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Drury CR, Armeli S, Loeb KL. Body checking and avoidance among dancers. Eat Behav 2024; 54:101897. [PMID: 38865853 DOI: 10.1016/j.eatbeh.2024.101897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/14/2024]
Abstract
Dancers are at heightened risk for eating disorders (EDs) and have job and training demands that obscure ED assessment and likely impede treatment. Two behavioral manifestations of ED psychopathology that may present uniquely in a dance environment are body checking and body avoidance. The current study sought to provide a foundational understanding of the phenomenology of body checking and avoidance among dancers by assessing the reliability (i.e., internal consistency) of existing body checking and avoidance measures and the relationships, or convergent validity, between measures of body checking and avoidance and measures of related constructs. Eighty professional and pre-professional (i.e., conservatory level) dancers (78.8 % female) from seven dance genres completed self-report measures of body checking and avoidance, ED pathology, clinical perfectionism, depression, and anxiety. Across the dancer sample, body checking and avoidance measures demonstrated adequate internal consistency. More frequent body checking and body avoidance was strongly related to higher levels of ED pathology. There were moderate to strong correlations between body checking and body avoidance and clinical perfectionism, depression, and anxiety such that higher body checking and body avoidance was related to higher clinical perfectionism, depression, and anxiety. Exploratory analyses found no significant differences between ballet dancers and dancers of other dance genres; professional dancers scored in the normative range on measures of body checking and body avoidance. Dancers' qualitative descriptions of body checking and avoidance revealed behaviors not included in existing questionnaires, such as unique mirror use behaviors, technology-assisted body checking, and the checking and avoidance of body parts relevant to the dance-specific body ideal. Results support the inclusion of body checking and avoidance interventions in ED treatments for dancers (particularly pre-professional dancers) and emphasize the need for dancer-specific ED assessment methods.
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Affiliation(s)
- Catherine R Drury
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 675 18th Street, San Francisco, CA 94107, USA; School of Psychology, Fairleigh Dickinson University, 1000 River Road, T-WH1-01, Teaneck, NJ 07666, USA.
| | - Stephen Armeli
- School of Psychology, Fairleigh Dickinson University, 1000 River Road, T-WH1-01, Teaneck, NJ 07666, USA.
| | - Katharine L Loeb
- Chicago Center for Evidence-Based Treatment, 25 East Washington Street, Suite 1015, Chicago, IL 60602, USA.
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2
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Kiser ET, Sinclair KL, Tullos EA, Ratcliff CG. Associations between disordered eating and body focused repetitive behaviors in college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:1184-1191. [PMID: 35549835 DOI: 10.1080/07448481.2022.2070713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 12/21/2021] [Accepted: 04/13/2022] [Indexed: 06/15/2023]
Abstract
Objective: College students with disordered eating (DE) are at increased risk of body focused repetitive behaviors (BFRBs). Both DE and BFRBs are described as impulsive and compulsive. However, the associations of impulsive DE with impulsive BFRBs and compulsive DE with compulsive BFRBs have not been examined. Methods: 191 college-aged students completed a survey of BFRBs and DE. Results: Participants who reported hair pulling were twice as likely to report clinically significant DE than those who denied hair pulling (p = .022). Participants who endorsed distressing hair pulling (p = .026), skin picking (p = .052), and nail biting (p = .094) were twice as likely to report clinically significant DE than those who were not distressed by these behaviors. Evidence did not support the association of BFRBs and DE along an impulsive/compulsive continuum. Conclusions: Results suggest that BFRBs and DE often co-occur, and the role of impulsivity and compulsivity in these behaviors is complex.
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Affiliation(s)
- Emalee T Kiser
- Department of Psychology, Sam Houston State University, Huntsville, Texas, USA
| | - Kelsey L Sinclair
- Department of Psychology, Sam Houston State University, Huntsville, Texas, USA
| | - Emily A Tullos
- Department of Psychology, Sam Houston State University, Huntsville, Texas, USA
| | - Chelsea G Ratcliff
- Department of Psychology, Sam Houston State University, Huntsville, Texas, USA
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3
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Baker S, Maïano C, Houle SA, Nadon L, Aimé A, Morin AJS. Profiles of body image concerns and their associations with disordered eating behaviors. Appetite 2023; 191:107082. [PMID: 37832721 DOI: 10.1016/j.appet.2023.107082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/03/2023] [Accepted: 10/09/2023] [Indexed: 10/15/2023]
Abstract
Although body image concerns (BIC) are recognized as a core driver in the development of disordered eating behaviors, the combined role of various types of BIC remains underexamined. This study relied on latent profile analysis to identify the main configurations of self-reported BIC (i.e., body checking and avoidance, perceived physical appearance, and fear of negative appearance evaluation) observed in a sample of 419 French-Canadian individuals (Mage = 26.59, SDage = 9.23). The role of body mass index, sex, and age on profile membership was also examined, as well as the relation between profile membership and disordered eating behaviors (i.e., dieting, bulimia and food preoccupation, and oral control). Six distinct BIC profiles differing in terms of shape and level were identified, with women being more likely to display a profile characterized by higher levels of BIC. In turn, profiles characterized by higher levels of BIC were associated with more disordered eating behaviors. The present study can broaden our understanding of the onset and maintenance of disordered eating behaviors and inspire the development of more tailored body-image interventions.
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Affiliation(s)
- Sarah Baker
- Substantive-Methodological Synergy Research Laboratory, Department of Psychology, Concordia University, Montreal, Canada
| | - Christophe Maïano
- Cyberpsychology Laboratory, Department of Psychoeducation and Psychology, Université du Québec en Outaouais (UQO|Campus de Saint-Jérôme), Saint-Jérôme, Canada.
| | - Simon A Houle
- Substantive-Methodological Synergy Research Laboratory, Department of Psychology, Concordia University, Montreal, Canada
| | - Lindsey Nadon
- Substantive-Methodological Synergy Research Laboratory, Department of Psychology, Concordia University, Montreal, Canada
| | - Annie Aimé
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais (UQO|Campus de Saint-Jérôme), Saint-Jérôme, Canada
| | - Alexandre J S Morin
- Substantive-Methodological Synergy Research Laboratory, Department of Psychology, Concordia University, Montreal, Canada
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4
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Bourke M, Pila E. Body-related self-conscious emotions, self-compassion, and dietary restraint in Canadian undergraduate university students: A multilevel mediation and moderation analysis. Int J Eat Disord 2023; 56:2131-2141. [PMID: 37610052 DOI: 10.1002/eat.24049] [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: 04/05/2023] [Revised: 07/13/2023] [Accepted: 08/08/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVE Self-compassion has an inverse association with dietary restraint however, the mechanisms linking self-compassion and dietary restraint are not clear. This study aimed to determine to what extent self-compassion was inversely concurrently related to dietary restraint, indirectly through body-related self-conscious emotions, and to what extent trait self-compassion moderated the concurrent within-person association between body-related self-conscious emotions and dietary restraint. METHOD Data was collected from 224 Canadian university students who reported on trait self-compassion at baseline and body-related shame, guilt, envy, and embarrassment, and dietary restraint biweekly between November 2020 and August 2021. RESULTS Results from a 2-1-1 multilevel mediation model showed that trait self-compassion was indirectly concurrently related to dietary restraint through body-related shame, guilt, envy, and embarrassment. Results from the moderation model showed that there was a significant positive concurrent within-person association between body-related shame, envy, and embarrassment, but not guilt, with dietary restraint. These relationships were not moderated by trait self-compassion. DISCUSSION This study adds to our understanding of the concurrent association between body-related self-conscious emotions and dietary restraint, and the mechanisms through which self-compassion is related to dietary restraint. Given body-related self-conscious emotions were related to dietary restraint at both the within-person and between-person level, both compassion-focused interventions that aim to improve general levels of body-related self-conscious emotions and interventions that aim to overcome spikes in these emotions compared with one's usual level are warranted. PUBLIC SIGNIFICANCE STATEMENT Negative body-related self-conscious emotions were related to higher levels of dietary restraint both across individuals and within individuals over time; and may play a mechanistic role in linking self-compassion with dietary restraint. Interventions aimed at reducing negative body-related self-conscious emotions are warranted in the prevention of eating disorder psychopathology.
