Perceived physical appearance mediates the rumination and bulimic symptom link in adolescent girls

Longitudinal associations between response-style strategies and abnormal eating behaviors/attitudes in adolescents: a cross-lagged panel model

BACKGROUND

Previous studies have suggested that response-style strategies (rumination, problem-solving, and distraction) can be risk or protective factors for the development of abnormal eating behaviors/attitudes (AEB) during adolescence. However, due to limited empirical data regarding the prospective effects of these strategies on AEB, further research is needed to clarify their role in developing AEB in adolescence.

METHODS

This study investigated the one-year lagged effects of response-style strategies on AEB in 24,883 fourth- to eighth-grade students in Japan between 2015 and 2019 using a cross-lagged panel model. Depressive symptoms and body mass index (BMI), which are reported to relate to AEB, were also included in the analytic model. The students self-reported their levels of response-style strategies, AEB, and depressive symptoms. We also evaluated BMI based on teachers' reports.

RESULTS

We found that greater rumination significantly predicted more severe AEB in the following year among students from all grades, with small to moderate effect sizes. In addition, distraction significantly predicted more severe binge eating/purging behaviors, but with very weak small effect sizes. Problem-solving did not predict any level of AEB. Furthermore, we observed significant reciprocal relationships between response-style strategies, AEB, and depressive symptoms. Positive reciprocal associations between BMI and AEB were also found except for some intervals.

CONCLUSIONS

We concluded that a decrease in rumination is critical to alleviating mental health problems, such as AEB and depressive symptoms, during adolescence. This suggests that interventions to reduce the level of rumination should be conducted in the early stages of adolescence.

TRIAL REGISTRATION NUMBER

Not Applicable.

Attachment, rumination, and disordered eating among adolescent girls: The moderating role of stress

PURPOSE

Disordered eating behaviors are prevalent and problematic in adolescent girls. Given that disordered eating has been linked to attachment insecurity and emotion dysregulation, the current study used an emotion regulation model of attachment theory to investigate pathways to disordered eating among adolescent girls. While past research has examined attachment and eating, an emotion regulation perspective is rarely used. Additionally, limited studies have investigated specific types of eating or mediators or moderators. To address these research gaps, this study examined whether rumination mediates the relationship between attachment anxiety and avoidance and three types of disordered eating and whether stress moderates this mediation.

METHODS

100 adolescent girls (M_age = 14.35 years, SD = 2.29) completed online surveys including the Relationship Structures Questionnaire, Dutch Eating Behaviour Questionnaire, Rumination Questionnaire, and Perceived Stress Scale.

RESULTS

The interaction between stress and attachment anxiety on rumination was significant (b = .09, SE = .04, p < .05), and stress and attachment anxiety predicted emotional eating through rumination (b = .50, SE = .15, p < .05). Rumination also predicted external eating (b = .32, SE = .11, p < .05). The mediation was not significant for restrained eating. Attachment avoidance did not significantly predict eating behaviors.

CONCLUSION

The emotion regulation model of attachment theory provides a suitable framework for studying disordered eating in adolescent girls. Future research may continue the use of this framework to examine related topics. Clinicians treating girls experiencing disordered eating may use interventions to promote healthy emotion regulation strategies.

LEVEL OF EVIDENCE

Level V: cross-sectional descriptive study.

Rumination and perceived social support from significant others interact to predict eating disorder attitudes and behaviors in university students

University students are at a greater risk for eating disorder attitudes and behaviors (EDAB) compared to the general population. This study examined the roles of rumination and perceived social support (PSS) from three domains in the occurrence of EDAB. Participants: A sample of students (N= 300) attending a rural Midwestern university. Methods: Participants completed online surveys which collected demographic information and assessed eating disorders, rumination, and PSS. Pearson's correlation and moderated regression were performed for analysis. Results: Of the sample, 63.6% of participants identified as women, 34.8% as men, and 1.7% with another gender. PSS from family and friends was negatively associated with EDAB. Rumination was positively associated with EDAB. High rumination and high PSS from significant others interacted to predict eating, shape, and weight concerns, but not dietary restraint. Conclusions: Findings support incorporating screening tools for PSS and rumination at on-campus counseling sessions to identify students at risk for EDAB.

