Mechanisms of influence of body checking on binge eating

Online Compassion Focused Therapy for overeating: Feasibility and acceptability pilot study

OBJECTIVE

This pilot study aims to investigate the feasibility, acceptability, and potential effectiveness of online Compassion Focused Therapy for overeating (CFT-OE).

METHOD

Eighteen Portuguese women seeking treatment for overeating were enrolled in this study, and 15 participants completed the CFT-OE. This was a single-arm study. Participants were assessed at pre- and post-intervention and 3-month follow-up. All participants completed measures assessing binge eating, cognitive restraint, uncontrolled eating, emotional eating, general eating psychopathology, general and body shame, self-criticism, self-compassion, and fears of self-compassion.

RESULTS

The treatment attrition rate was 16.7%, which is relatively low compared to other similar online interventions. Participants gave positive feedback on the program and indicated they would recommend it to people with similar difficulties. CFT-OE improved self-compassion and reduced eating psychopathology symptoms, general and body shame, self-criticism, and fears of self-compassion. Clinical significance analysis showed that the majority of participants were classified as in recovery in all measures at post-intervention and 3-month follow-up.

DISCUSSION

Preliminary results suggest that the online CFT-OE program is an acceptable and feasible intervention. Results also suggest that CFT-OE is beneficial for the treatment of women with difficulties with overeating. A future randomized controlled trial is necessary to establish the effectiveness of the CFT-OE.

PUBLIC SIGNIFICANCE

This study indicates that online CFT-OE is a feasible and adequate intervention for women who struggle with overeating. This therapy showed promising results in reducing eating disorder symptoms, shame, and self-criticism and improving self-compassion. As an online intervention, CFT-OE may be more accessible and offer an alternative to in-person therapy.

Shame and eating disorders symptoms: A meta-analysis

OBJECTIVE

Numerous empirical studies and theoretical models posit that shame is a common experience among individuals across the eating disorder spectrum. In this study we aim to investigate the association between shame and eating disorders symptoms using a meta-analytical approach.

METHOD

In this meta-analysis, we synthesized findings from 195 studies to examine the proposed association between shame and eating disorders symptoms. We looked at the associations with both general eating disorders symptoms and with specific eating disorders symptoms (i.e., anorexic, bulimic, and binge-eating symptoms). Moderation analyses testing for the effect of type of shame, type of eating symptoms, clinical status, quality of the study, age, and gender were conducted.

RESULTS

Shame was significantly associated with a medium to large effect size with all types of eating disorders symptoms (rs between .40 and .52). Body shame (r = .55) and shame around eating (r = .59) were more strongly related with eating disorders pathology. Type of eating disorders symptoms did not moderate the relationship between shame and disturbed eating.

DISCUSSION

Overall, the magnitude of the effect size of the association between shame and eating disorders symptoms is a medium to large one. Body shame and shame around eating seem to be the types of shame most closely tied with eating disorders symptoms, suggesting that directly targeting them in interventions might be highly beneficial. Findings highlight current gaps in the literature (e.g., mostly correlational studies, low quality studies) with implications for future research.

Shame and binge eating pathology: A systematic review

OBJECTIVE

Shame is broadly implicated in the development and maintenance of eating pathology. However, the relationship between shame and binge eating symptoms specifically is less clear. This review aimed to clarify what types of shame are associated with binge eating symptoms and the antecedents and maintenance factors in these relationships.

METHOD

A systematic search for quantitative and qualitative empirical studies was conducted to identify evidence of the relationship between shame and binge eating symptoms. Altogether, 270 articles were identified and screened for eligibility in the review.

RESULTS

Results of the relevant empirical studies (n = 31) identified several types of shame associated with binge eating pathology: (i) internal shame, (ii) external shame, (iii) body shame and (iv) binge eating-related shame, as well as several mechanisms and pathways through which shame was associated with binge eating symptoms.

DISCUSSION

Drawing from the research findings, this review presents an original, integrated model of the cyclical shame-binge eating relationship. Clinical interventions that might break this cycle are discussed, as well as methodological weaknesses which limit causal inferences and important areas of future research.

Body Image Quality of Life Inventory: cross-national study in college students from four different countries

PURPOSE

This study was aimed to examine the psychometric proprieties of the Body Image Quality of Life Inventory (BIQLI) among Brazilian, Portuguese, Mozambican, and Italian college students.