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Affiliation(s)
- Matthew Bourke
- School of Occupational Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Eva Pila
- School of Kinesiology, Faculty of Health Sciences, Western University, London, Ontario, Canada
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Goeden AV, Schaefer LM, Crosby RD, Peterson CB, Engel SG, Le Grange D, Crow SJ, Wonderlich SA. Examining the momentary relationships between body checking and eating disorder symptoms in women with anorexia nervosa. Eat Behav 2023; 50:101751. [PMID: 37244020 PMCID: PMC10525023 DOI: 10.1016/j.eatbeh.2023.101751] [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: 10/12/2022] [Revised: 04/26/2023] [Accepted: 05/18/2023] [Indexed: 05/29/2023]
Abstract
Body checking is common among individuals with anorexia nervosa (AN) and increases risk for dietary restriction. However, no study has examined whether body checking increases the immediate risk for engaging in other harmful weight loss behaviors, or whether this relationship is moderated by person-level traits. The current study utilized ecological momentary assessment (EMA) to examine whether (a) body checking predicted rapid use of weight loss behaviors, and (b) whether eating-related obsessionality/compulsivity moderated this relationship. Women with full or subthreshold anorexia nervosa (N = 118) completed a measure of eating-related obsessionality/compulsivity at baseline, followed by a 14-day EMA protocol during which they reported on body checking and weight loss behaviors (i.e., exercise, self-induced vomiting, laxative use, skipping meals, and increasing fluid intake). In a series of generalized linear mixed models, within-person effects indicated that momentary body checking significantly predicted subsequent meal skipping and using fluids to curb appetite. Between-person effects indicated that individuals who engage in more frequent body checking also engage in a higher frequency of self-induced vomiting, meal skipping, and use of fluids to curb appetite. An individual's degree of eating-related obsessionality/compulsivity did not moderate any of these relationships. Findings highlight body checking as an immediate precursor of dangerous weight loss behaviors among individuals with AN, and underscore the need for clinicians to address body checking during treatment.
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Affiliation(s)
- Allyson V Goeden
- Center for Biobehavioral Research, Sanford Research, United States of America; Department of Psychology, University of Wisconsin, La-Crosse, United States of America
| | - Lauren M Schaefer
- Center for Biobehavioral Research, Sanford Research, United States of America; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, United States of America.
| | - Ross D Crosby
- Center for Biobehavioral Research, Sanford Research, United States of America; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, United States of America
| | - Carol B Peterson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, United States of America
| | - Scott G Engel
- Center for Biobehavioral Research, Sanford Research, United States of America; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, United States of America
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, United States of America; Department of Psychiatry and Behavioral Sciences, University of Chicago (Emeritus), United States of America
| | - Scott J Crow
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, United States of America; Department of Psychiatry, Accanto Health, St. Paul Minnesota, United States of America
| | - Stephen A Wonderlich
- Center for Biobehavioral Research, Sanford Research, United States of America; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, United States of America
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6
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Srivastava P, Felonis CR, Piers AD, Nunez N, Fitzpatrick B, Juarascio A, Manasse S. Reward mediates the association between engagement in noneating activities and state body dissatisfaction: An ecological momentary assessment study. Int J Eat Disord 2023; 56:562-573. [PMID: 36444116 DOI: 10.1002/eat.23862] [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] [Received: 04/26/2022] [Revised: 10/27/2022] [Accepted: 11/15/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Momentary worsening (i.e., greater than one's average levels) of state body dissatisfaction (BD) has been implicated as a proximal risk factor for eating disorder (ED) behaviors in binge-spectrum EDs. Yet, research exploring the prospective association between noneating activities in daily life (e.g., chores, self-care/coping) and momentary state BD remains limited. Understanding the momentary link between engagement in noneating activities and state BD, and pathways through which engagement in said activities influences momentary state BD is critical to informing treatments. The current ecological momentary assessment (EMA) study examined whether (1) engagement in noneating activities at Time 1 prospectively predicted momentary state BD at Time 2 and (2) reward drawn from noneating activities at Time 1 mediates the prospective association between engagement in noneating activities at Time 1 and momentary state BD at Time 2. METHOD Sixty-six adults with transdiagnostic binge eating completed an EMA protocol over 7-14 days. Participants received six EMA signals per day (total EMA observations = 4038). Multilevel modeling was used to examine the research questions. RESULTS Engagement in an indoor hobby, outdoor recreation, socializing, and self-care/coping strategies prospectively predicted momentary state BD improvements, while using TV/social media and cooking prospectively predicted momentary state BD worsening. Reward drawn from engagement in these noneating activities mediated the associations. DISCUSSION If replicated, these findings suggest that increasing the frequency of certain noneating activities and enhancing their rewarding aspects to improve state BD and decrease ED behavior risk during treatment may be worthy of further exploration. PUBLIC SIGNIFICANCE Momentary worsening of state body dissatisfaction (BD) is a risk factor for eating disorder behaviors in individuals with binge eating. This study found that engaging in certain noneating activities (e.g., socializing) prospectively predicted momentary improvements in state BD, while other noneating activities (e.g., cooking) predicted momentary worsening of state BD. Reward drawn from activities mediated these relations. To improve state BD, treatments should target the frequency of, and reward obtained from these noneating activities.
