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Hill NG, Jo JH, Forney KJ. Testing "Feeling Fat" as a Mediator of the Longitudinal Relationship Between Negative Emotions and Eating Disorder Behaviors. Int J Eat Disord 2024. [PMID: 39051849 DOI: 10.1002/eat.24270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 07/10/2024] [Accepted: 07/10/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE Negative affect is central to eating disorder maintenance models; identifying mechanisms underlying this link may inform specific treatment targets. The current study evaluated which emotions (i.e., distress, fear, and moral emotions) were most strongly linked to feeling fat and tested feeling fat as a longitudinal mediator of the relationship between these emotions and restricting or binge eating (https://osf.io/3d5cq/). METHOD Community adults (N = 714, M[SD] age = 41.5[13.7], 84.6% female, 85.9% white) provided data at baseline, 3-month, and 6-month follow-up. Relative weights analysis examined which emotion categories exhibited the strongest longitudinal relationships with feeling fat. Cross-lagged panel models tested feeling fat as a mediator of the relationship between emotions and eating disorder behaviors. RESULTS Distress and moral emotions were the strongest emotional predictors of feeling fat. Feeling fat predicted binge eating (p's < 0.001), but not restricting (p's ≥ 0.832), in random effects cross-lagged panel models. Feeling fat partially mediated the longitudinal relationship between distress and binge eating (p = 0.044); however, this effect became nonsignificant after adjusting for BMI (p = 0.354). Feeling fat did not mediate relationships between moral emotions and binge eating or between either distress or moral emotions and restricting (p's ≥ 0.638). DISCUSSION Feeling fat was associated with binge eating, not restricting, highlighting the importance of specificity in maintenance models. Because the mediating effect of feeling fat was accounted for by body size, factors associated with body size, such as internalized weight stigma, may be more relevant mediators of the relationship between negative emotions and eating disorder behaviors. Future research on feeling fat should adjust for body size.
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Affiliation(s)
- Naomi G Hill
- Department of Psychology, Ohio University, Athens, Ohio, USA
| | - Jenny H Jo
- Department of Psychology, Ohio University, Athens, Ohio, USA
| | - K Jean Forney
- Department of Psychology, Ohio University, Athens, Ohio, USA
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2
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Provenzano L, Ciccarone S, Porciello G, Petrucci M, Cozzani B, Cotugno A, Bufalari I. Embodiment of underweight and normal-weight avatars affects bodily self-representations in anorexia nervosa. Heliyon 2024; 10:e32834. [PMID: 38988549 PMCID: PMC11233954 DOI: 10.1016/j.heliyon.2024.e32834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 06/05/2024] [Accepted: 06/10/2024] [Indexed: 07/12/2024] Open
Abstract
Body image distortion (BID) is a crucial aspect of anorexia nervosa (AN), leading to body overestimation, dissatisfaction, and low self-esteem. BID significantly influences the onset, maintenance, and relapse of the pathology. We assessed whether a Full Body Illusion (FBI) using under and normal-weight avatars' bodies affects perceptual body image and body schema estimations in both individuals with anorexia nervosa (AN) and healthy controls (HC). After each embodiment procedure, we asked participants to estimate the width of their hips (Perceptual Body Image Task) and the minimum aperture width of a virtual door necessary to pass through it (Body Schema Task). Additionally, we asked participants to rate the avatars in terms of self-similarity, attractiveness, and implicit disgust (i.e., pleasant/unpleasant body odour). Whereas participants with AN (N = 26) showed changes in body schema estimations after embodying the normal-weight avatar, no changes were found in HC (N = 25), highlighting increased bodily self-plasticity in AN. Notably, individuals with AN rated the normal weight avatar as the most similar to their real body, which was also considered the least attractive and the most repulsive. These ratings correlated with BID severity. Furthermore, at the explicit level, all participants reported feeling thinner than usual after embodying the underweight avatar. Overall, our findings suggest that BID in AN engages multiple sensory channels (from visual to olfactory) and components (from perceptual to affective), offering potential targets for innovative non-invasive treatments aimed at modifying flexible aspects of body representation.
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Affiliation(s)
| | - Sofia Ciccarone
- Dipartimento di Psicologia, Sapienza Università degli studi di Roma, Rome, Italy
- IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Giuseppina Porciello
- Dipartimento di Psicologia, Sapienza Università degli studi di Roma, Rome, Italy
- IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Manuel Petrucci
- Department of Human Sciences, Guglielmo Marconi University, Rome, Italy
| | - Barbara Cozzani
- Eating Disorders Unit, Department of Psychiatry, ASL Roma1, Rome, Italy
| | - Armando Cotugno
- Eating Disorders Unit, Department of Psychiatry, ASL Roma1, Rome, Italy
| | - Ilaria Bufalari
- Department of Developmental and Social Psychology, Sapienza Università degli studi di Roma, Rome, Italy
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3
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Torres S, Vieira AI, Vieira FM, Miller KM, Guerra MP, Lencastre L, Reis AC, Timóteo S, Nunes P, Barbosa MR. A Comprehensive Study of Positive Body Image as a Predictor of Psychological Well-Being in Anorexia Nervosa. Nutrients 2024; 16:1787. [PMID: 38892718 PMCID: PMC11174434 DOI: 10.3390/nu16111787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 05/31/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024] Open
Abstract
Recent data suggest a close association between positive body image (PBI) and eating disorder recovery. Nevertheless, the specific mechanisms through which PBI may facilitate recovery from anorexia nervosa (AN) remain unknown. To advance understanding of these mechanisms, this study examined core indices of PBI within AN, exploring its association with emotion regulation and well-being outcomes. Data were collected from 159 female participants, 64 with AN diagnosis and 95 healthy controls (HCs), who completed measures of PBI (body appreciation, functionality appreciation, and body responsiveness), emotion regulation, and psychological well-being (depression, anxiety, stress, and psychological quality of life). The AN group reported lower levels of PBI and psychological well-being, along with greater difficulties in regulating emotions, relative to HCs. PBI variables significantly predicted emotion regulation and psychological well-being in AN, accounting for 36% to 72% of the variance, with body appreciation emerging as the strongest predictor. These findings lend credence to the view that PBI can serve as a catalyst for psychological health. We hypothesize that enhancing PBI can improve interoceptive awareness, which is crucial for emotion regulation and reducing maladaptive food-related coping. Emphasizing a mind-body connection in lifestyle could be a relevant element to consider for both treating and preventing AN.
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Affiliation(s)
- Sandra Torres
- Faculty of Psychology and Education Sciences, University of Porto, 4200-135 Porto, Portugal; (F.M.V.); (M.P.G.); (L.L.); (M.R.B.)
- Center for Psychology at the University of Porto (CPUP), University of Porto, 4200-135 Porto, Portugal;
| | - Ana Isabel Vieira
- Center for Psychology at the University of Porto (CPUP), University of Porto, 4200-135 Porto, Portugal;
| | - Filipa Mucha Vieira
- Faculty of Psychology and Education Sciences, University of Porto, 4200-135 Porto, Portugal; (F.M.V.); (M.P.G.); (L.L.); (M.R.B.)
- Center for Psychology at the University of Porto (CPUP), University of Porto, 4200-135 Porto, Portugal;
| | - Kylee M. Miller
- Child Development and Rehabilitation Center (CDRC), Institute on Development & Disability, Oregon Health & Science University, Portland, OR 97403, USA;
| | - Marina Prista Guerra
- Faculty of Psychology and Education Sciences, University of Porto, 4200-135 Porto, Portugal; (F.M.V.); (M.P.G.); (L.L.); (M.R.B.)
- Center for Psychology at the University of Porto (CPUP), University of Porto, 4200-135 Porto, Portugal;
| | - Leonor Lencastre
- Faculty of Psychology and Education Sciences, University of Porto, 4200-135 Porto, Portugal; (F.M.V.); (M.P.G.); (L.L.); (M.R.B.)
- Center for Psychology at the University of Porto (CPUP), University of Porto, 4200-135 Porto, Portugal;
| | - Ana Catarina Reis
- Department of Psychiatry, Centro Hospitalar de São João, 4200-319 Porto, Portugal; (A.C.R.); (S.T.); (P.N.)
| | - Sertório Timóteo
- Department of Psychiatry, Centro Hospitalar de São João, 4200-319 Porto, Portugal; (A.C.R.); (S.T.); (P.N.)
| | - Patrícia Nunes
- Department of Psychiatry, Centro Hospitalar de São João, 4200-319 Porto, Portugal; (A.C.R.); (S.T.); (P.N.)
| | - Maria Raquel Barbosa
- Faculty of Psychology and Education Sciences, University of Porto, 4200-135 Porto, Portugal; (F.M.V.); (M.P.G.); (L.L.); (M.R.B.)
- Center for Psychology at the University of Porto (CPUP), University of Porto, 4200-135 Porto, Portugal;
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Maurel L, MacKean M, Lacey JH. Factors predicting long-term weight maintenance in anorexia nervosa: a systematic review. Eat Weight Disord 2024; 29:24. [PMID: 38582784 PMCID: PMC10998787 DOI: 10.1007/s40519-024-01649-5] [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: 10/19/2023] [Accepted: 03/03/2024] [Indexed: 04/08/2024] Open
Abstract
PURPOSE Eating disorder recovery is a poorly defined concept, with large variations among researchers' definitions. Weight maintenance is a key aspect of recovery that remains relatively underexplored in the literature. Understanding the role of weight maintenance may help guide the development of treatments. This paper aims to address this by (1) investigating the factors predicting long-term weight maintenance in anorexia nervosa (AN) patients; (2) exploring differences in predictive factors between adolescent and adult populations; and (3) exploring how weight maintenance is conceptualised in the literature. METHODS We conducted a systematic review following PRISMA guidelines to address our research questions. Five databases were searched and filtered according to our exclusion criteria. RESULTS From the search, 1059 studies were yielded, and 13 studies were included for review. A range of weight, biological and psychological factors were found to predict weight maintenance among these papers. BMI at admission and discharge from inpatient treatment was the most common predictor among the papers. Few studies investigated biological factors and mixed evidence was found for psychological factors. We found no observable differences between adult and adolescent populations. Finally, weight maintenance was defined and measured differently across studies. CONCLUSION This review's findings can help contribute to a well-rounded understanding of weight maintenance, and ultimately, of recovery. This can help support clinicians in tailoring interventions to improve long-term outcomes in AN. Future research should aim to replicate studies to better understand the relationship between the factors identified and weight maintenance. LEVEL I Systematic review.
