Examining Food-Specific and General Inhibitory Control and Working Memory as Moderators of Relations Between Emotion Regulation Difficulties and Eating Pathology in Adults With Overweight/Obesity: A Preregistered, Cross-Sectional Study

OBJECTIVE

Empirical research and theory support the interaction of executive functions (e.g., inhibitory control, working memory) and emotion regulation in guiding goal-oriented behavior; however, applications to eating pathology (e.g., binge eating) are limited. Such research is scant with adults with overweight/obesity (AwO/O), a population reporting high levels of binge eating, emotion regulation difficulties, and deficits in inhibitory control and working memory. We tested interactions between emotion regulation and executive functioning in relation to eating pathology in AwO/O while considering stimuli-specific deficits (e.g., food-specific deficits) in behavioral task performance.

METHOD

AwO/O (N = 204; MBMI = 32.11; Mage = 38.30 [SD = 12.16]) completed a preregistered, online study assessing demographics and emotion regulation difficulties (Difficulties in Emotional Regulation Scale), inhibitory control (go/no-go task, food and general stimuli), working memory (N-Back Task, food and general stimuli), binge eating (Binge Eating Scale), and disordered eating (Eating Disorder Examination-Questionnaire).

RESULTS

There was limited evidence of moderation in models examining food-specific and general inhibitory control and working memory, emotion regulation difficulties, and binge eating. Preliminary support was found for emotion regulation difficulties to be more strongly associated with more disordered eating in AwO/O reporting more food-specific and general working memory deficits. Consistent, positive associations between emotion regulation difficulties and eating pathology were observed.

CONCLUSIONS

Among adults with AwO/O, emotion regulation difficulties are closely related to eating pathology, regardless of performance on working memory and inhibitory control tasks. Clinicians and researchers working with AwO/O may consider how emotion regulation difficulties and working memory deficits work together to influence disordered eating.

Examining gender difference in disordered eating behaviour and its associated factors among college and university students in Sarawak

Background: Disordered eating is common among late adolescents and young adults who pursue an idealised body image. Aims: This study aims to determine the prevalence of disordered eating between males and females and its associated factors among college and university students in Sarawak. Methods: A cross-sectional study involving 20 public and private colleges and universities in Sarawak, from September 2017 to March 2020. Respondents completed self-administered questionnaires both in the English and Malay language. Data about sociodemographic characteristics, body mass index, eating attitude, body dissatisfaction, perceived sociocultural pressure, self-esteem, drive for muscularity and perfectionism were collected. Results: A total of 776 respondents (male: 30.9%; female: 69.1%) aged 19 to 25 years old took part in the study. The overall prevalence of disordered eating was 25.2% (95% confidence interval (CI) 21.9; 28.7) with females (28.6%, 95% CI 24.6; 32.9) higher than males (15.6%, 95% CI 10.5; 21.9). Multivariate analysis showed for both male and female models, perceived sociocultural pressure (male: β = 1.125, p < 0.01; female: β = 1.052, p = 0.003), drive for muscularity (male: β = 1.033, p = 0.017; female: β = 1.032, p < 0.01) and perfectionism (male: β = 1.098, p = 0.02; female:β = 1.119, p < 0.01) were predictors for disordered eating. Conclusion: The prevalence of disordered eating among college and university students in Sarawak was high. The findings suggest that although there were gender differences in the prevalence of disordered eating, its associated factors were the same. The findings of this study will be useful for designing and implementing disordered eating prevention and intervention programme.

Identifying factors that predict the onset and persistence of fasting for weight control: Prospective findings

OBJECTIVE

Fasting for weight control is an under-studied behaviour implicated in eating disorders. However, little is known about what factors account for its onset and persistence.

METHOD

This study sought to identify risk and maintenance factors for fasting among 1025 women recruited through an eating disorder self-help platform who completed study measures at baseline and 6 month follow-up. Univariate and multivariate logistic regressions were performed to test which variables at baseline predicted the onset (vs. stably asymptomatic) and persistence (vs. remission) of fasting at follow-up.

RESULTS

Univariate models showed that higher baseline overvaluation, dissatisfaction, fear of weight gain, generalised and social anxiety, depression, self-esteem deficits and eating disorder symptoms (inflexible eating rules, driven exercise) predicted greater likelihood of fasting onset. Only fear of weight gain and depressive symptoms remained significant in the multivariate model. Higher baseline overvaluation, fear of weight gain, driven exercise, inflexible eating rules, and depression predicted greater likelihood of fasting persistence in univariate models. An adherence to inflexible eating rules and overvaluation remained significant in the multivariate model.

