Stability and change in patterns of concerns related to eating, weight, and shape in young adult women: a latent transition analysis

Unraveling the complexity and instability of negative emotional eating: A latent transition analysis

The manifestations of emotional eating are complicated, encompassing both over- and under-eating. However, little is understood about how emotional over- and under-eating constitute individuals' eating patterns and how these patterns change over time. Employing latent transition analysis, a longitudinal and person-centered approach, this study examined the patterns and stability of emotional eating. Over six months, 755 participants completed two waves of self-reported questionnaires. Results revealed four distinct latent profiles: Low Emotional Eaters (11.5-15.8%), Emotional Eating-Undereaters (31.1-40.5%), Emotional Eating-Overeaters (15.9-18.3%), and Combined-Emotional Eaters (29.7-37.2%). Approximately 50% of participants in each profile maintained their behavioral patterns over time, with transitions often shifting towards Combined-Emotional Eaters. Individuals in the profile of Emotional Eating-Overeaters exhibited the highest level of anxiety, depression, stress, and disordered eating. Gender, self-esteem level, and self-esteem instability were associated with profile membership and transition probabilities. These findings highlight the presence of distinct and relatively unstable patterns of negative emotional eating, indicating the potential distinction between trait and state emotional eating. Recognizing these inherent characteristics is crucial for future studies and intervention programs addressing negative emotional eating.

Pathways from adolescent screen time to eating related symptoms: a multilevel longitudinal mediation analysis through self-esteem

OBJECTIVE

Screen time and self-esteem have been shown to be important correlates of eating disorders in adolescence. However, there is an absence of longitudinal studies that distinguish between time-varying factors, accounting for parallel developmental changes and common underlying vulnerability.

DESIGN

A total of 3,801 adolescents were administered self-report measures, annually, over the course of 5 years. The association of screen time (social media use, television watching, video gaming) on eating related symptoms was analyzed using a longitudinal Bayesian multilevel path analysis framework. Self-esteem was examined as a mediating factor in this model. This study investigated direct and indirect associations at between-person, concurrent within-person, and lagged-within-person levels, while controlling for gender.

RESULTS

The findings revealed that all types of screen time exposure were significantly associated with eating related symptoms at between and within-person levels. A significant association at the lagged-within person level was only revealed for social media use. Self-esteem was found to be a significant mediating factor between screen time and eating related symptoms.

CONCLUSION

An increase in social media use one year was associated with increased of eating related symptoms two years later through lower self-esteem. Implications for prevention are discussed.

Subclinical patterns of disordered eating behaviors in the daily life of adolescents and young adults from the general population

BACKGROUND

Disordered eating behaviors (DEBs), a risk factor for the development of eating disorders (EDs), are prevalent in young people and different DEBs frequently co-occur. Previous studies on DEB-patterns have largely used traditional retrospective questionnaires to assess DEBs. In addition, most previous studies did not specifically exclude individuals with clinical EDs, which limits current knowledge concerning purely subclinical patterns of DEBs. In the present study, we aimed to explore phenotypes and group sizes of subclinical patterns of DEBs reported in everyday life via smartphone-based ecological momentary assessment (EMA) in adolescents and young adults from the general population without lifetime EDs. In secondary analyses, we further aimed to investigate whether DEB-patterns would be associated with additional previously identified risk factors for ED-development.

METHODS

EMA was conducted in a community sample of 14-21-year-olds from Dresden, Germany, over four days for up to eight times a day and covered engagement in four DEBs: skipping eating, restrained eating, eating large amounts of food, and loss-of-control eating. Data were analyzed from N = 966 individuals without lifetime EDs with an EMA compliance rate of at least 50% (81.9% of the total sample; average compliance: 84.6%). Latent profile analyses were performed to identify subclinical patterns of DEBs, stratified by sex. Associations between symptomatic profiles and ED-risk factors were tested via regression analyses.

RESULTS

Based on theoretical deliberations, statistical indices, interpretability, and parsimony, a three-profile solution, namely no DEBs, high-mixed DEBs, and low-mixed DEBs, was selected for both sexes. Both symptomatic profiles in both sexes were associated with more unfavorable manifestations in additional ED risk factors compared to the no DEBs profile, with the highest number of associations being observed in the female high-mixed profile.