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Affiliation(s)
| | | | - J Hubert Lacey
- Schoen, Birmingham, UK.
- St George's, University of London, London, UK.
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Ralph-Nearman C, Hooper MA, Hunt RA, Levinson CA. Dynamic relationships among feeling fat, fear of weight gain, and eating disorder symptoms in an eating disorder sample. Appetite 2024; 195:107181. [PMID: 38182054 PMCID: PMC10922613 DOI: 10.1016/j.appet.2023.107181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/07/2024]
Abstract
Feeling fat and fear of weight gain are key cognitive-affective symptoms that are theorized to maintain eating disorders (EDs). Little research has examined the dynamic relationships among feeling fat, fear of weight gain, emotions, cognitions, and ED behaviors. Furthermore, it is unknown if these relations vary by ED diagnosis (e.g., anorexia nervosa (AN) vs other ED). The current study (N = 94 ED participants; AN n = 64) utilized ecological momentary assessments collected four times a day for 18 days (72 timepoints) asking about feeling fat, fear of weight gain, emotions (i.e., anxiety, guilt), cognitions (i.e., feelings of having overeaten, thoughts about dieting), and ED behaviors (i.e., vomiting, diuretic/laxative use, excessive exercise, body checking, self-weighing, binge-eating, restriction) at stressful timepoints (contemporaneous [mealtime], and prospective/temporal [next-meal]). Multilevel modeling was used to test for between and within-person associations. Higher feeling fat and fear of weight gain independently predicted higher next-meal emotions (i.e., anxiety, guilt), cognitions (i.e., feelings of having overeaten, thoughts about dieting, fear of weight gain, feeling fat), and ED behaviors (i.e., body checking, self-weighing [feeling fat]). There were relationships in the opposite direction, such that some emotions, cognitions, and ED behaviors prospectively predicted feeling fat and fear of weight gain, suggesting existence of a reciprocal cycle. Some differences were found via diagnosis. Findings pinpoint specific dynamic and cyclical relationships among feeling fat, fear of weight gain, and specific ED symptoms, and suggest the need for more research on how feeling fat, fear of weight gain and cognitive-affective-behavioral aspects of ED operate. Future research can test if treatment interventions targeted at feeling fat and fear of weight gain may disrupt these cycles.
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Affiliation(s)
- Christina Ralph-Nearman
- University of Louisville, Department of Psychological and Brain Sciences, Louisville, KY, USA.
| | - Madison A Hooper
- University of Louisville, Department of Psychological and Brain Sciences, Louisville, KY, USA; Vanderbilt University, Department of Psychology, Nashville, TN, USA
| | - Rowan A Hunt
- University of Louisville, Department of Psychological and Brain Sciences, Louisville, KY, USA
| | - Cheri A Levinson
- University of Louisville, Department of Psychological and Brain Sciences, Louisville, KY, USA; Unversity of Louisville, Department of Pediatrics, Louisville, KY, USA
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Manwaring JL, Blalock DV, Duffy A, Le Grange D, Mehler PS, Riddle M, Rienecke RD. An examination of adults with atypical anorexia nervosa at admission to treatment at higher levels of care: An attempt to increase diagnostic clarity. Int J Eat Disord 2024; 57:848-858. [PMID: 38168753 DOI: 10.1002/eat.24124] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE Anorexia nervosa (AN) is a serious illness with a high mortality rate and multiple physiological complications. The vague definition of atypical AN allows for subjective interpretation. This retrospective study aimed to focus future research on the operational definition of atypical AN by examining four factors associated with atypical AN at admission to higher level of care treatment. METHODS Adults with atypical AN (n = 69) were examined within sample analyses among four groups: (1) >10% versus ≤10% weight loss; (2) weight loss within the previous 3 months versus >3 months; (3) engaging in purging behaviors versus absence of purging behaviors; and (4) endorsing versus not endorsing significant cognitive aspects of AN. RESULTS Patients with atypical AN endorsed elevated ED cognitions on the Eating Disorder Examination-Questionnaire and depressive symptoms; a lack of association was found between weight loss severity and weight loss time frame with depressive symptoms, eating concern, and restraint. Purging behavior was associated with a higher expected body weight percentage (%EBW) and dietary restraint, while greater AN cognitions were associated with a higher EBW and weight loss percentage. Few patients demonstrated bradycardia, hypophosphatemia, or amenorrhea. DISCUSSION This study demonstrated the severity of ED cognitions and depressive symptoms in this atypical AN sample and provided directions for future studies in the nosology of atypical AN. It may be important to distinguish between individuals with atypical AN who are purging and those who are not. Atypical AN was associated with a low frequency of physiological disturbances. PUBLIC SIGNIFICANCE This study provides further clarification regarding the operational definition of atypical AN; currently, a constellation of symptoms under Other Specified Feeding or Eating Disorders. This study was consistent with previous research in reporting severe eating disorder cognitions in adults with atypical AN, and noted the potential importance of distinguishing a purging distinction. A minority of patients in this study had physiological impairments.
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Affiliation(s)
- Jamie L Manwaring
- ACUTE Center for Eating Disorders and Malnutrition at Denver Health, Denver, Colorado, USA
- Department of Medicine, University of Colorado School of Medicine, Denver, Colorado, USA
- Eating Recovery Center and Pathlight Behavioral Health Centers, Denver, Colorado, USA
| | - Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Alan Duffy
- Eating Recovery Center and Pathlight Behavioral Health Centers, Denver, Colorado, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
- Department of Psychiatry and Behavioral Neurosciences, The University of Chicago, Chicago, Illinois, USA
| | - Philip S Mehler
- ACUTE Center for Eating Disorders and Malnutrition at Denver Health, Denver, Colorado, USA
- Department of Medicine, University of Colorado School of Medicine, Denver, Colorado, USA
- Eating Recovery Center and Pathlight Behavioral Health Centers, Denver, Colorado, USA
| | - Megan Riddle
- Eating Recovery Center and Pathlight Behavioral Health Centers, Denver, Colorado, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Renee D Rienecke
- Eating Recovery Center and Pathlight Behavioral Health Centers, Denver, Colorado, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
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Mehak A, Bicaker E, Racine SE. The roles of negative affect and emotion differentiation in the experience of 'feeling fat' among undergraduate students: An ecological momentary assessment study. Body Image 2024; 48:101681. [PMID: 38310706 DOI: 10.1016/j.bodyim.2024.101681] [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: 08/07/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/06/2024]
Abstract
'Feeling fat' is the somatic experience of being overweight not fully explained by objective body mass. According to the body displacement hypothesis, 'feeling fat' occurs when diffuse negative emotions are projected onto the body in lieu of adaptive emotion regulation. Emotion differentiation, the ability to experience and label discrete emotions, is an important skill for adaptively addressing emotion that may reduce 'feeling fat.' We hypothesized that individuals with better negative emotion differentiation would be less likely to report 'feeling fat' when experiencing high negative emotion. We collected ecological momentary assessment data from 198 undergraduate students (52.24% female). Multilevel modeling revealed that both within-person increases in negative emotions and the tendency to experience greater negative emotion were associated with greater 'feeling fat.' Of the specific types of negative emotion, guilt and sadness predicted 'feeling fat.' Contrary to hypotheses, individuals with better emotion differentiation were more likely to report 'feeling fat' after experiencing elevated negative affect. These findings contradict the primary clinical conceptualization of 'feeling fat,' suggesting that factors beyond displacement of negative emotions onto the body may be responsible for 'feeling fat'. Results in a sample with pronounced shape/weight concern may better support the traditional clinical understanding of 'feeling fat.'
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Affiliation(s)
| | - Ege Bicaker
- Department of Psychology, McGill University, Canada
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8
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Engel MM, Woertman EM, Dijkerman HC, Keizer A. Functionality appreciation is associated with improvements in positive and negative body image in patients with an eating disorder and following recovery. J Eat Disord 2023; 11:179. [PMID: 37814348 PMCID: PMC10561462 DOI: 10.1186/s40337-023-00903-y] [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: 03/09/2023] [Accepted: 09/28/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Research on body image in eating disorders has predominantly focused on negative body image, only recently shifting to positive body image. Findings suggest that enhancing positive body image can, amongst other things, serve as a protective mechanism against (re)developing a negative body image. One suggested way of enhancing positive body image is to focus on enhancing body functionality appreciation. Although studies show promising effects, this research is mainly conducted in non-clinical samples. METHODS The current study investigated the levels of positive and negative body image in an online community sample of patients with an eating disorder (PAT, n = 227), patients recovered from an eating disorder (REC, n = 102) and controls (HC, n = 175) (self-reported diagnosis, not confirmed). In addition, we tested whether body functionality appreciation was associated with appearance dissatisfaction (negative body image) and body appreciation (positive body image). RESULTS REC showed similar results to controls to most of the body image measures except for how much importance one places on their appearance (no different between REC and PAT), and how satisfied one is with certain body parts. For this measure, REC scored in-between PAT and HC. We further found functionality appreciation to be significantly associated with of both positive and negative body image, except for appearance evaluation in patients with an eating disorder. CONCLUSIONS This study showed a positive association between body functionality appreciation and positive body image and a negative association between body functionality appreciation and negative body image. Further research is required to investigate the effectiveness of interventions targeting body functionality appreciation in clinical settings.