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Affiliation(s)
- Paakhi Srivastava
- Center for Weight, Eating, and Lifestyle Science (WELL Center), Drexel University, Philadelphia, Pennsylvania, USA.,Department of Psychology, Drexel University, Philadelphia, Pennsylvania, USA
| | - Christina R Felonis
- Center for Weight, Eating, and Lifestyle Science (WELL Center), Drexel University, Philadelphia, Pennsylvania, USA.,Department of Psychology, Drexel University, Philadelphia, Pennsylvania, USA
| | - Amani D Piers
- Center for Weight, Eating, and Lifestyle Science (WELL Center), Drexel University, Philadelphia, Pennsylvania, USA
| | - Nicole Nunez
- Center for Weight, Eating, and Lifestyle Science (WELL Center), Drexel University, Philadelphia, Pennsylvania, USA.,Department of Psychology, Drexel University, Philadelphia, Pennsylvania, USA
| | - Brighid Fitzpatrick
- Center for Weight, Eating, and Lifestyle Science (WELL Center), Drexel University, Philadelphia, Pennsylvania, USA
| | - Adrienne Juarascio
- Center for Weight, Eating, and Lifestyle Science (WELL Center), Drexel University, Philadelphia, Pennsylvania, USA.,Department of Psychology, Drexel University, Philadelphia, Pennsylvania, USA
| | - Stephanie Manasse
- 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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7
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Mason TB, Smith KE, Crosby RD, Engel SG, Peterson CB, Wonderlich SA, Jin H. Multi-state modeling of thought-shape fusion using ecological momentary assessment. Body Image 2021; 39:139-145. [PMID: 34358817 PMCID: PMC8654058 DOI: 10.1016/j.bodyim.2021.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 07/21/2021] [Accepted: 07/25/2021] [Indexed: 12/17/2022]
Abstract
Body dissatisfaction (BD) and preoccupation with thoughts of food (PTF) are intertwined and are components of thought-shape fusion. Thought-shape fusion describes the process by which PTF lead to beliefs about weight and shape. To study thought-shape fusion in daily life and explore various transitions between BD and PTF, 30 women with binge eating completed ecological momentary assessment for 14 days. BD and PTF were assessed using continuous rating scales at each prompt. Multi-state modeling, which analyzes micro-temporal transitions between discrete states, was used to examine transitions among four states created with BD and PTF ratings. The four states included low BD/low PTF, low BD/high PTF, high BD/low PTF, and high BD/high PTF. Affect and disordered eating were examined as covariates of state transitions. Results showed high BD states were self-perpetrating, such that when in high BD states, transition to low BD states were less likely. Regarding covariates, positive affect buffered against maladaptive transitions whereas negative affect and disordered eating increased risk. Findings highlighted high BD states as influential, and negative affect and disordered eating as risk factors and positive affect as preventive. This study enhances theory of thought-shape fusion and implicates transitions from BD to PTF as possible underlying transitions.
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Affiliation(s)
- Tyler B Mason
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, United States.
| | - Kathryn E Smith
- Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA, United States
| | - Ross D Crosby
- Department of Biobehavioral Research, Sanford Health, Fargo, ND, United States; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, United States
| | - Scott G Engel
- Department of Biobehavioral Research, Sanford Health, Fargo, ND, United States; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, United States
| | - Carol B Peterson
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Stephen A Wonderlich
- Department of Biobehavioral Research, Sanford Health, Fargo, ND, United States; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, United States
| | - Haomiao Jin
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA, United States
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8
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Walker DC, Gorrell S, Hildebrandt T, Anderson DA. Consequences of Repeated Critical Versus Neutral Body Checking in Women With High Shape or Weight Concern. Behav Ther 2021; 52:830-846. [PMID: 34134824 PMCID: PMC8827350 DOI: 10.1016/j.beth.2020.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 10/09/2020] [Accepted: 10/15/2020] [Indexed: 11/28/2022]
Abstract
Body checking is a repeated behavior conducted in an attempt to gain information about one's shape, weight, size, or body composition. Body checking is associated with negative behavioral, emotional, and cognitive outcomes and may maintain body dissatisfaction and eating disorders. The precise function and consequences of body checking remain less well understood. Specifically, immediate and delayed impacts of repeated critical body checking (CBC) have not been determined. The current study randomly assigned 142 young women with high shape/weight concern to daily 10-min CBC, neutral body checking (NBC), or a non-body critical checking (NBCC) comparison condition, examining their immediate and delayed (one-week follow-up) effects on body satisfaction, self-esteem, and negative affect. Multilevel modeling and follow-up planned comparisons found that compared to NBCC, CBC participants' body satisfaction and self-esteem immediately decreased, but negative affect improved from baseline to follow-up. Compared to CBC, NBC participants' self-esteem and negative affect improved immediately, and their self-esteem improved over time compared to NBCC. Over time, all participants' state body satisfaction improved, regardless of condition. Our findings suggest a 10-min CBC session may function differently than typical (harmful) in vivo body checking. However, reasons for this difference are unclear. Additional research is needed to distinguish (harmful) in vivo body checking from CBC procedures such as this and other mirror exposure interventions. Research is needed to examine the effects of varying CBC duration and instructions during body exposure to further clarify mechanisms of change during body exposures.
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9
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Opladen V, Vivell MB, Vocks S, Hartmann AS. Revisiting the Postulates of Etiological Models of Eating Disorders: Questioning Body Checking as a Longer-Term Maintaining Factor. Front Psychiatry 2021; 12:795189. [PMID: 35095608 PMCID: PMC8792988 DOI: 10.3389/fpsyt.2021.795189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/10/2021] [Indexed: 11/29/2022] Open
Abstract
Body checking (BC) is not only inherent to the maintenance of eating disorders but is also widespread among healthy females. According to etiological models, while BC serves as an affect-regulating behavior in the short term, in the longer term it is assumed to be disorder-maintaining and also produces more negative affect. The present study therefore aimed to empirically examine the proposed longer-term consequences of increased BC. In an online study, N = 167 women tracked their daily amount of BC over a total of 7 days: Following a 1-day baseline assessment of typical BC, participants were asked to check their bodies in an typical manner for 3 days and with a 3-fold increased frequency for 3-days. Before and after each BC episode, the impact of BC on affect, eating disorder symptoms, general pathology and endorsement of different functions of BC was assessed. Participants showed longer-term consequences of increased BC in terms of increased negative affect and general pathology, while eating disorder symptoms remained unaffected. In the case of typical BC, participants showed decreased general pathology and anxiety. Furthermore, the endorsement of a higher number of BC functions led to increased negative affect and an increased amount of typical BC. The findings support the theoretically assumed role of maladaptive BC in maintaining negative emotion in the longer term. However, though requiring replication, our finding of positive effects of typical BC calls into question the overall dysfunctionality of BC among non-clinical women who are not at risk of developing an eating disorder.
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Affiliation(s)
- Vanessa Opladen
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Osnabrück University, Osnabrück, Germany
| | - Maj-Britt Vivell
- Department of Psychology, Experimental Clinical Psychology, University of Konstanz, Konstanz, Germany
| | - Silja Vocks
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Osnabrück University, Osnabrück, Germany
| | - Andrea S Hartmann
- Department of Psychology, Experimental Clinical Psychology, University of Konstanz, Konstanz, Germany
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10
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Zaitsoff SL, Pullmer R, Coelho JS. A longitudinal examination of body-checking behaviors and eating disorder pathology in a community sample of adolescent males and females. Int J Eat Disord 2020; 53:1836-1843. [PMID: 32815197 DOI: 10.1002/eat.23364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 07/22/2020] [Accepted: 07/26/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Related to the cognitive-behavioral theory of eating disorders, body checking has gained increasing recognition as both a maintaining factor for eating disorders and an important target for treatment. However, it is unclear whether body-checking behaviors contribute to the development of disordered eating, or if these behaviors develop as a response to experiencing eating disorder thoughts and behaviors. This study aims to examine the relationships between body-checking behaviors and eating disordered thoughts and behaviors in adolescent females and males in the community over time. METHODS Participants included 238 adolescents (n = 104 males, n = 134 females, Mage = 16.5 years) recruited from high schools in British Columbia, Canada, who completed the Eating Disorder Examination Questionnaire and Body Checking Questionnaire at baseline (T1) and again approximately 4 months later (T2). RESULTS After controlling for baseline levels of eating pathology and body mass index (BMI), body checking at T1 predicted increases in eating pathology for both males and females. In contrast, after controlling for baseline levels of body checking and BMI, eating pathology at T1 did not predict changes in body checking for females, but it did for males. Findings suggest that, among adolescents, engaging in body-checking behaviors may increase risk for disordered eating. DISCUSSION If supported by further research, targeting body-checking behaviors in prevention programs may be warranted.
