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Jones EJ, Egan SJ, Howell JA, Hoiles KJ, Mazzucchelli TG. An examination of the transdiagnostic cognitive-behavioural model of eating disorders in adolescents. Eat Behav 2020; 39:101445. [PMID: 33142128 DOI: 10.1016/j.eatbeh.2020.101445] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 10/05/2020] [Accepted: 10/14/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The validity of the transdiagnostic cognitive-behavioural model of eating disorders has been examined in adults, however there is limited examination in adolescents with eating disorders. The present study examined the direct and indirect relationships between eating disorder symptoms and the four maintaining processes: perfectionism, low core self-esteem, mood intolerance, and interpersonal difficulties. METHOD Using a correlational cross-sectional design, adolescents with eating disorders (N = 270; anorexia nervosa [restricting; 35.9%]; anorexia nervosa [binge purge; 8.1%]; bulimia nervosa [9.3%]; atypical anorexia nervosa [27.4%]; bulimia nervosa [of low frequency and/or limited duration; 3%]; purging [1.1%]; and unspecified feeding or eating disorders [15.2%]) completed measures of perfectionism, self-esteem, mood intolerance, interpersonal difficulties, and eating disorder symptoms as part of the intake assessment to an eating disorders program. RESULTS Path analysis revealed that low self-esteem and mood intolerance were directly associated with eating disorder symptoms. Perfectionism was indirectly associated with eating disorder symptoms through self-esteem and mood intolerance. DISCUSSION The findings provide partial support for the transdiagnostic model of eating disorders in an adolescent clinical sample. In particular, core low self-esteem and mood intolerance were found to be pertinent in adolescents with eating disorders. A limitation of the current study was the use of cross-sectional data. Future research should examine the transdiagnostic model with the use of longitudinal data. Furthermore, future research is required to examine potential differences in the way the maintaining mechanisms operate between adolescents and adults with eating disorders and the implications for treatment.
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Affiliation(s)
- Emily J Jones
- School of Psychology, Curtin University, Perth, Australia.
| | - Sarah J Egan
- School of Psychology, Curtin University, Perth, Australia
| | - Joel A Howell
- School of Psychology, Curtin University, Perth, Australia
| | - Kimberley J Hoiles
- Eating Disorders Program, Child and Adolescent Health Service, Perth, Australia
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2
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Lo Coco G, Salerno L, Ingoglia S, Tasca GA. Self-esteem and binge eating: Do patients with binge eating disorder endorse more negatively worded items of the Rosenberg Self-Esteem Scale? J Clin Psychol 2020; 77:818-836. [PMID: 33037628 DOI: 10.1002/jclp.23065] [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: 02/17/2020] [Revised: 09/14/2020] [Accepted: 09/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Self-esteem is a core aspect of eating disorder symptomatology. This study aims to examine whether method effects associated with negatively worded items of the Rosenberg Self-Esteem Scale (RSES) may interact the negative self-evaluations experienced by patients with obesity and binge eating disorder (BED). We also examined whether negatively worded items were associated with psychological distress and eating symptoms. METHOD Five hundred thirty three female outpatients (mean age: 42.59) with BED (n = 160) or obesity without BED (n = 373) completed the RSES and measures of interpersonal problems, psychological distress, and eating symptoms. RESULTS Patients with BED responded more strongly to the negatively worded items of the RSES than those with obesity. The RSES negatively worded item factor was negatively associated with higher interpersonal problems, psychological distress, and binge eating. CONCLUSIONS Patients with BED may be more responsive to negatively phrased items on the RSES consistent with their negative self-evaluations and self-perceptions.
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Affiliation(s)
- Gianluca Lo Coco
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Laura Salerno
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Sonia Ingoglia
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
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3
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Konstantakopoulos G, Ioannidi N, Patrikelis P, Gonidakis F. Empathy, mentalizing, and cognitive functioning in anorexia nervosa and bulimia nervosa. Soc Neurosci 2020; 15:477-488. [PMID: 32321371 DOI: 10.1080/17470919.2020.1760131] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The existing evidence on the specific profile and the determinants of empathic and mentalizing abilities in anorexia nervosa (AN) and bulimia nervosa (BN) is not conclusive. Moreover, it is not clear whether patients with eating disorders also exhibit diminished ability to accurately appraise their own empathic skills. We examine in AN and BN: (a) the impairments in various aspects of empathy and theory of mind (ToM), while accounting for the effect of other cognitive functions and (b) the accuracy of self-appraisal of empathy. Self-reported and performance-based empathy, ToM, and cognitive functions were assessed in 46 patients with AN, 30 patients with BN, and 42 healthy controls (HC). Both AN and BN patients reported diminished overall empathic abilities, whereas only BN patients reported reduced cognitive empathy compared to HC. Deficits in performance-based empathy were found in both patient groups. Cognitive ToM was impaired only in AN. Significant correlations between self-reported and performance-based empathy were found in BN and HC but not in AN. Cognitive deficits negatively affected the self-appraisal of empathy in AN but not empathic skills per se. Our findings highlight a double deficit related to empathic responding in AN: diminished performance and inaccurate self-appraisal of empathic abilities, indicating dysfunctional self-reflection.
