"Just looking at food makes me gain weight": experimental induction of thought-shape fusion in eating-disordered and non-eating-disordered women

Gender differences in eating disorder-related intrusive thoughts

The present study aimed to examine gender differences in the experience of eating disorder-related intrusive thoughts (EDITs; i.e., frequency, content, emotional consequences, & control strategies). In addition, differences in the experience of EDITs across those atrisk of developing an eating disorder and those who are not atrisk were investigated. Six hundred and seventy-one adults completed self-report measures assessing the experience of EDITs, disordered eating attitudes and behaviours, and body dissatisfaction. It was found that females experienced EDITs more frequently and with higher levels of distress compared with males. With regard to control strategies, females tended to use distraction and thought suppression, whereas males were likely to do nothing in response. Participants in the at-risk group experienced EDITs more frequently, with higher distress, and responded by using obsessive-compulsive rituals or doing what the intrusion dictated significantly more than non-risk participants. Relationships between body dissatisfaction and EDITs related to bodily appearance were found to be stronger for men, whereas women revealed a stronger relationship between disordered eating and purging EDITs. The findings of this study support the growing literature regarding EDITs as a distinct clinical feature of eating disorders, and the developing evidence base regarding intrusive thoughts as a transdiagnostic mechanism.

'Feeling fat' amid the COVID-19 pandemic: Examining the role of emotion dysregulation in the body displacement hypothesis

'Feeling fat,' the somatic experience of being overweight not entirely explained by objective weight, may occur due to the projection of negative affect onto the body. Individuals may manage 'feeling fat' via eating pathology (e.g., binge eating or dietary restriction) rather than address the source of negative affect. Thus, 'feeling fat' may occur in the absence of adaptive emotion regulation strategies. The COVID-19 pandemic has increased negative affect widely and may potentially contribute to the experience of 'feeling fat' and eating pathology among individuals with emotion dysregulation. This study examined whether emotion dysregulation moderates 'feeling fat's' role as a mechanism underlying the relationship between COVID-19-related distress and eating pathology. This uniqueness of this model to eating pathology was investigated by comparing effects for binge eating and dietary restriction versus anxiety, depression, and problematic alcohol use. Structural equation modelling was used to analyze questionnaire data from 877 participants (77.3% women). 'Feeling fat' explained significant variance in the relationship between COVID-19-related distress and both binge eating and restriction. Emotion dysregulation modulated the strength of these relationships. However, 'feeling fat's role in the relationship between pandemic-related distress and negative psychological outcomes was not unique to eating pathology and did not vary based upon emotion dysregulation. Individuals with elevated emotion dysregulation are more likely to report eating pathology, but not other outcomes, in the context of 'feeling fat'. In contrast, 'feeling fat' underlies the relationship between COVID-19-distress and transdiagnostic psychological outcomes, meaning 'feeling fat' should be considered in risk for psychopathology beyond eating disorders.

'Feeling fat,' eating pathology, and eating pathology-related impairment in young men and women

'Feeling fat' has received little empirical attention despite clinical recognition as an eating disorder maintenance factor. This experience also occurs in non-clinical populations and may relate to elements of subclinical eating pathology. The present study examined whether 'feeling fat' independently contributes to eating pathology and eating pathology-related impairment, over and above over-evaluation of weight and shape and dysphoria. University students (N = 990; 54.3% female) completed questionnaires measuring these constructs. Moderated multiple hierarchical regression analyses evaluated 'feeling fat''s unique contribution to eating pathology and impairment, and the moderating effects of gender and eating disorder symptom severity. 'Feeling fat' accounted for significant unique variance in eating pathology, but not eating pathology-related impairment, over and above over-evaluation of weight and shape and dysphoria. The relationship between 'feeling fat' and eating pathology-related impairment was stronger in women than in men. Symptom severity did not moderate the relationship between 'feeling fat' and either dependent variable. 'Feeling fat' distinctly relates to eating pathology in a sample of young adults, suggesting that 'feeling fat' deserves attention in individuals without eating disorders. Future research should longitudinally investigate the direction of the relationship between 'feeling fat' and eating pathology and examine mechanisms of gender differences in 'feeling fat.'

Dieting and Disinhibited Eating Patterns in Adult Women with Normal Body Weight: Does Rumination Matter?