Determining the potential links of self-compassion with eating pathology and body image among women and men: A cross-sectional mediational study

This study examined whether rumination, shame, self-criticism, and perfectionism mediate the previously established link between self-compassion and both eating and body image concerns. A cross-sectional online survey was completed by a community sample of non-clinical adult women (n = 369) and men (n = 201). Participants completed standardised measures of self-compassion (predictor), rumination, external shame, perfectionism and self-criticism (mediating variables), and eating pathology and body image (criterion variables). Path analyses confirmed that higher self-compassion was serially linked to lower eating pathology and body dissatisfaction through comparative self-criticism and external shame. Compared with women, the association between higher self-compassion and lower body dissatisfaction was weaker in men. However, there were no mediating effects of rumination, perfectionism, or internalized self-criticism. Overall results indicate notable similarities between women and men, and emphasise the potential value of targeting external shame during eating disorder prevention and treatment. Longitudinal study of these constructs is warranted in future research.

Repetitive Negative Thinking and Eating Disorders: A Meta-Analysis of the Role of Worry and Rumination

The role of worry and rumination in eating disorders (EDs) is controversial. This meta-analysis of the literature is aimed at clarifying the relationship between repetitive negative thinking (RNT) and EDs. In accordance with the PRISMA criteria, a comprehensive search of the literature was conducted on PubMed and PsycInfo from inception to March 2021. Search terms: “eating disorder/anorexia/bulimia/binge eating disorder” AND “worry/rumination/brooding/repetitive thinking”. A manual search of reference lists was also run. Forty-three studies were included. RNT was found to be associated with anorexia, bulimia, and binge eating disorder. A moderating effect was found for “presence/absence ED diagnosis” and “subtype of ED symptom”. ED patients showed higher RNT than the general population. No differences were observed for age or between worry and rumination in the magnitude of their association with EDs.

The unique associations between self-compassion and eating disorder psychopathology and the mediating role of rumination

Mindfulness reduces eating disorder (ED) psychopathology. Self-compassion is a related but distinct construct that may predict other clinical outcomes more strongly than does mindfulness. Previous evidence suggests that self-compassion is associated with less ED psychopathology, although no studies have compared the unique effects of self-compassion and mindfulness. Moreover, few studies have explored mechanisms of this association. The current survey study explored the unique association between self-compassion and ED psychopathology, controlling for mindfulness, as well as whether depressive rumination mediates this association. One hundred and ninety undergraduates completed questionnaires assessing self-compassion, mindfulness, depressive rumination, and ED psychopathology at baseline and five months later. In cross-sectional and longitudinal analyses, self-compassion predicted ED psychopathology even when controlling for mindfulness. By contrast, mindfulness did not predict ED psychopathology when controlling for self-compassion. Depressive rumination mediated the unique association between self-compassion and ED psychopathology in cross-sectional but not longitudinal analyses. The current findings suggest that self-compassion may be a more proximal predictor of ED psychopathology than is mindfulness. Additional research will need to further explore whether depressive rumination is a mechanism of this effect.

Effects of induced rumination on body dissatisfaction: Is there any difference between men and women?

BACKGROUND AND OBJECTIVES

Rumination is a factor in the development and maintenance of body dissatisfaction. However, no study has yet investigated the impact of the type of rumination on body image. The first aim of this study was to examine whether the induction of analytic-abstract vs. concrete-experiential rumination affects body dissatisfaction following an induction of negative body image. The second objective was to examine gender differences in these effects.

METHODS

Following induction of negative body image, 102 university undergraduates were randomly assigned to one of three experimental conditions-distraction, concrete rumination or abstract rumination.

RESULTS

As expected, there were significant main effects of gender and condition, and a significant interaction between gender and condition on change in body dissatisfaction. In women abstract rumination predicted the highest increase in body dissatisfaction, whereas concrete rumination predicted the highest increase in body dissatisfaction in men.

LIMITATIONS

Given that our sample consisted of undergraduate students, our findings cannot be generalized to clinical sample suffering from eating disorder.

CONCLUSIONS

The different types of rumination seem to impact differentially body dissatisfaction in men and women.