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Affiliation(s)
- George Konstantakopoulos
- First Department of Psychiatry, National & Kapodistrian University of Athens, Eginition Hospital , Athens, Greece.,Department of Psychosis Studies, Institute of Psychiatry, King's College , London, UK
| | - Nikoleta Ioannidi
- First Department of Psychiatry, National & Kapodistrian University of Athens, Eginition Hospital , Athens, Greece
| | - Panayiotis Patrikelis
- Department of Neurosurgery, National & Kapodistrian University of Athens, Evangelismos Hospital , Athens, Greece
| | - Frangiskos Gonidakis
- First Department of Psychiatry, National & Kapodistrian University of Athens, Eginition Hospital , Athens, Greece
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4
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Kerr-Gaffney J, Harrison A, Tchanturia K. Autism spectrum disorder traits are associated with empathic abilities in adults with anorexia nervosa. J Affect Disord 2020; 266:273-281. [PMID: 32056888 DOI: 10.1016/j.jad.2020.01.169] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 12/10/2019] [Accepted: 01/28/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Social and emotional difficulties have been identified as key factors in the development and maintenance of anorexia nervosa (AN). However, few studies have investigated the influence of comorbid psychopathology on social cognition. The aim of the current study was to examine perception of nonverbal communication and empathy in AN using ecologically valid, performance-based measures, and to explore associations with comorbid psychopathology (anxiety, depression, autism spectrum disorder (ASD) traits, alexithymia, and social anxiety). METHODS In this cross-sectional study, the Multifaceted Empathy Test (MET) and the Mini Profile of Nonverbal Sensitivity (MiniPONS) were administered to 51 adults with AN, 51 recovered AN (REC), and 51 healthy controls (HCs). Comorbid psychopathological traits were assessed using self-report questionnaires and the Autism Diagnostic Observation Schedule - 2nd edition (ADOS-2). RESULTS Individuals with AN showed reduced affective empathy to positive stimuli compared to HCs, and a trend towards lower vocal prosody recognition scores relative to REC. Around a quarter of AN and REC scored above the clinical cut-off for ASD on the ADOS-2, and high ASD symptoms predicted lower cognitive and affective empathy scores. LIMITATIONS The study is cross-sectional, future research would benefit from examining social-cognition performance and comorbid psychopathology longitudinally. CONCLUSIONS The findings highlight the importance of ASD symptoms in empathy dysfunction in those with a lifetime history of AN. Future research should explore whether treatment adaptations to accommodate for differences in social-cognitive abilities may be helpful in the treatment of AN.
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Affiliation(s)
- Jess Kerr-Gaffney
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, London, United Kingdom.
| | - Amy Harrison
- University College London, Department of Psychology and Human Development, London, United Kingdom; South London and Maudsley NHS Trust, National Eating Disorders Service, Psychological Medicine Clinical Academic Group, London, United Kingdom
| | - Kate Tchanturia
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, London, United Kingdom; South London and Maudsley NHS Trust, National Eating Disorders Service, Psychological Medicine Clinical Academic Group, London, United Kingdom; Department of Psychology, Ilia State University, Tbilisi, Georgia
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5
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Kerr-Gaffney J, Harrison A, Tchanturia K. Cognitive and Affective Empathy in Eating Disorders: A Systematic Review and Meta-Analysis. Front Psychiatry 2019; 10:102. [PMID: 30886590 PMCID: PMC6410675 DOI: 10.3389/fpsyt.2019.00102] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 02/12/2019] [Indexed: 12/18/2022] Open
Abstract
Background: Recent models of eating disorders (EDs) have proposed social and emotional difficulties as key factors in the development and maintenance of the illness. While a number of studies have demonstrated difficulties in theory of mind and emotion recognition, little is known about empathic abilities in those with EDs. Further, few studies have examined the cognitive-affective empathy profile in EDs. The aim of this systematic review and meta-analysis was to provide a synthesis of empathy studies in EDs, and examine whether those with EDs differ from healthy controls (HC) on self-reported total, cognitive, and affective empathy. Methods: Electronic databases were systematically searched for studies using self-report measures of empathy in ED populations. In total, 17 studies were identified, 14 of which could be included in the total empathy meta-analysis. Eight of the 14 studies were included in the cognitive and affective empathy meta-analyses. Results: Meta-analyses showed that while total empathy and affective empathy scores did not differ between those with anorexia nervosa (AN) and HC, those with AN had significantly lower cognitive empathy scores compared to HCs (small effect size). Meta-analyses of Interpersonal Reactivity Index sub-scores revealed that AN had significantly lower Fantasy scores than HC (small effect size), indicating that those with AN have more difficulty in identifying themselves with fictional characters. Only 3 studies examined empathy in those with bulimia nervosa (BN) or binge eating disorder (BED). Conclusions: The lowered cognitive empathy and intact affective empathy profile found in AN is similar to that found in other psychiatric and neurodevelopmental conditions, such as autism spectrum disorder (ASD). These findings add to the literature characterizing the socio-emotional phenotype in EDs. Future research should examine the influence of comorbid psychopathology on empathy in EDs.
