Bulimic symptoms and the social withdrawal syndrome

A test of the social withdrawal syndrome hypothesis of bulimia nervosa

BACKGROUND

The study examined the social withdrawal syndrome (SWS) hypothesis of bulimia nervosa (BN). According to the hypothesis, eating disorders such as BN are associated with a coherent set of social withdrawal cognitions, affect, and behavior.

PARTICIPANTS AND PROCEDURE

Eight-eight young female adults completed a standardized measure of bulimic symptoms and measures of social withdrawal (affective withdrawal, trust beliefs in close others, and disclosure). Participants were engaged in a laboratory-based peer interaction which yielded the SWS measure of perceived lack of social connectiveness.

RESULTS

Bulimic symptoms were associated with each measure of social withdrawal. Structural equation modeling analysis confirmed that those measures contributed to a coherent latent factor which was associated with bulimic symptoms.

CONCLUSIONS

The findings supported the social withdrawal syndrome hypothesis of BN and have implications for the detection and treatment of eating disorders.

Prospective associations between loneliness and disordered eating from early adolescence to adulthood

OBJECTIVE

Despite findings from numerous cross-sectional studies suggesting a substantial association between loneliness and different types of disordered eating, much remains unknown about the impact of confounding, the order of cause and effect, and gender differences in the relationship. Thus, this study followed a large, population-based, mixed-gender sample through adolescence and young adulthood, applying a random intercept cross-lagged panel model (RI-CLPM) approach to examine the bidirectional prospective associations between loneliness and disordered eating while ruling out the effect of unmeasured time-invariant confounders.

METHOD

A Norwegian sample of N = 2933 adolescents (54.2% female) was examined across four time points (T1, M_age  = 15.44, grades 7-12; T2, M_age  = 16.93; T3, M_age  = 21.84; and T4, M_age  = 28.33) from 1992 to 2005 using RI-CLPMs for overall disordered eating and specific forms for disordered eating (dieting and bulimic symptoms). Multigroup structural equation models were used to assess gender differences.

RESULTS

For male participants, high levels of loneliness at T1 predicted more overall disordered eating and more dieting at T2. Meanwhile, among female participants, disordered eating and bulimic symptoms at T2 predicted more loneliness at T3, whereas loneliness at T3 predicted more disordered eating and bulimic symptoms at T4, and vice versa.

DISCUSSION

The findings suggest a pattern of bidirectional associations between loneliness and disordered eating that varies by time points, gender, and type of eating problem. Preventive interventions and treatment should consider social factors involved in the onset and maintenance of eating problems in male adolescents and young adult women.

PUBLIC SIGNIFICANCE

This study contributes to the existing knowledge by examining for the first time the dynamic nature of the association between loneliness and disordered eating while accounting for all time-invariant confounding. Our findings reveal a pattern of bidirectional associations between loneliness and disordered eating that appears to vary by developmental period, gender, and type of eating problem. Our findings suggest that social factors have to be taken into account when designing prevention strategies aimed at disordered eating.

Specific Learning Disorders and Eating Disorders: an Italian retrospective study

BACKGROUND

Although Anorexia Nervosa (AN) patients show dysfunctional behaviour in information processing, visual and verbal memory performance, and different cognitive fields, regardless of their BMI, the literature on the correlations between Eating Disorders (ED) and Neurodevelopmental Disorders (NDD) does not provide conclusive data. Rather than a consequence of the mental disorder, cognitive dysfunctions may be a risk factor for AN.

METHODS

Our retrospective study investigates the prevalence of Specific Learning Disorder (SLD) among patients with ED. We considered 262 patients being treated at the Emilia Romagna Feeding and Eating Disorders Outpatient Service in Bologna, Italy. We compared the results with the Italian reference values, according to the most recent data provided by the Italian Ministry of Education.

RESULTS

We found that 25 patients out of 262 (9.54%) presented a comorbid diagnosis of SLD. This SLD prevalence is higher than the Italian reference values (4.9% in the school year 2018/19, p < 0.001). Comorbidity with SLD was significantly more frequent in males. A diagnosis of SLD was not associated with a higher frequency of any specific ED diagnosis or with psychiatric comorbidity in general. Positive family history for SLD was not significantly associated with either a positive family history for ED or a diagnosis of SLD.

