affiliation(s)
- Erin E Reilly
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Leigh Brosof
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, USA
| | - James Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois (Emeritus), USA
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7
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Reilly EE, Berner LA, Trunko ME, Schwartz T, Anderson LK, Krueger A, Yu X, Chen JY, Cusack A, Nakamura T, Kaye WH. Evaluating the use of lamotrigine to reduce mood lability and impulsive behaviors in adults with chronic and severe eating disorders. Eat Weight Disord 2022; 27:1775-1785. [PMID: 35298791 PMCID: PMC9123051 DOI: 10.1007/s40519-021-01320-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/13/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Gold-standard psychological and pharmacological treatments for bulimic-spectrum eating disorders only result in remission for around 50% of patients; patients with affective lability and impulsivity represent a subgroup with particularly poor outcomes. Both dialectical behavior therapy (DBT), a treatment for emotion dysregulation, and lamotrigine, a mood stabilizer, have demonstrated promise for targeting affective lability and impulsivity; however, data exploring the combination of these interventions remain limited. OBJECTIVE We followed a group of women with recurrent dysregulated eating behaviors (N = 62) throughout intensive DBT treatment and compared the symptom trajectory of those prescribed lamotrigine (n = 28) and those who were not (n = 34). METHOD Participants completed surveys every 2 weeks throughout treatment. RESULTS Group analyses suggested that all participants self-reported decreases in emotional reactivity, negative urgency, and symptoms of borderline personality disorder (BPD). The lamotrigine group reported greater elevations in BPD symptoms at baseline, but demonstrated steeper decreases in emotion and behavioral dysregulation than the non-matched comparison group. Within-subject analyses suggested that within the lamotrigine group, subjects reported greater decreases in symptoms following prescription of lamotrigine. CONCLUSIONS Findings provide initial data suggesting that lamotrigine could be useful as an adjunctive treatment for patients with affective lability and impulsivity. LEVEL OF EVIDENCE IV, time series without randomization.
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Affiliation(s)
- Erin E Reilly
- Department of Psychology, Hofstra University, Hempstead, USA.,Department of Psychiatry, UCSD Health Eating Disorders Center for Research and Treatment, University of California, San Diego, San Diego, CA, USA.,Department of Psychiatry and Behavioral Sciences, University of California, CA, San Francisco, USA
| | - Laura A Berner
- Department of Psychiatry, UCSD Health Eating Disorders Center for Research and Treatment, University of California, San Diego, San Diego, CA, USA.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Mary Ellen Trunko
- Department of Psychiatry, UCSD Health Eating Disorders Center for Research and Treatment, University of California, San Diego, San Diego, CA, USA
| | - Terry Schwartz
- Department of Psychiatry, UCSD Health Eating Disorders Center for Research and Treatment, University of California, San Diego, San Diego, CA, USA
| | - Leslie K Anderson
- Department of Psychiatry, UCSD Health Eating Disorders Center for Research and Treatment, University of California, San Diego, San Diego, CA, USA
| | - Angeline Krueger
- Department of Psychiatry, UCSD Health Eating Disorders Center for Research and Treatment, University of California, San Diego, San Diego, CA, USA
| | - Xinze Yu
- Department of Psychiatry, UCSD Health Eating Disorders Center for Research and Treatment, University of California, San Diego, San Diego, CA, USA
| | - Joanna Y Chen
- Department of Psychiatry, UCSD Health Eating Disorders Center for Research and Treatment, University of California, San Diego, San Diego, CA, USA.,Department of Psychology, Drexel University, Philadelphia, USA
| | - Anne Cusack
- Department of Psychiatry, UCSD Health Eating Disorders Center for Research and Treatment, University of California, San Diego, San Diego, CA, USA
| | - Tiffany Nakamura
- Department of Psychiatry, UCSD Health Eating Disorders Center for Research and Treatment, University of California, San Diego, San Diego, CA, USA
| | - Walter H Kaye
- Department of Psychiatry, UCSD Health Eating Disorders Center for Research and Treatment, University of California, San Diego, San Diego, CA, USA.