Dieting and disinhibited eating patterns are presented in both clinical and nonclinical samples. Repetitive negative thinking (i.e., rumination) may lead to maladaptive eating behaviors. While numerous studies have focused on dieting and disinhibited eating behaviors in clinical samples, less is known about these behaviors in nonclinical samples with normal body weight. Therefore, the present study aimed to explore how dieting, uncontrolled eating and emotional eating are related to rumination in adult women with normal body weight. One hundred eighty-eight women (Mage = 29.46 ± 8.94; MBMI = 23.16 ± 4.04) were involved in the current study. The Eating Attitudes Test, the Three-Factor Eating Questionnaire-R18 and the Perseverative Thinking Questionnaire were administered to the participants. The results showed that repetitive negative thinking was a partial mediator in the relationship between dieting and uncontrolled eating, as well as in the relationship between dieting and emotional eating. Targeting repetitive negative thinking may be important for reducing disinhibited eating patterns in women with normal body weight.

Exploring a core psychopathology in disordered eating: the feelings of fat scale

BACKGROUND

Feelings of fat are common for people with eating disorders, but ways of measuring its intensity are needed. Therefore, our goal was to develop a self-report feelings of fat scale that asked participants to indicate how intensely they currently felt statements such as "I feel fat". With such a scale we can determine how strongly feelings of fat relate to evidence of disordered eating.

METHODS

We conducted three studies of eating disorders with undergraduate women taking introductory psychology classes. The combined sample was 472 participants. A previous eating disorder diagnosis was self-reported by 33 participants and a current diagnosis by 11. All participants completed the EDE-Q and the seven (Study 1) or nine item (Studies 2 and 3) "State Feelings of Fat" (SFF) scales we developed. Each item asked them to rate the intensity with which they felt statements such "I feel fat" on a seven-point scale from "not at all" to "the most I have ever felt".

RESULTS

Both the seven and nine item SFF scales were highly coherent (Cronbach's α were .94, .95 and .94), but factor analysis supported the seven-item version. We found high correlations between SFF and EDE-Q scores (Study 1: .816; Study 2: .808; Study 3: .841). SFF scores distinguished participants self-reporting no eating disorder diagnosis from those with a former diagnosis, t (361) = 2.33, p = .021, who in turn were distinguished from those with a current diagnosis, t (42) = 2.09, p = .043. Due to the high coherence of the scale, the single item "I feel fat" captured most of the variance in EDE-Q scores (r [472] = .793).

CONCLUSIONS

We have constructed an eating disorders relevant feelings of fat scale. Given that the EDE-Q is considered a valid questionnaire for measuring severity of eating disorders, our findings suggests that feelings of fat are core to the psychopathology of eating disorders. To the extent that EDE-Q scores are stable it also suggests that feelings of fat are surprisingly stable. Furthermore, the single item "I feel fat" alone may capture most of what the EDE-Q measures.

Reality check: An experimental manipulation of inferential confusion in eating disorders

BACKGROUND AND OBJECTIVES

Inferential confusion (IC) entails confusing an imagined possibility with a sensory-based possibility, and acting upon the imagined possibility as if it was real. Although IC was formulated in the context of obsessive-compulsive disorder (OCD), this reasoning bias has shown to be relevant to other obsessive-compulsive spectrum disorders, such as eating disorders (EDs). The goal of this study was to induce IC experimentally in individuals with EDs relative to healthy controls (HC).

METHODS

Thirty-six women (ED group, n = 18; HC group, n = 18) were assigned to one of two experimental conditions: in the High IC condition, participants watched ED-themed videos with key sequences missing - provoking a distrust of the senses and lending more space for the imagination, thus triggering IC. In the Low IC condition, participants watched videos without sequences missing. Participants completed measures of IC, negative affect and compulsive behaviors after watching the videos.

RESULTS

One-way ANOVA indicated that ED participants assigned to the High IC condition reported a greater urge to engage in compulsive behaviors. ED participants also neutralized more after watching the videos and endorsed higher trait IC.

LIMITATIONS

There was no clinical control group.

CONCLUSIONS

These findings suggest that individuals with EDs display a greater vulnerability to IC, as they are more prone to compulsive behaviors when IC is triggered. This investigation may foster our understanding of the relationship between EDs and OCD through the examination of cognitive factors that are implicated in both disorders.