A Reformulated Architecture of Cognitive Risks for Psychopathology: Common and Specific Dimensions and Links to Internalizing Outcomes in Adolescence

Multiple cognitive risk products (dysfunctional attitudes [DA], negative inferential style [NIS], self-criticism, dependency, rumination) predict internalizing disorders; however, an optimal structure to assess these risks is unknown. We evaluated the fit, construct validity, and utility of a bifactor, single, and correlated factor model in a community sample of 382 adolescents (age 11-15 years; 59% female). The bifactor, hierarchical single, and correlated factor models all fit well. The bifactor model included a common factor (c), capturing covariance across all cognitive risk measures, and specific latent factors for DA, NIS, dependency and rumination. Construct validity of these factor structures was evaluated with external validators, including depression and anxious arousal (AA) symptoms, positive affect (PA) and negative affect (NA), and onset of depression diagnostic onset over 2 years. C was associated with higher depression, NA, and AA; lower PA; and predicted depressive episodes. Hierarchical single and correlated factor models also related to external validators.

The unique effects of angry and depressive rumination on eating-disorder psychopathology and the mediating role of impulsivity

Negative affect and maladaptive emotion regulation strategies are associated with eating-disorder (ED) psychopathology. Depressive rumination is a maladaptive cognitive style associated with the onset, maintenance, and severity of ED psychopathology among both clinical and nonclinical samples. However, although anger is also strongly associated with ED behaviors, the associations between angry rumination and ED psychopathology, as well as mechanisms of the relationships between rumination and ED psychopathology, remain largely unknown. The current study sought to examine the unique influences of trait depressive and angry rumination on ED psychopathology and whether trait negative urgency (i.e., responding rashly to negative affect) mediated these relationships. Study 1 sampled undergraduate students (N = 119) cross-sectionally and longitudinally (five months), and Study 2 sampled patients with eating disorders (N = 85). All participants completed questionnaires assessing angry rumination, depressive rumination, ED psychopathology, and negative urgency. Angry rumination had consistent indirect effects on ED psychopathology via negative urgency among both clinical and nonclinical samples. However, there was mixed support for the influence of depressive rumination: whereas depressive rumination showed total and indirect effects on ED psychopathology in Study 1 cross-sectional analyses, no total or indirect effects emerged in Study 1 longitudinal analyses or in Study 2. Associations between depressive rumination and ED psychopathology may reflect the strong overlap between angry and depressive rumination. Interventions targeting angry rumination and negative urgency may enhance prevention and treatment of disordered eating across eating disorder diagnosis and severity.

Rumination and eating disorder psychopathology: A meta-analysis

Rumination is a cognitive process involving repetitive thoughts about negative experiences and emotions and is associated with psychopathology. Rumination has been implicated in mood and anxiety disorders, and there is a growing body of research on rumination in relation to eating disorder (ED) psychopathology. The current meta-analytic review focused on the literature addressing rumination and ED psychopathology. A comprehensive search process identified 38 studies, which primarily used cross-sectional designs with non-clinical samples. Results demonstrated that rumination was concurrently (r = 0.33) and prospectively (r = 0.22-0.23) associated with ED psychopathology, and that groups with ED psychopathology evidenced higher levels of rumination compared to non-ED control groups (g = 0.95), though no significant differences in rumination were observed when comparing anorexia nervosa to bulimia nervosa groups (g = 0.09). In addition, a narrative review of five experimental studies suggested that rumination in response to ED-related stimuli was related to increased negative affect and negative body-related cognitions across clinical and non-clinical samples. The type of rumination and sample population emerged as moderators of effect sizes, such that larger effects were observed among samples using ED-specific measures of rumination and heterogeneous samples compared to only non-clinical samples. Taken together, this literature demonstrates that rumination is a salient process in ED psychopathology, though the literature is characterized by methodological limitations and the need for more fully elaborated theories on the role of rumination in EDs. Findings are discussed in the context of existing models of rumination and ED psychopathology, with suggestions for future research in this area.