CONCLUSIONS

The present findings suggest that problematic manifestations of DEBs in young people may occur even in the absence of an ED diagnosis and that they are associated with additional risk factors for EDs, warranting increased efforts in targeted prevention, early identification and intervention in order to counteract symptom progression.

Visceral sensitivity, hunger responsiveness, and satiety responsiveness: Associations between facets of gastrointestinal interoception and disordered eating profiles in an undergraduate sample

This preregistered study examined associations between empirically derived profiles of disordered eating in a diverse nonclinical sample and three facets of gastrointestinal (GI) interoception (visceral sensitivity, hunger responsiveness, satiety responsiveness). University students (n = 591; 53.3% women; 23.0% Hispanic) completed the Visceral Sensitivity Index, Adult Eating Behavior Questionnaire, and Eating Pathology Symptom Inventory. Latent profile analysis was conducted in Mplus v8.3 with four behavioral indicators (restricting, binge eating, excessive exercise, purging [binary]). Facets of GI interoception predicting odds of disordered eating profile membership compared to an asymptomatic group were evaluated. Five profiles were identified. Facets of GI interoception differentially predicted odds of membership in disordered eating profiles. However, higher scores on all three facets of GI interoception were associated with increased odds of membership in a high disordered eating profile. The relationship between distinct facets of GI interoception and specific disordered eating patterns appears nuanced, though individuals displaying a range of disordered eating behaviors may exhibit broad GI interoceptive dysfunction. Findings are consistent with the recent emphasis on idiographic treatment approaches for disordered eating and may have implications for screening among university students. Prospective longitudinal work and extension to clinical samples is needed.

Pathways by Which Self-Compassion Improves Positive Body Image: A Qualitative Analysis

The current study applied consensual qualitative research-modified to essays written by 51 college women completing an expressive writing intervention over three time points for a total of 153 essays to identify how increases in self-compassion improve body image. A qualitative coding team tracked changes in affect and cognition over three time points. The results demonstrated that college women consistently expressed body acceptance and psychological flexibility. Additionally, the participants expressed important increases in mindfulness as well as decreases in social influences, feelings of separation, negative health behaviors, and attention to media messages. Decreases were found in their expressions of body functionality, love and kindness toward their body, and internal locus of control. These findings suggest pathways through which self-compassion may improve women's body image by increasing mindfulness and decreasing the negative ways of relating to one's body, specifically in the areas of media, clothing, make-up, and negative social interactions.

Exploring latent profiles of disordered eating using an indicator of dietary restriction in an undergraduate sample of men and women

OBJECTIVE

Latent class or latent profile analysis (LPA) studies in patients with eating disorders consistently identify a low-weight, restrictive eating subgroup that does not endorse weight/shape concerns. To date, similar studies in samples unselected for disordered eating symptoms have not identified a high restriction-low weight/shape concerns group, which may be due to a lack of inclusion of measures of dietary restriction.

METHOD

We conducted an LPA using data from 1623 college students (54% female) recruited across three different studies. The Eating Pathology Symptoms Inventory Body Dissatisfaction, Cognitive Restraint, Restricting, and Binge Eating subscales were used as indicators, and body mass index, gender, and dataset were covaried. Purging, excessive exercise, emotion dysregulation, and harmful alcohol use were compared across resulting clusters.

RESULTS

Fit indices supported a 10-class solution, including five disordered eating groups (largest to smallest): "Elevated General Disordered Eating", "Body Dissatisfied Binge Eating," "Most Severe General Disordered Eating," "Non-Body Dissatisfied Binge Eating," and "Non-Body Dissatisfied Restriction." The "Non-Body Dissatisfied Restriction" group scored as low on other measures of traditional eating pathology and harmful alcohol use as non-disordered eating groups but scored as high on a measure of emotion dysregulation as other disordered eating groups.

DISCUSSION

This study is the first to identify a latent restrictive eating group that does not endorse traditional disordered eating cognitions in an unselected sample of undergraduate students. Results underscore the importance of using measures of disordered eating behaviors without implied motivation to capture overlooked problematic eating patterns in the population that are distinct from our "traditional" understanding of disordered eating.