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Affiliation(s)
- Shannon L Zaitsoff
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada.,Provincial Specialized Eating Disorders Program for Children and Adolescents, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Rachelle Pullmer
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Jennifer S Coelho
- Provincial Specialized Eating Disorders Program for Children and Adolescents, BC Children's Hospital, Vancouver, British Columbia, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
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11
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Predicting the restrictive eating, exercise, and weight monitoring compulsions of anorexia nervosa. Eat Weight Disord 2020; 25:701-707. [PMID: 30900140 PMCID: PMC7256099 DOI: 10.1007/s40519-019-00674-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 03/13/2019] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Compulsions surrounding restrictive eating, exercise, and weight monitoring are thought to maintain abnormal eating behaviour in individuals with anorexia nervosa (AN). This study aimed to determine if AN psychopathology and trait anxiety explain the presence of restrictive eating, exercise, and weight monitoring compulsions in a mixed sample. METHODS Participants were 31 females with AN and 31 age and gender-matched healthy individuals (HC). Restrictive eating, exercise and weight monitoring compulsion presence was compared between AN and HC groups. Multivariable poisson regression analyses, adjusted for diagnostic status, were conducted to assess the association of both AN psychopathology and trait anxiety with compulsions across the mixed group. RESULTS Individuals with AN endorsed a greater number of restrictive eating, exercise and weight monitoring compulsions compared to HC. In adjusted poisson regression analyses neither AN psychopathology nor trait anxiety predicted compulsion presence: incidence rate ratio (IRR) for AN psychopathology = 1.15 [95% CI 0.84, 1.57], p = 0.39; IRR for trait anxiety = 1.01 [95% CI 0.97, 1.06], p = 0.50. CONCLUSIONS Greater presence of restrictive eating, exercise and weight monitoring compulsions was reported by individuals with AN, supporting the conceptualisation of disorder behaviours as compulsive. The study was underpowered to robustly evaluate the association between predictors of interest and the compulsions outcome, largely owing to the small sample size. Further investigation is required, ideally using methods able to identify causal and mediation effects. LEVEL OF EVIDENCE Level V, cross-sectional study.
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12
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Romano KA, Heron KE. Racial differences in overeating, loss of control eating, and binge eating: Extending core tenets of the Cognitive Behavioral Theory of Eating Disorders. Appetite 2020; 153:104747. [PMID: 32454077 DOI: 10.1016/j.appet.2020.104747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 05/15/2020] [Accepted: 05/17/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE The present study examined racial differences in associations among body dissatisfaction, body checking, and dietary restraint relative to overeating, loss of control eating, and binge eating outcomes among college women. METHOD Young adult women (N = 903) at three Mid-Atlantic US institutions completed measures assessing negative body image and eating pathology via an online survey. Structural equation modeling was used to test a model examining associations among body dissatisfaction, body checking, dietary restraint, and disinhibited eating behaviors. Multigroup analyses examined whether these associations differed for women who identified as White (n = 432) versus Black (n = 359). RESULTS More frequent body checking explained associations between elevated body dissatisfaction and more frequent use of all three disinhibited eating outcomes for White and Black women, whereas restraint solely mediated an association between body dissatisfaction and overeating. The assessed constructs generally operated in a similar manner across racial groups. However, stronger associations among body dissatisfaction, restraint, and overeating, and between body checking and loss of control eating were identified for women who identified as White versus Black. CONCLUSIONS Eating disorder programming efforts targeting body checking behavior may prove useful in decreasing White and Black women's disinhibited eating.
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Affiliation(s)
- Kelly A Romano
- The Virginia Consortium Program in Clinical Psychology, 555 Park Avenue, Norfolk, VA, 23504, USA.
| | - Kristin E Heron
- The Virginia Consortium Program in Clinical Psychology, 555 Park Avenue, Norfolk, VA, 23504, USA; Old Dominion University, 250 Mills Godwin Building, Norfolk, VA, 23529, USA
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13
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Deutsch BC, Piccirillo JF. Momentary Analysis of Tinnitus: Considering the Patient. Curr Top Behav Neurosci 2020; 51:383-401. [PMID: 32808091 DOI: 10.1007/7854_2020_176] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Ecological momentary assessment is a valuable research technique meant to capture real-time data and contextualize disease. While more common in neuropsychiatric research, this methodology is exceptionally fit for tinnitus. Tinnitus has been shown to be affected by many patient-level and environment-specific factors. From an individual's baseline anxiety to the level of ambient noise in their environment, the level of bother experienced by those with tinnitus can vary widely. Only assessing tinnitus within a clinical environment can distort the true impact of the disease. Ecological data can minimize bias while generating an individualistic picture of the burden being experienced by the patient. Individual data can also compliment new research methods rooted in precision medicine, providing clearer, better-suited treatments for each patient on the tinnitus spectrum.
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Affiliation(s)
- Brian C Deutsch
- Department of Otolaryngology, Head and Neck Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA. .,Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Jay F Piccirillo
- Department of Otolaryngology, Head and Neck Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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14
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The role of body image disturbance in the onset, maintenance, and relapse of anorexia nervosa: A systematic review. Clin Psychol Rev 2019; 74:101771. [DOI: 10.1016/j.cpr.2019.101771] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 09/04/2019] [Accepted: 10/15/2019] [Indexed: 12/16/2022]
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15
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Body image states in everyday life: Evidence from ecological momentary assessment methodology. Body Image 2019; 31:245-272. [PMID: 30852080 DOI: 10.1016/j.bodyim.2019.02.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/19/2019] [Accepted: 02/21/2019] [Indexed: 01/26/2023]
Abstract
This review highlights the contributions of Professor Thomas Cash to the scholarship of body image experiences in daily life, including his influence on subsequent research in this field. Cash's arguments for capturing a broad range of state-based body image experiences have been heeded, with recent studies exploring positive body image constructs as well as the more studied negative body image experiences. Appearance comparisons are the most commonly studied contextual influence on body image, and they seem to have a consistent effect. However, the experiences of body image in sexual contexts, and among adolescents, those who are pregnant, or have other physical characteristics that may increase the salience of appearance warrant further attention. Findings generally support Cash's contention that trait body image relates to likelihood and level of experience of body image in daily life, though the moderating effects of trait aspects on state-based relationships remains unclear. The discussion concludes with consideration of the impact of assessment schedules on obtained results. It is also discussed how accumulated knowledge regarding state-based body image experiences may be leveraged in treatment contexts, particularly in light of clear evidence that repeated assessment of body image in daily life increases self-awareness of one's body image characteristics.
