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Horvath SA, Keel PK, Forney KJ. Examining negative urgency as a predictor of eating disorder maintenance in purging syndromes. J Clin Psychol 2024. [PMID: 38554059 DOI: 10.1002/jclp.23683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 12/21/2023] [Accepted: 03/20/2024] [Indexed: 04/01/2024]
Abstract
OBJECTIVES Negative urgency is associated with short-term maintenance of binge eating and purging in unselected samples. The current study used an eating disorder sample to test the hypothesis that negative urgency maintains bulimia nervosa (BN) and purging disorder (PD) at long-term follow-up. It was also hypothesized that baseline differences in negative urgency between BN and PD would remain at follow-up. METHODS Secondary analyses were conducted on a sample of women who engaged in recurrent self-induced vomiting (n = 68; 52.9% BN; 47.1% PD). Women completed diagnostic interviews and questionnaires at baseline and at a mean (SD) of 5.95 (1.58) years follow-up (range = 2.51-9.62; retention rate = 75%). RESULTS Negative urgency did not predict eating disorder diagnostic status, recovery status, or global eating pathology at follow-up (p's = .06-.83). There were no significant differences in negative urgency across women with BN and PD at follow-up (p = .16). However, post hoc analyses indicated that negative urgency was not stable across time (ICC = .102). Increases in negative urgency from baseline to follow-up were associated with greater global eating pathology at follow-up (p = .002). CONCLUSION Results suggest negative urgency does not predict long-term eating disorder maintenance. Negative urgency may not be a stable personality trait but rather an indicator of overall poor emotion regulation. Future research should confirm that changes in negative urgency predict chronic eating pathology over long durations of follow-up in women who have increasing negative urgency across time.
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Affiliation(s)
- Sarah A Horvath
- Department of Psychology, Ohio University, Athens, Ohio, USA
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Pamela K Keel
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - K Jean Forney
- Department of Psychology, Ohio University, Athens, Ohio, USA
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2
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Davis HA, Smith ZR, Smith GT. Longitudinal transactions between negative urgency and fasting predict binge eating. Appetite 2024; 192:107113. [PMID: 37924849 DOI: 10.1016/j.appet.2023.107113] [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: 06/19/2023] [Revised: 09/11/2023] [Accepted: 11/01/2023] [Indexed: 11/06/2023]
Abstract
Fasting and negative urgency (the disposition to act rashly when distressed) are risk factors for binge eating. It may be that each influences the other over time to predict binge eating. OBJECTIVE This study tested whether (1) fasting predicts binge eating through negative urgency, and (2) negative urgency predicts binge eating through fasting. METHOD Path analysis and mediation tests were used to investigate objectives in n = 302 college women assessed three times over eight months. We controlled for each variable at the previous time point, and concurrent negative affect and body mass index at each time point. RESULTS Time 1 (T1) fasting predicted elevated negative urgency three months later at Time 2 (T2) and T2 negative urgency predicted increases in binge eating five months later at Time 3 (T3). T2 negative urgency mediated the relationship between T1 fasting and T3 binge eating. T1 negative urgency predicted increases in T2 fasting, which then predicted increases in T3 binge eating. T2 fasting mediated the relationship between T1 negative urgency and T3 binge eating. DISCUSSION Findings suggest fasting and negative urgency transact to predict binge eating among college women. Interventions targeting negative urgency may prevent or reduce both fasting and binge eating.