PUBLIC SIGNIFICANCE

We identified a group of individuals with high levels of restrictive eating but low body dissatisfaction and intent to diet in an unselected adult sample of men and women. Results underscore the need to investigate restrictive eating outside of the traditional lens of body shape concerns. Findings also suggest that individuals with nontraditional eating difficulties may struggle with emotion dysregulation, putting them at risk of poor psychological and relational outcomes.

Emotion regulation, perfectionism, and eating disorder symptoms in adolescents: the mediating role of cognitive eating patterns

Poor emotion regulation, along with elevated perfectionism, is recognised as a risk factor for the development of eating disorder (ED) symptoms. Therefore, the aim of our study was to examine the relationship between emotion regulation difficulties and perfectionism with ED symptoms, while controlling for emotional eating, uncontrolled eating, and cognitive restraint as mediators. In total, 482 adolescents (246 girls and 236 boys; M = 15.00, SD = 0.31) participated in this study. Based on the participants' body height and weight measured by the medical team during their regular preventive health examinations, the body mass index (BMI) was calculated. Participants also answered the Difficulties in Emotion Regulation Scale, Multidimensional Perfectionism Scale, Three-Factor Eating Questionnaire, and Eating Disorder Examination Questionnaire. According to the results obtained, adolescent girls in our sample reported more difficulties in emotion regulation, more uncontrolled and emotional eating, and more ED symptoms. A significant direct effect was found for difficulties in emotion regulation and ED symptoms but not for perfectionism. In addition, only emotional eating and cognitive restraint (not uncontrolled eating) mediated the relationship between difficulties in emotion regulation and perfectionism and ED symptoms. The results suggest that difficulties in emotion regulation may be more important than perfectionism in explaining ED symptoms in a sample of healthy adolescents. When adolescents experience problems in emotion regulation in combination with emotional or uncontrolled eating, they might be at a higher risk of experiencing concerns about weight and a variety of other ED symptoms, and this should be considered when planning preventive interventions for adolescents.

Healthy eating behaviors and self-control in scarcity: The protective effects of self-compassion

Maintaining healthy eating habits requires self-control and this process can become unsuccessful in certain stressful situations (e.g., economic scarcity). This study tested whether self-compassion can buffer the negative impacts of economic scarcity on healthy eating behaviors and self-control. In the correlational Study 1 (n = 304) based on self-reports, a mediating effect of self-control between economic scarcity and healthy eating behaviors was found in females but not males, and that self-compassion moderated the direct relationship between economic scarcity and healthy eating behaviors in females. No significant moderated mediation effect was found. In Study 2, female participants (n = 113) completed economic scarcity (ES) (or abundance) and self-compassion (SC) (or writing-control (WC)) manipulations and a food-selection task. The ES + WC group chose more high-calorie food than the economic abundance (EA) + WC group and the ES + SC group, and the EA + SC group also selected more high-calorie food compared with the EA + WC group and the ES + SC group. In Study 3 (n = 136), similar manipulations and a dot-mixed task were used to measure self-control, and the ES + SC group showed higher accuracy than the ES + audio-control (AC) group at a trend level. These findings support the protective role of self-compassion in healthy eating behaviors and self-control impairments resulted from economic scarcity, which offer promise for promoting healthy lifestyles among individuals living in scarcity.

Interactional Effects of Multidimensional Perfectionism and Cognitive Emotion Regulation Strategies on Eating Disorder Symptoms in Female College Students

Given the inconclusive findings regarding the relation between perfectionism and eating disorder symptoms, it is important that we determine whether this relation is modulated by emotion dysregulation, which is a prominent risk factor for eating disorders. We sought to identify specific cognitive emotion regulatory strategies—rumination, self-blame, and catastrophizing—that interact with multidimensional perfectionism to shape eating disorder symptoms (i.e., shape, weight, eating concerns, and dietary restraint). Using latent moderated structural equation modeling, we analyzed data from 167 healthy young female adults. We found that only rumination significantly moderated the relation between socially prescribed perfectionism and eating disorder symptoms. However, this was not observed for self-oriented perfectionism or other regulatory strategies. These findings held true when a host of covariates were controlled for. Our findings underscore the crucial role of rumination, a modifiable emotion regulatory strategy, in augmenting the relation between socially prescribed perfectionism and eating disorder symptoms in young women.