Understanding "feeling fat" and its underlying mechanisms: The importance of multimethod measurement

"Feeling fat," the somatic sensation of being overweight that does not entirely correlate with one's actual weight, is recognized clinically as a maintenance factor in eating disorders. Occurring amidst Western internalized thin ideals and weight stigma, "feeling fat" is wide-reaching and also reported by those with subclinical and absent eating pathology. However, empirical study of "feeling fat" is limited. Regarding proposed mechanisms, "feeling fat" may (a) reflect the displacement of negative affect onto the body, (b) represent one element of a cognitive distortion related to the imagined consumption of fattening food, and/or (c) be a function of impaired interoceptive awareness. However, the relative and/or joint contributions of these mechanisms to "feeling fat" are unclear. Regarding measurement, retrospective assessment with single items has been the norm. Innovative measures of "feeling fat" will expand our understanding of this construct. Ecological momentary assessment can clarify the transitory nature of this experience, and physiological measures can allow for assessment of somatic elements of "feeling fat. Multi-method and implicit measurement strategies of 'feeling fat'" may clarify the mechanisms underlying this experience. Further research with improved measurement techniques may also benefit eating disorder treatment by highlighting new treatment foci (e.g., cognitive distortions, interoceptive awareness).

Obsessive compulsive disorder and thought action fusion: Relationships with eating disorder outcomes

Obsessive Compulsive Disorder (OCD) is among the most common psychiatric comorbidities with eating disorders (EDs) and most studies have only examined this relationship at a diagnostic level. More research is needed to determine whether specific symptom domains and cognitive patterns commonly observed in OCD are most salient among individuals with clinically significant EDs, and whether these symptoms appear to change and/or influence treatment outcomes. Thought Action Fusion (TAF) is one cognitive pattern that may underlie OCD-ED comorbidity. The current study assessed 112 adolescent and adult female patients at a residential ED treatment facility on levels of ED severity, OCD symptom severity, and TAF at pre- and post-treatment. All OCD symptom dimensions were positively correlated with ED severity at pretreatment, with Obsessing, Neutralizing and Ordering OCD symptoms being most elevated. TAF was also positively correlated with ED severity at pre-treatment, and higher levels of TAF at pretreatment significantly predicted greater ED severity at post-treatment after controlling for all other OCD symptoms. Improvements in TAF specific to thoughts about others also predicted improvements in ED severity after controlling for changes in OCD symptoms. Clinically, these results indicate that efforts targeting specific OCD symptom dimensions and TAF in addition to ED-focused treatment as usual may be beneficial for enhancing overall treatment outcomes.

Body-related cognitive distortions (thought-shape fusion body) associated with thin-ideal exposure in female students-An ecological momentary assessment study

Etiological models of eating disorders (EDs) describe body dissatisfaction (BD)as one of the major influences fostering dysfunctional body-related behaviour and disordered eating behaviour. BD is influenced by repeated exposure to thin ideals that evoke high self-ideal discrepancy and result in body-related cognitive distortions such as thought-shape fusion body (TSF-B). The aim of this study was to investigate the covariation of daily media exposure and the experience of TSF-B in a naturalistic setting. It was further analysed whether TSF-B is associated with self-ideal discrepancy, dysfunctional body-related behaviour, and disordered eating behaviour. Moreover, person-related predictors of TSF-B were explored. Altogether, 51healthy female students (mean age 21.06years, SD = 1.76) participated in an ecological momentary assessment study with four daily surveys during 10consecutive days. Exposure with thin ideals in contrast to exposure to unspecific media contents went along with the experience of TSF-B. TSF-B was associated with higher self-ideal discrepancy and dysfunctional body-related behaviour as well as more pronounced disordered eating behaviour, suggesting that TSF-B is a common phenomenon in young healthy females' everyday life. A main effect of trait measures (e.g., pre-existing BD) on TSF-B was observable but has no moderating effect. Thus, a specific vulnerability has not been detected.

Cognitive and behavioral correlates of depressive symptoms in a community sample of adolescents

Research in adults demonstrates a positive association among obsessive-compulsive symptoms, eating pathology, cognitive distortions, and comorbid depressive symptoms. Given that adolescence is characterized by unique and rapid changes in biopsychosocial processes, it is imperative to elucidate the relationship between these variables in youth. In this cross-sectional study, we explored whether obsessive-compulsive symptoms, thought-action fusion, thought-shape fusion, and eating pathology would be positively associated with and predict depressive symptoms in a school-based community sample of adolescents (n = 86; M_age = 15.60). All study variables were positively correlated with depressive symptoms. Results indicated that obsessive-compulsive symptoms, thought-shape fusion, and eating pathology explained a significant proportion of variance in depressive symptoms, whereas thought-action fusion did not. In accordance with the cognitive behavioral model of psychopathology, these findings highlight the relationships between key interrelated correlates of depressive symptoms that may be pertinent targets for prevention and treatment efforts in adolescents.