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8
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Shroff A, Fassler J, Fox KR, Schleider JL. The impact of COVID-19 on U.S. adolescents: loss of basic needs and engagement in health risk behaviors. CURRENT PSYCHOLOGY 2022:1-11. [PMID: 35095242 PMCID: PMC8783170 DOI: 10.1007/s12144-021-02411-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2021] [Indexed: 11/03/2022]
Abstract
Across the United States, the COVID-19 pandemic created myriad challenges for youth and families, including losses of basic needs which may be associated with increased use of maladaptive coping behaviors. In a sample of 2491 U.S. youth (ages 13-16), demographic differences in loss of basic needs and maladaptive coping were assessed using regression models. More than 21% of adolescents endorsed losing one or more basic needs (e.g., loss of access to food or shelter) and 83% endorsed use of maladaptive coping strategies (e.g., using drugs or alcohol; self-harming behaviors) during the COVID-19 pandemic. Although adolescents with both majority and minority identities reported losing basic needs and engaging in maladaptive coping behaviors, minoritized youth reported more basic needs losses (ps < 0.05) and greater reliance on maladaptive coping strategies (ps < .05) than their non-minoritized peers. Furthermore, adolescents who endorsed losing basic needs were more likely to also endorse engaging in maladaptive coping behaviors (p < .05). Healthcare providers and teachers must consider basic need losses while structuring emotional and behavioral supports for youth during and beyond the COVID-19 pandemic.
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Affiliation(s)
- Akash Shroff
- Department of Psychology, Stony Brook University, Stony Brook, NY USA
| | - Julia Fassler
- Department of Psychology, Stony Brook University, Stony Brook, NY USA
| | - Kathryn R. Fox
- Department of Psychology, University of Denver, Denver, CO USA
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9
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Trompeter N, Bussey K, Forbes MK, Hay P, Goldstein M, Thornton C, Basten C, Heruc G, Roberts M, Byrne S, Griffiths S, Lonergan A, Mitchison D. Emotion Dysregulation and Eating Disorder Symptoms: Examining Distinct Associations and Interactions in Adolescents. Res Child Adolesc Psychopathol 2022; 50:683-694. [PMID: 35029782 PMCID: PMC9054869 DOI: 10.1007/s10802-022-00898-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2022] [Indexed: 11/30/2022]
Abstract
Emotion dysregulation has been posited as a key transdiagnostic factor of mental health difficulties, including eating disorders. However, how this transdiagnostic factor interacts with the disorder-specific factor of weight and shape concerns remains unclear. The current study examined whether emotion dysregulation is associated with eating disorder behaviors over and above the association between weight and shape concerns and whether these two factors interacted. The current study used data from two samples, a community sample of high school students (n = 2699), and a clinical sample of adolescents receiving outpatient treatment for an eating disorder (n = 149). Participants completed self-report measures on their eating behaviors, weight/shape concerns, and emotion dysregulation. Findings showed that emotion dysregulation had a unique association with engaging in binge eating and purging (community sample only). Weight and shape concerns were found to have a unique association with engaging in binge eating, fasting, purging, and driven exercise (community sample only). Additionally, weight and shape concerns moderated the association between emotion dysregulation and the probability of engaging in binge eating and driven exercise, whereby the strongest association between emotion dysregulation and these behaviors were observed among adolescents with the lowest levels of weight and shape concerns. Regarding the frequency of eating disorder behaviors, emotion dysregulation had a unique association with severity of binge eating and fasting. Weight and shape concerns were uniquely associated with severity of fasting and driven exercise (community sample only). Findings suggest that emotion dysregulation is a distinct factor of eating disorder behaviors among adolescents.
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Affiliation(s)
- Nora Trompeter
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.