METHODS

A total of 1630 subjects (Brazilians = 446; Portuguese = 480, Mozambicans = 360, and Italians = 344) completed the Portuguese (Brazilian, Portuguese, and Mozambican students) and the Italian versions (Italian students) of the BIQLI for measuring the effects of body image on one's quality of life. Psychometric testing included confirmatory factor analysis (CFA), discriminant and convergent validity, internal consistency, and composite reliability. The cross-national invariance of the BIQLI was assessed by multi-group analysis using ΔCFI. Moreover, the global score of the BIQLI for all countries was calculated by an algorithm and compared using the Welch's ANOVA and the Games-Howell post-test (α = 5%).

RESULTS

CFA showed an inadequate fit of unifactorial model of the BIQLI. Therefore, an alternative model comprising nine first-order factors and one second-order factor was proposed and evaluated. This new model showed adequate fit in all samples, despite some limitations that were found with respect to its convergent and discriminant validity. The alternative BIQLI model was invariant among countries. Global scores for the influence of body image on quality of life were significantly different across countries, with the Italians presenting the lowest scores.

CONCLUSIONS

The BIQLI factorial model found in this study represents a reliable and valid alternative to its original structure for the assessment of the effect of body image on college students' perceived quality of life. This model must be further tested in other populations.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Executive functioning and spatial processing in anorexia nervosa: an experimental study and its significance for the allocentric lock theory

PURPOSE

The allocentric lock theory (ALT) suggests that people with eating disorders have difficulties in multisensory integration in two reference frames-egocentric and allocentric, whereby the egocentric, but not allocentric, is impaired. This leads to a distorted body image that contributes to the development and maintenance of the disorder. The current study aimed to explore a facet of the ALT, namely, the visuo-spatial aspect, and its relation to cognitive flexibility in patients with anorexia nervosa (AN).

METHODS

Fifty-five participants took part in the study: 20 AN patients and 35 controls, matched by age and education. The object perspective taking test (OPTT) and the mental rotation test (MRT), tapping egocentric and allocentric representations, respectively, and a set-shifting task were administered. The brief symptom inventory was used to measure overall levels of distress.

RESULTS

AN patients showed higher level of distress. They performed poorer on the OPTT and set-shifting task but not on the MRT. The OPTT and MRT were correlated for controls but not for AN patients, while the set-shifting task and body mass index were associated with the OPTT but not with the MRT for the AN patients.

CONCLUSIONS

The findings support the ALT by demonstrating impaired visual egocentric representations and intact allocentric visual functions in AN patients, with cognitive flexibility associated only with the egocentric frame. Therefore, egocentric frame impairment in AN patients may be influenced by visual perception and cognitive flexibility deficiency.

LEVEL OF EVIDENCE

Level III: case-control analytic study.

Evaluation of the DSM-5 Severity Specifier for Bulimia Nervosa in Treatment-Seeking Youth

A new severity specifier for bulimia nervosa (BN), based on the frequency of inappropriate weight compensatory behaviours (e.g., laxative misuse, self-induced vomiting, fasting, diuretic misuse, and excessive exercise), has been added to the most recent (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a means of addressing variability and heterogeneity in the severity of the disorder. While existing research provides support for the DSM-5 severity specifier for BN in adult patients, evidence for its validity and clinical utility in youth is currently lacking. To address this gap, data from 272 treatment-seeking adolescents with DSM-5 BN (94.2% female, M _age = 15.3 years, SD 1.7) were analysed to examine whether these patients, sub-grouped based on the DSM-5 severity definitions, would show meaningful differences in a broad range of clinical variables and demographic and physical characteristics. Analyses revealed that participants categorized with mild, moderate, severe, and extreme severity of BN significantly differed from each other in 15 variables regarding eating disorder pathological features and putative maintenance factors (i.e., core low self-esteem, perfectionism, social appearance anxiety, body surveillance, and mood intolerance), health-related quality of life and comorbid psychiatric (i.e., affective and anxiety) disorders (large effect sizes). Between-group differences in demographics, body mass index, or age-of-BN onset were not observed. Collectively, our findings provide support for the utility of the frequency of inappropriate weight compensatory behaviours as a severity indicator for BN and suggest that age-at-onset of BN is probably more disorder- than severity-dependent. Implications for future research are outlined.