Self-reported emotion regulation difficulties are associated with mood but not with the biological stress response to thin ideal exposure

BACKGROUND

Difficulties in emotion regulation have been related to psychological and physiological stress responses such as lower mood and lower parasympathetic activation (HF-HRV) under resting condition, but evidence on the potential link to the hypothalamic-pituitary-adrenal (HPA) axis functioning and to physiological stress responses during a stress task is still scarce. The aim of the study was to investigate stress responses in young women when confronted to a daily stressor such as exposure to thin ideals and to understand the role of correlates of self-reported trait-like emotion regulation difficulties (ERD).

METHODS

Heart rate variability (HRV) and salivary cortisol data were collected in a sample of 273 young women aged 18-35 with and without mental disorders during a vivid imagination of thin ideals (experimental condition) or landscapes (control condition). Changes in mood states were measured on a visual analogue scale (0-100). Correlates of trait-like ERD were self-reported using the Difficulties in Emotion Regulation Scale (DERS).

RESULTS

Participants with higher ERD showed a stronger decline in self-reported mood after vivid imagination of thin ideals compared to participants with lower ERD in the experimental condition but also a stronger increase of positive mood with increasing ERD in the control condition. ERD were not related to baseline HF-HRV or baseline salivary cortisol levels nor to any physiological response during and after the imagination of thin ideals.

DISCUSSION AND CONCLUSION

The results corroborate the role of ERD regarding the immediate psychological impact of daily stressors. Exposition to daily stressors in the laboratory results in discrepant psychological and physiological reactivity. Future studies should investigate under what conditions the complex interrelations between immediate and long-term ERD and biological activation are amenable to assessment in a laboratory setting. The additive effects of multiple exposition to stressors, such as thin ideals in daily life, also need to be addressed.

Relevance of the Thought-Shape Fusion Trait Questionnaire for healthy women and women presenting symptoms of eating disorders and mixed mental disorders

Thought-shape fusion (TSF) describes the experience of marked concerns about body weight/shape, feelings of fatness, the perception of weight gain, and the impression of moral wrongdoing after thinking about eating fattening/forbidden foods. This study sets out to evaluate the short version of the TSF trait questionnaire (TSF). The sample consists of 315 healthy control women, 244 women with clinical and subthreshold eating disorders, and 113 women with mixed mental disorders (mixed). The factor structure of the TSF questionnaire was examined using exploratory and subsequent confirmatory factor analyses. The questionnaire distinguishes between a Concept scale and a Clinical Impact scale. However, a lack of measurement invariances refers to significant differences between groups in terms of factor loadings, thresholds, and residuals, which questions cross-group validity. Results indicate that the concept is understood differently in the 3 groups and refers to the suitability of the questionnaire primarily for individuals presenting with symptoms of eating disorders.

Cognitive distortions in anorexia nervosa and borderline personality disorder

Thought-shape fusion (TSF) is a cognitive distortion associated with eating disorders (ED). A similar distortion, thought-abandonment fusion (TAbF), is assumed to occur in borderline personality disorder (BPD). In this study the specificity of TSF in participants with anorexia nervosa (AN) and TAbF in participants with BPD was examined. 63 patients completed questionnaires assessing the manifestation of trait-TAbF and trait-TSF, as well as relevant psychopathology. Nonparametric conditional inference trees were used to test for cognitive disorder-specificity. Participants with AN exhibited higher trait-TSF-scores than those with BPD, when participants with BPD and a co-occurring AN were removed. Trait-TSF in participants with AN seemed to be disorder-specific. Participants with BPD and a co-occurring AN had the highest TAbF-scores. The specificity hypothesis could only be partially confirmed for trait-TAbF: while participants with BPD and a co-occurring AN tended to have the highest trait-TAbF scores, high mean values could also be found in participants with AN. The results indicate that TAbF is not specific to BPD, but may also play a role in AN. Both distortions seem to play a role in the maintenance of the respective disorders.