| | - Kay Bussey
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Miriam K Forbes
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Phillipa Hay
- School of Medicine, Translational Health Research Institute, Western Sydney University, Camden and Campbelltown Hospital, SWSLHD, Sydney, Campbelltown, Australia
| | - Mandy Goldstein
- School of Medicine, Translational Health Research Institute, Western Sydney University, Camden and Campbelltown Hospital, SWSLHD, Sydney, Campbelltown, Australia
| | | | - Christopher Basten
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Gabriella Heruc
- School of Medicine, Translational Health Research Institute, Western Sydney University, Camden and Campbelltown Hospital, SWSLHD, Sydney, Campbelltown, Australia
| | - Marion Roberts
- School of Population Health, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
| | - Susan Byrne
- School of Psychological Sciences, University of Western Australia, Perth, Australia
| | - Scott Griffiths
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Alexandra Lonergan
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Deborah Mitchison
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.,School of Medicine, Translational Health Research Institute, Western Sydney University, Camden and Campbelltown Hospital, SWSLHD, Sydney, Campbelltown, Australia
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10
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Grunewald W, Calzo JP, Brown TA, Pennesi JL, Jun HJ, Corliss HL, Blashill AJ. Appearance-ideal internalization, body dissatisfaction, and suicidality among sexual minority men. Body Image 2021; 38:289-294. [PMID: 34023807 DOI: 10.1016/j.bodyim.2021.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/24/2021] [Accepted: 05/01/2021] [Indexed: 10/21/2022]
Abstract
Sexual minority men (SMM) are disproportionately at risk for suicidality. Furthermore, SMM are at elevated risk for appearance-ideal internalization and body dissatisfaction, which are both associated with suicidality. Theoretical recommendations suggest including interaction terms between appearance-ideal internalization and body dissatisfaction when examining deleterious health outcomes. To test these interactions and examine whether appearance-ideal internalization or body dissatisfaction impart greater suicidality, the current study analyzed associations between specific forms of appearance-ideal internalization and suicidality among SMM, and whether body dissatisfaction moderated these associations. Participants were 171 SMM recruited for an eating disorder prevention program. Analyses examined the association between thin and muscular-ideal internalization with count of suicide risk, with body fat and muscularity dissatisfaction moderating these associations. Zero-inflated Poisson regressions revealed that the association between thin-ideal internalization and suicide risk was moderated by body fat dissatisfaction, such that thin-ideal internalization was associated with increased suicide risk at high levels of body fat dissatisfaction. Muscularity concerns were not significantly associated with suicidality, suggesting that thinness concerns may be more salient than muscularity for suicidality among SMM. Future research should replicate findings among larger SMM samples and extend the current design into non-SMM samples to examine if results generalize to other vulnerable populations.
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Affiliation(s)
- William Grunewald
- Department of Psychology, San Diego State University, 5500 Campanile Dr, San Diego, CA, 92182, USA.
| | - Jerel P Calzo
- School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, CA, 92182, USA; Institute for Behavioral and Community Health, San Diego State University, 5500 Campanile Dr, San Diego, CA, 92182, USA.
| | - Tiffany A Brown
- Department of Psychology, San Diego State University, 5500 Campanile Dr, San Diego, CA, 92182, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92023, USA.
| | - Jamie-Lee Pennesi
- Department of Psychology, San Diego State University, 5500 Campanile Dr, San Diego, CA, 92182, USA.
| | - Hee-Jin Jun
- School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, CA, 92182, USA; Institute for Behavioral and Community Health, San Diego State University, 5500 Campanile Dr, San Diego, CA, 92182, USA.
| | - Heather L Corliss
- School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, CA, 92182, USA; Institute for Behavioral and Community Health, San Diego State University, 5500 Campanile Dr, San Diego, CA, 92182, USA.
| | - Aaron J Blashill
- Department of Psychology, San Diego State University, 5500 Campanile Dr, San Diego, CA, 92182, USA; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 5500 Campanile Dr, San Diego, CA, 92182, USA.
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11
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Reilly EE, Brown TA, Wierenga CE. Evaluating patterns of inconsistent and missing data on the eating disorders examination-questionnaire in a sample of treatment-seeking adults and adolescents. Eat Disord 2021; 29:550-559. [PMID: 31775572 DOI: 10.1080/10640266.2019.1695453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Missing or inconsistent responses on self-report assessments can have implications for the use of empirically validated measurements in research and clinical practice. However, literature on frequency and systematic patterns of missingness on common measures of eating pathology is lacking. The current study evaluated EDE-Q missing and inconsistent responding in a clinical eating disorders (EDs) sample (N = 739). Thirteen percent (13.4%; n = 99) of the sample failed to provide complete responses on the EDE-Q and 13.8% (n = 101) inconsistently responded to behavioral items of the EDE-Q. Males were more likely to provide missing data, and mean BMI was higher among individuals with missing responses. Inconsistent responders endorsed higher scores on several EDE-Q subscales, were younger, and were more likely to be Hispanic/Latinx. However, many of these differences were not significant following correction for multiple comparisons. Although our results indicated similar rates of missingness and inconsistency to past work in college samples, our results suggest that missing and inconsistent responding on the EDE-Q in clinical samples may not warrant specialized consideration within statistical analyses.