Emotional eating and cognitive conflicts as predictors of binge eating disorder in patients with obesity

Background/Objectives: Binge Eating Disorder (BED) is often associated with obesity. In order to identify the variables that allow to better detect the presence of BED, people with overnutrition were compared with and without BED in the presence of cognitive conflicts, eating symptoms and anxious-depressive symptoms. The inclusion of cognitive conflicts had been relevant in bulimia studies but had not been investigated with respect to BED. Method: Two groups with obesity were evaluated, one without BED (OB, n = 54) and the other with BED (OB-BED, n = 48), using a social-demographic questionnaire as well as a semi-structured interview to assess BED, questionnaires (DASS-21, EDE-Q, EEQ) and the Repertory Grid Technique. Results: Overall, the OB-BED group presented more conflicts and more symptoms. The model that best differentiated between the groups included emotional eating and level of cognitive conflicts, correctly classifying 91.4% of the sample. Conclusion: These results highlight the role played by cognitive conflicts and emotional eating as differentiating elements between OB and OB-BED, with a high level of predictive accuracy.

Risk and maintenance factors for young women's DSM-5 eating disorders

Recent research with young women attending colleges, who are at the average age of eating disorder (ED) onset, established that the ED symptoms are not only prevalent but also relatively stable over the college period. Nonetheless, our knowledge regarding the course and modifiable factors associated with both the onset and maintenance of diagnosable (DSM-5) EDs in this population is limited. The objective of this report was to address these key research gaps. Data were examined from 2713 women who completed assessments of potential vulnerability factors and EDs in the autumn semester of the first (baseline) and fourth (follow-up) college years. A total of 13.1% of the sample met DSM-5 criteria for an ED diagnosis at baseline. At 4-year follow-up, 7.6% of the sample met DSM-5 criteria for an ED, with 67.5% of these cases representing women who had maintained an ED diagnosis from baseline, and 32.5% representing new onset EDs. Elevated appearance-ideal internalization, body dissatisfaction, self-objectification, dieting, and negative affectivity at baseline as well as changes in these factors between assessments all predicted onset and maintenance of DSM-5 EDs at 4-year follow-up. Self-objectification (thinking about and monitoring the body's appearance from an external observer's perspective) was the largest contributor to both ED onset and maintenance. In addition to enhancing our knowledge about the course of young women's (DSM-5) EDs during college, this work highlights potentially similar psychological foci for prevention and treatment efforts. Implications for improving existing preventive and treatment approaches are outlined.

Body checking is associated with weight- and body-related shame and weight- and body-related guilt among men and women

This study examined whether body checking was a correlate of weight- and body-related shame and guilt for men and women. Participants were 537 adults (386 women) between the ages of 17 and 74 (M_age=28.29, SD=14.63). Preliminary analyses showed women reported significantly more body-checking (p<.001), weight- and body-related shame (p<.001), and weight- and body-related guilt (p<.001) than men. In sex-stratified hierarchical linear regression models, body checking was significantly and positively associated with weight- and body-related shame (R²=.29 and .43, p<.001) and weight- and body-related guilt (R²=.34 and .45, p<.001) for men and women, respectively. Based on these findings, body checking is associated with negative weight- and body-related self-conscious emotions. Intervention and prevention efforts aimed at reducing negative weight- and body-related self-conscious emotions should consider focusing on body checking for adult men and women.

The impact of early shame memories in Binge Eating Disorder: The mediator effect of current body image shame and cognitive fusion

This study examined the phenomenology of shame experiences from childhood and adolescence in a sample of women with Binge Eating Disorder. Moreover, a path analysis was investigated testing whether the association between shame-related memories which are traumatic and central to identity, and binge eating symptoms' severity, is mediated by current external shame, body image shame and body image cognitive fusion. Participants in this study were 114 patients, who were assessed through the Eating Disorder Examination and the Shame Experiences Interview, and through self-report measures of external shame, body image shame, body image cognitive fusion and binge eating symptoms. Shame experiences where physical appearance was negatively commented or criticized by others were the most frequently recalled. A path analysis showed a good fit between the hypothesised mediational model and the data. The traumatic and centrality qualities of shame-related memories predicted current external shame, especially body image shame. Current shame feelings were associated with body image cognitive fusion, which, in turn, predicted levels of binge eating symptomatology. Findings support the relevance of addressing early shame-related memories and negative affective and self-evaluative experiences, namely related to body image, in the understanding and management of binge eating.