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Affiliation(s)
- Manja M Engel
- Department of Experimental Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, 3584 CS, Utrecht, The Netherlands.
| | - E M Woertman
- Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
| | - H C Dijkerman
- Department of Experimental Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, 3584 CS, Utrecht, The Netherlands
| | - A Keizer
- Department of Experimental Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, 3584 CS, Utrecht, The Netherlands
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Meschberger-Annweiler FA, Ascione M, Porras-Garcia B, Ferrer-Garcia M, Moreno-Sanchez M, Miquel-Nabau H, Serrano-Troncoso E, Carulla-Roig M, Gutiérrez-Maldonado J. An Attentional Bias Modification Task, through Virtual Reality and Eye-Tracking Technologies, to Enhance the Treatment of Anorexia Nervosa. J Clin Med 2023; 12:jcm12062185. [PMID: 36983186 PMCID: PMC10054656 DOI: 10.3390/jcm12062185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023] Open
Abstract
Mirror exposure therapies (METs) have been shown to be effective in reducing body image disturbances through the habituation process. Virtual reality (VR) combined with eye-tracking techniques can provide innovative solutions to some of METs’ limitations reported with patients with anorexia nervosa (AN), especially the negative influence of body-related attentional bias (AB). This pilot study aimed to assess the preliminary efficacy of a new VR-based AB modification task (ABMT) among healthy women and the procedure’s user experience. AB levels towards weight- and non-weight-related body parts, using complete fixation time (CFT) and number of fixations (NF), were assessed throughout the ABMT procedure (300 trials). The user experience was evaluated at the end of the procedure. The results showed that VR-based ABMT was effective in reducing AB significantly after 150 trials for both CFT- and NF-based measures, although 225 trials were necessary to get the same result for women with an NF initially more oriented towards weight-related body parts. Overall, the software received a “C-rating” on a scale from “A” (most usable) to “F” (least usable). These results provide evidence of the opportunity to use a VR-based ABMT procedure to reduce AB and improve existing treatments for AN.
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Affiliation(s)
- Franck-Alexandre Meschberger-Annweiler
- Department of Clinical Psychology and Psychobiology, Institute of Neurosciences, University of Barcelona, Passeig de la Vall d’Hebron 171, 08035 Barcelona, Spain
| | - Mariarca Ascione
- Department of Clinical Psychology and Psychobiology, Institute of Neurosciences, University of Barcelona, Passeig de la Vall d’Hebron 171, 08035 Barcelona, Spain
| | - Bruno Porras-Garcia
- Department of Population Health Science, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84112, USA
| | - Marta Ferrer-Garcia
- Department of Clinical Psychology and Psychobiology, Institute of Neurosciences, University of Barcelona, Passeig de la Vall d’Hebron 171, 08035 Barcelona, Spain
| | - Manuel Moreno-Sanchez
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Passeig de la Vall d’Hebron 171, 08035 Barcelona, Spain
| | - Helena Miquel-Nabau
- Department of Clinical Psychology and Psychobiology, Institute of Neurosciences, University of Barcelona, Passeig de la Vall d’Hebron 171, 08035 Barcelona, Spain
| | - Eduardo Serrano-Troncoso
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Sant Joan de Déu of Barcelona, Passeig de Sant Joan de Déu, 2, Esplugues de Llobregat, 08950 Barcelona, Spain
| | - Marta Carulla-Roig
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Sant Joan de Déu of Barcelona, Passeig de Sant Joan de Déu, 2, Esplugues de Llobregat, 08950 Barcelona, Spain
| | - José Gutiérrez-Maldonado
- Department of Clinical Psychology and Psychobiology, Institute of Neurosciences, University of Barcelona, Passeig de la Vall d’Hebron 171, 08035 Barcelona, Spain
- Correspondence:
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10
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Fear of weight gain during cognitive behavioral therapy for binge-spectrum eating disorders. Eat Weight Disord 2023; 28:29. [PMID: 36879078 PMCID: PMC9988191 DOI: 10.1007/s40519-023-01541-8] [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: 10/05/2022] [Accepted: 01/12/2023] [Indexed: 03/08/2023] Open
Abstract
PURPOSE Fear of weight gain may play a central role in maintaining eating disorders (EDs), but research on the role of fear of weight gain during cognitive behavioral therapy (CBT-E) for binge-spectrum EDs is sparse. We examined changes in fear of weight gain during CBT-E for binge-spectrum EDs. We investigated whether fear of weight gain predicted loss of control (LOC) eating or weight change. METHODS Participants (N = 63) were adults of any gender recruited as part of a larger trial. Participants received 12 sessions of CBT-E, completed diagnostic assessments at pre-, mid-, and post-treatment, and completed brief surveys before sessions. RESULTS Fear of weight gain decreased across treatment, moderated by diagnosis. Those with bulimia nervosa spectrum EDs (BN-spectrum), compared to binge eating disorder, reported higher fear of weight gain at baseline and experienced a larger decrease in fear across treatment. Those reporting higher fear of weight gain at a given session experienced more frequent LOC episodes the following week. Fear of weight gain was not associated with session-by-session changes in BMI. CONCLUSION CBT-E results in decreases in fear of weight gain, but levels remain high at post-treatment, especially for those with BN-spectrum EDs. Future interventions should consider targeting fear of weight gain as a maintaining factor for LOC episodes TRIAL REGISTRATION: NCT04076553. LEVEL OF EVIDENCE Level II controlled trial without randomization.
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11
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Wilson S, Mehak A, Racine SE. Exposure to thin and non-thin bodies elicits 'feeling fat': Validation of a novel state measure. Eat Behav 2023; 48:101700. [PMID: 36608389 DOI: 10.1016/j.eatbeh.2022.101700] [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: 09/22/2021] [Revised: 08/25/2022] [Accepted: 12/20/2022] [Indexed: 12/26/2022]
Abstract
'Feeling fat' refers to the subjective experience of carrying excess weight and relates to severity of eating pathology. Despite research suggesting that 'feeling fat' fluctuates across contexts, this construct is almost exclusively assessed in terms of frequency or as a trait. Examining state 'feeling fat' in response to external stimuli can inform us of the nature of this construct. In an experimental study, 290 community women were exposed to five categories of affective (pleasant, aversive, and neutral) and body (thin and non-thin) images in quasi-random order. Self-Assessment Manikin (SAM) valence and arousal rating scales as well as a novel SAM 'feeling fat' scale were rated for each image. Theoretically-relevant constructs (i.e., trait 'feeling fat', thin-ideal internalization, body dissatisfaction, eating pathology) were also measured. Body images elicited greater state 'feeling fat' than affective images, with images of non-thin bodies producing higher state 'feeling fat' than thin bodies. Positive correlations were observed between state 'feeling fat' in response to thin and all variables of interest, whereas associations between these variables and 'feeling fat' in response to non-thin images were small or non-significant. The development of a state measure of 'feeling fat' allows for the investigation of triggers of this bodily experience and will facilitate future research.
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Affiliation(s)
- Samantha Wilson
- Department of Psychology, McGill University, 2001 avenue McGill College, Montréal, QC H3A 1G1, Canada.
| | - Adrienne Mehak
- Department of Psychology, McGill University, 2001 avenue McGill College, Montréal, QC H3A 1G1, Canada
| | - Sarah E Racine
- Department of Psychology, McGill University, 2001 avenue McGill College, Montréal, QC H3A 1G1, Canada
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Woods ES, Jessup SC, Olatunji BO. Fear of fat in eating disorders: The mediating role of individual differences in self-disgust. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2023. [DOI: 10.1016/j.jadr.2022.100452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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13
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Hoover LV, Ackerman JM, Cummings JR, Gearhardt AN. The Association of Perceived Vulnerability to Disease with Cognitive Restraint and Compensatory Behaviors. Nutrients 2022; 15:nu15010008. [PMID: 36615665 PMCID: PMC9824184 DOI: 10.3390/nu15010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Individual differences exist in perceived vulnerability to disease (PVD). PVD is associated with negative responses (e.g., disgust) towards individuals with obesity and heightened sensitivity regarding personal appearance. Through increasing fear of fat (FOF), PVD may be associated with cognitive restraint and compensatory behaviors. We utilized an adult sample (n = 247; 53.3% male sex assigned at birth) recruited through Amazon's MTurk prior to the COVID-19 pandemic to investigate associations between PVD, cognitive restraint and compensatory behaviors. Participants completed the Perceived Vulnerability to Disease Scale, Eating Disorder Diagnostic Scale, Dutch Eating Behaviors Questionnaire, and Goldfarb's Fear of Fat Scale. Mediation analyses were used to test our hypotheses. Perceived infectability (PVD-Infection) was associated with cognitive restraint and compensatory behaviors through increased FOF. Perceived germ aversion (PVD-Germ) was associated with cognitive restraint, but FOF did not mediate this association. Sex-stratified analyses revealed no significant sex differences. PVD may be an overlooked factor associated with cognitive restraint and compensatory behaviors in males and females. FOF was an important mediating factor in these associations. Increased engagement in cognitive restraint and compensatory behaviors may reflect attempts to reduce FOF. Future longitudinal research should explore whether PVD is a risk factor for cognitive restraint and compensatory behaviors.