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16
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Grilo CM, Crosby RD, Machado PPP. Examining the distinctiveness of body image concerns in patients with anorexia nervosa and bulimia nervosa. Int J Eat Disord 2019; 52:1229-1236. [PMID: 31486125 DOI: 10.1002/eat.23161] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study examined the distinctiveness of specific constructs of body-image disturbance in patients with anorexia nervosa (AN) and bulimia nervosa (BN). We compared weight/shape dissatisfaction, weight/shape overvaluation, weight/shape preoccupation, and fear of weight gain in patients with AN and BN and examined how each specific body-image construct relates to clinical measures within and between AN and BN. METHOD A clinical sample of 490 treatment-seeking patients diagnosed with DSM-5 AN (N = 310) or BN (N = 180) by clinicians using structured interviews in Portugal completed the Eating Disorder Examination-Questionnaire to assess body image and eating-disorder (ED) psychopathology. RESULTS Both within and between AN and BN, the four body-image constructs varied in their strengths of association among themselves, with ED psychopathology, and body mass index (BMI). Analyses revealed considerable variability in variance accounted for in clinical measures by body-image constructs. Body-image constructs predicted significant, albeit small, variance in BMI within BN (dissatisfaction, preoccupation significant) but not within AN. Body-image constructs predicted significant, albeit small, variance in the frequencies of binge eating and purging in AN (with preoccupation significant for both and fear for purging) but not within BN. Body-image constructs predicted significant variance in ED psychopathology (large amounts of variance for Eating Concern and Restraint) within both AN and BN (with overvaluation, preoccupation, and fear significant). CONCLUSION Clinical manifestations of body-image disturbances are complex and show important differences across AN and BN. Understanding distinctions and differential salience of different body-image constructs across different EDs can inform refinement of specific case conceptualization.
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Affiliation(s)
- Carlos M Grilo
- Yale University School of Medicine, New Haven, Connecticut
| | - Ross D Crosby
- Neuropsychiatric Research Institute, Fargo, North Dakota.,University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
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17
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Smith JM, Whisenhunt BL, Buchanan EM, Hudson DL. Evaluating the effectiveness of ecological momentary assessment and intervention targeting body checking behaviors. Eat Disord 2019; 27:521-537. [PMID: 30664400 DOI: 10.1080/10640266.2018.1560850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study investigated the efficacy of using ecological momentary assessment and intervention (EMA/EMI) to target body checking behaviors. Body checking has been shown to increase body dissatisfaction and play a role in eating disorders, but few treatments specifically targeting body checking have been empirically evaluated. Forty-four female undergraduates who reported engaging in frequent body checking behaviors participated in a five-day study wherein they were assessed five times a day via smart phone. On the final two days of the study, intervention messages were sent containing cognitive-behavioral strategies for decreasing body checking. Body checking behaviors increased within each day, but decreased across the five day intervention period. Pretest to posttest analyses found healthy improvements in a number of body image related constructs. These results highlight that 1) body checking appears to increase throughout the day, and 2) targeting body checking behaviors through brief EMA/EMI may be a useful clinical tool.
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Affiliation(s)
- Jamie M Smith
- Psychology Department, University of New Mexico, Albuquerque, NM, USA
| | | | - Erin M Buchanan
- Psychology Department, Missouri State University, Springfield, MO, USA
| | - Danae L Hudson
- Psychology Department, Missouri State University, Springfield, MO, USA
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18
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Disentangling relations between the desirability of the thin-ideal, body checking, and worry on college women's weight-loss dieting: A self-regulation perspective. Eat Behav 2019; 34:101312. [PMID: 31351360 DOI: 10.1016/j.eatbeh.2019.101312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 07/09/2019] [Accepted: 07/10/2019] [Indexed: 12/29/2022]
Abstract
The study used self-regulation theory to elucidate the relationships between the desirability of the thin-ideal goal, dispositional worry, body checking and weight-loss dieting (WLD) in college women. We hypothesized that body checking would mediate the relationship between the desirability of the thin-ideal goal and WLD: the desire to be thin would be associated with more WLD through more frequent body checking. We also hypothesized that dispositional worry would moderate this mediation pathway, such that the mediation pathway would be stronger for those higher in worry. Finally, all effects were expected to occur when controlling for self-reported body size. A paper and pencil survey was conducted on a convenience sample of 237 college women who completed measures of: thin-ideal desirability, dispositional worry, body checking, WLD, as well as providing height and weight. A bootstrap analysis using PROCESS (Hayes, 2013) supported the hypothesized moderated mediation model. Findings add to current knowledge by elucidating the nature and function of body checking, and by so doing may provide insight into the prevention and treatment of disordered eating.
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19
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Guthoff H, Cordes M, Wilhelm L, Hartmann AS, Vocks S. Body Checking bei Frauen mit hohen und niedrigen Figur- und Gewichtssorgen. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2019. [DOI: 10.1026/1616-3443/a000547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Gemäß Theorien zu Essstörungen ist die Aufrechterhaltung von Body Checking (BC)-Verhalten mit zwei divergierenden kognitiv-affektiven Prozessen assoziiert, d. h. Anstieg an Arousal versus Abnahme negativer emotionaler Valenz. Fragestellung: Ziel ist die Replikation einer Online-Studie zur Untersuchung, ob BC mit beiden postulierten Prozessen einhergeht und welche Relevanz die subjektive Attraktivität der kontrollierten Körperpartien hierbei hat. Methode: 125 Frauen mit hohen versus niedrigen Figur- und Gewichtssorgen schätzten ihr Level an Arousal und negativer emotionaler Valenz in erinnerten BC-Episoden der subjektiv unattraktivsten und attraktivsten Körperpartien ein. Ergebnisse: Nur bei Frauen mit hohen Figur- und Gewichtssorgen in BC-Episoden der subjektiv unattraktivsten Körperpartien traten sowohl ein Anstieg an Arousal als auch eine Abnahme negativer emotionaler Valenz ein. Schlussfolgerungen: Beide postulierten Prozesse wurden nachgewiesen.
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Affiliation(s)
- Henrike Guthoff
- Institut für Psychologie, Fachgebiet Klinische Psychologie und Psychotherapie, Universität Osnabrück
| | - Martin Cordes
- Institut für Psychologie, Fachgebiet Klinische Psychologie und Psychotherapie, Universität Osnabrück
| | - Leonie Wilhelm
- Institut für Psychologie, Fachgebiet Klinische Psychologie und Psychotherapie, Universität Osnabrück
| | - Andrea S. Hartmann
- Institut für Psychologie, Fachgebiet Klinische Psychologie und Psychotherapie, Universität Osnabrück
| | - Silja Vocks
- Institut für Psychologie, Fachgebiet Klinische Psychologie und Psychotherapie, Universität Osnabrück
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20
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Hartmann AS, Cordes M, Hirschfeld G, Vocks S. Affect and worry during a checking episode: A comparison of individuals with symptoms of obsessive-compulsive disorder, anorexia nervosa, bulimia nervosa, body dysmorphic disorder, illness anxiety disorder, and panic disorder. Psychiatry Res 2019; 272:349-358. [PMID: 30599438 DOI: 10.1016/j.psychres.2018.12.132] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 12/04/2018] [Accepted: 12/23/2018] [Indexed: 11/27/2022]
Abstract
Checking behavior (CB) occurs in a variety of disorders such as obsessive-compulsive (OCD), body dysmorphic (BDD), illness anxiety (IA), and panic disorder (PD), as well as anorexia (AN) and bulimia nervosa (BN). Etiological models of these disorders - with the exception of those for PD - postulate that CB mainly occurs in situations characterized by negative affect and serves to regulate it. We aimed to test these assumptions: N = 386 individuals with a self-reported diagnosis of one of the disorders rated their affect at baseline, directly before a remembered CB episode, during, immediately afterwards, and 15 and 60 minutes afterwards, and rated their endorsement of different functions of CB. The results show that transdiagnostically negative affect is significantly higher before CB compared to baseline, and is significantly reduced from before CB to all post-CB assessments. Reduction of negative affect and Attainment of certainty were the sole functions predicting the affective course during CB, and most prominently reported transdiagnostically. Assumptions of the etiological models were confirmed, suggesting that exposure and ritual prevention should be examined across disorders. As attainment of certainty seems to be predictive for the course of CB, this might be targeted in cognitive interventions.