Functional links of obsessive, dysmorphic, hypochondriac, and eating-disorders related mental intrusions

Unwanted mental intrusions (UMIs) are the normal variants of obsessions in Obsessive-Compulsive Disorder (OCD), preoccupations about defects in Body Dysmorphic Disorder (BDD), images about illness in Hypochondriasis (HYP), and thoughts about eating in Eating Disorders (EDs). The aim was to examine the similarities and differences in the functional links of four UMI contents, adopting a within-subject perspective. Method: 438 university students and community participants (M _age = 29.84, SD = 11.41; 70.54% women) completed the Questionnaire of Unpleasant Intrusive Thoughts (QUIT) to assess the functional links (emotions, appraisals, and neutralizing/control strategies) of the most upsetting UMIs with OCD, BDD, HYP and EDs-contents. Results: HYP-related intrusions caused the highest emotional impact, OCD-related intrusions were the most interfering, and EDs-related intrusions interfered the least. The four UMI were equally ego-dystonic. Women appraised OCD-related intrusions more dysfunctionally, but men appraised the four intrusive contents similarly. All UMI instigated the urge to "do something", to keep them under control and/or neutralizing them. Conclusions: Similarities among the functional links of intrusions related to OCD, BDD, HYP and EDs contents support their transdiagnostic nature and they might contribute to understanding common factors in these disorders.

A Randomised Controlled Comparison of Second-Level Treatment Approaches for Treatment-Resistant Adults with Bulimia Nervosa and Binge Eating Disorder: Assessing the Benefits of Virtual Reality Cue Exposure Therapy

A question that arises from the literature on therapy is whether second-level treatment is effective for patients with recurrent binge eating who fail first-level treatment. It has been shown that subjects who do not stop binge eating after an initial structured cognitive-behavioural treatment (CBT) programme benefit from additional CBT (A-CBT) sessions; however, it has been suggested that these resistant patients would benefit even more from cue exposure therapy (CET) targeting features associated with poor response (e.g. urge to binge in response to a cue and anxiety experienced in the presence of binge-related cues). We assessed the effectiveness of virtual reality-CET as a second-level treatment strategy for 64 patients with bulimia nervosa and binge eating disorder who had been treated with limited results after using a structured CBT programme, in comparison with A-CBT. The significant differences observed between the two groups at post-treatment in dimensional (behavioural and attitudinal features, anxiety, food craving) and categorical (abstinence rates) outcomes highlighted the superiority of virtual reality-CET over A-CBT. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Validity and utility of the DSM-5 severity specifier for binge-eating disorder

OBJECTIVE

To test both the concurrent and predictive significance of the new DSM-5 severity specifier for binge-eating disorder (BED) in adult outpatients.

METHOD

Existing data from 195 adults with DSM-5 BED who received evidence-based treatment (manual-based cognitive-behavioral therapy) in an outpatient setting were re-analysed to examine whether these patients sub-grouped according to the DSM-5 severity levels, defined by the frequency of binge-eating (BE) episodes, would show meaningful differences in a range of variables of clinical interest assessed at pre-treatment and end-of treatment abstinence from BE.

RESULTS

Participants categorized with mild (33.3% of the sample), moderate (35.4%), severe (15.9%), and extreme (15.4%) severity of BED, based on their pre-treatment clinician-rated frequency of BE episodes, differed significantly from each other in physical characteristics (body mass index) and another sixteen variables of clinical interest assessed at pre-treatment regarding eating disorder psychopathology and putative maintenance factors, lifetime and current psychiatric disorder comorbidity, general psychiatric distress, and psychosocial impairment. The four DSM-5 severity groups were statistically indistinguishable in demographics or age-of-BED onset. However, significant between-group differences were observed in the treatment outcome, i.e., abstinence from BE, achieved by 98.5%, 66.7%, 38.7% and 6.7% of participants categorized with mild, moderate, severe, and extreme severity respectively. The outcome analyses repeated in the completer sample (n = 187) yielded the same pattern of the aforementioned intent-to-treat (N = 195) results.

DISCUSSION

The findings provide support for the severity specifier for BED introduced in the DSM-5 as a means of addressing within-group variability in severity.