CONCLUSIONS

This is the first Italian study to investigate the prevalence of SLD in ED patients during childhood and adolescence. Our data support previous research documenting that neuropsychological deficit could lead to the development of ED.

Depressive Symptoms and Trust of Healthcare Provider in Rural Adolescents: Relationships and Predictors

The purpose of this study was to evaluate associations among depressive symptoms, trust of healthcare provider, and health behavior in adolescents who live in a rural area. Two hundred twenty-four adolescents aged 14-19 years old attending public high school in the Midwestern United States were surveyed. Results showed a diagnosis of depression, trust of healthcare provider, health awareness, and stress management predicted depressive symptoms in adolescents living in a rural area. Healthcare providers should take extra care to promote trust in the healthcare provider-patient relationship with adolescents and to follow guidelines for annual screening of adolescents for depressive symptoms. Nursing implications include adolescent psychoeducation to improve health awareness and stress management.

Associations between Trust of Healthcare Provider and Body Mass Index in Adolescents

Adolescent obesity continues to be a serious concern around the world, placing young people at risk for chronic conditions and early death. Research has shown that social relationships are important in making health behavior changes, such as following health-care recommendations for eating and physical activity. Specifically, the trust of health-care providers has been shown to be important in making health behavior change. Evidence suggests that obese young adults are less trusting of health-care providers than their healthy weight peers, but it is not known if this also applies to obese adolescents. The purpose of this secondary analysis study was to determine relationships between the trust of health-care providers and body mass index percentile in adolescents. Participants were 224 adolescents aged 14-19 years attending a public high school in the Midwestern United States. The Wake Forest Physician Trust scale measured the trust of health-care providers. Height and weight were collected at a school screening; body mass index percentile categories were determined according to age- and sex-adjusted body mass index percentiles. One-way analysis of variance and post hoc Tukey tests showed trust scores varied significantly between body mass index percentile categories of girls. Results suggest it may be necessary for health-care providers to make additional efforts to build trust with obese adolescent girls than with other groups of adolescents.

A theoretical review of interpersonal emotion regulation in eating disorders: enhancing knowledge by bridging interpersonal and affective dysfunction

Individuals with eating disorders (EDs) frequently report interpersonal and affective dysfunction. A useful lens for uniting these ideas is through the framework of interpersonal emotion regulation (IER), which consists of the ways others assist a distressed individual and how this shapes his or her subsequent emotional, behavioral, and cognitive responses. In this theoretical review, we provide an overview of the rationale for exploring IER and review IER processes in this population using the framework of the Process Model of Emotion Regulation. Finally, we offer suggestions for next steps in conducting research. IER offers a parsimonious way to explore social and emotional constructs related to ED pathology and may provide potential targets for prevention and intervention in these difficult-to-treat disorders.

Reciprocal Prospective Relationships Between Loneliness and Weight Status in Late Childhood and Early Adolescence

Adolescents who do not conform to weight ideals are vulnerable to disapproval and victimization from peers in school. But, missing from the literature is a prospective examination of weight status and feelings of loneliness that might come from those experiences. Using data from the Québec Longitudinal Study of Child Development, we filled that gap by examining the prospective associations between loneliness and weight status when the sample was aged 10-13 years. At ages 10, 12, and 13 years, 1042 youth (572 females; 92% from French speaking homes) reported on their loneliness and were weighed and measured. Family income sufficiency was included in our analyses given its relationship with weight status, but also its possible link with loneliness during early adolescence. The findings showed that (1) weight status and loneliness were not associated concurrently; (2) weight status predicted increases in loneliness from ages 12 to 13 years; and (3) loneliness predicted increases in weight from ages 12 to 13 years among female adolescents, but weight loss among male adolescents. The fact that loneliness was involved in weight gain for females suggests that interventions focused on reducing loneliness and increasing connection with peers during early adolescence could help in reducing obesity.