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The Effects of Comorbid Disordered Eating Behaviours on Outcomes at Follow-up from Residential Substance Use Disorder Treatment: a Latent Class Approach. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00975-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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15
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Marzola E, Martini M, Longo P, Toppino F, Bevione F, Delsedime N, Abbate-Daga G, Preti A. Psychometric properties of the Italian body shape questionnaire: an investigation of its reliability, factorial, concurrent, and criterion validity. Eat Weight Disord 2022; 27:3637-3648. [PMID: 36352341 PMCID: PMC9803762 DOI: 10.1007/s40519-022-01503-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022] Open
Abstract
PURPOSE This study was set up to investigate the reliability, factorial, concurrent, and criterion validity of the Italian version of the 34-item Body Shape Questionnaire (BSQ) and its shorter versions. METHODS The study included 231 patients diagnosed with an eating disorder and 58 putatively healthy people (comparison sample). The Italian BSQ-34 was administered to participants together with the Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale. Information on body mass index, caloric intake at baseline, and the number of episodes of self-vomiting per week was also acquired. RESULTS Cronbach's alpha of BSQ-34 was 0.971 (95% confidence interval [CI] 0.965-0.976) in patients and 0.960 (0.944-0.974) in controls. Test-retest stability in patients (n = 69), measured with intraclass correlation coefficient, was 0.987 (0.983-0.991). Confirmatory factor analysis of the single-factor model yielded acceptable fit for all versions of the BSQ. On all BSQ versions, patients scored higher than controls with a large effect size when calculated as Cliff's delta. BMI and mean caloric intake at baseline had a stronger association with BSQ-34 than levels of anxiety and depression. The analysis with the receiver operating characteristics (ROC) curve showed that the BSQ-34 distinguished patients with an eating disorder from controls with good accuracy (Area Under the Curve = 86.5; 95% CI 82.2-90.7). CONCLUSION The Italian version of the BSQ possesses good psychometric properties, in both the long and the shortened versions, and it can be applied to measure body dissatisfaction for both clinical and research purposes. LEVEL OF EVIDENCE Level III, Evidence obtained from well-designed cohort or case-control analytic studies.
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Affiliation(s)
- Enrica Marzola
- Eating Disorders Unit, Department of Neuroscience, University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - Matteo Martini
- Eating Disorders Unit, Department of Neuroscience, University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - Paola Longo
- Eating Disorders Unit, Department of Neuroscience, University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - Federica Toppino
- Eating Disorders Unit, Department of Neuroscience, University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - Francesco Bevione
- Eating Disorders Unit, Department of Neuroscience, University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - Nadia Delsedime
- Eating Disorders Unit, Department of Neuroscience, University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - Giovanni Abbate-Daga
- Eating Disorders Unit, Department of Neuroscience, University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - Antonio Preti
- Eating Disorders Unit, Department of Neuroscience, University of Turin, Via Cherasco 15, 10126, Turin, Italy.
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Morales C, Dolan SC, Anderson DA, Anderson LM, Reilly EE. Exploring the contributions of affective constructs and interoceptive awareness to feeling fat. Eat Weight Disord 2022; 27:3533-3541. [PMID: 36261777 PMCID: PMC10136370 DOI: 10.1007/s40519-022-01490-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 10/02/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Feeling fat, a subjective feeling of being overweight that does not always correspond to actual body weight, is commonly reported in patients with an eating disorder. Research suggests that feeling fat relates to deficits in interoceptive awareness, the perception and integration of signals related to body states. Relatedly, recent work has linked feeling fat to affective constructs, such as depressive symptoms and guilt. The current study explores the unique relationships between feeling fat, self-reported, and objective IA, guilt, alexithymia, and depressive symptoms. METHOD Female undergraduates (N = 128) completed the 11th item of the Eating Disorder Examination Questionnaire, the Toronto Alexithymia Scale, the Guilt subscale of the Positive and Negative Affect Schedule, and the Beck Depression Inventory-II. Participants also completed two IA measures: a heartbeat perception task and the Multidimensional Assessment of Interoceptive Awareness. RESULTS All collected measures explained 56% of the variability in feeling fat. Depressive symptoms, self-reported IA, and BMI accounted for significant variability in feeling fat. Relative weights analyses revealed that depressive symptoms accounted for the most variability in feeling fat (19%). This finding remained significant after controlling for BMI, which also accounted for significant variability in feeling fat (25%). CONCLUSIONS Our results replicate previous findings that depressive symptoms relate significantly to feeling fat and extend this work by incorporating the role of interoceptive awareness, guilt, and alexithymia. Endorsement of feeling fat during an intake assessment may alert clinicians to assess for depressive symptoms, and focusing on depressive symptoms in treatment may improve feeling fat. LEVEL OF EVIDENCE Level I Evidence obtained from an experimental study.
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Affiliation(s)
- Cate Morales
- Department of Psychology, Hofstra University, Hempstead, USA
| | - Sarah C Dolan
- Department of Psychology, Hofstra University, Hempstead, USA
| | - Drew A Anderson
- Department of Psychology, University at Albany, SUNY, Albany, USA
| | - Lisa M Anderson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, 2450 Riverside Avenue, F229, Minneapolis, MN, 55454, USA.
| | - Erin E Reilly
- Department of Psychiatry, University of California, San Francisco, San Francisco, USA
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Cerea S, Doron G, Manoli T, Patania F, Bottesi G, Ghisi M. Cognitive training via a mobile application to reduce some forms of body dissatisfaction in young females at high-risk for body image disorders: A randomized controlled trial. Body Image 2022; 42:297-306. [PMID: 35908296 DOI: 10.1016/j.bodyim.2022.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 07/05/2022] [Accepted: 07/14/2022] [Indexed: 11/18/2022]
Abstract
Body dissatisfaction has been related to Body Image Disorders (BIDs) such as Eating Disorders (EDs) and Body Dysmorphic Disorder (BDD). This study investigates the efficacy of a mHealth app in reducing body dissatisfaction, BDD/ED symptoms and related features. Ninety-five women who were identified as high-risk of developing BIDs (using the Structured Clinical Interview for DSM-5) were randomized into: immediate-use App (iApp group; n = 47) and delayed-use App (dApp group; n = 48). The iApp group started using the app at baseline for 16 days (T1). The dApp group started using the app at T1 for 16 days. Participants completed questionnaires at baseline (T0), 16 days from baseline (T1), and 32 days from baseline (T2). Repeated measure Multivariate Analysis of Variance (MANOVA) showed Group (iApp vs. dApp) × Time (T0 vs. T1) interactions indicating decrease in BDD symptoms and body dissatisfaction related to EDs in the iApp group at T1. The Reliable Change Index indicated changes on extreme body dissatisfaction/BDD symptoms for 34.74% of participants. Although preliminary, these findings highlight that a mHeatlh app might reduce BDD symptoms and body dissatisfaction related to EDs in women at high-risk for BIDs. Effects on ED symptoms and associated features seem more limited.
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Affiliation(s)
- Silvia Cerea
- Department of General Psychology, University of Padova, Padova, Italy.
| | - Guy Doron
- Baruch Ivcher School of Psychology, Reichman University (IDC) Herzliya, Israel.
| | - Teresa Manoli
- Department of General Psychology, University of Padova, Padova, Italy
| | - Federica Patania
- Department of General Psychology, University of Padova, Padova, Italy
| | - Gioia Bottesi
- Department of General Psychology, University of Padova, Padova, Italy
| | - Marta Ghisi
- Department of General Psychology, University of Padova, Padova, Italy; U.O.C. Hospital Psychology, University-Hospital of Padova, Padova, Italy
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18
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Anderson LM, Hall LMJ, Crosby RD, Crow SJ, Berg KC, Durkin NE, Engel SG, Peterson CB. "Feeling fat," disgust, guilt, and shame: Preliminary evaluation of a mediation model of binge-eating in adults with higher-weight bodies. Body Image 2022; 42:32-42. [PMID: 35653964 PMCID: PMC10136371 DOI: 10.1016/j.bodyim.2022.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 05/11/2022] [Accepted: 05/23/2022] [Indexed: 11/29/2022]
Abstract
"Feeling fat" is a subjective state that theoretically contributes to the maintenance of binge eating (BE). However, feeling fat, and its relation to BE among individuals with higher-weight bodies, has been infrequently studied. This study proposes a momentary-level model in which negative moral emotion states (disgust, guilt, shame) mediate the association between feeling fat and binge eating. In this study, 50 adults with higher-weight bodies (MBMI=40.3 ± 8.5 kg/m2; 84% female) completed a two-week ecological momentary assessment protocol, which measured experiences of feeling fat, emotion states, and binge-eating behavior. Univariate generalized linear mixed models (GLMM) evaluated the momentary associations among levels of feeling fat at Time 1, emotion states at Time 2, and binge eating at Time 2, controlling for Time 1 emotion states. GLMM results suggest that increases in each emotion from Time 1 to Time 2 mediated the association between Time 1 feeling fat and Time 2 binge eating. When modeled simultaneously within one multivariate multilevel structured equation model, disgust appeared to drive the relation between feeling fat and binge eating, over and above guilt and shame. Although preliminary, findings suggest increases in negative moral emotions, particularly disgust, mediate the feeling fat-binge eating association in adults with higher-weight bodies.
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Affiliation(s)
- Lisa M Anderson
- University of Minnesota, Department of Psychiatry and Behavioral Sciences, Minneapolis, MI, USA.
| | - Leah M J Hall
- Eastern Oklahoma Veterans' Affairs Health Care System, Tulsa, OH, USA
| | - Ross D Crosby
- Sanford Research, Center for Bio-behavioral Research, Fargo, ND, USA; University of North Dakota School of Medicine and Health Sciences, Department of Psychiatry, Fargo, ND, USA
| | - Scott J Crow
- University of Minnesota, Department of Psychiatry and Behavioral Sciences, Minneapolis, MI, USA; The Emily Program, St. Paul, MI, USA
| | - Kelly C Berg
- University of Minnesota, Department of Psychiatry and Behavioral Sciences, Minneapolis, MI, USA
| | - Nora E Durkin
- University of Minnesota, Department of Psychiatry and Behavioral Sciences, Minneapolis, MI, USA; Hazelden Betty Ford Foundation, Plymouth, MI, USA
| | - Scott G Engel
- Sanford Research, Center for Bio-behavioral Research, Fargo, ND, USA; University of North Dakota School of Medicine and Health Sciences, Department of Psychiatry, Fargo, ND, USA
| | - Carol B Peterson
- University of Minnesota, Department of Psychiatry and Behavioral Sciences, Minneapolis, MI, USA
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Prnjak K, Jukic I, Mitchison D, Griffiths S, Hay P. Body image as a multidimensional concept: A systematic review of body image facets in eating disorders and muscle dysmorphia. Body Image 2022; 42:347-360. [PMID: 35926364 DOI: 10.1016/j.bodyim.2022.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 07/08/2022] [Accepted: 07/10/2022] [Indexed: 10/16/2022]
Abstract
Body image disturbance is core to the psychopathology of eating disorders (EDs), and related disorders such as muscle dysmorphia (MD). Global measures of body image fail to quantify specific aspects of body image disturbance that characterizes EDs, and may be differentially associated to outcomes. The aim of this systematic review was to provide an overview of specific body image facets and synthesize findings from controlled studies that compared clinical ED/MD and control-comparison groups in body image disturbance. One-hundred sixty-seven studies met inclusion criteria, and reported on comparisons among 30,584 individuals in 28 body image facets, which were more broadly grouped into evaluative, perceptual, cognitive-affective and motivational categories for the purpose of the present review. Effect sizes were calculated as Cohen's d for every comparison between ED and control groups. Body dissatisfaction (evaluative category) was the most prevalent facet assessed across studies (62 %), and differences between clinical and control groups were the largest in this category, especially for bulimia nervosa (d = 1.37). Scarcity of studies with male and MD clinical samples, and use of single-item and non-validated measures, should encourage development of instruments for body image facets pertinent to EDs and MD that can be validly applied across gender.