Cognitive Distortions Associated with Imagination of the Thin Ideal: Validation of the Thought-Shape Fusion Body Questionnaire (TSF-B)

Thought-shape fusion (TSF) describes the experience of body-related cognitive distortions associated with eating disorder (ED) pathology. In the laboratory TSF has been activated by thoughts about fattening/forbidden foods and thin ideals. This study aims at validating a questionnaire to assess the trait susceptibility to TSF (i.e., body-related cognitive distortions) associated with the imagination of thin ideals, and developing an adapted version of the original TSF trait questionnaire, the Thought-Shape Fusion Body Questionnaire (TSF-B). Healthy control women (HC, n = 317) and women diagnosed with subthreshold and clinical EDs (n = 243) completed an online-questionnaire. The factor structure of the TSF-B questionnaire was examined using exploratory (EFA) and subsequent confirmatory factor analysis (CFA). EFA pointed to a two-factor solution, confirmed by CFA. Subscale 1 was named Imagination of thin ideals, containing five items referring to the imagination of female thin ideals. Subscale 2 was named Striving for own thin ideal, with seven items about pursuing/abandoning attempts to reach one’s own thin ideal. The total scale and both subscales showed good convergent validity, excellent reliability, and good ability to discriminate between individuals with subthreshold/clinical EDs and HCs. Results indicate that cognitive distortions are also related to the imagination of thin ideals, and are associated with ED pathology. With two subscales, the TSF-B trait questionnaire appropriately measures this construct. Future studies should clarify whether TSF-B is predictive for the development and course of EDs. Assessing cognitive distortions with the TSF-B questionnaire could improve understanding of EDs and stimulate the development of cognitively oriented interventions. Clinical Trial Registration Number: DRKS-ID: DRKS00005709.

A model of disturbed eating behavior in men: The role of body dissatisfaction, emotion dysregulation and cognitive distortions

Comprehensive models, targeting the development of eating disorders (EDs) in males, often employ a sociocultural perspective and empathize the importance of body dissatisfaction (BD). To further illuminate psychological factors contributing to the development of ED pathology, we propose a mediator model of disturbed eating and compensatory behavior (DECB) for men. This model suggests that emotion dysregulation and the susceptibility to body-related cognitive distortions (thought-shape fusion, TSF) mediate the relationship between BD and DECB. Based on data from a cross-sectional online-survey we tested our model in a non-clinical community sample of young men (N=123, 18-37 years). We found a significant positive association between BD and DECB, accounting for participant's body mass index (BMI), age and depressive symptoms. While TSF partially mediated the relationship between BD and DECB, we did not detect a corresponding effect for emotion dysregulation. Based on our findings, we concluded that TSF, which describes specific distorted cognitions with respect to one's own body triggered by fattening/ forbidden food, contributes to the pathological eating- and body-related behavior in men who are dissatisfied with their body. We suggest that TSF should be included in etiological models as a relevant aspect of cognitive information processing with emotional and behavioral consequences.

Thought-shape fusion in young healthy females appears after vivid imagination of thin ideals

BACKGROUND AND OBJECTIVES

It has been shown that exposure to female thin ideals in media has minimal to moderate direct effects on body image satisfaction (BIS), mood and dysfunctional eating in healthy young women. Evidence has been found for several intervening variables such as social comparison processes. Accordingly it is assumed, that cognitive processing (rather than mere media exposure) is crucial. Consequently, vivid imagination of thin ideals after exposure to a fashion magazine was induced in order to trigger cognitive processes. Changes in mood, BIS and resulting bodyrelated cognitive distortions (Thought-Shape Fusion Body, TSF-B) were assessed.

METHODS

A total of 91 healthy women (mean age 21.9 years, SD = 2.0) were exposed to either a fashion magazine (thin-ideal group) or a nature magazine (control group) in a waiting room design. Afterwards they were instructed to vividly imagine either the thin ideals or landscapes.

RESULTS

When exposed to thin ideals, a significant decrease in mood and BIS emerged after vivid imagination, but not after mere magazine exposure. Imagining thin ideals triggered body-related cognitive distortions (TSF-B). A higher degree of eating disorder (ED) symptomatology amplified this effect.

LIMITATIONS

These findings apply to young healthy females and cannot be generalized to samples with obesity, EDs or males. Internal validity is limited since the intensity of the exposure has not been systematically controlled.

CONCLUSIONS

Vivid imagination of thin ideals promoted by magazines results in impaired mood and BIS and moreover in body-related cognitive distortions (TSF-B) in healthy women, especially, for those with stronger ED symptomatology.