Rumination in Patients with Binge-Eating Disorder and Obesity: Associations with Eating-Disorder Psychopathology and Weight-bias Internalization

Overvaluation of shape and weight in binge-eating disorder (BED) is associated with greater eating-disorder psychopathology and greater weight-bias internalization, which are-in turn-associated with poorer mental and physical health. Little is known, however, about the significance of other cognitive processes, such as rumination, in BED. This study examined rumination and overvaluation of shape/weight with eating-disorder psychopathology and weight-bias internalization among 237 treatment-seeking patients with BED and comorbid obesity. Hierarchical multiple regressions indicated that rumination was associated with eating-disorder psychopathology and weight-bias internalization above and beyond the influence of overvaluation of shape/weight. Findings suggest that, among patients with BED/obesity, rumination is an important cognitive process associated with severity of eating-disorder psychopathology even after accounting for overvaluation of shape/weight. Patients with greater rumination might be more likely to dwell on weight-based discrimination experiences and internalize these negative attitudes. Additional controlled examination could determine whether rumination represents another potential target for BED/obesity treatment. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Rumination and self-control interact to predict bulimic symptomatology in college students

Recent studies suggest that a ruminative response style may contribute to the development and maintenance of Bulimia nervosa. However it is not clear what factors may contribute to the relationship between rumination and BN. One factor may be self-control, as studies suggest that BN symptomatology relates to deficits in self-control. In the present study, we hypothesized that the association between rumination and BN symptomatology would be the strongest among individuals with lower self-control relative to those with higher self-control. Participants were 353 students at a large university. Participants completed measures of self-control, rumination, and eating disorder symptomology as part of an online study. A hierarchical regression supported an interaction between rumination and self-control predicting bulimic symptomatology, controlling for BMI. Individuals with higher levels of rumination presented more bulimic symptoms if they also had lower levels of self-control, supporting our hypothesis. Based on these findings, assessing rumination in conjunction with self-control among individuals who present with eating concerns may help to direct treatment. Additionally, clinical interventions increasing self-control may also alleviate some BN symptoms in ruminators.

Do children emotionally rehearse about their body image?

This study examined the association between propensity for emotional rehearsal, body image self-perception and weight status in Chinese Hong Kong pre-adolescents. Children 8-12 years of age (n = 278) completed measurement of body mass index, body image and emotional rehearsal. Multinomial regression analyses revealed that body mass index was positively associated with body image dissatisfaction and a significant predictor of body size estimation. However, only body size underestimation was associated with lower rehearsal tendencies. The prevalence of body image dissatisfaction and body size estimation was also reported for this population. Future research is suggested for greater understanding of emotional coping in body image dissatisfaction in young children.

Future directions in vulnerability to depression among youth: integrating risk factors and processes across multiple levels of analysis

Depression is a developmental phenomenon. Considerable progress has been made in describing the syndrome, establishing its prevalence and features, providing clues as to its etiology, and developing evidence-based treatment and prevention options. Despite considerable headway in distinct lines of vulnerability research, there is an explanatory gap in the field's ability to more comprehensively explain and predict who is likely to become depressed, when, and why. Still, despite clear success in predicting moderate variance for future depression, especially with empirically rigorous methods and designs, the heterogeneous and multi-determined nature of depression suggests that additional etiologies need to be included to advance knowledge on developmental pathways to depression. This paper advocates for a multiple levels of analysis approach to investigating vulnerability to depression across the lifespan and providing a more comprehensive understanding of its etiology. One example of a multiple levels of analysis model of vulnerabilities to depression is provided that integrates the most accessible, observable factors (e.g., cognitive and temperament risks), intermediate processes and endophenotypes (e.g., information-processing biases, biological stress physiology, and neural activation and connectivity), and genetic influences (e.g., candidate genes and epigenetics). Evidence for each of these factors as well as their cross-level integration is provided. Methodological and conceptual considerations important for conducting integrative, multiple levels of depression vulnerability research are discussed. Finally, translational implications for how a multiple levels of analysis perspective may confer additional leverage to reduce the global burden of depression and improve care are considered.