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Affiliation(s)
- Katarina Prnjak
- School of Medicine, Western Sydney University, Sydney, Australia.
| | - Ivan Jukic
- Sport Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand; School of Engineering, Computer and Mathematical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Deborah Mitchison
- School of Medicine, Western Sydney University, Sydney, Australia; Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Scott Griffiths
- School of Psychology, University of Melbourne, Melbourne, Australia
| | - Phillipa Hay
- School of Medicine, Western Sydney University, Sydney, Australia; Camden and Campbelltown Hospitals, SWSLHD, Campbelltown, Australia
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Robinson LD, Kelly PJ, Larance BK, Griffiths S, Deane FP. Eating Disorder Behaviours and Substance Use in Women Attending Treatment for Substance Use Disorders: a Latent Class Analysis. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-021-00497-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Casper RC. Restlessness and an Increased Urge to Move (Drive for Activity) in Anorexia Nervosa May Strengthen Personal Motivation to Maintain Caloric Restriction and May Augment Body Awareness and Proprioception: A Lesson From Leptin Administration in Anorexia Nervosa. Front Psychol 2022; 13:885274. [PMID: 35959022 PMCID: PMC9359127 DOI: 10.3389/fpsyg.2022.885274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 06/20/2022] [Indexed: 12/02/2022] Open
Abstract
Anorexia nervosa (AN), a disorder of voluntary food restriction leading to severe weight loss in female adolescents, remains an enigma. In particular, the appropriation of the starved thin body into the self-concept in AN is a process insufficiently researched and still poorly understood. Healthy humans undergoing starvation experience a slowing of movements and avoid voluntary exercise. By contrast, AN tends to be not infrequently associated with voluntary, sometimes excessive and/or compulsive exercise. Such deliberate exercise, not reported in starvation, seems to be facilitated by an increased urge for movement and physical restlessness, particular to AN. The increased urge to move would reflect spontaneous daily activity, the energy expended for everything that is not sleeping, eating, or voluntary exercise. Our hypothesis is that the starvation-induced increased urge to move and restlessness may promote the development of AN. Reversal of the fasting state, by either high caloric food or by leptin administration, would be expected to reduce restlessness and the increased urge to move along with improvement in other symptoms in AN. This review explores the idea that such restless activation in AN, in itself and through accelerating body weight loss, might foster the integration of the starving body into the self-concept by (1) enhancing the person’s sense of self-control and sense of achievement and (2) through invigorating proprioception and through intensifying the perception of the changing body shape. (3) Tentative evidence from studies piloting leptin administration in chronic AN patients which support this hypothesis is reviewed. The findings show that short term administration of high doses of leptin indeed mitigated depressive feelings, inner tension, intrusive thoughts of food, and the increased urge to be physically active, easing the way to recovery, yet had little influence on the patients’ personal commitment to remain at a low weight. Full recovery then requires resolution of the individuals’ personal unresolved psychological conflicts through psychotherapy and frequently needs specialized treatment approaches to address psychiatric co-morbidities. AN might be conceptualized as a hereditary form of starvation resistance, facilitated by the effects of starvation on fitness allowing for an exceptionally intense personal commitment to perpetuate food restriction.
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22
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Agne A, Quesnel DA, Larumbe-Zabala E, Olmedillas H, Graell-Berna M, Perez M, Fernandez-del-Valle M. Progressive resistance exercise as complementary therapy improves quality of life and body composition in anorexia nervosa: A randomized controlled trial. Complement Ther Clin Pract 2022; 48:101576. [DOI: 10.1016/j.ctcp.2022.101576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 11/03/2022]
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Gupta A, Bhatt RR, Rivera-Cancel A, Makkar R, Kragel PA, Rodriguez T, Graner JL, Alaverdyan A, Hamadani K, Vora P, Naliboff B, Labus JS, LaBar KS, Mayer EA, Zucker N. Complex functional brain network properties in anorexia nervosa. J Eat Disord 2022; 10:13. [PMID: 35123579 PMCID: PMC8817538 DOI: 10.1186/s40337-022-00534-9] [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: 10/08/2021] [Accepted: 01/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is a disorder characterized by an incapacitating fear of weight gain and by a disturbance in the way the body is experienced, facets that motivate dangerous weight loss behaviors. Multimodal neuroimaging studies highlight atypical neural activity in brain networks involved in interoceptive awareness and reward processing. METHODS The current study used resting-state neuroimaging to model the architecture of large-scale functional brain networks and characterize network properties of individual brain regions to clinical measures. Resting-state neuroimaging was conducted in 62 adolescents, 22 (21 female) with a history of AN and 40 (39 female) healthy controls (HCs). Sensorimotor and basal ganglia regions, as part of a 165-region whole-brain network, were investigated. Subject-specific functional brain networks were computed to index centrality. A contrast analysis within the general linear model covarying for age was performed. Correlations between network properties and behavioral measures were conducted (significance q < .05). RESULTS Compared to HCs, AN had lower connectivity from sensorimotor regions, and greater connectivity from the left caudate nucleus to the right postcentral gyrus. AN demonstrated lower sensorimotor centrality, but higher basal ganglia centrality. Sensorimotor connectivity dyads and centrality exhibited negative correlations with body dissatisfaction and drive for thinness, two essential features of AN. CONCLUSIONS These findings suggest that AN is associated with greater communication from the basal ganglia, and lower information propagation in sensorimotor cortices. This is consistent with the clinical presentation of AN, where individuals exhibit patterns of rigid habitual behavior that is not responsive to bodily needs, and seem "disconnected" from their bodies.
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Affiliation(s)
- Arpana Gupta
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, 90095, USA. .,David Geffen School of Medicine, UCLA, Los Angeles, CA, 90095, USA. .,Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA, Los Angeles, CA, 90095, USA.
| | - Ravi R Bhatt
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, 90095, USA.,Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine at USC, University of Southern California, Los Angeles, USA
| | | | - Rishi Makkar
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, 90095, USA
| | | | - Thomas Rodriguez
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, 90095, USA
| | - John L Graner
- Department of Psychology and Neuroscience, Duke University, Durham, USA
| | - Anita Alaverdyan
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, 90095, USA
| | - Kareem Hamadani
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, 90095, USA
| | - Priten Vora
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, 90095, USA
| | - Bruce Naliboff
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, 90095, USA.,David Geffen School of Medicine, UCLA, Los Angeles, CA, 90095, USA.,Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA, Los Angeles, CA, 90095, USA
| | - Jennifer S Labus
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, 90095, USA.,David Geffen School of Medicine, UCLA, Los Angeles, CA, 90095, USA.,Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA, Los Angeles, CA, 90095, USA
| | - Kevin S LaBar
- Department of Psychology and Neuroscience, Duke University, Durham, USA
| | - Emeran A Mayer
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA, Los Angeles, CA, 90095, USA.,David Geffen School of Medicine, UCLA, Los Angeles, CA, 90095, USA.,Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA, Los Angeles, CA, 90095, USA.,Ahmanson-Lovelace Brain Mapping Center, UCLA, Los Angeles, CA, 90095, USA
| | - Nancy Zucker
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, USA.,Department of Psychology and Neuroscience, Duke University, Durham, USA
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Mehak A, Miller AE, Trolio V, Racine SE. 'Feeling fat' amid the COVID-19 pandemic: Examining the role of emotion dysregulation in the body displacement hypothesis. Eat Behav 2022; 44:101597. [PMID: 35124542 PMCID: PMC8805909 DOI: 10.1016/j.eatbeh.2022.101597] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/07/2022] [Accepted: 01/21/2022] [Indexed: 11/16/2022]
Abstract
'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.
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Affiliation(s)
| | | | | | - Sarah E. Racine
- Corresponding author at: Department of Psychology, McGill University, 2001 Avenue McGill College, Room 1411, Montréal QC H3A 1G1, Canada
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Lydecker JA, Simpson L, Smith SR, White MA, Grilo CM. Preoccupation in bulimia nervosa, binge-eating disorder, anorexia nervosa, and higher weight. Int J Eat Disord 2022; 55:76-84. [PMID: 34713460 PMCID: PMC8963447 DOI: 10.1002/eat.23630] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 09/15/2021] [Accepted: 10/07/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Preoccupation (excessive and constant thoughts) about shape/weight and food/eating is thought to be prominent in individuals with eating disorders but has received much less research than overt behavioral features. This study examined the significance and distinctiveness of different foci of preoccupation in individuals categorized with different forms of eating disorders and in individuals with higher weight. METHOD Participants (N = 1,363) completed a web-based survey with established measures of eating-disorder psychopathology and depression. The current study compared preoccupation among individuals with core features of bulimia nervosa (BN; n = 144), binge-eating disorder (BED; n = 576), anorexia nervosa (AN; n = 48), and higher body weight (body mass index [BMI] ≥ 25) without eating-disorder features (higher weight [HW]; n = 595). Associations of each type of preoccupation with other eating-disorder psychopathology and depression were examined both between and within study groups. RESULTS Preoccupation with shape/weight and with food/eating showed a graded pattern of statistically significant differences: AN and BN had higher preoccupation than BED, which was higher than HW. Within BN, BED, and AN study groups, correlation magnitudes of shape/weight and food/eating preoccupation with eating-disorder psychopathology and depression did not differ significantly. Within the HW group, shape/weight preoccupation was significantly more strongly correlated than food/eating preoccupation with overvaluation, body dissatisfaction, and depression. DISCUSSION The preoccupation cognitive style, as well as focus, appears associated with other facets of eating-disorder psychopathology and depression. If results are confirmed among individuals with formal diagnoses, clinicians addressing maladaptive cognitions in cognitive-behavioral therapy should consider the role of preoccupation. Future research should investigate whether preoccupation predicts or moderates eating disorder treatment outcomes.