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Affiliation(s)
- Jess Kerr-Gaffney
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Amy Harrison
- Department of Psychology and Human Development, University College London, London, United Kingdom.,Psychological Medicine Clinical Academic Group, South London and Maudsley NHS Trust, National Eating Disorders Service, London, United Kingdom
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.,Psychological Medicine Clinical Academic Group, South London and Maudsley NHS Trust, National Eating Disorders Service, London, United Kingdom.,Department of Psychology, Ilia State University, Tbilisi, Georgia
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6
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Brugnera A, Lo Coco G, Salerno L, Sutton R, Gullo S, Compare A, Tasca GA. Patients with Binge Eating Disorder and Obesity have qualitatively different interpersonal characteristics: Results from an Interpersonal Circumplex study. Compr Psychiatry 2018; 85:36-41. [PMID: 29960139 DOI: 10.1016/j.comppsych.2018.06.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 06/14/2018] [Accepted: 06/19/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Patients with Binge Eating Disorder (BED) and obesity experience distressing relationships, which could trigger negative affect and over-eating. To date no studies compared the interpersonal profiles and prototypicality of both groups using the Interpersonal Circumplex. METHOD A sample of 177 patients with BED (mean age: 41.0 ± 12.5 years; 11.3% males), 321 obese non-BED adults (mean age: 44.5 ± 13.4 years; 28% males), and 108 normal weight adults (mean age: 37.3 ± 9.6 years; 52.77% males) completed the Inventory of Interpersonal Problems (IIP-32), and scales of binge eating and psychological distress at one time-point. RESULTS Compared to normal weight and obese participants, those with BED reported higher levels of interpersonal problems on all circumplex dimensions, except for Vindictive, with small to medium effects. All groups had highly prototypical profiles. Both obese and normal weight adults had very similar interpersonal profiles characterized by predominant friendly-dominant themes. On the contrary, those with BED had predominant friendly-submissive themes. Patients with BED reported significantly higher levels of psychological distress and binge eating severity, compared to the other two groups. Greater Domineering, Cold, Socially Inhibited and Non-Assertive scale scores, and lower Vindictive scale scores significantly predicted higher binge eating and psychological distress, regardless of group membership. DISCUSSION Findings lend support to an interpersonal model of binge eating and to the presence of qualitative differences between patients with obesity and BED. Finally, results suggest some strategies for the clinical management of BED focused on non-assertion and problems with experiences and expression of anger.
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Affiliation(s)
- Agostino Brugnera
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy.
| | - Gianluca Lo Coco
- Department of Psychology and Educational Sciences, University of Palermo, Palermo, Italy
| | - Laura Salerno
- Department of Psychology and Educational Sciences, University of Palermo, Palermo, Italy
| | - Rachel Sutton
- School of Psychology, University of Ottawa, Ottawa, Canada
| | - Salvatore Gullo
- Department of Psychology, University "N. Cusano", Rome, Italy
| | - Angelo Compare
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
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7
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Raykos BC, McEvoy PM, Fursland A. Socializing problems and low self-esteem enhance interpersonal models of eating disorders: Evidence from a clinical sample. Int J Eat Disord 2017. [PMID: 28649729 DOI: 10.1002/eat.22740] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The present study evaluated the relative clinical validity of two interpersonal models of the maintenance of eating disorders, IPT-ED (Rieger et al., ) and the interpersonal model of binge eating (Wilfley, MacKenzie, Welch, Ayres, & Weissman, ; Wilfley, Pike, & Striegel-Moore, ). While both models propose an indirect relationship between interpersonal problems and eating disorder symptoms via negative affect, IPT-ED specifies negative social evaluation as the key interpersonal problem, and places greater emphasis on the role of low self-esteem as an intermediate variable between negative social evaluation and eating pathology. METHOD Treatment-seeking individuals (N = 306) with a diagnosed eating disorder completed measures of socializing problems, generic interpersonal problems, self-esteem, eating disorder symptoms, and negative affect (depression and anxiety). Structural equation models were run for both models. RESULTS Consistent with IPT-ED, a significant indirect pathway was found from socializing problems to eating disorder symptoms via low self-esteem and anxiety symptoms. There was also a direct pathway from low self-esteem to eating disorder symptoms. Using a socializing problems factor in the model resulted in a significantly better fit than a generic interpersonal problems factor. Inconsistent with both interpersonal models, the direct pathway from socializing problems to eating disorder symptoms was not supported. DISCUSSION Interpersonal models that included self-esteem and focused on socializing problems (rather than generic interpersonal problems) explained more variance in eating disorder symptoms. Future experimental, prospective, and treatment studies are required to strengthen the case that these pathways are causal.
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Affiliation(s)
| | - Peter M McEvoy
- Centre for Clinical Interventions, Perth, Australia
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Anthea Fursland
- Centre for Clinical Interventions, Perth, Australia
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia
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8
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Grenon R, Schwartze D, Hammond N, Ivanova I, Mcquaid N, Proulx G, Tasca GA. Group psychotherapy for eating disorders: A meta-analysis. Int J Eat Disord 2017; 50:997-1013. [PMID: 28771758 DOI: 10.1002/eat.22744] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 05/26/2017] [Accepted: 06/05/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVE In the current meta-analysis, we review the effect of group psychotherapy compared to both wait-list controls and other active treatments for adults with eating disorders (EDs). METHOD Twenty-seven randomized controlled trials (RCTs) that provide direct comparisons with a total of 1,853 participants were included. RESULTS Group psychotherapy is significantly more effective than wait-list controls at achieving abstinence rates of binge eating and/or purging (RR = 5.51, 95% CI: 3.73, 8.12), decreasing the frequency of binge eating and/or purging (g = 0.70, 95% CI: 0.51, 0.90), and reducing related ED psychopathology (g = 0.49, 95% CI: 0.32, 0.66) after treatment. The effects of group psychotherapy and other active treatments (e.g., behavioral weight loss, self-help, individual psychotherapy) did not differ on any outcome at post-treatment or at follow-ups. Group cognitive behavioral therapy (CBT) and other forms of group psychotherapy did not differ significantly on outcomes at any time point. DISCUSSION Additional research is needed to evaluate other group psychotherapy approaches, along with CBT, to provide more evidence-based treatment options for individuals with an ED. Group psychotherapy appears as effective as other common treatments and is perhaps more cost-effective than the most popular treatment, individual psychotherapy. Only 8.33% of comparisons in the current meta-analysis had at least 80% power to detect a moderate effect (d = .50) and we recommend that future RCTs be adequately powered.