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Affiliation(s)
- Heather A Davis
- Department of Psychology, Virginia Polytechnic Institute and State University, USA.
| | - Zoe R Smith
- Department of Psychology, Loyola University Chicago, USA
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3
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Keel PK, Eckel LA, Hildebrandt BA, Haedt-Matt AA, Murry DJ, Appelbaum J, Jimerson DC. Disentangling the links between gastric emptying and binge eating v. purging in eating disorders using a case-control design. Psychol Med 2023; 53:1947-1954. [PMID: 37310328 PMCID: PMC10106287 DOI: 10.1017/s0033291721003640] [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: 05/24/2021] [Revised: 08/11/2021] [Accepted: 08/18/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Prior work supports delayed gastric emptying in anorexia nervosa and bulimia nervosa (BN) but not binge-eating disorder, suggesting that neither low body weight nor binge eating fully accounts for slowed gastric motility. Specifying a link between delayed gastric emptying and self-induced vomiting could offer new insights into the pathophysiology of purging disorder (PD). METHODS Women (N = 95) recruited from the community meeting criteria for DSM-5 BN who purged (n = 26), BN with nonpurging compensatory behaviors (n = 18), PD (n = 25), or healthy control women (n = 26) completed assessments of gastric emptying, gut peptides, and subjective responses over the course of a standardized test meal under two conditions administered in a double-blind, crossover sequence: placebo and 10 mg of metoclopramide. RESULTS Delayed gastric emptying was associated with purging with no main or moderating effects of binge eating in the placebo condition. Medication eliminated group differences in gastric emptying but did not alter group differences in reported gastrointestinal distress. Exploratory analyses revealed that medication caused increased postprandial PYY release, which predicted elevated gastrointestinal distress. CONCLUSIONS Delayed gastric emptying demonstrates a specific association with purging behaviors. However, correcting disruptions in gastric emptying may exacerbate disruptions in gut peptide responses specifically linked to the presence of purging after normal amounts of food.
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Affiliation(s)
- Pamela K. Keel
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Lisa A. Eckel
- Department of Psychology and Neuroscience Program, Florida State University, Tallahassee, FL, USA
| | - Britny A. Hildebrandt
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Daryl J. Murry
- College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - David C. Jimerson
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
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4
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Gilmartin T, Gurvich C, Dipnall JF, Sharp G. One size does not fit all: Exploring how the five-factor model facets predict disordered eating behaviours among adolescent and young adult males and females. Br J Psychol 2023; 114:132-158. [PMID: 36183174 PMCID: PMC10092835 DOI: 10.1111/bjop.12601] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 09/14/2022] [Indexed: 01/11/2023]
Abstract
There is a wealth of research that has highlighted the relationship between personality and eating disorders. It has been suggested that understanding how subclinical disordered eating behaviours are uniquely associated with personality can help to improve the conceptualization of individuals with eating disorders. This study aimed to explore how the facets of the Five-Factor Model (FFM) predicted restrictive eating, binge eating, purging, chewing and spitting, excessive exercising and muscle building among males and females. An online survey assessing disordered eating behaviours, FFM and general psychopathology was completed by 394 females and 167 males aged between 16 and 30 years. Simultaneous equations path models were systematically generated for each disordered eating behaviour to identify how the FFM facets, body dissatisfaction and age predicted behaviour. The results indicated that each of the six disordered behaviours were predicted by a unique pattern of thinking, feeling and behaving. Considerable differences between males and females were found for each path model, suggesting differences between males and females in the personality traits that drive disordered eating behaviours. It was concluded that it is important to take personality into account when treating males and females who engage in disordered eating behaviours.