Susceptibility to cognitive distortions: the role of eating pathology

BACKGROUND

Thought-Shape Fusion (TSF) and Thought-Action Fusion (TAF) are cognitive distortions that are associated with eating and obsessional pathology respectively. Both involve the underlying belief that mere thoughts and mental images can lead to negative outcomes. TSF involves the belief that food-related thoughts lead to weight gain, body dissatisfaction, and perceptions of moral wrong-doing. TAF is more general, and involves the belief that merely thinking about a negative event (e.g., a loved one getting into a car accident) can make this event more likely to happen, and leads to perceptions of moral wrong-doing. However, the shared susceptibility across related cognitive distortions-TAF and TSF-has not yet been studied.

METHOD

The effects of TSF and TAF inductions in women with an eating disorder (n = 21) and a group of healthy control women with no history of an eating disorder (n = 23) were measured. A repeated-measures design was employed, with all participants exposed to a TSF, TAF and neutral induction during three separate experimental sessions. Participants' cognitive and behavioral responses were assessed.

RESULTS

Individuals with eating disorders were more susceptible to TSF and TAF than were control participants, demonstrating more neutralization behavior after TSF and TAF inductions (i.e., actions to try to reduce the negative effects of the induction), and reporting higher levels of trait TAF and TSF than did controls.

CONCLUSIONS

Individuals with eating disorders are particularly susceptible to both TAF and TSF. Clinical implications of these findings will be discussed.

Study protocol: psychological and physiological consequences of exposure to mass media in young women - an experimental cross-sectional and longitudinal study and the role of moderators

BACKGROUND

Repeated exposure to thin beauty ideals is part of the daily routine. Exposure to thin ideals via mass media plays an important role in the development and maintenance of eating disorders (EDs), low self-esteem, depressive or anxious feelings in young females. It is important to elucidate the circumstances under which exposure to thin ideals develops its detrimental impact and to investigate whether these features are more pronounced in EDs than in other mental disorders also related to negative body image.

METHODS/DESIGN

We investigate the following key questions: (1) Does laboratory induced exposure to thin ideals (waiting room design) relate to impairments in terms of body image, affect and eating behavior and biological stress response (salivary alpha-amylase, salivary cortisol, heart rate and heart rate variability) in 18 to 35 year old female suffering from anorexia and bulimia nervosa (AN, BN) compared to female healthy controls and to a sample of females suffering from mixed mental disorders (depression, anxiety and somatic symptom disorder (SSD) disorders)? (2) How do moderators such as cognitive distortions ("Thought-Shape Fusion, TSF"), and correlates of emotion regulation (ER) moderate the influence of the exposure? (3) Are these characteristics amenable to change after treatment? Altogether 250 female participants including patients with AN, BN, depressive, anxiety and SSD disorders, and healthy women will be recruited in Switzerland and Germany.

DISCUSSION

The findings will provide knowledge about the role of moderators influencing the effects of exposure to thin ideals promoted by mass media in eating disorder (ED) patients, patients suffering from mixed mental disorders and healthy controls. Evaluating their differential susceptibility will contribute to a better understanding of the role of negative body image in the maintenance of not only symptoms of ED, but also of depression, anxiety and SSD. Additionally our results will shed light on the stability of effects in healthy controls as well as in the patient groups before and after treatment as usual. Findings foster the development of tailored interventions including a training in specific ER strategies as well as cognitive restructuring of distorted beliefs about the own body when confronted with thin ideals.

TRIAL REGISTRATION

German Clinical Trials Register: DRKS00005709. Date of registration: 6(th) of February, 2014.

Reactivity to thought-shape fusion in adolescents: the effects of obesity status

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

Thought-shape fusion (TSF) is a cognitive distortion associated with eating pathology. TSF is a phenomenon associated with perceptions of weight gain, body dissatisfaction and moral wrongdoing after merely thinking about consumption of high-caloric foods. Women who are overweight are less susceptible to inductions of TSF than are women who are normal-weight.

WHAT THIS STUDY ADDS

Obese adolescents were less susceptible to a TSF induction than were lean adolescents (i.e., they reported lower state TSF in comparison with lean adolescents, and did not demonstrate an increase in state TSF relative to a neutral induction). Eating pathology, but not obesity status or gender, predicted trait TSF.

BACKGROUND

Previous research has demonstrated that imagining consumption of high-caloric foods can lead to feelings of guilt, and perception of weight gain and moral wrongdoing. This psychological response is known as thought-shape fusion (TSF).

OBJECTIVES

This study was conducted to assess the susceptibility of obese and lean adolescents to TSF.