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Affiliation(s)
- Renee Grenon
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada, K1N 6N5
| | - Dominique Schwartze
- Institute of Psychosocial Medicine and Psychotherapy, University Hospital Jena, Jena, D-07743, Germany
| | - Nicole Hammond
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada, K1H 8L1
| | - Iryna Ivanova
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada, K1H 8L6
| | - Nancy Mcquaid
- Department of Psychology, The Ottawa Hospital, Ottawa, Ontario, Canada, K1H 8L6
| | - Genevieve Proulx
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada, K1H 8L6
| | - Giorgio A Tasca
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada, K1N 6N5.,Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada, K1H 8L6.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada, K1H 8L6
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9
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Wade S, Byrne S, Allen K. Enhanced cognitive behavioral therapy for eating disorders adapted for a group setting. Int J Eat Disord 2017; 50:863-872. [PMID: 28489288 DOI: 10.1002/eat.22723] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 03/21/2017] [Accepted: 04/15/2017] [Indexed: 01/17/2023]
Abstract
OBJECTIVE This randomized control trial is an evaluation of the effectiveness of enhanced cognitive behavioral treatment (CBT-E) for eating disorders adapted for a group setting. The study aimed to examine the effects of group CBT-E on eating disorder psychopathology and additional maintaining pathology. METHOD A transdiagnostic sample of individuals with eating disorders with a BMI ≥ 18 kg/m2 (N = 40) were randomized to an immediate-start or delayed-start condition so as to compare therapeutic effects of group CBT-E with a waitlist control. Global Eating Disorder Examination Questionnaire (EDE-Q) scores, BMI, and measures of Clinical Perfectionism, Self-Esteem, Interpersonal Difficulties, and Mood Intolerance were measured across the 8-week control period, throughout the group treatment and at 3-months post-treatment. RESULTS Over 70% of those who entered the trial completed treatment. The first eight weeks of group CBT-E were more effective at reducing Global EDE-Q scores than no treatment (waitlist control). By post-treatment, good outcome (a Global EDE-Q within 1 SD of Australian community norms plus BMI ≥ 18.5) was achieved by 67.9% of treatment completers and 66.7% of the total sample. Symptom abstinence within the previous month was reported by 14.3% of treatment completers and 10.3% of the total sample. Significant reductions in Clinical Perfectionism, Self-Esteem, Interpersonal Difficulties, and Mood Intolerance were also observed. DISCUSSION This study demonstrated that a group version of CBT-E can be effective at reducing eating disorder psychopathology in a transdiagnostic sample of individuals with eating disorders. Group CBT-E could provide a means of increasing availability of evidence-based treatment for eating disorders.
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Affiliation(s)
- Stephanie Wade
- School of Psychology, University of Western Australia, Perth, Australia
| | - Sue Byrne
- School of Psychology, University of Western Australia, Perth, Australia
| | - Karina Allen
- School of Psychology, University of Western Australia, Perth, Australia.,Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom.,The Eating Disorders Service, Maudsley Hospital, South London & Maudsley NHS Foundation Trust, London, United Kingdom
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10
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Grenon R, Tasca GA, Maxwell H, Balfour L, Proulx G, Bissada H. Parental bonds and body dissatisfaction in a clinical sample: The mediating roles of attachment anxiety and media internalization. Body Image 2016; 19:49-56. [PMID: 27614193 DOI: 10.1016/j.bodyim.2016.08.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 07/15/2016] [Accepted: 08/13/2016] [Indexed: 01/21/2023]
Abstract
We evaluated an attachment theory model in which mother and father care were hypothesized to be indirectly related to body dissatisfaction mediated by attachment anxiety and media internalization. Participants were 232 women diagnosed with an eating disorder who completed a retrospective measure of parental bonds, and measures of attachment anxiety, media internalization, and body image. Mother care was negatively associated with body dissatisfaction, suggesting that recollection of mothers as less caring was directly related to poorer body image. Lower father care, was indirectly associated with greater body dissatisfaction mediated by higher attachment anxiety and higher media internalization. That is, women with an eating disorder who recollected fathers as less caring had higher attachment anxiety, which was related to greater internalizing of media-related thin ideals, that in turn was associated with poorer body image. Mothers and fathers may impact body dissatisfaction by differing mechanisms in clinical samples.