Sex and Racial Differences in Patterns of Disordered Eating and Alcohol Use

The present study aimed to determine how young adults' use of disordered eating behaviors (DEBs) and alcohol uniquely cluster with one another, how these clusters differ by sex and race, and map onto health-related correlates. As a part of a cross-sectional study assessing college student health and experiences, female (n = 1,026), male (n = 336), White (n = 640), and Black (n = 561) young adult college students at three universities (M_age = 20.54, SD = 1.80) completed measures assessing DEBs and alcohol use, and physical and mental health. Multigroup mixture modeling was used to identify subgroups of female, male, White, and Black young adults that are characterized by different levels of DEBs (fasting, food avoidance, loss of control eating, overeating) and alcohol use (binge drinking, drinking quantity). Whether group membership relates to theoretically and clinically relevant health correlates (stress, depressive symptoms, sleep health) was examined via auxiliary analyses. Qualitative and quantitative differences were identified in the best-fitting mixture models for female (four groups), male (four groups), White (five groups), and Black (three groups) participants that suggest sex and racial variations exist in patterns of DEBs and alcohol use severity. Generally, classification in groups characterized by moderate to high probabilities of DEBs only, or the combination of moderate to high DEBs and alcohol use, was associated with worse affective concerns across sexes and races. Targeting young adults' DEBs and alcohol use via diversity-informed treatments focused on coping skill development may help promote health and well-being.

Framing real beauty: A framing approach to the effects of beauty advertisements on body image and advertising effectiveness

Current literature is inconsistent about the effects of idealized (i.e., thin) vs. non-idealized (i.e., average or plus-size) models on young women's well-being. This inconsistency may be explained by different frames (i.e., passive body, active body, and subject) surrounding beauty ad models. The current experimental study among 568 women aged 18-30 years (M = 21.45, SD = 1.84) tested the effects of differently framed ads featuring idealized vs. non-idealized models on well-being and ad effectiveness while taking into account the mediating role of cognitive schemas and moderating role of thin-ideal internalization. Results showed that a passive body frame generated more appearance schemas compared to a subject frame. The effects of framing on body functionality schemas operated differently for idealized vs. non-idealized models. The passive body frame also induced inferior ad outcomes (i.e., lower attitudes to the advertisement and brand and lower purchase intent) compared to an active body frame. No other main framing effects nor moderating effects of thin-ideal internalization were found. These results for advertising outcomes can encourage beauty brands to stop using typical objectifying ads.

A longitudinal study of weight and shape concerns and disordered eating groups by gender and their relationship to self-control

PURPOSE

Weight/shape concerns and disordered eating are common among young adults. Minimal research has examined these variables longitudinally by gender and in connection to self-control. The present study examined the level of weight/shape concerns and disordered eating at the end of the first and fourth year of college separately by gender and explored differences in self-control.

METHODS

Participants included 394 female and 157 male undergraduates (N = 551; 40% non-white) who were categorized into three groups using a cluster analysis by gender: low weight/shape concerns and low disordered eating (LowWS-LowDE group), high weight/shape concerns and low disordered eating (HighWS-LowDE group), and high weight/shape concerns and high disordered eating (HighWS-HighDE group).

RESULTS

Approximately, 62% of women and 54% of men reported having weight/shape concerns and/or disordered eating at the end of the first year of college, and around 51% of women and 44% of men reported having weight/shape concerns and/or disordered eating at the end of the fourth year. Results indicated that those in the HighWS-HighDE group had lower self-control compared to those in the LowWS-LowDE group at the end of the first and fourth year in both women and men. Women, but not men, who worsened in weight/shape concerns and/or disordered eating over time also reported significantly decreased self-control from their first to their fourth year.

CONCLUSION

Findings support the role of self-control in the maintenance of weight/shape concerns and disordered eating for both women and men.

LEVEL III

Evidence obtained from well-designed cohort or case-control analytic studies.