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Affiliation(s)
- Erin E Reilly
- Department of Psychology, Hofstra University, Hempstead, New York, USA.,Department of Psychiatry, University of California, San Diego, California, USA
| | - Tiffany A Brown
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Christina E Wierenga
- Department of Psychiatry, University of California, San Diego, California, USA.,VA San Diego Healthcare System, San Diego, California, USA
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12
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Carrard I, Rothen S. Factors associated with disordered eating behaviors and attitudes in older women. Eat Weight Disord 2020; 25:567-575. [PMID: 30734223 DOI: 10.1007/s40519-019-00645-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 01/18/2019] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The present study explored the potential factors associated with disordered eating behaviors and attitudes in older women. METHODS Women aged 60-75 years were recruited in the community (n = 203) and completed questionnaires. The Eating Disorder Examination-Questionnaire (EDE-Q) was used to evaluate disordered eating behaviors and attitudes. The independent variables were BMI, age, importance of appearance, importance of body competence, cognitive reappraisal, and fear of age-related appearance changes. Spearman correlation analyses and zero-inflated negative binomial regression models were used to analyze the data. RESULTS BMI was positively associated with EDE-Q restraint, EDE-Q eating concern, and EDE-Q frequency of objective binge-eating episodes. Importance of appearance was positively related to EDE-Q restraint, and fear of age-related appearance changes to EDE-Q eating concern and objective binge-eating episodes. Cognitive reappraisal was negatively associated with EDE-Q eating concern and excessive exercise in bivariate associations, but the relationships disappeared in the multivariate analyses. CONCLUSIONS BMI, importance of appearance, and fear of age-related appearance changes turned out to be positively associated with eating disordered behaviors and attitudes, similarly to what can be observed in middle-aged samples. However, the role of cognitive reappraisal was unclear and should be investigated further. LEVEL OF EVIDENCE Level V: cross-sectional descriptive study.
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Affiliation(s)
- Isabelle Carrard
- Department of Nutrition and Dietetics, School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Geneva, Switzerland.
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13
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Schaumberg K, Wonderlich S, Crosby R, Peterson C, Le Grange D, Mitchell JE, Crow S, Joiner T, Bardone-Cone AM. Impulsivity and anxiety-related dimensions in adults with bulimic-spectrum disorders differentially relate to eating disordered behaviors. Eat Behav 2020; 37:101382. [PMID: 32247895 PMCID: PMC7259439 DOI: 10.1016/j.eatbeh.2020.101382] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 03/18/2020] [Accepted: 03/25/2020] [Indexed: 01/04/2023]
Abstract
While facets of both anxiety and impulsivity appear central to the development and maintenance of bulimia nervosa (BN), specific BN behaviors may be propagated by differing profiles of risk. The current study examined associations between dimensions of anxiety and impulsivity and BN symptoms (binge eating, vomiting, laxative misuse, driven exercise), both in terms of the presence of such behaviors and their frequency. Two hundred and four women (Mage = 25.7 years) who met DSM-IV criteria for full or subthreshold BN completed self-report measures of perfectionism (Frost Multidimensional Perfectionism Scale), anxiety (Spielberger Trait Anxiety Inventory), impulsivity (Barratt Impulsiveness Scale-11; Impulsive Behavior Scale), eating disordered behaviors (Eating Disorder Examination - Questionnaire), and associated psychiatric symptoms (Michigan Assessment Screening Test/Alcohol-Drug; Maudsley Obsessive-Compulsive Inventory). Factor analysis revealed multidimensional impulsive and anxiety-related traits (5 anxiety-related factors; 7 impulsivity-related factors). In zero-sensitive regression models, different facets of impulsivity evidenced association with the presence of binge eating (risk taking), laxative misuse (impulsive spending), and fasting (difficulty concentrating), along with the frequency of vomiting (long-term planning difficulties). In contrast, anxiety-related dimensions were only associated with driven exercise (high standards) and fasting (concern over mistakes, high standards, parental expectations). Overall, impulsive and anxiety-related factors and symptoms showed distinct associations with specific eating disorder behaviors, even among those with the same diagnosis.