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Affiliation(s)
- Renee Grenon
- School of Psychology, University of Ottawa, 75 Laurier Ave. E, Ottawa, ON K1N 6N5, Canada
| | - Giorgio A Tasca
- School of Psychology and Department of Psychiatry, University of Ottawa, 75 Laurier Ave. E, Ottawa, ON K1N 6N5, Canada.
| | - Hilary Maxwell
- School of Psychology, University of Ottawa, 75 Laurier Ave. E, Ottawa, ON K1N 6N5, Canada
| | - Louise Balfour
- Department of Psychology, The Ottawa Hospital, 501 Smyth Rd., Ottawa, ON K1G 0H9, Canada
| | - Genevieve Proulx
- Department of Psychiatry, The Ottawa Hospital, 501 Smyth Rd., Ottawa, ON K1G 0H9, Canada
| | - Hany Bissada
- Department of Psychiatry, The Ottawa Hospital, 501 Smyth Rd., Ottawa, ON K1G 0H9, Canada
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11
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Patel K, Tchanturia K, Harrison A. An Exploration of Social Functioning in Young People with Eating Disorders: A Qualitative Study. PLoS One 2016; 11:e0159910. [PMID: 27458808 PMCID: PMC4961427 DOI: 10.1371/journal.pone.0159910] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 07/11/2016] [Indexed: 11/19/2022] Open
Abstract
Previous research indicates adults with eating disorders (EDs) report smaller social networks, and difficulties with social functioning, alongside demonstrating difficulties recognising and regulating emotions in social contexts. Concurrently, those recovered from the illness have discussed the vital role offered by social support and interaction in their recovery. To date, little is known about the social skills and social networks of adolescents with EDs and this study aimed to conduct focus groups to explore the social functioning of 17 inpatients aged 12-17. Data were analysed using thematic analysis and six core themes were identified: group belonging, self-monitoring, social sensitivity, impact of hospitalisation, limited coping strategies and strategies for service provision. Key areas for service provision were: management of anxiety, development and/or maintenance of a social network and development of inter and intrapersonal skills. The most salient finding was that adolescents with EDs reported social difficulties which appeared to persist over and above those typically experienced at this point in the lifespan and therefore a key area for future focus is the development of appropriate coping strategies and solutions to deal with these reported difficulties.
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Affiliation(s)
- Krisna Patel
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Kate Tchanturia
- Department of Psychological Medicine, Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Amy Harrison
- Regent’s University London, Faculty of Humanities, Arts and Social Sciences, School of Psychotherapy and Psychology, London, United Kingdom
- Ellern Mede Service for Eating Disorders, London, United Kingdom
- * E-mail:
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12
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The Social Appearance Anxiety Scale in Italian Adolescent Populations: Construct Validation and Group Discrimination in Community and Clinical Eating Disorders Samples. Child Psychiatry Hum Dev 2016; 47:133-50. [PMID: 25976291 DOI: 10.1007/s10578-015-0551-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Anxiety in situations where one's overall appearance (including body shape) may be negatively evaluated is hypothesized to play a central role in Eating Disorders (EDs) and in their co-occurrence with Social Anxiety Disorder (SAD). Three studies were conducted among community (N = 1995) and clinical (N = 703) ED samples of 11- to 18-year-old Italian girls and boys to (a) evaluate the psychometric qualities and measurement equivalence/invariance (ME/I) of the Social Appearance Anxiety (SAA) Scale (SAAS) and (b) determine to what extent SAA or other situational domains of social anxiety related to EDs distinguish adolescents with an ED only from those with SAD. Results upheld the one-factor structure and ME/I of the SAAS across samples, gender, age categories, and diagnostic status (i.e., ED participants with and without comorbid SAD). The SAAS demonstrated high internal consistency and 3-week test-retest reliability. The strength of the inter-relationships between SAAS and measures of body image, teasing about appearance, ED symptoms, depression, social anxiety, avoidance, and distress, as well as the ability of SAAS to discriminate community adolescents with high and low levels of ED symptoms and community participants from ED participants provided construct validity evidence. Only SAA strongly differentiated adolescents with any ED from those with comorbid SAD (23.2 %). Latent mean comparisons across all study groups were performed and discussed.
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13
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Dakanalis A, Carrà G, Calogero R, Zanetti MA, Gaudio S, Caccialanza R, Riva G, Clerici M. Testing the cognitive-behavioural maintenance models across DSM-5 bulimic-type eating disorder diagnostic groups: a multi-centre study. Eur Arch Psychiatry Clin Neurosci 2015; 265:663-76. [PMID: 25416408 DOI: 10.1007/s00406-014-0560-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 11/07/2014] [Indexed: 12/23/2022]
Abstract
The original cognitive-behavioural (CB) model of bulimia nervosa, which provided the basis for the widely used CB therapy, proposed that specific dysfunctional cognitions and behaviours maintain the disorder. However, amongst treatment completers, only 40-50 % have a full and lasting response. The enhanced CB model (CB-E), upon which the enhanced version of the CB treatment was based, extended the original approach by including four additional maintenance factors. This study evaluated and compared both CB models in a large clinical treatment seeking sample (N = 679), applying both DSM-IV and DSM-5 criteria for bulimic-type eating disorders. Application of the DSM-5 criteria reduced the number of cases of DSM-IV bulimic-type eating disorders not otherwise specified to 29.6 %. Structural equation modelling analysis indicated that (a) although both models provided a good fit to the data, the CB-E model accounted for a greater proportion of variance in eating-disordered behaviours than the original one, (b) interpersonal problems, clinical perfectionism and low self-esteem were indirectly associated with dietary restraint through over-evaluation of shape and weight, (c) interpersonal problems and mood intolerance were directly linked to binge eating, whereas restraint only indirectly affected binge eating through mood intolerance, suggesting that factors other than restraint may play a more critical role in the maintenance of binge eating. In terms of strength of the associations, differences across DSM-5 bulimic-type eating disorder diagnostic groups were not observed. The results are discussed with reference to theory and research, including neurobiological findings and recent hypotheses.