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Affiliation(s)
- Janet A. Lydecker
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Lauren Simpson
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA,Amherst College, Amherst, MA USA
| | - Shannon R. Smith
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Marney A. White
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA,Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT
| | - Carlos M. Grilo
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA,Department of Psychology, Yale University, New Haven, CT
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Messer M, Linardon J. Exploring the role of feeling fat in individuals categorized with bulimia nervosa, binge-eating disorder and overweight/obesity. Eat Weight Disord 2021; 26:2617-2623. [PMID: 33570744 DOI: 10.1007/s40519-021-01119-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 01/19/2021] [Indexed: 10/22/2022] Open
Abstract
PURPOSE Despite featuring in prominent theoretical models, the role of "feeling fat" in certain eating and weight disorder presentations remains poorly understood. This study compared levels of feeling fat between people categorized with referable bulimia nervosa (BN) symptoms, binge-eating disorder (BED) symptoms, and overweight/obesity, and examined the unique associations of feeling fat on measures of eating pathology and functional impairment within each of these subgroups. METHODS Data were analyzed from 977 participants who met criteria referable to BN symptoms (n = 419), BED symptoms (n = 346), or overweight/obesity without ED psychopathology (n = 212) based on self-report symptom frequency. RESULTS Analysis of variance revealed that feeling fat levels were highest in the referable BN group, followed by the referable BED group, and then the overweight/obese subgroup. Multiple regressions revealed that feeling fat contributed additional variance to functional impairment and key cognitive (e.g., eating concerns) and behavioural (e.g., dietary restraint) symptoms only among those who met criteria referable to BN. CONCLUSION Overall, findings suggest that the experience of feeling fat may be an important component of body image particularly among individuals with BN-type symptoms. Present findings may also have implications for the assessment and treatment of feeling fat among different eating and weight disorder presentations. LEVEL OF EVIDENCE Cross-sectional descriptive study, Level V.
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Affiliation(s)
- Mariel Messer
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia.
| | - Jake Linardon
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
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'Feeling fat' is associated with specific eating disorder symptom dimensions in young men and women. Eat Weight Disord 2021; 26:2345-2351. [PMID: 33389705 DOI: 10.1007/s40519-020-01074-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 11/13/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE 'Feeling fat,' the somatic experience of having excess body weight that is not fully explained by true adiposity, correlates with eating pathology in clinical and non-clinical samples. It is unknown whether 'feeling fat' more strongly relates to specific eating disorder symptom dimensions that typically characterize anorexia nervosa, bulimia nervosa, and/or binge eating disorder. Understanding the significance of 'feeling fat's relationship with specific eating disorder symptom dimensions-cognitive restraint, dietary restriction, binge eating, and purging-may suggest its relevance to particular forms of eating pathology and elucidate treatment directions for addressing 'feeling fat'. METHODS Questionnaires were completed by 989 undergraduates (54.3% female). RESULTS Path analyses indicated significant associations between feeling fat and all symptom dimensions; these paths were not moderated by gender. The best fitting model was the model including paths from 'feeling fat' to all symptom dimensions; no other model had equivalent fit. CONCLUSION 'Feeling fat' relates to all examined symptoms of eating disorders in a mixed-gender non-clinical population. These results indicate that 'feeling fat' is associated with multiple core symptoms of eating pathology, pointing to 'feeling fat's significance to eating pathology maintenance across the spectrum of eating pathology. Future research should compare the influence of 'feeling fat' on these symptoms in mixed-gender clinical samples. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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Mehak A, Racine SE. 'Feeling fat,' eating pathology, and eating pathology-related impairment in young men and women. Eat Disord 2021; 29:523-538. [PMID: 31762406 DOI: 10.1080/10640266.2019.1695451] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
'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.'
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Affiliation(s)
- Adrienne Mehak
- Department of Psychology, McGill University, Montréal, Canada
| | - Sarah E Racine
- Department of Psychology, McGill University, Montréal, Canada
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Change in normative eating self-efficacy is associated with six-month weight restoration following inpatient treatment for anorexia nervosa. Eat Behav 2021; 42:101518. [PMID: 33989938 DOI: 10.1016/j.eatbeh.2021.101518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 04/29/2021] [Accepted: 05/04/2021] [Indexed: 11/22/2022]
Abstract
Anorexia nervosa (AN) is a disorder characterized by rigid and restrictive eating behaviors, resulting in significantly low body weight. While specialized behavioral intensive treatment programs can reliably support individuals with AN to normalize eating and weight control behaviors and achieve weight restoration, prognostic factors predicting relapse following treatment are unclear. We examined whether changes in (i) normative eating self-efficacy, (ii) body image self-efficacy, (iii) drive for thinness, and (iv) body dissatisfaction from inpatient admission to six-month follow-up were associated with weight restoration status at program discharge and at six-month follow-up. The sample comprised 146 participants with AN admitted to a meal-based inpatient-partial hospitalization program. Participants completed questionnaires at inpatient admission and six months following program discharge. Additionally, at follow-up, participants reported the frequency of engaging in normalized eating behaviors since discharge (e.g. eating with others and preparing a balanced meal). The majority (73.3%) of participants attained a BMI > 19 at discharge and 59.6% were weight restored at six-month follow-up. Change in normative eating self-efficacy was significantly associated with weight restoration at follow-up, whereas change in body image self-efficacy, drive for thinness, and body dissatisfaction were not. For each one unit increase in normative eating self-efficacy, patients were 4.65 times more likely to be weight restored at follow-up (p = .002). Additionally, individuals reporting a higher frequency of normalized eating behaviors at follow-up were more likely to be weight restored. Normative eating self-efficacy and normalized eating behaviors may represent vital treatment targets for relapse prevention interventions for this high-risk population.
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Rousselet M, Reinhardt H, Forestier B, Eyzop E, Lambert S, Rocher B, Gailledrat L, Hardouin JB, Grall-Bronnec M. Are marked body shape concerns associated with poorer outcomes at the one-year follow-up in anorexia nervosa? Brain Behav 2021; 11:e02199. [PMID: 34037330 PMCID: PMC8323028 DOI: 10.1002/brb3.2199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 05/04/2021] [Accepted: 05/07/2021] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Anorexia nervosa (AN) is a complex disease in which obsessive thoughts about body image, shape, or weight are expressed. The intensity of these concerns varies among individuals, and only a few studies have focused on their impact on patients' clinical course when patients are treated on an outpatient basis. Our study aimed to determine whether marked body concerns at inclusion were predictive of the one-year follow-up. METHOD Participants (N = 72) were women seeking treatment for AN in a specialized unit for eating disorder management. All participants were assessed at inclusion and at the 1-year follow-up. Clinical outcome was assessed using the Morgan & Russel Outcome Average Score (MROAS), and body concerns were assessed using the Body Shape Questionnaires (BSQ). RESULTS Marked body concerns (BSQ score >140) at inclusion were associated with a poorer outcome at the 12-month follow-up (lower MROAS "total score"). Other characteristics at inclusion that were predictive of a poorer outcome at 12 months were as follows: higher severity of ED at inclusion, longer hospitalization during follow-up, and experiencing a lower impact of the illness on school/work life. DISCUSSION The results confirmed the importance of a multifocal treatment that should address body concerns and motivation to change. Our results also highlighted the necessity of promoting the maintenance of school/work during the treatment course.
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Affiliation(s)
- Morgane Rousselet
- Addictology and Psychiatry Department, Nantes University Hospital, Nantes, France.,UMR 1246, Nantes University and Tours University, Nantes, France
| | - Hélène Reinhardt
- Addictology and Psychiatry Department, Nantes University Hospital, Nantes, France
| | | | - Emeline Eyzop
- Addictology and Psychiatry Department, Nantes University Hospital, Nantes, France
| | - Sylvain Lambert
- Addictology and Psychiatry Department, Nantes University Hospital, Nantes, France
| | - Bruno Rocher
- Addictology and Psychiatry Department, Nantes University Hospital, Nantes, France
| | - Lucie Gailledrat
- Addictology and Psychiatry Department, Nantes University Hospital, Nantes, France
| | | | - Marie Grall-Bronnec
- Addictology and Psychiatry Department, Nantes University Hospital, Nantes, France.,UMR 1246, Nantes University and Tours University, Nantes, France
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A Reference-Dependent Computational Model of Anorexia Nervosa. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2021; 21:269-277. [PMID: 33751479 PMCID: PMC8121716 DOI: 10.3758/s13415-021-00886-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 12/16/2022]
Abstract
Influential accounts interpret anorexia as arising from perfectionism, dichotomous thinking, and poor control expressed in a variety of life domains, resulting in low self-esteem. In this context, restraining eating would allow patients to re-establish some control and self-esteem. Although this view has offered important insight, one shortcoming is that constructs such as perfectionism, control, and dichotomous thinking, remain poorly specified. To clarify these constructs, we propose a computational model of anorexia. This relies on previous theories of evaluation, which highlight its reference-dependent nature: when attributing a value to an outcome, our brain automatically assesses the outcome relative to its context. Following these theories, the model proposes that a high reference point explains general characteristics such as perfectionism, dichotomous thinking, low self-esteem, and low sense of control. These characteristics would result specifically in anorexia when the sense of control regarding body shape, compared with other life domains, is relatively high. The model raises the possibility that reference effects also might explain why patients pursue extremely low weight; exposure to skinny body images-one product of obsessive dieting-might change the reference point for their own body, hence leading to extremely low body weight, staunch refusal to gain weight, and body misperceptions. The model contributes to clarify key concepts adopted in the literature and their relation. Such computational formulation might help to foster theoretical debate, formulating novel empirical predictions, and integrate psychological and neuroscientific perspectives on anorexia.