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Affiliation(s)
- Andrea S Hartmann
- Faculty of Human Sciences, Department of Psychology, Division of Clinical Psychology and Psychotherapy, Osnabrück University, Knollstr. 15, 49069 Osnabrück, Germany.
| | - Martin Cordes
- Faculty of Human Sciences, Department of Psychology, Division of Clinical Psychology and Psychotherapy, Osnabrück University, Knollstr. 15, 49069 Osnabrück, Germany
| | - Gerrit Hirschfeld
- Faculty of Economics and Health, Department of Applied Psychology, Division of Research Methods and Diagnostics, University of Applied Sciences Bielefeld, Interaktion 1, 33619 Bielefeld, Germany
| | - Silja Vocks
- Faculty of Human Sciences, Department of Psychology, Division of Clinical Psychology and Psychotherapy, Osnabrück University, Knollstr. 15, 49069 Osnabrück, Germany
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21
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Pak KN, Wonderlich J, le Grange D, Engel SG, Crow S, Peterson C, Crosby RD, Wonderlich SA, Fischer S. The moderating effect of impulsivity on negative affect and body checking. Compr Psychiatry 2018; 86:137-142. [PMID: 30145404 PMCID: PMC8666955 DOI: 10.1016/j.comppsych.2018.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 07/18/2018] [Accepted: 08/14/2018] [Indexed: 11/30/2022] Open
Abstract
This study examined the moderating effects of different aspects of trait impulsivity on trajectories of negative affect prior to and following body checking in the natural environment in women with anorexia nervosa (AN). Body checking is a compulsive behavior that may maintain the cycle of eating disordered behavior through negative reinforcement. Previous studies regarding the relationship of negative affect to body checking have been inconsistent, making it unclear how negative affect functions as an antecedent to this behavior in the natural environment. We hypothesized that individual differences in trait impulsivity may influence body checking in response to negative affect. Negative urgency (NU) (the tendency to act rashly under distress) and (lack of) perseverance (the tendency to give up on goal directed behavior) may be unique facets of impulsivity that play a role in body checking. Women with AN (n = 82) completed a self-report measure of impulsivity and used ecological momentary assessment (EMA) to record negative affect and body checking for two weeks. Results indicated that women with low (lack of) perseverance experienced a greater increase in negative affect than those with high (lack of) perseverance prior to and following body checking. Overall, results indicate that individual differences in trait impulsivity moderated the relationship of negative affect to body checking in women with AN.
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Affiliation(s)
- K. Naomi Pak
- George Mason University, 4400 University Drive, Fairfax, VA 22032, USA,Corresponding author. (K.N. Pak)
| | - Joseph Wonderlich
- George Mason University, 4400 University Drive, Fairfax, VA 22032, USA
| | - Daniel le Grange
- University of California San Francisco, 3333 California Street, Box 0503, LH Suite 245, San Francisco, CA 94143-0503, USA
| | - Scott G. Engel
- Neuropsychiatric Research Institute, University of North Dakota School of Medicine and Health Sciences, 120 8th Street South, Fargo, ND 58103, USA
| | - Scott Crow
- University of Minnesota, 2450 Riverside Ave, Minneapolis, MN 55454, USA
| | - Carol Peterson
- University of Minnesota, 2450 Riverside Ave, Minneapolis, MN 55454, USA
| | - Ross D. Crosby
- Neuropsychiatric Research Institute, University of North Dakota School of Medicine and Health Sciences, 120 8th Street South, Fargo, ND 58103, USA
| | - Stephen A. Wonderlich
- Neuropsychiatric Research Institute, University of North Dakota School of Medicine and Health Sciences, 120 8th Street South, Fargo, ND 58103, USA
| | - Sarah Fischer
- George Mason University, 4400 University Drive, Fairfax, VA 22032, USA
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22
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Walker DC, White EK, Srinivasan VJ. A meta-analysis of the relationships between body checking, body image avoidance, body image dissatisfaction, mood, and disordered eating. Int J Eat Disord 2018; 51:745-770. [PMID: 29659039 DOI: 10.1002/eat.22867] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 03/08/2018] [Accepted: 03/08/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Body checking (BC) and body image avoidance (BIA) have been proposed as etiological and maintaining mechanisms for eating disorder (ED) pathology. To date, no comprehensive review summarizes the relationships of BC and BIA with ED pathology, body image dissatisfaction, or mood/affect. METHOD Meta-analyses examined the relationships of BC and BIA with ED pathology, body image dissatisfaction, and mood/affect. Gender, publication status, and presence or absence of ED diagnoses were examined as potential moderators. RESULTS Results showed strong relationships between BC and ED pathology (ρ = 0.588) and BC and body image dissatisfaction (ρ = 0.631) and a moderate relationship between BC and mood/affect (ρ = 0.385). Similarly, results showed strong relationships between BIA and ED pathology (ρ = 0.553) and BIA and body image dissatisfaction (ρ = 0.543) and a moderate relationship between BIA and mood/affect (ρ = 0.392). Overall, limited evidence supported publication bias; however, publication bias may exist in the relationship between BIA and body image dissatisfaction in the literature. Subgroup moderator analyses suggested that gender moderates the strength of the relationships between BC and ED pathology, body image dissatisfaction, and mood/affect and between BIA and body image dissatisfaction. DISCUSSION Results are consistent with cognitive-behavioral models of ED pathology that suggest BC and BIA are behavioral expressions of overvaluation of weight and shape. Notably, more published research has investigated BC than BIA. Future studies, incorporating methods such as meta-analytic structural equation modeling, should examine these variables to further test cognitive-behavioral models of ED development and maintenance.
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Affiliation(s)
| | - Emily K White
- Department of Psychiatry & Psychology, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
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23
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Forrest LN, Jones PJ, Ortiz SN, Smith AR. Core psychopathology in anorexia nervosa and bulimia nervosa: A network analysis. Int J Eat Disord 2018; 51:668-679. [PMID: 29693747 DOI: 10.1002/eat.22871] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 04/05/2018] [Accepted: 04/05/2018] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The cognitive-behavioral theory of eating disorders (EDs) proposes that shape and weight overvaluation are the core ED psychopathology. Core symptoms can be statistically identified using network analysis. Existing ED network studies support that shape and weight overvaluation are the core ED psychopathology, yet no studies have estimated AN core psychopathology and concerns exist about the replicability of network analysis findings. The current study estimated ED symptom networks among people with anorexia nervosa (AN) and bulimia nervosa (BN) and among a combined group of people with AN and BN. METHOD Participants were girls and women with AN (n = 604) and BN (n = 477) seeking residential ED treatment. ED symptoms were assessed with the Eating Disorder Examination-Questionnaire (EDE-Q); 27 of the EDE-Q items were included as nodes in symptom networks. Core symptoms were determined by expected influence and strength values. RESULTS In all networks, desiring weight loss, restraint, shape and weight preoccupation, and shape overvaluation emerged as the most important symptoms. In addition, in the AN and combined networks, fearing weight gain emerged as an important symptom. In the BN network, weight overvaluation emerged as another important symptom. DISCUSSION Findings support the cognitive-behavioral premise that shape and weight overvaluation are at the core of AN psychopathology. Our BN and combined network findings provide a high degree of replication of previous findings. Clinically, findings highlight the importance of considering shape and weight overvaluation as a severity specifier and primary treatment target for people with EDs.