METHODS

To investigate TSF susceptibility in adolescents, and predictors of this distortion, a total of 82 adolescents (44 obese and 38 lean) were randomly assigned to receive either a TSF or a neutral induction. Subsequent TSF reactivity was assessed (i.e., levels of state TSF after the induction), as was trait TSF, eating pathology and depression.

RESULTS AND CONCLUSIONS

The results suggest that obese adolescents are less susceptible to TSF than are lean adolescents, as lean (but not obese) adolescents reported significantly higher state TSF relative to participants who received the neutral induction. Similarly, lean adolescents who were exposed to a TSF induction reported higher state TSF than did obese adolescents. Furthermore, obesity did not emerge as a predictor of trait TSF. Factors that may account for decreased TSF susceptibility in obese adolescents relative to lean adolescents will be discussed.

Thought-shape fusion in anorexia and bulimia nervosa: a comparative experimental study

'Thought-shape fusion' (TSF) is a cognitive distortion specific in patients with eating disorders and occurs when the thought about eating a forbidden food increases a person's estimate of her weight/shape, elicits a perception of moral wrongdoing and makes her feel fat. This study aimed to experimentally induce, study and compare TSF between patients with bulimia nervosa (BN) and patients with anorexia nervosa (AN). 31 patients diagnosed with a current eating disorder, of which 20 met DSM-IV-TR criteria for BN and 11 for AN, participated in a mixed-model experimental design with the aim of eliciting TSF and investigating the effects of corrective behaviors (checking and mental neutralizing). Verbal analogue scales constituted the main outcome measures. TSF was experimentally induced and expressed in a similar way in both clinical groups, apart from 'feeling fat' which was higher in BN patients. TSF induction triggered heightened levels of anxiety, guilt and urges to engage in corrective behaviors in both groups. Body dissatisfaction only increased in the BN patients. Mental neutralizing and to a lesser extent checking reduced most effects of the experimental procedure, but this effect was larger for BN patients. The nature of TSF seems to have similarities between BN and AN patients; however, the precise connection between TSF and different types of eating disorders remains to be explored in future clinical trials.

Assessment of thought-shape fusion: initial validation of a short version of the trait thought-shape fusion scale

OBJECTIVE

Thought-shape fusion (TSF) is a cognitive distortion that has been linked to eating pathology. Two studies were conducted to further explore this phenomenon and to establish the psychometric properties of a French short version of the TSF scale.

METHOD

In Study 1, students (n = 284) completed questionnaires assessing TSF and related psychopathology. In Study 2, the responses of women with eating disorders (n = 22) and women with no history of an eating disorder (n = 23) were compared.

RESULTS

The French short version of the TSF scale has a unifactorial structure, with convergent validity with measures of eating pathology, and good internal consistency. Depression, eating pathology, body dissatisfaction, and thought-action fusion emerged as predictors of TSF. Individuals with eating disorders have higher TSF, and more clinically relevant food-related thoughts than do women with no history of an eating disorder.

DISCUSSION

This research suggests that the shortened TSF scale can suitably measure this construct, and provides support for the notion that TSF is associated with eating pathology.

Thought-shape fusion and body image in eating disorders

Purpose

The aim of this study was to analyze the relationships among thought–shape fusion (TSF), specific instruments to assess body image disturbances, and body image quality of life in eating disorder patients in order to improve the understanding of the links between body image concerns and a specific bias consisting of beliefs about the consequences of thinking about forbidden foods.

Patients and methods

The final sample included 76 eating disorder patients (mean age 20.13 ± 2.28 years; 59 women and seven men). After having obtained informed consent, the following questionnaires were administered: Body Appreciation Scale (BAS), Body Image Quality of Life Inventory (BIQLI-SP), Body Shape Questionnaire (BSQ), Eating Disorders Inventory-2 (EDI-2), State-Trait Anxiety Inventory (STAI), Symptom Checklist-90-Revised (SCL-90-R) and Thought-Shape Fusion Questionnaire (TSF-Q).

Results

Significant correlations were found between TSF-Q and body image-related variables. Those with higher scores in TSF showed higher scores in the BSQ (P < 0.0001), Eating Disorder Inventory – Drive for Thinness (EDI-DT) (P < 0.0001), and Eating Disorder Inventory – Body Dissatisfaction (EDI-BD) (P < 0.0001). The same patients showed lower scores in the BAS (P < 0.0001). With respect to the psychopathological variables, patients with high TSF obtained higher scores in all SCL-90-R subscales as well as in the STAI.