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Individualisierte Therapieplanung mithilfe des Gewichtsmappings bei Anorexia nervosa. PSYCHOTHERAPEUT 2021. [DOI: 10.1007/s00278-021-00495-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
ZusammenfassungDie Anorexia nervosa ist eine seltene, schwerwiegende Erkrankung, deren Therapie bislang oft nur mäßig wirksam ist. Stagnierende Verläufe oder ein erhebliches Auf und Ab in der Gewichtsentwicklung zwischen stationären Behandlungen und dem häuslichen Transfer sind verbreitet und können stationäre Aufnahmen bzw. Wiederaufnahmen notwendig machen. Im Folgenden werden daher Techniken des Gewichtsmappings vorgestellt, die eine individualisierte Therapieplanung ermöglichen. Hierzu zählt zum einen die retrospektive Analyse des Lifecharts, in der die Gewichtsentwicklung über die Lebenspanne aufgezeigt wird und die damit Schweregrad der Essstörung, Krankheitsdauer und -verlauf sowie transdiagnostisch relevante Prozesse veranschaulichen kann. Zum anderen gehört dazu die prospektive Technik des Gewichtsmappings, die in einem standardisierten Vorgehen die individuell relevanten Gewichtsmarker erfasst und visualisiert. Diese diagnostischen Informationen können eine personalisierte Therapieplanung unterstützen, die sowohl den Zeitverlauf als auch den Schwierigkeitsgrad des Bewältigungsprozesses antizipiert. Mithilfe der Techniken des Gewichtsmanagements kann die Expositionsbehandlung zielgerichtet therapeutisch angeleitet und begleitet werden. Dabei werden die Arbeit mit Intervallmodulen und ihre Rolle für eine bewältigungsorientierte Expositionsbehandlung diskutiert.
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Gutiérrez E, Carrera O. Severe and Enduring Anorexia Nervosa: Enduring Wrong Assumptions? Front Psychiatry 2021; 11:538997. [PMID: 33658948 PMCID: PMC7917110 DOI: 10.3389/fpsyt.2020.538997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 12/17/2020] [Indexed: 11/13/2022] Open
Abstract
To the extent that severe and lasting anorexia nervosa (SE-AN) is defined in terms of refractoriness to the best treatments available, it is mandatory to scrutinize the proven effectiveness of the treatments offered to patients. The array of so-called current evidence-based treatments for anorexia nervosa (AN) encompasses the entire spectrum of treatments ranging from specialized brand-type treatments to new treatments adapted to the specific characteristics of people suffering from AN. However, after several randomized control trials, parity in efficacy is the characteristic among these treatments. To further complicate the landscape of effective treatments, this "tie score" extends to the treatment originally conceived as control conditions, or treatment as usual conditions. In retrospection, one can understand that treatments considered to be the best treatments available in the past were unaware of their possible iatrogenic effects. Obviously, the same can be said of the theoretical assumptions underpinning such treatments. In either case, if the definition of chronicity mentioned above is applied, it is clear that the responsibility for the chronicity of the disorder says more about the flagrant inefficacy of the treatments and the defective assumptions underpinning them, than the nature of the disorder itself. A historical analysis traces the emergence of the current concept of "typical" AN and Hilde Bruch's contribution to it. It is concluded that today's diagnostic criteria resulting from a long process of acculturation distort rather than capture the essence of the disorder, as well as marginalizing and invalidating patients' perspectives.
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Affiliation(s)
- Emilio Gutiérrez
- Department of Clinical Psychology and Psychobiology, College of Psychology, University of Santiago, Santiago de Compostela, Spain
- Venres Clínicos Unit, College of Psychology, University of Santiago, Santiago de Compostela, Spain
| | - Olaia Carrera
- Venres Clínicos Unit, College of Psychology, University of Santiago, Santiago de Compostela, Spain
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AN-VR-BE. A Randomized Controlled Trial for Reducing Fear of Gaining Weight and Other Eating Disorder Symptoms in Anorexia Nervosa through Virtual Reality-Based Body Exposure. J Clin Med 2021; 10:jcm10040682. [PMID: 33578767 PMCID: PMC7916489 DOI: 10.3390/jcm10040682] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/03/2021] [Accepted: 02/07/2021] [Indexed: 12/18/2022] Open
Abstract
In vivo body exposure therapy is considered an effective and suitable intervention to help patients with anorexia nervosa (AN) reduce their body image disturbances (BIDs). However, these interventions have notable limitations and cannot effectively reproduce certain fears usually found in AN, such as the fear of gaining weight (FGW). The latest developments in virtual reality (VR) technology and embodiment-based procedures could overcome these limitations and allow AN patients to confront their FGW and BIDs. This study aimed to provide further evidence of the efficacy of an enhanced (by means of embodiment) VR-based body exposure therapy for the treatment of AN. Thirty-five AN patients (16 in the experimental group, 19 in the control group) participated in the study. FGW, BIDs, and other body-related and ED measures were assessed before and after the intervention and three months later. The experimental group received treatment as usual (TAU) and five additional sessions of VR-based body exposure therapy, while the control group received only TAU. After the intervention, ED symptoms were clearly reduced in both groups, with most of the changes being more noticeable in the experimental group. Specifically, after the intervention and at follow-up, significant group differences were found in the FGW and BIDs, with the experimental group showing significantly lower values than the control group. The current study provides new insights and encouraging findings in the field of exposure-based therapies in AN. VR technology might improve research and clinical practice in AN by providing new tools to help patients confront their core fears (i.e., food- or weight-related cues) and improve their emotional, cognitive, and behavioral responses to their body image.
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Levinson CA, Vanzhula IA, Smith TW, Stice E. Group and longitudinal intra-individual networks of eating disorder symptoms in adolescents and young adults at-risk for an eating disorder. Behav Res Ther 2020; 135:103731. [PMID: 33010651 PMCID: PMC7688499 DOI: 10.1016/j.brat.2020.103731] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 09/04/2020] [Accepted: 09/16/2020] [Indexed: 12/19/2022]
Abstract
Several studies have identified risk factors that predict future onset of eating disorders (ED) in adolescence, however, it is currently unknown how specific ED symptom dynamics operate both across time and within individuals. Advances in network methodologies allow for the study of how dynamic symptoms interrelate and predict each other within-persons and across time. In the current study, we used longitudinal group-level (N = 1272) (addressing symptom interrelations across people and across time; between-subjects, contemporaneous, and temporal networks) and intra-individual (symptom interrelations within each person and across time; contemporaneous and temporal networks) network analyses (subset n = 50) in prospective 48-month interview data in at-risk adolescents and young adults. We computed between-subject networks (how symptoms are associated on average, for group sample only), contemporaneous networks (how symptoms are associated at one time point, accounting for previous time points), and temporal networks (examining how symptoms predict each other across time). We replicated prior network results which suggest that overvaluation of weight and shape are central in at-risk adolescents and young adults. We found that individual networks (n = 1 networks) were highly variable across individuals. Overall, our results show how both group-level and longitudinal intra-individual network analysis can inform our understanding of how EDs develop in adolescence and point to the importance of conceptualizing development on an individual level of analysis.
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Affiliation(s)
- Cheri A Levinson
- University of Louisville, Department of Psychological & Brain Sciences, Louisville, USA.
| | - Irina A Vanzhula
- University of Louisville, Department of Psychological & Brain Sciences, Louisville, USA
| | - Tosha Woods Smith
- Center of Excellence for Eating Disorders, School of Medicine, University of North Carolina, Chapel Hill, USA
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36
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Levinson CA, Williams BM, Christian C. What are the emotions underlying feeling fat and fear of weight gain? J Affect Disord 2020; 277:146-152. [PMID: 32828001 DOI: 10.1016/j.jad.2020.08.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/29/2020] [Accepted: 08/08/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Eating disorders (EDs) are most always accompanied by cognitive-affective comorbidities, such as anxiety and depression. In addition to these common comorbidities, EDs are unique in that they are characterized by affective symptoms centered on body image and weight. Two of these primary, yet understudied, affective symptoms are feelings of fatness and fears of weight gain, which are theorized to be maintaining symptoms of EDs and are highly common in those with EDs. Despite the importance of these symptoms, there is no research characterizing which cognitive-affective symptoms contribute to feelings of fatness and fears of weight gain. METHODS The current study (N=168 individuals with an ED) tested cross-sectional and prospective models of cognitive-affect variables (negative affect, guilt, shame, fear of negative evaluation, anxiety sensitivity, and depression) to identify which thoughts and emotions were uniquely associated and prospectively predicted feelings of fatness and fear of weight gain. RESULTS Depression both cross-sectionally and prospectively predicted feeling fat over and above all other forms of affect. Fears of negative evaluation and depression were uniquely associated with fears of weight gain, and shame prospectively predicted fear of weight gain. LIMITATIONS Variables were self-reported, and the sample primarily consisted of women. Fear of weight gain and feelings of fatness were assessed using single items. CONCLUSIONS This research suggests that depression may be an important intervention target when individuals with an ED report feeling fat. Additionally, treatment targeting fear of negative evaluation, depression, and shame may decrease fears of weight gain.