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Affiliation(s)
| | - Payton J Jones
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Shelby N Ortiz
- Department of Psychology, Miami University, Oxford, Ohio
| | - April R Smith
- Department of Psychology, Miami University, Oxford, Ohio
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24
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Linardon J, Phillipou A, Newton R, Fuller-Tyszkiewicz M, Jenkins Z, Cistullo LL, Castle D. Testing the relative associations of different components of dietary restraint on psychological functioning in anorexia nervosa and bulimia nervosa. Appetite 2018; 128:1-6. [PMID: 29807122 DOI: 10.1016/j.appet.2018.05.138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/11/2018] [Accepted: 05/24/2018] [Indexed: 10/16/2022]
Abstract
Although empirical evidence identifies dietary restraint as a transdiagnostic eating disorder maintaining mechanism, the distinctiveness and significance of the different behavioural and cognitive components of dietary restraint are poorly understood. The present study examined the relative associations of the purportedly distinct dietary restraint components (intention to restrict, delayed eating, food avoidance, and diet rules) with measures of psychological distress (depression, anxiety, and stress), disability, and core eating disorder symptoms (overvaluation and binge eating) in patients with anorexia nervosa (AN) and bulimia nervosa (BN). Data were analysed from a treatment-seeking sample of individuals with AN (n = 124) and BN (n = 54). Intention to restrict, food avoidance, and diet rules were strongly related to each other (all r's > 0.78), but only weakly-moderately related to delayed eating behaviours (all r's < 0.47). In subsequent moderated ridge regression analyses, delayed eating was the only restraint component to independently predict variance in measures of psychological distress. Patient diagnosis did not moderate these associations. Overall, findings indicate that delayed eating behaviours may be a distinct component from other indices of dietary restraint (e.g., intention to restrict, food avoidance, diet rules). This study highlights the potential importance of ensuring that delayed eating behaviours are screened, assessed, and targeted early in treatment for patients with AN and BN.
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Affiliation(s)
- Jake Linardon
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC 3220, Australia.
| | - Andrea Phillipou
- Centre for Mental Health, Swinburne University of Technology, John St, Hawthorn, VIC 3122, Australia; Department of Mental Health, St Vincent's Hospital, Level 2, 46 Nicholson St, Fitzroy, VIC 3065, Australia; Department of Psychiatry, The University of Melbourne, Parkville, VIC 3010, Australia; Department of Mental Health, Austin Hospital, 145 Studley Rd, Heidelberg, VIC 3084, Australia
| | - Richard Newton
- Department of Mental Health, Austin Hospital, 145 Studley Rd, Heidelberg, VIC 3084, Australia
| | | | - Zoe Jenkins
- Department of Mental Health, St Vincent's Hospital, Level 2, 46 Nicholson St, Fitzroy, VIC 3065, Australia
| | | | - David Castle
- Department of Psychiatry, The University of Melbourne, Parkville, VIC 3010, Australia; Department of Psychiatry, St Vincent's Hospital, Australia
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25
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Lloyd EC, Frampton I, Verplanken B, Haase AM. How extreme dieting becomes compulsive: A novel hypothesis for the role of anxiety in the development and maintenance of anorexia nervosa. Med Hypotheses 2017; 108:144-150. [PMID: 29055388 DOI: 10.1016/j.mehy.2017.09.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 08/22/2017] [Accepted: 09/03/2017] [Indexed: 02/07/2023]
Abstract
The US National Institute of Mental Health's Research Domain Criteria (NIMH RDoC) advocates the study of features common to psychiatric conditions. This transdiagnostic approach has recently been adopted into the study of anorexia nervosa (AN), an illness that can be considered compulsive in nature. This has led to the development of an account of AN that identifies key roles for the heightened reinforcement of starvation, leading to its excessive repetition, and goal-directed system dysfunction. Considering models of illness in other compulsive disorders, we extend the existing account to explain the emergence of reinforcement and goal-directed system abnormalities in AN, proposing that anxiety is central to both processes. As such we emphasise the particular importance of the anxiolytic effects of starvation, over other reinforcing outcomes, in encouraging the continuation of starvation within a model that proposes a number of mechanisms by which anxiety operates in the development and maintenance of AN. We suggest the psychopathology of AN mediates the relationship between the anxiolytic effects of starvation and excessive repetition of starvation, and that compulsive starvation has reciprocal effects on its determinants. We thus account for the emergence of symptoms of AN other than compulsive starvation, and for the relationship between different features of the disorder. By extending and adapting an existing explanation of AN, we provide a richer aetiological model that invites new research questions and could inform novel approaches to prevention and treatment.
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Affiliation(s)
- E C Lloyd
- School of Exercise, Nutrition and Health Sciences, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK.
| | - I Frampton
- Department of Psychology, Washington Singer Laboratories, University of Exeter, Perry Road, Prince of Wales Road, Exeter EX4 4QG, UK.
| | - B Verplanken
- Department of Psychology, 10 West, University of Bath, Bath BA2 7AY, UK.
| | - A M Haase
- School of Exercise, Nutrition and Health Sciences, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK.
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26
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Examination of body checking, body image dissatisfaction, and negative affect using Ecological momentary assessment. Eat Behav 2016; 22:51-54. [PMID: 27086048 DOI: 10.1016/j.eatbeh.2016.03.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 03/17/2016] [Accepted: 03/30/2016] [Indexed: 11/22/2022]
Abstract
Research has shown that non-clinical women, particularly those with high body concern, engage in frequent body checking behaviors. The purpose of this study was to use ecological momentary assessment (EMA) to examine the frequency and correlates of body checking behavior, including its association with body image dissatisfaction and negative affect, in non-clinical women with high body concern. Undergraduate female participants with high body concern (n=22) were assessed five times per day for five days via text messages sent to their smart phones. During each assessment, participants reported the number of times they engaged in eight different body checking behaviors and their current level of negative affect and body dissatisfaction. After aggregation, a total of 3064 body checking behaviors were reported by the sample during the five-day period. All participants reported engaging in body checking at least once per day, with a mean of 27.85 checking behaviors per day. Hierarchical Linear Modeling revealed that body checking significantly predicted both body dissatisfaction and negative affect. These results provide preliminary support for the cognitive behavioral theory of eating disorders, suggesting that as women engage in more frequent body checking behaviors, they also experience higher levels of body dissatisfaction and negative affect.
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27
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White EK, Warren CS, Cao L, Crosby RD, Engel SG, Wonderlich SA, Mitchell JE, Peterson CB, Crow SJ, Le Grange D. Media exposure and associated stress contribute to eating pathology in women with Anorexia Nervosa: Daily and momentary associations. Int J Eat Disord 2016; 49:617-21. [PMID: 26711707 PMCID: PMC8764637 DOI: 10.1002/eat.22490] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 11/18/2015] [Accepted: 11/18/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We examined whether media exposure and media-induced stress contributed to eating disorder behaviors immediately and over the course of a day in women with anorexia nervosa (AN). METHOD Women with AN (N = 118) completed a 2-week ecological momentary assessment protocol during which they reported on exposure to food, shape, or weight-related media, associated stress, and eating behaviors. RESULTS Food, weight, or shape-related media exposure alone did not predict more frequent daily eating disorder behaviors. However, stress associated with media exposure was prospectively associated with a greater likelihood of binge eating and vomiting at the next assessment point. In addition, media-induced stress increased the probability of restrictive eating and fluid intake, vomiting, and laxative abuse across the day. DISCUSSION Media-induced stress may contribute to increased eating disorder behaviors in women with AN, as women who saw a media image and reported this experience as stressful were more likely to engage in momentary binge eating or vomiting. Reducing stress associated with viewing media images could be a potential target for therapeutic intervention with disordered eating. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:617-621).