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Affiliation(s)
- Antonios Dakanalis
- Department of Brain and Behavioral Sciences, University of Pavia, P.za Botta 11, 27100, Pavia, Italy.
| | - Giuseppe Carrà
- Division of Psychiatry, Faculty of Brain Sciences, University College of London, Gower Street, London, WC1E 6BT, UK
| | - Rachel Calogero
- School of Psychology, University of Kent, Canterbury, Kent, CT2 7NZ, UK
| | - Maria Assunta Zanetti
- Department of Brain and Behavioral Sciences, University of Pavia, P.za Botta 11, 27100, Pavia, Italy
| | - Santino Gaudio
- Centre for Integrated Research, Area of Diagnostic Imaging, University "Campus Bio-Medico di Roma", Via Pietro Tacchini 24, 00197, Rome, Italy
| | - Riccardo Caccialanza
- Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Giuseppe Riva
- Department of Psychology, Catholic University, Largo Gemelli 1, 20123, Milan, Italy.,Applied Technology for Neuro-Psychology Laboratory, Istituto Auxologico Italiano, IRCCS, Via Ariosto 13, 20145, Milan, Italy
| | - Massimo Clerici
- Department of Neurosciences and Biomedical Technologies, University of Milano-Bicocca, Medical School, Via Cadore, 48, 20052, Monza, Italy
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Ivanova IV, Tasca GA, Proulx G, Bissada H. Does the interpersonal model apply across eating disorder diagnostic groups? A structural equation modeling approach. Compr Psychiatry 2015; 63:80-7. [PMID: 26555495 DOI: 10.1016/j.comppsych.2015.08.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 08/21/2015] [Accepted: 08/26/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Interpersonal model has been validated with binge-eating disorder (BED), but it is not yet known if the model applies across a range of eating disorders (ED). PURPOSE The goal of this study was to investigate the validity of the interpersonal model in anorexia nervosa (restricting type; ANR and binge-eating/purge type; ANBP), bulimia nervosa (BN), BED, and eating disorder not otherwise specified (EDNOS). PROCEDURE Data from a cross-sectional sample of 1459 treatment-seeking women diagnosed with ANR, ANBP, BN, BED and EDNOS were examined for indirect effects of interpersonal problems on ED psychopathology mediated through negative affect. RESULTS Findings from structural equation modeling demonstrated the mediating role of negative affect in four of the five diagnostic groups. There were significant, medium to large (.239, .558), indirect effects in the ANR, BN, BED and EDNOS groups but not in the ANBP group. The results of the first reverse model of interpersonal problems as a mediator between negative affect and ED psychopathology were nonsignificant, suggesting the specificity of these hypothesized paths. However, in the second reverse model ED psychopathology was related to interpersonal problems indirectly through negative affect. CONCLUSION This is the first study to find support for the interpersonal model of ED in a clinical sample of women with diverse ED diagnoses, though there may be a reciprocal relationship between ED psychopathology and relationship problems through negative affect. Negative affect partially explains the relationship between interpersonal problems and ED psychopathology in women diagnosed with ANR, BN, BED and EDNOS. Interpersonal psychotherapies for ED may be addressing the underlying interpersonal-affective difficulties, thereby reducing ED psychopathology.
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Affiliation(s)
- Iryna V Ivanova
- Ottawa Hospital Research Institute, Canada; The Ottawa Hospital, Canada.
| | | | | | - Hany Bissada
- The Ottawa Hospital, Canada; University of Ottawa, Canada
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15
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Tasca GA, Balfour L. Eating disorders and attachment: a contemporary psychodynamic perspective. Psychodyn Psychiatry 2014; 42:257-276. [PMID: 24828595 DOI: 10.1521/pdps.2014.42.2.257] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A contemporary psychodynamic framework can add much to our understanding of eating disorders. Eating disorders are associated with complex comorbidities, high levels of mortality, and therapist countertransferences that can complicate psychological treatments. Mainstream models currently focus on cognitive, biological, or cultural factors to the near exclusion of attachment functioning, and the individual's dynamics. As such, standard models appear to exclude person-centred and developmental considerations when providing treatments. In this article, we describe a contemporary psychodynamic model that understands eating disorder symptoms as a consequence of vulnerability to social pressures to be thin and biological predispositions to body weight. Individual vulnerabilities are rooted in unmet attachment needs causing negative affect, and subsequent maladaptive defenses and eating disorder symptoms as a means of coping. We describe how this model can inform transdiagnostic eating disorder treatment that focuses on symptoms as well as specific attachment functions including: interpersonal style, affect regulation, reflective functioning, and coherence of mind. Two clinical examples are presented to illustrate case formulations and psychological treatments informed by these conceptualizations.