Rumination and body dissatisfaction interact to predict concurrent binge eating

Based upon the escape theory (Baumeister, 1991; Heatherton & Baumeister, 1991) and the emotional cascade model (Selby, Anestis, & Joiner, 2008), it was hypothesized that body dissatisfaction and rumination tendencies would interact to predict concurrent binge eating symptoms. This hypothesis was tested in a sample of 780 undergraduate students. The results conformed to prediction, in that individuals with high levels of body dissatisfaction were most likely to report binge eating behavior when they also had a tendency to ruminate. This interaction had a significant association with binge eating, above and beyond variance accounted for by participant sex, depression symptoms, and body mass index. Moreover, there was evidence of specificity for the model, as the interaction did not predict concurrent problematic drinking. Our findings suggest compatibility between the escape theory and emotional cascade models, and identify two factors that, in combination, may render individuals particularly vulnerable to binge eating.

Multi-wave prospective examination of the stress-reactivity extension of response styles theory of depression in high-risk children and early adolescents

The current study tested the stress-reactivity extension of response styles theory of depression (Nolen-Hoeksema Journal of Abnormal Psychology 100:569-582, 1991) in a sample of high-risk children and early adolescents from a vulnerability-stress perspective using a multi-wave longitudinal design. In addition, we examined whether obtained results varied as a function of either age or sex. During an initial assessment, 56 high-risk children (offspring of depressed parents; ages 7-14) completed measures assessing rumination and depressive symptoms. Children were subsequently given a handheld personal computer which signalled them to complete measures assessing depressive symptoms and negative events at six randomly selected times over an 8-week follow-up interval. In line with hypotheses, higher levels of rumination were associated with prospective elevations in depressive symptoms following the occurrence of negative events. Sex, but not age, moderated this association. Rumination was more strongly associated with elevations in depressive symptoms following the occurrence of negative events in girls than in boys.

The effects of rumination on the timing of maternal and child negative affect

The current study examined whether rumination serves as a moderator of the temporal association between maternal and child negative affect. Participants included 88 mothers with a history of major depressive episodes and their 123 children. During an initial assessment, mothers and their children completed measures assessing negative affect and children completed a measure assessing the tendency to ruminate in response to such symptoms. Every 6 weeks for the subsequent year, mothers and their children completed measures assessing negative affect. Consistent with hypotheses, children with a ruminative response style were more likely than other children to report elevations in negative affect when their mothers' level of negative affect increased over time. Neither child gender nor mothers' current clinical depression status moderated the association between child rumination and maternal negative affect.

Emotion regulation and psychopathology: the role of gender

This review addresses three questions regarding the relationships among gender, emotion regulation, and psychopathology: (a) are there gender differences in emotion regulation strategies, (b) are emotion regulation strategies similarly related to psychopathology in men and women, and (c) do gender differences in emotion regulation strategies account for gender differences in psychopathology? Women report using most emotion regulation strategies more than men do, and emotion regulation strategies are similarly related to psychopathology in women and men. More rumination in women compared to men partially accounts for greater depression and anxiety in women compared to men, while a greater tendency to use alcohol to cope partially accounts for more alcohol misuse in men compared to women. The literature on emotion regulation is likely missing vital information on how men regulate their emotions. I discuss lessons learned and questions raised about the relationships between gender differences in emotion regulation and gender differences in psychopathology.

A Heuristic for Developing Transdiagnostic Models of Psychopathology

Transdiagnostic models of psychopathology are increasingly prominent because they focus on fundamental processes underlying multiple disorders, help to explain comorbidity among disorders, and may lead to more effective assessment and treatment of disorders. Current transdiagnostic models, however, have difficulty simultaneously explaining the mechanisms by which a transdiagnostic risk factor leads to multiple disorders (i.e., multifinality) and why one individual with a particular transdiagnostic risk factor develops one set of symptoms while another with the same transdiagnostic risk factor develops another set of symptoms (i.e., divergent trajectories). In this article, we propose a heuristic for developing transdiagnostic models that can guide theorists in explicating how a transdiagnostic risk factor results in both multifinality and divergent trajectories. We also (a) describe different levels of transdiagnostic factors and their relative theoretical and clinical usefulness, (b) suggest the types of mechanisms by which factors at 1 level may be related to factors at other levels, and (c) suggest the types of moderating factors that may determine whether a transdiagnostic factor leads to certain specific disorders or symptoms and not others. We illustrate this heuristic using research on rumination, a process for which there is evidence it is a transdiagnostic risk factor.