Body image and the relation to mindfulness and self-compassion in physical education students: a cross-cultural study

The present study investigated the body images of Omani and German physical education students. 199 students completed a body image test, a dispositional mindfulness and a self-compassion measurement, as well as a short physical activity questionnaire. Overall, our results demonstrate that females showed a higher body distortion than males and students in Germany displayed a higher body distortion effect. Concerning mindfulness and self-compassion, students from Oman showed higher values than German students in self-compassion, but not in the dispositional mindfulness measurement. However, self-compassion and mindfulness were not related to the body distortion effect. This is the first study that provides unique data of self-compassion and mindfulness in an Arabic sample, and shows that self-compassion is higher in Omani students.

A Randomised Controlled Trial Examining the Effects of Self-Compassion Meditations on Women's Body Image

Although research has suggested that body image improves following self-compassion meditation training, studies have been limited due to the use of a wait-list control group. This study therefore compared the effects of self-compassion meditations to an active control group. Seventy young adult women (17-35 years) were randomly assigned to receive either self-compassion or nature-focused guided imagery meditations. Over one week, participants engaged in two meditations and completed pre- and post-test measures of trait self-compassion, body appreciation, body shame, and appearance-contingent self-worth. A mixed design analysis of variance revealed a main effect of time; women in both meditation groups demonstrated significant increases in self-compassion and body appreciation, and significant reductions in body shame. No effect was found for appearance-contingent self-worth. There were no interactions or main effects for group. Self-compassion may improve body image in women, although there was no evidence for an advantage of self-compassion over guided imagery meditations. Common elements between self-compassion and guided imagery may be a mechanism for improving body image. However, further research is warranted to isolate the effects of these meditations from other specific and non-specific treatment effects. (This study was pre-registered with the Australian New Zealand Clinical Trials Registry, ACTRN12618001814268).

Eating Disorder Symptomatology in Adolescent Boys and Girls: Identifying Distinct Developmental Trajectory Classes

Eating disorder symptomatology is highly prevalent in adolescence and is regarded one of the most important precursors of clinical eating disorders. The present longitudinal study examined the development of eating disorder symptomatology in adolescents over two years. At Time 1,528 high school students filled out self-report questionnaires (50.5% female; M_age = 15 years). Multivariate latent growth curve modeling and latent class growth analyses were performed to model latent trajectories and to identify latent trajectory classes. Stable trajectories of drive for thinness and body dissatisfaction were found, whereas bulimia and BMI increased over time. Important gender differences pointed to girls experiencing more eating disorder symptoms at each time point. Additionally, more diverse trajectory classes were found in girls than in boys. Finally, classes with the most eating disorder symptoms also experienced the most problems in identity development, internalizing symptoms, and the least effortful control. The present study underscores the importance of identifying vulnerable adolescents that experience greater eating disorder symptomatology, as they also seem to experience the worst psychosocial development.

A study on the interplay between emerging adulthood and eating disorder symptomatology in young adults

PURPOSE

The primary aim of this study was to investigate the interplay between Arnett's five features of emerging adulthood and ED symptomatology. The secondary aim of the study was to investigate possible gender differences concerning the relation between emerging adulthood and ED symptomatology.

METHODS

337 university students (252 females and 85 males) participated in this study. Each participant was asked to anonymously complete the following questionnaires: Inventory of the Dimensions of Emerging Adulthood (IDEA), Eating Attitudes Test (EAT-26), and Social Physique Anxiety Scale (SPAS).

RESULTS

The female group scored higher in the EAT-26 diet, SPAS, IDEA self-focus and IDEA total score measurements. Additionally, in the female group, identity exploration was correlated with EAT-26 total and bulimia, experimentation/possibilities with EAT-26 total and diet, and negativity/instability with EAT-26 total, diet and bulimia as well as SPAS score. In the male groups, the only significant correlation was between SPAS and instability/negativity. Finally, identity exploration could predict a higher probability of developing ED (EAT ≥ 20) for both the female and male groups.

CONCLUSIONS

Emerging adulthood and ED were found to have a close relationship, especially for females. Identity exploration was the emerging adulthood factor that showed the highest relation to ED symptomatology in both the male and female groups. More research is necessary to investigate the specifics of this relationship.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

The moderating role of self-compassion on weight and shape concerns and eating pathology: A longitudinal study

OBJECTIVE

The present study employed a longitudinal design to examine the moderating role of self-compassion in the relationship between weight/shape concerns and the outcomes of eating pathology and stress in a diverse college student population.