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Dakanalis A, Timko CA, Zanetti MA, Rinaldi L, Prunas A, Carrà G, Riva G, Clerici M. Attachment insecurities, maladaptive perfectionism, and eating disorder symptoms: a latent mediated and moderated structural equation modeling analysis across diagnostic groups. Psychiatry Res 2014; 215:176-84. [PMID: 24295762 DOI: 10.1016/j.psychres.2013.10.039] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Revised: 07/24/2013] [Accepted: 10/31/2013] [Indexed: 12/01/2022]
Abstract
Although 96-100% of individuals with eating disorders (EDs) report insecure attachment, the specific mechanisms by which adult insecure attachment dimensions affect ED symptomatology remain to date largely unknown. This study examined maladaptive perfectionism as both a mediator and a moderator of the relationship between insecure attachment (anxiety and avoidance) and ED symptomatology in a clinical, treatment seeking, sample. Insecure anxious and avoidant attachment, maladaptive perfectionism, and ED symptomatology were assessed in 403 participants from three medium size specialized care centres for EDs in Italy. Structural equation modeling indicated that maladaptive perfectionism served as mediator between both insecure attachment patterns and ED symptomatology. It also interacted with insecure attachment to predict higher levels of ED symptoms - highlighting the importance of both insecure attachment patterns and maladaptive aspects of perfectionism as treatment targets. Multiple-group comparison analysis did not reveal differences across diagnostic groups (AN, BN, EDNOS) in mediating, main and interaction effects of perfectionism. These findings are consistent with recent discussions on the classification and treatment of EDs that have highlighted similarities between ED diagnostic groups and could be viewed through the lens of the Trans-theoretical Model of EDs. Implications for future research and intervention are discussed.
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Affiliation(s)
- Antonios Dakanalis
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Department of Psychiatry, S. Gerardo Hospital, Monza, Italy; Clinical and Health Psychology Unit, San Raffaele Hospital, Milan, Italy.
| | - C Alix Timko
- Behavioral and Social Sciences Department, University of the Sciences, Philadelphia, PA, USA
| | - M Assunta Zanetti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Lucio Rinaldi
- Catholic University, Rome, Italy; Department of Psychiatry, A. Gemelli, University General Hospital, Rome, Italy
| | - Antonio Prunas
- Department of Psychology, University of Milano-Bicocca, Milan, Italy; Personality Disorder Lab, Milan, Italy
| | - Giuseppe Carrà
- Mental Health Sciences Unit, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Giuseppe Riva
- Faculty of Psychology, Catholic University, Milan, Italy; Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Milan, Italy
| | - Massimo Clerici
- Department of Psychiatry, S. Gerardo Hospital, Monza, Italy; Department of Neurosciences and Biomedical Technologies, University of Milano-Bicocca, Milan, Italy
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17
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Dakanalis A, Timko CA, Clerici M, Zanetti MA, Riva G. Comprehensive examination of the trans-diagnostic cognitive behavioral model of eating disorders in males. Eat Behav 2014; 15:63-7. [PMID: 24411752 DOI: 10.1016/j.eatbeh.2013.10.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 08/19/2013] [Accepted: 10/09/2013] [Indexed: 11/28/2022]
Abstract
The Trans-diagnostic Model (TM) of eating pathology describes how one or more of four hypothesized mechanisms (i.e., mood intolerance, core low self-esteem, clinical perfectionism and interpersonal difficulties) may interrelate with each other and with the core psychopathology of eating disorders (i.e., over-evaluation of weight and shape) to maintain the disordered behaviors. Although a cognitive behavioral treatment based on the TM has shown to be effective in treating eating disorders, the model itself has undergone only limited testing. This is the first study to both elaborate and test the validity of the TM in a large sample (N=605) of undergraduate men. Body mass index was controlled within structural equation modeling analyses. Although not all expected associations for the maintenance variables were significant, overall the validity of the model was supported. Concern about shape and weight directly led to exercise behaviors. There was a direct path from binge eating to exercise and other forms of compensatory behaviors (i.e., purging); but no significant path from restriction to binge eating. Of the maintaining factors, mood intolerance was the only maintaining variable directly linked to men's eating disorder symptoms. The other three maintaining factors of the TM indirectly impacted restriction through concerns about shape and weight, whereas only interpersonal difficulties predicted low self-esteem and binge eating. Potential implications for understanding and targeting eating disturbances in men are discussed.
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Affiliation(s)
- Antonios Dakanalis
- Department of Brain and Behavioural Sciences, University of Pavia, Italy.
| | - C Alix Timko
- Behavioral and Social Sciences Department, University of the Sciences, Philadelphia, PA, USA
| | - Massimo Clerici
- Department of Neurosciences and Biomedical Technologies, University of Milano-Bicocca, Italy
| | - M Assunta Zanetti
- Department of Brain and Behavioural Sciences, University of Pavia, Italy
| | - Giuseppe Riva
- Faculty of Psychology Catholic University of Milan, Italy; Applied Technology for Neuro-Psychology Laboratory, Istituto Auxologico Italiano, Milan, Italy
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18
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Holland LA, Bodell LP, Keel PK. Psychological factors predict eating disorder onset and maintenance at 10-year follow-up. EUROPEAN EATING DISORDERS REVIEW 2013; 21:405-10. [PMID: 23847146 DOI: 10.1002/erv.2241] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 05/22/2013] [Accepted: 05/27/2013] [Indexed: 12/18/2022]
Abstract
The present study sought to identify psychological factors that predict onset and maintenance of eating disorders. Secondary analyses were conducted using data from an epidemiological study of health and eating behaviours in men and women (N = 1320; 72% female) to examine the prospective and independent influence of the Eating Disorder Inventory Perfectionism, Interpersonal Distrust, and Maturity Fears subscales in predicting the onset and maintenance of eating disorders at 10-year follow-up. Multivariate models indicated higher Perfectionism (p = .025), lower Interpersonal Distrust (p < .001), and higher Maturity Fears (p = .037) predicted increased risk for eating disorder onset at 10-year follow-up, but only Perfectionism (p = .004) predicted eating disorder maintenance. Differential prediction of eating disorder onset versus maintenance highlights potentially different psychological foci for prevention versus treatment efforts.