CONCLUSION

Findings shed new light on factors that may account for the development and maintenance of fasting, which have implications for guiding effective interventions targeting this behaviour.

Latent Change Trajectories in Mood During Focused CBT Enhanced for Eating Disorders Are Associated With Global Eating Pathology at Posttreatment and Follow-Up Among Individuals With Bulimia Nervosa Spectrum Disorders: A Preliminary Examination

Bulimia nervosa (BN) is characterized by recurrent loss of control over eating (LOC) and inappropriate compensatory behaviors. Although cognitive-behavioral therapy (CBT) is efficacious for BN, many patients continue to experience symptoms at posttreatment. One potential driver of this low treatment response may be low mood, which maintains BN symptoms through negative reinforcement. Thus, it is important to understand how mood changes over enhanced cognitive-behavioral therapy (CBT-E) and whether these changes are associated with improved treatment outcomes. Participants (N = 56) with BN-spectrum eating disorders (EDs) received 16 sessions of the focused version of CBT-E. The Eating Disorder Examination (EDE) was used to measure ED symptoms (global ED pathology, frequency of binge episodes, and compensatory behaviors) at pre- and posttreatment. Latent growth mixture modeling (LGMM) of affective ratings via digital self-monitoring identified latent growth classes. Kruskal-Wallis H tests examined the effect of trajectory of change in mood on pre- to posttreatment symptom change. LGMM yielded a four-class model that best fit the data representing distinct mood trajectories over the course of treatment: (a) highest baseline mood, linear improving; (b) moderate baseline mood, stable; (c) moderate baseline mood, quadratic worsening; and (d) lowest baseline mood, quadratic improving. Participants who demonstrated worsening mood over treatment (i.e., individuals in the "moderate baseline mood, quadratic worsening" class) had significantly higher EDE global scores at posttreatment and follow-up compared to participants with stable mood across treatment. Change in LOC eating frequency and compensatory behaviors across treatment did not significantly differ by mood class. The main effect of mood class or interaction effect between time and mood class on objective binge episodes, subjective binge episodes, and compensatory behaviors was not significant. There were no significant differences in global ED pathology at either posttreatment or follow-up for any other class comparisons. These results suggest that certain trajectories of change in mood during treatment are particularly associated with change in pre- to posttreatment EDE global score. If replicated, our findings could suggest that future iterations of CBT-E should target mood early in treatment in order to maximize reductions in global eating pathology.

The Moderating Effect of Suggestibility on the Relationship between Body Mass Index and Body Dissatisfaction in Women

Background: Body dissatisfaction (BD) has been consistently linked to adverse consequences on mental health and overall well-being, and is recognized as a significant contributing factor in the initiation and persistence of eating disorders (EDs). Empirical evidence has demonstrated that an elevated body mass index (BMI) and media influence and pressure about a thin ideal heighten the risk of subsequent BD. Moreover, suggestibility, a propensity to accept and act upon messages without critical evaluation, has been shown to be positively associated with greater susceptibility to the influence of sociocultural messages that endorse the thin ideal. This study aimed to assess whether suggestibility moderates the association between BMI and BD in women. Methods: A total of 117 women completed assessments using the Eating Disorder Inventory-3 (EDI-3) BD subscale and the Suggestibility Inventory, which encompasses a general suggestibility index and a subscale that evaluates susceptibility to influence by others. We conducted moderation analyses employing the PROCESS macro, with BMI as the central predictor, BD as the outcome variable, and suggestibility and its subscale as moderators. Results: The findings revealed statistically significant positive moderating interactions for both the general suggestibility index and susceptibility to influence by others. Specifically, women who exhibited high levels of suggestibility and susceptibility to influence by others demonstrated a more pronounced increase in BD as their BMI increased. Conclusions: These outcomes are in line with the sociocultural model of EDs, suggesting that greater susceptibility to external influences amplifies the impact of societal pressures to conform to thin ideals.

A randomized controlled trial of an online single session intervention for body image in individuals with recurrent binge eating

OBJECTIVE

Theoretical models highlight body image disturbances as central to the maintenance of eating disorders, with empirical evidence finding negative body image to be a robust predictor of treatment nonresponse, relapse and symptom persistence. Accessible, scalable, and inexpensive interventions that can effectively target negative body image across the eating disorders are needed. We developed an online single session intervention (SSI) for negative body image and evaluated its acceptability and efficacy in a randomized controlled trial in individuals with recurrent binge eating.