METHOD

Participants were 765 students who completed measures of self-compassion, weight/shape concerns, eating pathology, and stress over their first 2 years of college. We tested whether self-compassion attenuated the relation between weight/shape concerns at the beginning of college and eating pathology, and stress later in college.

RESULTS

For the first year of college, self-compassion significantly moderated the relationship of weight/shape concerns and eating pathology. For participants who were low in self-compassion, there was a stronger relationship between weight/shape concerns and disordered eating; whereas, for individuals high in self-compassion, there was a weaker relationship between weight/shape concerns and disordered eating. However, these findings did not replicate for the second year of college. Self-compassion also significantly moderated the relationship between weight/shape concerns and stress for the first year of college, though the relationship was complex and warrants further research.

DISCUSSION

Our findings suggest that high self-compassion may reduce the likelihood that undergraduate students with weight/shape concerns will engage in disordered eating behavior in the first year of college. They also highlight the influence of self-compassion on general stress.

Empirically derived classes of eating pathology in male and female college students

BACKGROUND

The empirical structure of eating disorder (ED) pathology has often been studied in female, clinical samples, leaving questions about the structure of ED pathology in males and nonclinical samples.

METHOD

A latent class analysis was performed on data combined from two different studies (N = 1,751) using the behavioral items in the Eating Disorder Examination Questionnaire (EDE-Q; binge eating, self-induced vomiting, laxative use, and excessive exercise), with the addition of an item representing restraint. Validation analyses examined weight, shape, and eating concern among the classes.

RESULTS

Three similar classes emerged for both the men and women's models: very low ED behaviors, binge eating, and high ED behaviors.

DISCUSSION

These results suggest that binge eating occurs within the context of lower symptom and higher symptom presentations, and that the empirical structure of ED symptoms does not differ in men and women in the nonclinical population. Further research is needed to clarify whether ED phenotypes differ in men and women.

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.

Stability and change in patterns of eating disorder symptoms from adolescence to young adulthood

Using a community adolescent sample, we aimed to (a) empirically derive eating disorder (ED) symptom groups, (b) examine the longitudinal stability of those groups over 10 years, and (c) identify risk factors associated with ED group stability and transition through young adulthood. Young people (N = 2,287) from the Project EAT cohort participated at baseline (1998-1999) and at 10-year follow-up (2008-2009). Participants completed anthropometric measures at baseline and self-report surveys on disordered eating symptoms and risk factors at both time points. Latent transition modeling was used to test the first two aims and multinomial logistic regression was used for the third aim. Three groups emerged and were labeled as: (a) asymptomatic, (b) dieting, (c) disordered eating (e.g., binge eating, compensatory behaviors). Stability of group membership over 10 years was highest for those in the asymptomatic group, while those in the dieting group showed equal likelihood of transitioning to any group. There was a 75% chance that those in the disordered eating group would continue to belong to a symptomatic group 10 years later. We found that these transitions could be predicted by baseline risk factors. For example, adolescents with one standard deviation higher depressive symptoms than their peers had 53% higher odds (OR = 1.53, 95% CI 1.09-2.16) of transitioning from the asymptomatic group to the disordered eating group. Transition among ED groups is relatively common during adolescence and early adulthood. By targeting risk factors such as self-esteem and familial factors in early adolescence, prevention efforts may be improved.

Eating disorder behaviours amongst adolescents: investigating classification, persistence and prospective associations with adverse outcomes using latent class models

Diagnostic criteria for eating disorders (ED) remain largely based on clinical presentations, but do not capture the full range of behaviours in the population. We aimed to derive an empirically based ED behaviour classification using behavioural and body mass index (BMI) indicators at three time-points in adolescence, and to validate classes investigating prospective associations with adverse outcomes. Adolescents from the Avon Longitudinal Study of Parents and Children (ALSPAC) provided data on ED at age 14 (n = 6615), 16 (n = 5888), and 18 years (n = 5100), and had weight and height measured. Psychological and behavioural outcomes were assessed at 15.5/16 and 17.5/18 years. We fit gender- and age-stratified latent class models, and employed logistic regression to investigate associations between classes and later outcomes. One asymptomatic and two symptomatic (largely representing higher and lower frequency ED behaviours) classes were observed at each time-point, although their relative prevalence varied by age and gender. The majority of girls in symptomatic classes remained symptomatic at subsequent assessments. Girls in symptomatic classes had higher odds of subsequent anxiety and depressive disorders, binge drinking, drug use, and deliberate self-harm. Data analyses were underpowered amongst boys. The presence of two symptomatic classes (characterised by different ED behaviour frequency) and their prospective association with adverse outcomes suggest a need to refine diagnostic thresholds based on empirical data. Despite some instability of classes, particularly in mid-adolescence, evidence that half of girls in symptomatic classes remained symptomatic suggests persistence of ED behaviours in adolescence, and highlights a need for early identification to reduce chronicity.