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Affiliation(s)
- Tanya Gilmartin
- Monash Alfred Psychiatry Research Centre, Monash University and The Alfred Hospital, Melbourne, Victoria, Australia
| | - Caroline Gurvich
- Monash Alfred Psychiatry Research Centre, Monash University and The Alfred Hospital, Melbourne, Victoria, Australia
| | - Joanna F Dipnall
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Gemma Sharp
- Monash Alfred Psychiatry Research Centre, Monash University and The Alfred Hospital, Melbourne, Victoria, Australia
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Ertl MM, Pazienza R, Cannon M, Cabrera Tineo YA, Fresquez CL, McDonough AK, Bozek DM, Ozmat EE, Ladouceur GM, Planz EK, Martin JL. Associations between Impulsivity and Exercise Addiction, Disordered Eating, and Alcohol Use Behaviors: A Latent Profile Analysis. Subst Use Misuse 2022; 57:886-896. [PMID: 35321617 PMCID: PMC9019863 DOI: 10.1080/10826084.2022.2052095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BackgroundDespite the known negative consequences of exercise addiction and preliminary evidence suggesting that it may co-occur with other health risk behaviors, no studies to date have examined exercise addiction among college students in conjunction with disordered eating behaviors and alcohol use. The aim of this study was to describe which college students are most at-risk for co-occurring health risk behaviors to enhance the efficiency of health risk prevention efforts. Method: Guided by multidimensional theories of impulsivity and substance use models of comorbidity, this study used latent profile analysis to examine whether separate, conceptually meaningful profiles of risk for exercise addiction, disordered eating behaviors, and alcohol use would emerge among 503 college students from a large public university. Results: The best-fitting model supported three profiles. MANOVA results revealed significant profile differences based on exercise addiction, binge eating, purging, laxative/pill/diuretic use, exercising longer than 60 minutes, negative urgency, and problematic alcohol use. Profile 3 students (n = 29), labeled the Affect Driven Health Risk-Takers, demonstrated the highest levels of impulsivity (i.e., negative urgency, lack of premeditation, lack of perseverance, and sensation seeking) and the most risk behaviors compared to the other two profiles. Profile membership was associated with distinct levels of negative urgency, exercise addiction, disordered eating behaviors, and problematic alcohol use. A small proportion of undergraduates demonstrated co-occurring exercise addiction, disordered eating behaviors, and problematic alcohol use. Profile membership also predicted the health outcomes of clinically significant exercise addiction and hazardous alcohol use. Conclusions: Findings illuminated how patterns of risk behavior engagement were associated with clinically significant exercise addiction and hazardous alcohol use and will inform prevention efforts and clinical interventions with at-risk college students.
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Affiliation(s)
- Melissa M Ertl
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, New York, USA
| | - Rena Pazienza
- Clover Educational Consulting Group, Austin, Texas, USA
| | - Margeaux Cannon
- Department of Educational and Counseling Psychology, University at Albany-State University of New York, Albany, New York, USA
| | - Yajaira A Cabrera Tineo
- Department of Educational and Counseling Psychology, University at Albany-State University of New York, Albany, New York, USA
| | - Cara L Fresquez
- Department of Educational and Counseling Psychology, University at Albany-State University of New York, Albany, New York, USA
| | - Alicia K McDonough
- Department of Educational and Counseling Psychology, University at Albany-State University of New York, Albany, New York, USA
| | - Dana M Bozek
- Department of Educational and Counseling Psychology, University at Albany-State University of New York, Albany, New York, USA
| | - Evan E Ozmat
- Department of Educational and Counseling Psychology, University at Albany-State University of New York, Albany, New York, USA
| | - Guy M Ladouceur
- Department of Educational and Counseling Psychology, University at Albany-State University of New York, Albany, New York, USA
| | - Emily K Planz
- Department of Educational and Counseling Psychology, University at Albany-State University of New York, Albany, New York, USA
| | - Jessica L Martin
- Department of Educational and Counseling Psychology, University at Albany-State University of New York, Albany, New York, USA
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Krug I, Giles SE, Granero R, Agüera Z, Sánchez I, Sánchez-Gonzalez J, Jimenez-Murcia S, Fernandez-Aranda F. Where does purging disorder lie on the symptomatologic and personality continuum when compared to other eating disorder subtypes? Implications for the DSM. EUROPEAN EATING DISORDERS REVIEW 2021; 30:36-49. [PMID: 34825434 DOI: 10.1002/erv.2872] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 09/07/2021] [Accepted: 10/26/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To assess the clinical significance and distinctiveness of purging disorder (PD) from other eating disorder (ED) diagnoses. METHOD Participants included 3127 women consecutively admitted to an ED treatment centre (246 PD, 465 anorexia nervosa restrictive [AN-R], 327 AN-binge purging [AN-BP], 1436 bulimia nervosa [BN], 360 binge eating disorder [BED], 177 atypical AN and 116 unspecified feeding or eating disorder [UFED]) who were diagnosed according to DSM-5 criteria. Additionally, 822 control participants were recruited from the community. All participants completed measures assessing ED symptoms (EDI-2), general psychopathology (SCL-90-R) and personality (TCI-R). RESULTS Patients with PD, when compared to controls, scored significantly higher on the EDI-2 and SCL-90-R, and most TCI-R dimensions. Most of the significant differences between PD and the other ED diagnoses emerged between PD and AN-R, followed by Atypical-AN, UFED, AN-BP and BED, with patients with PD typically reporting higher scores on the EDI-2 and SCL-90-R subscales. Significant differences between PD and BN were also present, but to a lesser extent. The findings for personality varied amongst the different ED diagnoses. CONCLUSIONS PD is a clinically significant disorder, which seems to be more similar to BN than it is to AN and the other ED subtypes.