METHOD

Participants with recurrent binge eating were randomly assigned to the SSI (n = 99) or a waitlist (n = 101). Assessments were conducted at baseline, 4 week follow-up, and 8 week follow-up.

RESULTS

81% of participants accessed the SSI, demonstrating reasonable uptake. However, issues with attrition were apparent; a 32% study dropout rate was observed at posttest, while a 58% dropout rate was observed at follow-up. 87% of participants who completed satisfaction measures would recommend the SSI. SSI participants experienced greater improvements in negative body image at both 4 (d = -0.65) and 8 week (d = -0.74) follow-up. Significant between-group effects were also observed on most other secondary symptom measures, though no differences were found for motivations and help-seeking beliefs and intentions.

CONCLUSION

Body image-focused self-guided SSIs for recurrent binge are largely accepted by those who are retained in the trial, but are associated with significant attrition. Although SSIs are not intended to replace standard treatment, they may help with short-term symptom management and could play an important role in eating disorder care.

PUBLIC SIGNIFICANCE

Single session interventions (SSI) are a potentially accessible, scalable, and cost-effective way to deliver evidence-based treatment content to people with eating disorders. This study shows that an online (SSI) designed to target body image among people with recurrent binge eating is accepted and produced short-term symptom relief.

Eating Disorders in Sexual and Gender Minority Adolescents

PURPOSE OF REVIEW

To consolidate recent literature addressing eating disorders and disordered eating behaviors among sexual and gender minority (SGM) adolescents, including but not limited to lesbian, gay, bisexual, transgender, and queer (LGBTQ) adolescents.

RECENT FINDINGS

Sexual and gender minority adolescents are at heightened vulnerability to eating disorders and disordered eating behaviors compared to their cisgender and heterosexual peers, potentially due to minority stress, gender norms, objectification, and the influence of the media, peers, and parents. We report findings from recent literature on the epidemiology and prevalence, assessment, mental health comorbidity, quality of life and psychosocial functioning, risk and protective factors, and treatment and interventions for eating disorders in sexual and gender minority adolescents. Addressing eating disorders in sexual and gender minority adolescents requires an integrated approach consisting of screening, tailored treatment, and comprehensive support to address intersectional challenges. Gender-affirming and trauma-informed care approaches may be considered.

A qualitative analysis of college women's experiences with dieting

OBJECTIVE

Dieting is a known risk factor for disordered eating, yet many college women engage in this behavior. Given the popularity of diets, and the risks associated with dieting, it is important to enhance understanding of dieters' experiences. This study utilized a qualitative approach to investigate college women's experiences of dieting.

PARTICIPANTS

Eighty-four woman-identifying undergraduates [42% White, 24% Asian, 20% Black, 14% other; Mage = 19.18 (1.77)] who endorsed dieting were included in the study.

METHODS

Participants provided short-answer responses to open-ended questions. Data were analyzed using a thematic analysis approach.

RESULTS

The following themes were identified: A complicated relationship, variability of experiences, and social factors. Subthemes highlighted the complexity of college women's dieting behavior.

CONCLUSIONS

Results provide important insight into college women's dieting experiences and their consequences. Future qualitative research should aim to understand how to apply these findings to eating disorder prevention efforts.

A pilot randomized trial of the body advocacy movement: a novel, dissonance-based intervention designed to target fear of weight gain and anti-fat bias in young adults

The Body Advocacy Movement (BAM) is a novel, cognitive-dissonance-based intervention designed to target fatphobia and anti-fat bias as mechanisms to drive reductions in eating disorder (ED) risk. Previous dissonance-based programs (i.e. the Body Project; BP) have successfully targeted thin-ideal internalization as an intervention mechanism. As burgeoning research indicates that fatphobia and anti-fat bias may play a central role in the maintenance of ED pathology, a focused intervention designed to target these constructs could bolster prevention efforts. The aims of this pilot study include confirming acceptability and feasibility of BAM and developing preliminary estimates of its effects on intervention targets, along with benchmarking these effects against the BP intervention. BAM was found to be accepted by participants and feasible to facilitate in a peer-led model. Preliminary results from 50 participants (BAM: N = 26; BP: N = 24) reveal small-to-moderate pre-to-post intervention effects on fatphobia, anti-fat bias, thin-ideal internalization, and eating pathology, which dissipated at 8-week follow-up. The BAM intervention has the potential to supplement the existing suite of ED prevention programs by specifically targeting anti-fat bias, though additional testing in larger and more diverse samples is necessary to clarify its impact on both hypothesized risk mechanisms and ED outcomes.