Brief self-compassion meditation training for body image distress in young adult women

Self-compassion interventions may be uniquely suited to address body image distress (BID), as change-based strategies may have limited utility in a cultural context that so highly values appearance. The current study evaluated a version of an Internet-based self-compassion training, which had previously shown promising results, but was limited by high attrition. The intervention period was reduced from three weeks to one week in the present study to improve retention. Eighty undergraduate women endorsing body image concerns were randomized to either self-compassion meditation training or a waitlist control group. Results suggest that brief exposure to the basic tenets of self-compassion holds promise for improving aspects of self-compassion and BID. Attrition was minimal, but compliance with meditation practice instructions during the week was low. Efforts are needed to improve engagement, but this approach has the potential to be an acceptable and cost effective method to reduce BID.

Mixture modeling methods for the assessment of normal and abnormal personality, part II: longitudinal models

Studying personality and its pathology as it changes, develops, or remains stable over time offers exciting insight into the nature of individual differences. Researchers interested in examining personal characteristics over time have a number of time-honored analytic approaches at their disposal. In recent years there have also been considerable advances in person-oriented analytic approaches, particularly longitudinal mixture models. In this methodological primer we focus on mixture modeling approaches to the study of normative and individual change in the form of growth mixture models and ipsative change in the form of latent transition analysis. We describe the conceptual underpinnings of each of these models, outline approaches for their implementation, and provide accessible examples for researchers studying personality and its assessment.

Response patterns on interview and questionnaire versions of the Eating Disorder Examination and their impact on latent structure analyses

OBJECTIVE

The purpose of this investigation was to compare the latent structures of the interview (EDE) and questionnaire (EDE-Q) versions of the Eating Disorder Examination.

METHODS

Participants were 280 children, adolescents, and young adults seeking eating disorder treatment. Two separate latent structure analyses (LSAs) were conducted; one used variables from the EDE as indicators and the other used the corresponding variables from the EDE-Q as indicators.

RESULTS

The EDE and EDE-Q models both yielded four-class solutions. Three of the four classes from the EDE-Q model demonstrated moderate to high concordance with their paired class from the EDE model. Using the EDE-Q to detect the EDE, the sensitivity and specificity of measuring certain classes varied from poor (18.6%) to excellent (93.7%). The overall concordance was moderate (κ=.49).

DISCUSSION

These data suggest that LSAs using the EDE and EDE-Q may be directly compared; however, differences between results may represent inconsistencies in response patterns rather than true differences in psychopathology.

Latent profile and latent transition analyses of eating disorder phenotypes in a clinical sample: a 6-year follow-up study

The DSM-IV classification of Eating Disorders (EDs) identifies clinical entities showing considerable overlap and diagnostic instability across time. Latent profile analysis (LPA) allows the identification of underlying groups of individuals according to their patterned responses across a set of features. LPA was applied to data regarding EDs symptoms of a clinical sample of 716 EDs patients, with a current DSM-IV diagnosis of threshold and subthreshold EDs. Latent transition analysis (LTA) was used to examine the longitudinal stability of the obtained profiles. The latent profiles were compared for psychopathological variables and long-term outcomes (recovery, relapse), based on a 6-year follow-up after a cognitive behavioural treatment. Five different phenotypes were identified: "severe binging", "moderate binging", "restricted eating", "binge and moderate purging", and "binge and severe purging". The relevance of this characterization was confirmed by the differences in terms of psychopathological features and outcomes. Over the long term, a three-profile solution was adopted, clustering the subjects into "binge eating", "binge eating and purging", and "restricted eating". Latent profiles showed a moderate stability over the 6-year period, with probability estimates of stability within status over time of 0.57 for "binge eating", 0.40 for "binge eating and purging", and 0.41 for "restricted eating". The implications for DSM 5 were discussed, and the relative high rate of transition within phenotypes confirmed the significant instability of EDs phenomenology.