Purging behaviors and therapeutic prognosis of women with eating disorders treated in a healthcare context

Background/Objective: The evidence on efficacy of cognitive-behavioral interventions in Eating Disorders (ED) still shows inconclusive results with respect to the role of purging behaviors, more so in uncontrolled situations. Evolution of ED patients with and without purging behavior was studied 30 months after start of a multicomponent treatment. Method: 162 women (87 purging, 75 non-purging) treated in outpatient or hospitals + outpatient care units in Spain participated. The evaluation instruments were: BSQ, EAT-40, EDI, STAI, BDI and BITE. Results: At the beginning of the treatment, participants with purging behavior showed higher bulimic symptomatology, more body dissatisfaction, drive for thinness, perfectionism and ineffectiveness, anxiety and depressive symptomatology. After thirty months, intervention produced improvement in ED characteristics, emotional alterations and personal development variables, in both groups, but less in patients with no purging behavior. The effect of intervention was stronger in purging patients and variables with larger effect size: body dissatisfaction, bulimic symptomatology and anxiety. Conclusions: Purging behaviors must be considered in the design of these treatments with a view to prognosis.

Body-Image Acceptance and Action Questionnaire: Its deleterious influence on binge eating and psychometric validation

Background/Objectives: This study aimed to explore the psychometric properties of BI-AAQ (Body-Image Acceptance and Action Questionnaire) and the body image psychological flexibility role as a mediator in a pervasive path towards binge eating in Brazilian samples. Method: This cross-sectional study was conducted in clinical (overweight or obese women currently in treatment for weight loss; n= 330) and non-clinical (general population; n= 682) groups of women. Results: BI-AAQ has one-factor structure, excellent internal consistency, ability to detect differences between groups and measurement invariance across samples. It was also negatively associated with self-compassion and positively associated with binge eating severity, drive for thinness and self-criticism. Conclusions: This study provides data confirming the robust psychometric properties of BI-AAQ in qualitatively different samples. Furthermore, an additional study conducted in a clinical sample of women with overweight or obesity revealed that body image psychological inflexibility has emerged as a partial and significant mediator of the effect of self-criticism and drive for thinness on binge eating severity.

Testing the DSM-5 severity indicator for bulimia nervosa in a treatment-seeking sample

PURPOSE

This study tested the new DSM-5 severity criterion for bulimia nervosa (BN) based on the frequency of inappropriate weight compensatory behaviors in a treatment-seeking sample.

METHODS

Participants were 345 adults with DSM-5 BN presenting for treatment. They were sub-grouped based on DSM-5 severity levels and compared on a range of variables of clinical interest and demographics.

RESULTS

Based on DSM-5 severity definitions, 27.2 % of the sample was categorized with mild, 26.1 % with moderate, 24.9 % with severe, and 21.8 % with extreme severity of BN. Analyses revealed that the four (mild, moderate, severe, and extreme) severity groups of BN significantly differed from each other in eating disordered and body-related attitudes and behaviors, factors involved in the maintenance process of the disorder, comorbid psychiatric disorders, psychological distress, and psychosocial impairment (medium-to-large effect sizes). No significant between-group differences were observed in demographics, body mass index, or at the age when BN first occurred, lending some credence to recent suggestions that age-at-onset of BN may be more a disorder- than a severity-dependent variable.

CONCLUSIONS

Collectively, our findings provide support for the severity indicator for BN introduced in the DSM-5 as a means of addressing heterogeneity and variability in the severity of the disorder.

Western Cultural Identification Explains Variations in the Objectification Model for Eating Pathology Across Australian Caucasians and Asian Women

Objective: To assess differences in trait objectifying measures and eating pathology between Australian Caucasians and Asian women living in Australia and in Hong Kong with high and low levels of western cultural identification (WCI) and to see if exposure to objectifying images had an effect on state-objectification. A further aim was to assess using path analyses whether an extended version of the objectification model, including thin-ideal internalization, differed depending on the level of WCI. Method: A total of 424 participants comprising 162 Australian Caucasians and 262 Asians (n = 183 currently residing in Australia and n = 79 living in Hong Kong) took part in the study. Of the overall Asian sample, 133 individuals were classified as high-WCI and 129 participants as low-WCI. Participants were randomly allocated into one of two conditions, presenting either objectifying images of attractive and thin Asian and Caucasian female models (objectification group, n = 204), or showing neutral images of objects (e.g., chairs, tables; control group, n = 220). Subsequently, participants were asked to complete a series of questionnaires assessing objectification processes and eating pathology. Results: Findings revealed that the Caucasian group presented with significantly higher internalization and body surveillance scores than either of the two Asian groups and also revealed higher scores on trait-self-objectification than the low-WCI Asian sample. As regards to the effects of objectifying images on state self-objectification, we found that ratings were higher after exposure to women than to control objects for all groups. Finally, multi-group analyses revealed that our revised objectification model functioned equally across the Caucasian and the high-WCI Asian group, but differed between the Caucasian and the low-WCI Asian group. Conclusion: Our findings outline that individuals with varying levels of WCI might respond differently to self-objectification processes. Levels of WCI should therefore be taken into consideration when working with women from different cultural backgrounds.