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Affiliation(s)
| | | | - Ross Crosby
- Biobehavioral Research Institute, Sanford Health
| | | | - Daniel Le Grange
- University of California, San Francisco,The University of Chicago
| | | | - Scott Crow
- University of Minnesota, Department of Psychiatry
| | | | - Anna M. Bardone-Cone
- University of North Carolina at Chapel Hill, Department of Psychology and Neuroscience
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14
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Allen KJD, Sammon MM, Fox KR, Stewart JG. Emotional Response Inhibition: A Shared Neurocognitive Deficit in Eating Disorder Symptoms and Nonsuicidal Self-Injury. Brain Sci 2020; 10:E104. [PMID: 32075254 PMCID: PMC7071419 DOI: 10.3390/brainsci10020104] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 01/18/2023] Open
Abstract
Eating disorder (ED) symptoms often co-occur with non-suicidal self-injury (NSSI). This comorbidity is consistent with evidence that trait negative urgency increases risk for both of these phenomena. We previously found that impaired late-stage negative emotional response inhibition (i.e., negative emotional action termination or NEAT) might represent a neurocognitive mechanism for heightened negative urgency among people with NSSI history. The current study evaluated whether relations between negative urgency and ED symptoms similarly reflect deficits in this neurocognitive process. A total of 105 community adults completed an assessment of ED symptoms, negative urgency, and an emotional response inhibition task. Results indicated that, contrary to predictions, negative urgency and NEAT contributed independent variance to the prediction of ED symptoms, while controlling for demographic covariates and NSSI history. Worse NEAT was also uniquely associated with restrictive eating, after accounting for negative urgency. Our findings suggest that difficulty inhibiting ongoing motor responses triggered by negative emotional reactions (i.e., NEAT) may be a shared neurocognitive characteristic of ED symptoms and NSSI. However, negative urgency and NEAT dysfunction capture separate variance in the prediction of ED-related cognitions and behaviors, distinct from the pattern of results we previously observed in NSSI.
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Affiliation(s)
| | - M. McLean Sammon
- Department of Psychology, Oberlin College, Oberlin, OH 44074-1024, USA;
| | - Kathryn R. Fox
- Department of Psychology, University of Denver, Denver, CO 80210-4638, USA;
| | - Jeremy G. Stewart
- Department of Psychology, Queen’s University, Kingston, ON K7L 3N6, Canada
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15
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Liebman RE, Coniglio KA, Becker KR, Tabri N, Keshishian AC, Wons O, Keel PK, Eddy KT, Thomas JJ. Behavioral inhibition moderates the association between overvaluation of shape and weight and noncompensatory purging in eating disorders. Int J Eat Disord 2020; 53:143-148. [PMID: 31758819 DOI: 10.1002/eat.23195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/19/2019] [Accepted: 10/07/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The cognitive-behavioral therapy (CBT) model of eating disorders suggests that compensatory purging behaviors (e.g., self-induced vomiting, inappropriate laxative use) are primarily driven by binge eating. However, many individuals endorse purging in the absence of binge eating (i.e., noncompensatory purging [NCP]). Research is needed to understand why some individuals purge in the absence of objective or subjective binge-eating episodes. METHOD Given the importance of overvaluation of shape/weight in the CBT model, and the existing evidence linking temperamental characteristics like behavioral inhibition (i.e., the tendency to withdraw in response to threat cues) with purging in general, we tested whether behavioral inhibition moderated the relationship between overvaluation of shape/weight and NCP in a sample of individuals in a residential eating disorder treatment center (N = 143). RESULTS Overvaluation was more strongly related to NCP in individuals with high (relative to low) levels of behavioral inhibition. Among individuals low in behavioral inhibition, overvaluation predicted engagement in NCP to a much weaker extent. DISCUSSION For those high (relative to low) in behavioral inhibition, both emotional avoidance and overvaluation may be important targets in the treatment of NCP, particularly in the absence of binge eating.
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Affiliation(s)
- Rachel E Liebman
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | | | - Kendra R Becker
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Nassim Tabri
- Department of Psychology, Carleton University, Ottawa, Ontario
| | - Ani C Keshishian
- Department of Psychology, University of Louisville, Louisville, KY
| | - Olivia Wons
- Department of Psychology, Drexel University, Philadelphia, PA
| | - Pamela K Keel
- Department of Psychology, Florida State University, Tallahassee, FL
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Jennifer J Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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