A measure of family eating habits: initial psychometric properties using the profile pattern approach (PPA)

Although it seems likely that family characteristics and eating habits are a major factor in the development of eating behaviors, there are no self-report measures that examine how individuals view their family's eating habits. Seventy-one women ages 18-22 were recruited from a private university in a large northeastern city and asked to complete a short questionnaire packet consisting of demographic questions, the newly developed Family Eating Habits Questionnaire (FEHQ) and the Eating Inventory (EI). Internal consistency and test-retest reliability of the FEHQ was established. Significant associations were found between the FEHQ and the EI, indicating convergent validity for the FEHQ. Further validation was conducted using a novel statistical technique, the profile pattern approach (PPA). The results of the present study are limited by the restricted sample characteristic of a university setting. However, our findings show that the family eating habits' measure appears psychometrically sound. A future aim will be to continue validating this instrument in other samples, particularly to determine its predictive value.

A Monte Carlo investigation of factors influencing latent class analysis: an application to eating disorder research

OBJECTIVE

Latent class analysis (LCA) has frequently been used to identify qualitatively distinct phenotypes of disordered eating. However, little consideration has been given to methodological factors that may influence the accuracy of these results.

METHOD

Monte Carlo simulations were used to evaluate methodological factors that may influence the accuracy of LCA under scenarios similar to those seen in previous eating disorder research.

RESULTS

Under these scenarios, the aBIC provided the best overall performance as an information criterion, requiring sample sizes of 300 in both balanced and unbalanced structures to achieve accuracy proportions of at least 80%. The BIC and cAIC required larger samples to achieve comparable performance, while the AIC performed poorly universally in comparison. Accuracy generally was lower with unbalanced classes, fewer indicators, greater or nonrandom missing data, conditional independence assumption violations, and lower base rates of indicator endorsement.

DISCUSSION

These results provide critical information for interpreting previous LCA research and designing future classification studies.

The relationship between anxiety sensitivity and disordered eating: the mediating role of experiential avoidance

This study examined the role of experiential avoidance in the association between dimensions of anxiety sensitivity (AS) and disordered eating. A sample of 395 undergraduate students completed a series of questionnaires assessing the constructs of interest. Results indicate that the AS dimension of fear of cognitive dyscontrol was significantly uniquely associated with disordered eating. Furthermore, results provide support for a model in which experiential avoidance mediates the association between fear of cognitive dyscontrol and disordered eating. Findings of the present study highlight one potential mechanism underlying the association between AS and disordered eating, suggesting that efforts to avoid internal experiences may play a role in eating pathology. Clinical implications of these findings are discussed.

An investigation of the joint longitudinal trajectories of low body weight, binge eating, and purging in women with anorexia nervosa and bulimia nervosa

OBJECTIVES

To describe the longitudinal course of three core eating disorder symptoms-low body weight, binge eating, and purging-in women with anorexia nervosa (AN) and bulimia nervosa (BN) using a novel statistical approach.

METHOD

Treatment-seeking women with AN (n = 136) or BN (n = 110) completed the Eating Disorders Longitudinal Interval Follow-Up Evaluation interview every 6 months, yielding weekly eating disorder symptom data for a 5-year period. Semiparametric mixture modeling was used to identify longitudinal trajectories for the three core symptoms.

RESULTS

Four individual trajectories were identified for each eating disorder symptom. The number and general shape of the individual trajectories was similar across symptoms, with each model including trajectories depicting stable absence and stable presence of symptoms as well as one or more trajectories depicting the declining presence of symptoms. Unique trajectories were found for low body weight (fluctuating presence) and purging (increasing presence). Conjunction analyses yielded the following joint trajectories: low body weight and binge eating, low body weight and purging, and binge eating and purging.

DISCUSSION

The course of individual eating disorder symptoms among patients with AN and BN is highly variable. Future research identifying clinical predictors of trajectory membership may inform treatment and nosological research.