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Affiliation(s)
- Lauren A Holland
- Department of Psychology, Florida State University, Tallahassee, USA
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19
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Obeid N, Henderson KA, Tasca GA, Lyons JS, Norris ML, Spettigue W. Growth trajectories of maintenance variables related to refractory eating disorders in youth. Psychother Res 2013; 23:265-76. [DOI: 10.1080/10503307.2013.775529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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20
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Tasca GA, Ritchie K, Demidenko N, Balfour L, Krysanski V, Weekes K, Barber A, Keating L, Bissada H. Matching women with binge eating disorder to group treatment based on attachment anxiety: Outcomes and moderating effects. Psychother Res 2013; 23:301-14. [DOI: 10.1080/10503307.2012.717309] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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21
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Lampard AM, Tasca GA, Balfour L, Bissada H. An Evaluation of the Transdiagnostic Cognitive-behavioural Model of Eating Disorders. EUROPEAN EATING DISORDERS REVIEW 2012. [DOI: 10.1002/erv.2214] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | | | - Louise Balfour
- Department of Psychology; The Ottawa Hospital and University of Ottawa; Ottawa; Canada
| | - Hany Bissada
- Department of Psychiatry; The Ottawa Hospital and University of Ottawa; Ottawa; Canada
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22
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Adding thin-ideal internalization and impulsiveness to the cognitive-behavioral model of bulimic symptoms. Eat Behav 2012; 13:219-25. [PMID: 22664400 DOI: 10.1016/j.eatbeh.2012.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 02/06/2012] [Accepted: 02/21/2012] [Indexed: 11/23/2022]
Abstract
This study evaluated the cognitive-behavioral (CB) model of bulimia nervosa and an extension that included two additional maintaining factors - thin-ideal internalization and impulsiveness - in 327 undergraduate women. Participants completed measures of demographics, self-esteem, concern about shape and weight, dieting, bulimic symptoms, thin-ideal internalization, and impulsiveness. Both the original CB model and the extended model provided good fits to the data. Although structural equation modeling analyses suggested that the original CB model was most parsimonious, hierarchical regression analyses indicated that the additional variables accounted for significantly more variance. Additional analyses showed that the model fit could be improved by adding a path from concern about shape and weight, and deleting the path from dieting, to bulimic symptoms. Expanding upon the factors considered in the model may better capture the scope of variables maintaining bulimic symptoms in young women with a range of severity of bulimic symptoms.
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23
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Treasure J, Corfield F, Cardi V. A three-phase model of the social emotional functioning in eating disorders. EUROPEAN EATING DISORDERS REVIEW 2012; 20:431-8. [PMID: 22539368 DOI: 10.1002/erv.2181] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Problems with social emotional functioning are an important part of eating disorder psychopathology. AIM This study aimed to propose a model of social emotional functioning before and during the illness and to explain the consequences for those involved. METHOD We propose a three-phase model of social and emotional processes as both causal and maintaining factors in anorexia nervosa. The predictions from this model are examined, and we consider the relevance for treatment. RESULTS The evidence base for the theoretical model is presented: Phase 1 describes causal predispositions and environments, Phase 2 notes the way in which the symptoms themselves impact on brain function and social cognition and Phase 3 explains the reactions of close others. CONCLUSIONS A three-phase model including interpersonal and socio-emotional elements can be used to shape and plan treatment interventions. Understanding causal chains and consequences can give a rationale for change and frame therapeutic interventions.
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Affiliation(s)
- Janet Treasure
- Eating Disorders Unit, Institute of Psychiatry, London, UK.
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Allen KL, Byrne SM, McLean NJ. The dual-pathway and cognitive-behavioural models of binge eating: prospective evaluation and comparison. Eur Child Adolesc Psychiatry 2012; 21:51-62. [PMID: 22120762 DOI: 10.1007/s00787-011-0231-z] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 11/11/2011] [Indexed: 11/29/2022]
Abstract
To evaluate and compare the dual-pathway, original cognitive-behavioural, and enhanced "transdiagnostic" cognitive-behavioural models of binge eating, using prospective data from a pre-adolescent sample. Models were tested using multilevel longitudinal structural equation modelling. Participants were 236 children (48% male) aged between 8 and 13 years at baseline, who were interviewed annually over a 2-year period. Binge eating was assessed using the Child Eating Disorder Examination. The dual-pathway and enhanced cognitive-behavioural models provided an acceptable fit to the data, whereas the original cognitive-behavioural model did not. Partial support is provided for the prospective validity of the dual-pathway and enhanced cognitive-behavioural models of binge eating in childhood. Results suggest that body dissatisfaction and weight and shape over-evaluation may both contribute to dieting behaviour in youth, and that dieting and affect-related difficulties both require consideration in theories of binge eating development.
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Affiliation(s)
- Karina L Allen
- School of Psychology, The University of Western Australia, Crawley, WA, Australia.
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