The relation between anorexic symptoms in women and their reports of trustworthiness in interactions with close persons

The study examined the relation between women's anorexic symptoms and their reports of trustworthiness in interactions with close persons. Ninety-eight females (mean age=24years-10months) completed the anorexic symptom subscale of the SEDS and reported (ascribed) the extent to which they showed reliability, emotional, and honesty trustworthiness behaviors in interactions with their mother, father, and close friend. Negative linear relations were found between anorexic symptoms and ascribed: (a) trustworthiness with close friends; (b) reliability trustworthiness; and (c) at a trend level, honesty trustworthiness. These were qualified by curvilinear relations and by elevated anorexic vs normative group comparisons. It was found that women with elevated anorexic symptoms ascribed lower trustworthiness than did women with the normal range of anorexic symptoms. The findings were interpreted as supporting the conclusion that women with elevated levels of anorexic symptoms are inclined to believe that they are deceptive in their interactions with close persons, primarily friends.

Obesity and the Social Withdrawal Syndrome

The relation between obesity and Social Withdrawal Syndrome (SWS) was examined using the data gathered by Rotenberg, Bharathi, Davies, and Finch (2013). One hundred and 35 undergraduates (80 females; Mage=21years-10months) completed standardized scales that assessed the SWS (low emotional trust beliefs in close others, low disclosure to close others, and high loneliness). BMI was calculated from self-reported weight and height. As hypothesized, quadratic relations were found in which participants with BMI>30 (i.e., obese) demonstrated the SWS pattern of low emotional trust beliefs in close others, low disclosure to close others, and high loneliness. As further evidence, lower emotional trust in close others, lower disclosure to close others, and greater loneliness were found for obese participants (>30 BMI, n=27) than both normal weight (<25 BMI, n=67) and overweight participants (25 to 30 BMI, n=41). The findings confirmed the hypothesis that obesity was associated with the SWS. The findings suggested that the lack of trust in others by obese individuals contributes to their unwillingness to seek out help for health and psychosocial problems.

Two distinct mediated pathways to disordered eating in response to weight stigmatization and their application to prevention programs

OBJECTIVE

Disordered eating behaviors among undergraduate women are common and, thus, are an important public health concern. Weight stigmatization, stress, and social withdrawal are often associated with disordered eating behaviors; however, it is unclear whether stress and social withdrawal act as mediators between weight stigmatization and disordered eating. By testing specific pathways to disordered eating, theory-driven prevention programs can be implemented.

METHODS

Self-reported surveys were administered to 217 undergraduate women during the Fall 2014 semester.

RESULTS

There were 2 distinct mediational pathways in response to weight stigmatization. Stress partially mediated the path between weight stigmatization and emotional eating (38%), whereas social withdrawal partially mediated the path between weight stigmatization and dietary restraint (44%).

CONCLUSIONS

Stress and social withdrawal mediate the relationship between weight stigmatization and disordered eating. The results of this study identified potentially critical risk factors that, if addressed, may improve outcomes of campus-based disordered eating programs for women.

The relation between Bulimic symptoms and the social withdrawal syndrome during early adolescence

OBJECTIVE

The short-term longitudinal study tested the hypothesis that there was a prospective relation between the social withdrawal syndrome and Bulimic symptoms during early adolescence.

METHOD

Ninety-six adolescents (47 males, mean age=13 years - 10 months) completed standardized scales assessing Bulimic symptoms, trust beliefs in others and loneliness at Time 1/T1 and again 5 months later at Time 2/T2.

RESULTS

Analyses showed that: (1) Bulimic symptoms were negatively correlated with trust beliefs, (2) Bulimic symptoms were positively correlated with loneliness, and (3) trust beliefs were negatively correlated with loneliness. The SEM and mediation analyses showed that trust beliefs at T1 were negatively and concurrently associated with Bulimic symptoms at T1 and longitudinally (and negatively) predicted changes in Bulimic symptoms. It was found that loneliness at T1 statistically mediated those concurrent and longitudinal relations.

CONCLUSION

The findings yielded support for the conclusion that the social withdrawal syndrome, as assessed by low trust beliefs and resulting experiences of loneliness, contributes to Bulimia nervosa during early adolescence.