Threat processing in women with bulimia

Discerning thoughts from feelings: the cognitive-affective division in eating disorders

This article delineates the phenomenon of "cognitive-affective division" in eating disorders, used to refer to the difficulty some patients face in translating what they "think" cognitively to what they "feel" emotionally. A clinical description of cognitive-affective division is first presented, drawing on existing research, before moving on to discuss psychological theories that might shed some light on this often-seen but seldom understood phenomenon. These include the role of emotion awareness and alexithymia, cognitive and emotional development, and neuropsychological theories. We discuss implications for treatment and further research of the cognitive-affective division in eating disorders.

Anorexia nervosa: selective processing of food-related word and pictorial stimuli in recognition and free recall tests

OBJECTIVE

Maladaptive processing of food cues is considered pivotal in the psychopathology of anorexia nervosa. However, the influence of hunger and differences in processing because of the type of stimuli remain largely unclear.

METHOD

Memory bias for food-related pictorial and semantic stimuli was assessed in a recognition and a free recall test in 16 anorexia nervosa (AN) patients, 16 control participants with food intake prior to the study (CG-FI) and 16 control participants with a fasting period prior to the study (CG-NF).

RESULTS

Compared with CG-FI participants, both AN and CG-NF participants responded faster to food-related as compared with neutral words (p < .001) in the recognition test. Differences were found for word but not for pictorial stimuli. No group differences were observed with respect to the number of correct retrievals in either the recognition or the free recall test.

CONCLUSION

The present study found behavioral indications of abnormal processing of food-related and neutral stimuli in anorectic patients similar to those found in fasted healthy controls. Results are discussed in terms of self-schemata in eating disorders, competitive interference, and levels of processing.

Assessing the functional nature of binge eating in the eating disorders

This study explored the functional nature of binge eating through the development of a new self-report instrument called the Binge Eating Adjective Checklist. Participants were 405 adult females who presented to a specialized eating disorders clinic. A subset of participants with bulimia nervosa also completed additional psychometrics and treatment. Those participants who reported greater reductions in negative affective and somatic states during a binge episode were also more distressed on measures of perfectionism, self-esteem, ineffectiveness, and interceptive awareness. They were also less likely to achieve abstinence from bingeing and vomiting over the course of treatment. Thus, the instrument appears to offer a methodology for studying the phenomenology of binge eating and the prediction of therapeutic outcome in bulimia nervosa.

Changes in weight and body image over time in women with eating disorders

BACKGROUND

This study examined the changes in body image and weight in young women with an adolescent eating disorder, relative to women without an eating disorder (noED).

METHOD

Three diagnostic groups, anorexia nervosa (AN; n = 10), bulimia nervosa (BN; n = 27), and binge eating disorder (BED; n = 42) and three comparison groups (noED; n = 659 each) were compared on body mass index (BMI) and self-reported current body size, ideal body size, and weight dissatisfaction. Dependent variables were examined 2 and 1 year before the onset, the onset year, and 1 and 2 years after the onset of the eating disorder in a model that was adjusted for ethnicity and BMI.

RESULTS

BMI was lower in the AN group at all time points except 2 years before onset. AN girls evidenced a significantly stronger relation between BMI and current self-ratings and weight dissatisfaction than noED girls. BMI did not differ between the BN group and the noED group. Girls with BN reported larger current body sizes and greater weight dissatisfaction across all time points. The BED group had higher BMI than the noED group across time. BED girls reported greater current body size ratings and weight dissatisfaction than the noED girls. Girls with AN, BN, or BED did not differ from the noED girls on body ideal ratings.

DISCUSSION

Body weight seems to influence perception of body size more so for girls with AN than for noED girls. No support was found for an accelerated weight gain over time for BN. Weight may increase over time for the BED group relative to the noED group, but larger studies are needed. Across all three groups, ideal body size appears to be unrelated to diagnostic status. Rather, the risk for developing an eating disorder appears to arise from size overestimation and related weight dissatisfaction.

Differences between women with anorexia nervosa and restrained eaters on shape and weight concerns, self-esteem, and depression

OBJECTIVE

The current study examined the relation among shape and weight concerns, domain-specific self-esteem, dietary restraint, and depression.

METHOD

Women with anorexia nervosa (AN; n = 19), restrained eaters (n = 20), and unrestrained eaters (n = 21) completed measures of shape and weight concerns, depression, and self-esteem.

RESULTS

Women with AN had significantly higher shape and weight concerns and lower self-esteem than restrained eaters. However, once depression was controlled, these significant differences disappeared on all but the morality self-esteem subscale. Unrestrained eaters had significantly lower shape and weight concerns and higher self-esteem than restrained participants both before and after depression was controlled.

DISCUSSION

Shape and weight concerns and low self-esteem are associated with dietary restriction. However, results from the current study suggest these two variables may not be the primary driving forces behind extreme dietary restriction.