Conclusion

The current study shows the interrelations among different body image-related variables, TSF, and body image quality of life.

Psychometric properties of the Spanish version of the Thougth-Shape Fusion Questionnaire

The objectives of the study were to analyze the psychometric properties, factor structure and internal consistency of the Spanish version of the Thought-Shape Fusion Questionnaire (TSF-Q), as well as to determine its validity by evaluating the relationship of the TSF-Q to different instruments. Two groups were studied: one comprising 146 patients with a diagnosis of anorexia (n = 82), bulimia (n = 33) or unspecified eating disorder (n = 31), and another group of 115 undergraduates with no history of psychological disorder. All participants completed the TSF-Q, TAF-Q, EDI-2, STAI, BDI and SCL-90-R. Differences in TSF-Q scores between the diagnostic subgroups were also analyzed. Two factors were obtained which coincided with the two sections indicated by the authors of the questionnaire: conceptual and interpretative. The internal consistency of the TSF-Q and its subscales was determined by means of Cronbach's alpha, with values ranging between .93 and .96. The correlations with other instruments reflected adequate validity. There were no significant differences between the diagnostic subgroups. The Spanish version of the TSF-Q meets the psychometric requirements for measuring thought-shape fusion and shows adequate internal consistency and validity.

Study of Obsessive Compulsive Beliefs: Relationship with Eating Disorders

Background: The relationship between Eating Disorders (ED) and Obsessive Compulsive Disorder (OCD) has been extensively studied in the last few years. However, little effort has been devoted to studying the link between these disorders with regard to their distorted beliefs. Aims: The first objective of the study was to analyze the differences in OCD-related beliefs among ED subtypes and the general population, controlling for age, Body Mass Index, and obsessionality. The second objective was to explore which OCD beliefs explain ED symptomatology. Method: Seventy-nine ED patients without OCD comorbidity, divided into diagnostic subtypes, and 50 community participants completed the Obsessive Beliefs Spanish Inventory-Revised and measures of ED and OCD symptomatology. Results: There were no differences found among clinical ED subtypes in obsessive beliefs, but the bulimia nervosa purgative subtype and binge eating groups obtained significantly different scores from the community group on Thought-Action-Fusion (TAF)-likelihood and TAF-moral, respectively. OCD symptomatology had the most important predictive effect on ED symptoms, followed by Overestimation of Threat, BMI and FPA-moral. Conclusions: The different patterns of beliefs among subtypes reflect what other studies have suggested about the relevance of the presentation of ED symptoms associated with restriction, purges and binge without purges. Our results agree with the transdiagnostic perspective of ED.

The role of food-cue exposure and negative affect in the experience of thought-shape fusion

Thought-shape fusion (TSF) is a cognitive distortion that can be induced by imagining eating high-caloric foods, and involves increased guilt, feelings of fatness, and perceptions of weight gain and moral wrong-doing. Two studies were conducted to further elucidate this phenomenon. Study 1 investigated whether merely being exposed to fattening foods (without being asked to think about these foods) could induce a TSF-like experience. Study 2 investigated the relationship between negative affect and TSF-like experiences. The results suggested that TSF is specific to thinking about eating fattening foods, as mere exposure to high-caloric foods did not increase state TSF scores in healthy females relative to a neutral control condition. Furthermore, susceptibility to TSF is associated with negative affect. Healthy females with low levels of negative affect appear to be protected against TSF, medium negative affect is associated with susceptibility to TSF inductions, while those with high levels of negative affect appear to be particularly vulnerable to TSF-like experiences (even after imagining a neutral situation). Overall, the studies suggest that negative affect is associated with a TSF-like experience, and that TSF is a phenomenon that is experienced (to at least some extent) by females in the general population.

Food cue exposure and body image satisfaction: the moderating role of BMI and dietary restraint

Effects of cue exposure to high and low-caloric food on body image satisfaction and the moderating role of body mass index (BMI) and restraint were investigated in 77 lean unrestrained, lean restrained and overweight restrained females. Body (BS) and weight satisfaction (WS) were assessed before and after the cue exposure. Lean restrained participants were significantly less satisfied with their weight after cue exposure to high-caloric foods in comparison to cue exposure to low-caloric foods, whereas no such effect was present in overweight restrained and lean unrestrained participants. Low-caloric food cues did not influence WS. Food cues had a nonsignificant trend effect on BS. Yet, only lean unrestrained participants experienced significantly more BS in response to food cue exposure.