Attachment-Based Family Therapy to Improve Family Functioning in Adolescent Binge-Spectrum Eating Disorders: An Initial Evaluation Via Case Series Design

Binge-spectrum eating disorders (EDs; bulimia nervosa, binge eating disorder) often develop during adolescence and are associated with serious psychological and physical consequences. Current treatments for adolescents are highly behavioral in nature and while efficacious, many patients do not reach remission indicating that current treatments fail to target a key maintenance factor for EDs. One potential maintenance factor is poor family functioning (FF). In particular, high family conflict (e.g., arguing, critical comments) and low family cohesion (e.g., warmth, support) are known to maintain ED behaviors. Poor FF can (1) cause or exacerbate an adolescent's use of ED behaviors to cope with life stress and/or (2) inhibit parents from being a resource to adolescents during ED treatment. Attachment-Based Family Therapy (ABFT) is specifically designed to improve FF, and thus may be a promising adjunct to behavioral ED intervention strategies. ABFT, however, has not been tested in adolescents with binge-spectrum EDs. Thus, the current study is the first to evaluate a 16-week adapted ABFT treatment for adolescents with EDs (N = 8, Mage = 16.00, 71.43% female, 71.43% White) fusing together behavioral treatment for EDs with ABFT for highest possible impact. Eight families were treated in an open pilot trial to examine treatment feasibility, acceptability, and preliminary efficacy on FF and eating pathology. Overall, findings were promising. ABFT + B treatment was feasible and acceptable and showed preliminary evidence that it could improve FF and ED behaviors. Future research will test this intervention in a larger sample and further examine the role of FF in maintaining ED symptoms.

Trajectories of therapeutic skills use and their dynamic relations to symptom change during cognitive-behavioral therapy for bulimia nervosa

OBJECTIVE

To examine trajectories of therapeutic skills use and weekly relations between skills use and symptom change during the enhanced version of cognitive-behavioral therapy (CBT-E) for bulimia nervosa (BN).

METHOD

Fifty-five adults (M age: 39.0 ± 14.1; 83.9% female; 64.3% White, 93.6% non-Hispanic/Latino) receiving CBT-E for BN-spectrum eating disorders (EDs) self-monitored their use of five therapeutic skills (i.e., regular eating, eating enough to prevent excessive hunger and eating a range of macronutrients, breaking dietary rules, urge management strategies, and mood management strategies) several times per day during treatment. Patients also self-reported their ED symptoms (i.e., frequency of binge eating, compensatory behaviors, and dietary restraint) weekly. We examined trajectories of use of each CBT-E skill and temporal relations between skills use and ED symptoms from week-to-week during treatment.

RESULTS

Participants showed significant increases in eating enough to prevent excessive hunger and eating a range of macronutrients from week-to-week (p < .05). Regular eating, eating enough to prevent excessive hunger, and eating a range of macronutrients 1 week predicted lower binge eating and compensatory behaviors the same week and the following week, and urge management strategy use predicted greater binge eating the same week and the following week (p < .05).

CONCLUSIONS

Results showed temporal relationships between therapeutic skills use and symptom change on a weekly level, with evidence that using skills targeting dietary restraint was associated with lower BN symptoms. Findings highlight the promise of future work to elucidate the most potent CBT-E skills for symptom improvement and inform more targeted interventions.

PUBLIC SIGNIFICANCE

Findings showed weekly relationships between therapeutic skills use and symptom change during treatment, with evidence that using CBT-E skills aimed to reduce dietary restraint (i.e., regular eating, eating enough to prevent excessive hunger, and eating a range of macronutrients) was associated with lower BN symptoms. Future work has the potential to identify the most potent CBT-E skills for symptom improvement and inform more targeted interventions.

When Eating Intuitively Is Not Always a Positive Response: Using Machine Learning to Better Unravel Eaters Profiles

BACKGROUND

The aim of the present study was to identify eaters profiles using the latest advantages of Machine Learning approach to cluster analysis.

METHODS

A total of 317 participants completed an online-based survey including self-reported measures of body image dissatisfaction, bulimia, restraint, and intuitive eating. Analyses were conducted in two steps: (a) identifying an optimal number of clusters, and (b) validating the clustering model of eaters profile using a procedure inspired by the Causal Reasoning approach.

RESULTS

This study reveals a 7-cluster model of eaters profiles. The characteristics, needs, and strengths of each eater profile are discussed along with the presentation of a continuum of eaters profiles.