Predicting onset and maintenance of men's eating disorders

BACKGROUND/OBJECTIVE

Eating disorders (EDs) represent serious yet understudied mental health issues, particularly amongst young adult men attending colleges, who are at the average age of onset. Despite this and recent evidence that in young adult men the core ED symptoms are prevalent and remain relatively stable over the college period, little is known about factors associated with both the onset and maintenance of diagnosable EDs in this population. This work sought to address these research gaps.

METHOD

Logistic regression analyses were conducted using data from an on-going longitudinal study of eating and mental health issues to examine the influence of theoretically relevant factors in predicting the onset and maintenance of men's (DSM-5) EDs at 4-year follow-up (N = 2,507).

RESULTS

Body dissatisfaction, self-objectification, appearance-ideal internalization, dieting, and negative affectivity were all predictors of ED onset and maintenance. Self-objectification was the largest contributor to both ED onset and maintenance.

CONCLUSIONS

The findings highlight potentially similar psychosocial foci for prevention and treatment efforts. Implications for improving existing preventive and treatment approaches are discussed.

Objectified Body Consciousness (OBC) in Eating Psychopathology

Objectified body consciousness (OBC) appears to play a crucial role in eating and body-related disturbances, which typically emerge during adolescence. The 24-item OBC Scale (OBCS) has been employed in eating disorder (ED) research and school-based adolescent samples, but evidence for its psychometric proprieties exists only in adult (nonclinical) populations. We evaluated (a) the construct validity and reliability of the 24-item OBCS with data collected from 1,259 adolescent girls and boys from the community (Study 1) and 643 adolescents of both genders with an ED (Study 2) and (b) whether the instrument functions similarly and equivalently measures the underlying construct(s) across gender and samples (i.e., test of measurement equivalence/invariance; Study 3). Results upheld the three-factor structure and measurement equivalence/invariance of the 24-item OBCS across gender and samples. OBCS subscale scores were internally consistent and stable over a 4-week period. OBCS subscales discriminated community participants with high and low ED symptom levels with fair accuracy, as well as community participants from those with an ED. They were also associated with five constructs closely related to both OBC and ED psychopathology. Latent mean comparisons across samples and gender were performed and discussed. Implications and directions for future research are also outlined.

The Social Appearance Anxiety Scale in Italian Adolescent Populations: Construct Validation and Group Discrimination in Community and Clinical Eating Disorders Samples

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.

Narcissistic Vulnerability and Grandiosity as Mediators Between Insecure Attachment and Future Eating Disordered Behaviors: A Prospective Analysis of Over 2,000 Freshmen

OBJECTIVE

This study aimed to build on existing literature by examining the potential mediating role of two variants of narcissism (grandiosity and vulnerability) in explaining part of the underlying mechanism by which insecure (avoidant and anxiety) attachment affects behavioral elements of eating pathology (dieting and bulimic behaviors).

METHOD

Longitudinal data collected from 2,055 freshman college students (52.2% women; mean age 18.34 years) were analysed using a latent variable structural equation modelling approach, controlling for initial levels of the endogenous (i.e., dependent) latent variables and holding body mass index, anxiety, stress, depression, and self-esteem levels as time-varying covariates.

RESULTS

The effect of attachment anxiety on future bulimic behaviors was fully mediated through vulnerable narcissism (i.e., no significant direct link between attachment anxiety and bulimic behaviors), whereas grandiose narcissism fully mediated the association between attachment avoidance and future dieting behaviors. Dieting also predicted future bulimic behaviors and served as an additional (full) mediator between grandiose narcissism and bulimic behaviors. Differences in the strength of these associations across gender were not observed, and all indirect effects were statistically significant.

CONCLUSION

Overall, the findings (a) seem to support the theoretical postulations linking different insecure attachment experiences to different narcissistic tendencies, (b) imply that specific insecure attachment patterns may pass through different mediating pathways (narcissistic grandiosity and vulnerability) to specific behavioral elements of eating pathology (dieting and bulimic behaviors) regardless of gender, and (c) suggest that individuals with high grandiose narcissistic levels may not be protected from bulimic behaviors as previously indicated.