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Affiliation(s)
- Isabel Krug
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sarah Elizabeth Giles
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Roser Granero
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain.,Department of Psychobiology and Methodology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Zaida Agüera
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain.,Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain.,Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Public Health, Mental Health and Perinatal Nursing, School of Nursing, University of Barcelona, Barcelona, Spain
| | - Isabel Sánchez
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain.,Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain
| | | | - Susana Jimenez-Murcia
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain.,Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain.,Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Fernando Fernandez-Aranda
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain.,Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain.,Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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7
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Krug I, Granero R, Giles S, Riesco N, Agüera Z, Sánchez I, Jiménez-Murcia S, Del Pino-Gutierrez A, Codina E, Baenas I, Valenciano-Mendoza E, Menchón JM, Fernández-Aranda F. A cluster analysis of purging disorder: Validation analyses with eating disorder symptoms, general psychopathology and personality. EUROPEAN EATING DISORDERS REVIEW 2020; 28:643-656. [PMID: 32944981 DOI: 10.1002/erv.2769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/29/2020] [Accepted: 07/06/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To assess the natural grouping of Purging Disorder (PD) patients based on purging symptomatology and to evaluate the derived classes (a) against each other and (b) to a control group on a range of clinical and psychological measures. METHOD Participants included 223 PD women consecutively admitted to a tertiary ED treatment centre and 822 controls. Purging behaviours (self-induced vomiting, laxative and diuretic use) were used as indicators, while the EDI-2 (ED symptoms), the SCL-90-R (general psychopathology), and the TCI-R (personality traits) were used as validators. RESULTS Three distinct PD clusters emerged: Cluster 1 (only self-induced vomiting), Cluster 2 (self-induced vomiting and laxative use) and Cluster 3 (all purging methods). Significant differences between Cluster 1 and Cluster 3 were found for the EDI-2 drive for thinness and perfectionism subscales, and the TCI-persistence scale. All clusters differed significantly from the controls on all the EDI-2 and the SCL-90-R scales, but findings for the TCI-R scales were less consistent. CONCLUSIONS This study adds to a growing literature on the validity and distinctiveness of PD and provides evidence of dimensional symptom differences amongst PD clusters.
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Affiliation(s)
- Isabel Krug
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Roser Granero
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain.,Department of Psychobiology and Methodology, Universitat Autònoma de Barcelona-UAB, Barcelona, Spain
| | - Sarah Giles
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Nadine Riesco
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain.,Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Zaida Agüera
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain.,Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,Department of Public Health, Mental Health and Maternal-Child Nursing, School of Nursing, University of Barcelona, Barcelona, Spain
| | - Isabel Sánchez
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain.,Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Susana Jiménez-Murcia
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain.,Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Amparo Del Pino-Gutierrez
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain.,Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,Department of Public Health, Mental Health and Maternal-Child Nursing, School of Nursing, University of Barcelona, Barcelona, Spain
| | - Ester Codina
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Isabel Baenas
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | | | - Jose M Menchón
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,CIBER Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
| | - Fernando Fernández-Aranda
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain.,Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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