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Affiliation(s)
- Emily K. White
- Department of Psychology, University of Nevada, Las Vegas, Nevada,Correspondence to: E.K. White,
| | | | - Li Cao
- Department of Biomedical Statistics, Neuropsychiatric Research Institute, Fargo, North Dakota
| | - Ross D. Crosby
- Department of Biomedical Statistics, Neuropsychiatric Research Institute, Fargo, North Dakota,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Scott G. Engel
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota,Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, North Dakota
| | - Stephen A. Wonderlich
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota,Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, North Dakota
| | - James E. Mitchell
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota,Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, North Dakota
| | - Carol B. Peterson
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
| | - Scott J. Crow
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota,The Emily Program, St. Paul, Minnesota
| | - Daniel Le Grange
- Department of Psychiatry, University of California, San Francisco, San Francisco, California
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Engel SG, Crosby RD, Thomas G, Bond D, Lavender JM, Mason T, Steffen KJ, Green DD, Wonderlich SA. Ecological Momentary Assessment in Eating Disorder and Obesity Research: a Review of the Recent Literature. Curr Psychiatry Rep 2016; 18:37. [PMID: 26893235 DOI: 10.1007/s11920-016-0672-7] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Our current understanding of the etiology and maintenance of eating disorders and obesity continues to be far from complete. Similarly, our understanding of determinants of both successful and unsuccessful weight loss surgery is also quite limited. While a number of research methodologies have been applied to these areas, one methodology that has recently seen a rise in popularity is the use of ecological momentary assessment (EMA). EMA allows one to study a variety of variables of interest in the natural environment. The study of eating disorders, obesity, and bariatric surgery has all been conducted using EMA recently. The current study is a review of these areas and summarizes the recent literature (past 3 years) in eating disorders, obesity, and bariatric surgery using EMA methodology.
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Affiliation(s)
- Scott G Engel
- Neuropsychiatric Research Institute, Fargo, ND, USA. .,University of North Dakota School of Medicine, University of North Dakota, Grand Forks, ND, USA.
| | - Ross D Crosby
- Neuropsychiatric Research Institute, Fargo, ND, USA.,University of North Dakota School of Medicine, University of North Dakota, Grand Forks, ND, USA
| | - Graham Thomas
- Department of Psychiatry and Human Behavior, Brown Alpert Medical School/The Miriam Hospital, Weight Control and Diabetes Research Center, Brown University, Providence, RI, USA
| | - Dale Bond
- Department of Psychiatry and Human Behavior, Brown Alpert Medical School/The Miriam Hospital, Weight Control and Diabetes Research Center, Brown University, Providence, RI, USA
| | | | - Tyler Mason
- Neuropsychiatric Research Institute, Fargo, ND, USA
| | - Kristine J Steffen
- Neuropsychiatric Research Institute, Fargo, ND, USA.,School of Pharmacy/Pharmaceutical Sciences, North Dakota State University, Fargo, ND, USA
| | - Dan D Green
- Neuropsychiatric Research Institute, Fargo, ND, USA
| | - Stephen A Wonderlich
- Neuropsychiatric Research Institute, Fargo, ND, USA.,University of North Dakota School of Medicine, University of North Dakota, Grand Forks, ND, USA
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Kraus N, Lindenberg J, Zeeck A, Kosfelder J, Vocks S. Immediate Effects of Body Checking Behaviour on Negative and Positive Emotions in Women with Eating Disorders: An Ecological Momentary Assessment Approach. EUROPEAN EATING DISORDERS REVIEW 2015; 23:399-407. [DOI: 10.1002/erv.2380] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 04/24/2015] [Accepted: 05/24/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Nicole Kraus
- Department of Clinical Psychology and Psychotherapy; University of Osnabrück; Germany
| | - Julia Lindenberg
- Department of Psychiatry and Psychotherapy; University Medical Center Freiburg; Germany
| | - Almut Zeeck
- Department of Psychiatry and Psychotherapy; University Medical Center Freiburg; Germany
| | - Joachim Kosfelder
- Department of Social and Cultural Sciences; University of Applied Sciences Düsseldorf; Germany
| | - Silja Vocks
- Department of Clinical Psychology and Psychotherapy; University of Osnabrück; Germany
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Goldschmidt AB, Wonderlich SA, Crosby RD, Cao L, Engel SG, Lavender JM, Mitchell JE, Crow SJ, Peterson CB, Le Grange D. Latent profile analysis of eating episodes in anorexia nervosa. J Psychiatr Res 2014; 53:193-9. [PMID: 24630466 PMCID: PMC4011391 DOI: 10.1016/j.jpsychires.2014.02.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 02/18/2014] [Accepted: 02/20/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Despite being characterized primarily by disturbances in eating behavior, relatively little is known about specific eating behaviors in anorexia nervosa (AN) and how they relate to different emotional, behavioral, and environmental features. METHODS Women with AN (n = 118) completed a 2-week ecological momentary assessment (EMA) protocol during which they reported on daily eating- and mood-related patterns. Latent profile analysis was used to identify classes of eating episodes based on the presence or absence of the following indicators: loss of control; overeating; eating by oneself; food avoidance; and dietary restraint. RESULTS The best-fitting model supported a 5-class solution: avoidant eating; solitary eating; binge eating; restrictive eating; and loss of control eating. The loss of control and binge eating classes were characterized by high levels of concurrent negative affect and a greater likelihood of engaging in compensatory behaviors. The restrictive eating class was associated with the greatest number of concurrently-reported stressful events, while the avoidant and solitary eating episode classes were characterized by relatively few accompanying stressful events. Body checking was least likely to occur in conjunction with restrictive eating behaviors. CONCLUSIONS Results support the presence of discrete types of eating episodes in AN that are associated with varying degrees of negative affect, stress, and behavioral features of eating disorders. Loss of control and dietary restriction may serve distinct functional purposes in AN, as highlighted by their differing associations with negative affect and stress. Clinical interventions for AN may benefit from targeting functional aspects of eating behavior among those with the disorder.
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Affiliation(s)
- Andrea B. Goldschmidt
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
| | - Stephen A. Wonderlich
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, North Dakota, USA,Department of Clinical Neuroscience, University of North Dakota School of Medicine, Fargo, North Dakota, USA
| | - Ross D. Crosby
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, North Dakota, USA,Department of Clinical Neuroscience, University of North Dakota School of Medicine, Fargo, North Dakota, USA
| | - Li Cao
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, North Dakota, USA
| | - Scott G. Engel
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, North Dakota, USA,Department of Clinical Neuroscience, University of North Dakota School of Medicine, Fargo, North Dakota, USA
| | - Jason M. Lavender
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, North Dakota, USA
| | - James E. Mitchell
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, North Dakota, USA,Department of Clinical Neuroscience, University of North Dakota School of Medicine, Fargo, North Dakota, USA
| | - Scott J. Crow
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA,The Emily Program, St. Paul, Minnesota, USA
| | - Carol B. Peterson
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
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