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Affiliation(s)
- Cheri A Levinson
- Department of Psychological & Brain Sciences, University of Louisville, Life Sciences Building 317, Louisville, KY 40292, United States.
| | - Brenna M Williams
- Department of Psychological & Brain Sciences, University of Louisville, Life Sciences Building 317, Louisville, KY 40292, United States
| | - Caroline Christian
- Department of Psychological & Brain Sciences, University of Louisville, Life Sciences Building 317, Louisville, KY 40292, United States
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Porras-Garcia B, Ferrer-Garcia M, Serrano-Troncoso E, Carulla-Roig M, Soto-Usera P, Miquel-Nabau H, Shojaeian N, de la Montaña Santos-Carrasco I, Borszewski B, Díaz-Marsá M, Sánchez-Díaz I, Fernández-Aranda F, Gutiérrez-Maldonado J. Validity of Virtual Reality Body Exposure to Elicit Fear of Gaining Weight, Body Anxiety and Body-Related Attentional Bias in Patients with Anorexia Nervosa. J Clin Med 2020; 9:E3210. [PMID: 33027945 PMCID: PMC7600187 DOI: 10.3390/jcm9103210] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/01/2020] [Accepted: 10/02/2020] [Indexed: 12/19/2022] Open
Abstract
Fear of gaining weight (FGW), body image disturbances, associated anxiety and body-related attentional bias are the core symptoms of anorexia nervosa (AN) and play critical roles in its development and maintenance. The aim of the current study is to evaluate the usefulness of virtual reality-based body exposure software for the assessment of important body-related cognitive and emotional responses in AN. Thirty female patients with AN, one of them subclinical, and 43 healthy college women, 25 with low body dissatisfaction (BD) and 18 with high BD, owned a virtual body that had their silhouette and body mass index. Full-body illusion (FBI) over the virtual body was induced using both visuo-motor and visuo-tactile stimulation. Once the FBI was induced, the FBI itself, FGW, body anxiety and body-related attentional bias toward weight-related and non-weight-related body areas were assessed. One-way analyses of covariance (ANCOVA), controlling for age, showed that AN patients reported higher FGW, body anxiety and body-related attentional bias than healthy controls. Unexpectedly, patients with AN reported significantly lower FBI levels than healthy participants. Finally, Pearson correlations showed significant relationships between visual analog scales and body-related attentional bias measures, compared to other eating disorder measures. These results provide evidence about the usefulness of virtual reality-based body exposure to elicit FGW and other body-related disturbances in AN patients. Thus, it may be a suitable intervention for reducing these emotional responses and for easing weight recovery.
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Affiliation(s)
- Bruno Porras-Garcia
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Passeig de la Vall d’Hebron 171, 08035 Barcelona, Spain; (B.P.-G.); (M.F.-G.); (H.M.-N.); (N.S.)
| | - Marta Ferrer-Garcia
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Passeig de la Vall d’Hebron 171, 08035 Barcelona, Spain; (B.P.-G.); (M.F.-G.); (H.M.-N.); (N.S.)
| | - Eduardo Serrano-Troncoso
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Sant Joan de Déu of Barcelona; Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Spain; (E.S.-T.); (M.C.-R.); (P.S.-U.)
| | - Marta Carulla-Roig
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Sant Joan de Déu of Barcelona; Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Spain; (E.S.-T.); (M.C.-R.); (P.S.-U.)
| | - Pau Soto-Usera
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Sant Joan de Déu of Barcelona; Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Spain; (E.S.-T.); (M.C.-R.); (P.S.-U.)
| | - Helena Miquel-Nabau
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Passeig de la Vall d’Hebron 171, 08035 Barcelona, Spain; (B.P.-G.); (M.F.-G.); (H.M.-N.); (N.S.)
| | - Nazilla Shojaeian
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Passeig de la Vall d’Hebron 171, 08035 Barcelona, Spain; (B.P.-G.); (M.F.-G.); (H.M.-N.); (N.S.)
| | - Isabel de la Montaña Santos-Carrasco
- Department of Psychiatry and Mental Health, Hospital Clínico San Carlos, Madrid, Calle del Prof Martín Lagos, s/n, 28040 Madrid, Spain; (I.d.l.M.S.-C.); (B.B.); (M.D.-M.)
| | - Bianca Borszewski
- Department of Psychiatry and Mental Health, Hospital Clínico San Carlos, Madrid, Calle del Prof Martín Lagos, s/n, 28040 Madrid, Spain; (I.d.l.M.S.-C.); (B.B.); (M.D.-M.)
| | - Marina Díaz-Marsá
- Department of Psychiatry and Mental Health, Hospital Clínico San Carlos, Madrid, Calle del Prof Martín Lagos, s/n, 28040 Madrid, Spain; (I.d.l.M.S.-C.); (B.B.); (M.D.-M.)
| | - Isabel Sánchez-Díaz
- Department of Psychiatry and Mental Health, Hospital Universitario de Bellvitge- IDIBELL and CIBEROBN, Barcelona; Carrer Feixa Llarga s/n, 08907 Hospitalet del Llobregat, Spain; (I.S.-D.); (F.F.-A.)
| | - Fernando Fernández-Aranda
- Department of Psychiatry and Mental Health, Hospital Universitario de Bellvitge- IDIBELL and CIBEROBN, Barcelona; Carrer Feixa Llarga s/n, 08907 Hospitalet del Llobregat, Spain; (I.S.-D.); (F.F.-A.)
| | - José Gutiérrez-Maldonado
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Passeig de la Vall d’Hebron 171, 08035 Barcelona, Spain; (B.P.-G.); (M.F.-G.); (H.M.-N.); (N.S.)
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Mehak A, Racine SE. Understanding "feeling fat" and its underlying mechanisms: The importance of multimethod measurement. Int J Eat Disord 2020; 53:1400-1404. [PMID: 32632974 DOI: 10.1002/eat.23336] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/12/2020] [Accepted: 06/12/2020] [Indexed: 11/09/2022]
Abstract
"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).
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Affiliation(s)
- Adrienne Mehak
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Sarah E Racine
- Department of Psychology, McGill University, Montreal, Quebec, Canada
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Brockmeyer T, Burdenski K, Anderle A, Voges MM, Vocks S, Schmidt H, Wünsch-Leiteritz W, Leiteritz A, Friederich HC. Approach and avoidance bias for thin-ideal and normal-weight body shapes in anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2020; 28:536-550. [PMID: 32431093 DOI: 10.1002/erv.2744] [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: 09/11/2019] [Revised: 03/06/2020] [Accepted: 04/28/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The two studies aimed to examine implicit affective evaluations of thin-ideal and normal-weight body shapes in women with anorexia nervosa (AN), taking identification with body shapes into account. METHOD In study 1, approach-avoidance bias for thin-ideal and normal-weight bodies was assessed in 40 women with AN and 40 healthy women by using an Approach-Avoidance Task and female avatar bodies with a standard face as stimuli. In study 2, 39 women with AN and 38 healthy women underwent a similar task but identification with bodies was manipulated by presenting bodies once with the participant's own face and once with another woman's face. RESULTS In study 1, patients with AN did not differ from healthy participants in their automatic approach-avoidance tendencies towards thin-ideal and normal-weight bodies. In study 2, no definite approach bias for a thin self and no avoidance bias for thin other women or for a normal-weight self were found. However, as compared to healthy women, those with AN showed a less positive implicit evaluation of thin other women, and an implicit preference for thin bodies depicted as themselves over thin bodies depicted as another woman. CONCLUSIONS The findings suggest that intra-sexual competition for being slim is increased in AN.
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Affiliation(s)
- Timo Brockmeyer
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Goettingen, Goettingen, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Kathrin Burdenski
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Alisa Anderle
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Mona M Voges
- Department of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany
| | - Silja Vocks
- Department of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany
| | | | | | | | - Hans-Christoph Friederich
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.,Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
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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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Calugi S, Dalle Grave R. Body image concern and treatment outcomes in adolescents with anorexia nervosa. Int J Eat Disord 2019; 52:582-585. [PMID: 30702170 DOI: 10.1002/eat.23031] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/14/2019] [Accepted: 01/14/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To ascertain the role of baseline measures of body-image concern (BIC) in changes in body mass index (BMI) centile and psychopathological outcomes associated with intensive enhanced cognitive behavioral therapy (CBT-E) in adolescents with anorexia nervosa (AN). METHOD The BMI centile of 62 adolescent patients with AN was recorded at four time-points over 12 months, and Eating Disorder Examination interview (EDE) and Brief Symptom Inventory (BSI) scores, were recorded at admission and discharge from CBT-E. Changes in three BIC components, namely "Preoccupation with shape/weight", "Fear of weight gain" and "Feeling fat", were assessed at admission and discharge. RESULTS CBT-E was associated with a significant improvement in outcome variables and BIC components. Among completers, 96.4% reached an end-of treatment BMI centile corresponding to a BMI ≥ 18.5 at 18 years, which fell slightly to 78.7% and 80.4% at 6- and 12-month follow-ups, respectively. Baseline "Preoccupation with shape/weight" and "Feeling fat" predicted improvement in BMI centile over time, and all three baseline BIC components independently predicted end-of-treatment EDE Eating Concern subscale score. Baseline "Feeling fat" also predicted end-of-treatment EDE Dietary Restraint subscale and BSI scores. DISCUSSION These findings highlight the importance of assessing and addressing body image when managing adolescent patients with AN.
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Affiliation(s)
- Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda (VR), Italy
| | - Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda (VR), Italy
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Abstract
Body dissatisfaction is a risk factor for development of eating disorders and represents a core psychopathologic feature of eating disorders. Prevention and treatment interventions address established risk and maintaining factors for body dissatisfaction: appearance pressures, internalization of appearance ideals, upward appearance comparison, avoidance and checking, and body disparagement. It is essential to address body dissatisfaction within eating disorders treatment to improve outcomes and reduce risk of relapse. Future directions in research and treatment aim to reach populations increasingly recognized as in need, including children, men, and individuals at higher weights, with the ultimate goal of reducing the significant distress associated with body dissatisfaction.
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