CONCLUSIONS

This conceptualization of eaters profiles could guide the direction of health education and treatment interventions targeting perceptual and eating dimensions.

Project Body Neutrality: Piloting a digital single-session intervention for adolescent body image and depression

OBJECTIVE

Eating disorders and depression impact youth at alarming rates, yet most adolescents do not access support. Single-session interventions (SSIs) can reach youth in need. This pilot examines the acceptability and utility of a SSI designed to help adolescents improve functionality appreciation (a component of body neutrality) by focusing on valuing one's body based on the functions it performs, regardless of appearance satisfaction.

METHOD

Pre- to post-intervention data were collected, and within-group effect sizes and 95% confidence intervals were computed, to evaluate the immediate effects of the SSI on hopelessness, functionality appreciation, and body dissatisfaction. Patterns of use, demographics, program feedback, and responses from within the SSI were collected.

RESULTS

The SSI and all questionnaires were completed by 75 adolescents (ages: 13-17 years, 74.70% White/Caucasian, 48.00% woman/girl) who reported elevated body image and mood problems. Analyses detected significant pre-post improvements in hopelessness (dav  = 0.60, 95% CI: 0.35-0.84; dz  = 0.77, 95% CI: 0.51-1.02), functionality appreciation (dav  = 0.72, 95% CI: 0.46-0.97; dz  = 0.94, 95% CI: 0.67-1.21), and body dissatisfaction (dav  = 0.61, 95% CI: 0.36-0.86; dz  = 0.76, 95% CI: 0.50-1.02). The SSI was rated as highly acceptable, with a mean overall score of 4.34/5 (SD = 0.54). Qualitative feedback suggested adolescents' endorsement of body neutrality concepts, including functionality appreciation, as personally-relevant, helpful targets for intervention.

DISCUSSION

This evaluation supports the acceptability and preliminary effectiveness of the Project Body Neutrality SSI for adolescents with body image and mood concerns.

PUBLIC SIGNIFICANCE

Results suggest the acceptability and utility of a digital, self-guided, single-session intervention-Project Body Neutrality-for adolescents experiencing co-occurring depressive symptoms and body image disturbances. Given the intervention's low cost and inherent scalability, it may be positioned to provide support to youth with limited access to traditional care.

Differentiating types of dietary restraint and their momentary relations with loss-of-control eating

OBJECTIVE

Despite evidence supporting the link between dietary restraint (i.e., attempts at dietary restriction) and loss of control (LOC) eating among individuals with binge-spectrum eating disorders (EDs), some research suggests that dietary restraint may not be linked to LOC eating in all contexts. It is currently unknown how often dietary restraint results in successful dietary restriction, or which types of restraint/restriction confer highest risk for LOC eating. Furthermore, little research has evaluated momentary, temporal associations between dietary restraint and LOC eating. Thus, the present study aimed to (1) characterize dietary restraint and restriction, among individuals with LOC eating, and (2) examine temporal relationships between restraint/restriction and LOC eating within- and between-subjects.

METHOD

The current study recruited adults with binge spectrum EDs (n = 96, 80.4% female) to complete a 7-14-day ecological momentary assessment protocol assessing ED symptoms. Multilevel models and linear regression evaluated within- and between-subjects associations between momentary restraint/restriction and LOC eating, respectively.

RESULTS

Attempted avoidance of enjoyable foods, limiting the amount eaten, and any restraint predicted greater likelihood of LOC eating at the next survey. Attempts to delay eating predicted reduced likelihood of LOC eating at the next survey, though this effect was no longer statistically significant after correcting for multiple comparisons. Diagnostic presentation moderated the association between attempted avoidance of enjoyable foods and LOC eating such that this association was significantly stronger for those on the BN-spectrum.

DISCUSSION

Dietary restraint seems to be more predictive of LOC eating than dietary restriction both within- and between-subjects. Future treatments should target dietary restraint to reduce LOC eating.

PUBLIC SIGNIFICANCE

Some research suggests that dietary restriction (i.e., reduced calorie intake) and restraint (i.e., attempted restriction) may not be linked to LOC eating in all contexts. We found that dietary restraint is more predictive of LOC eating than dietary restriction both within and between individuals. Future treatments should target dietary restraint to reduce LOC eating.

Exploring the impact of the COVID-19 pandemic on perceptual disturbances and dysfunctional eating attitudes and behaviors: A review of the literature

From the outbreak of the novel coronavirus 2019 (COVID-19) a new physical and social distancing environment has changed our lives and, more particularly, the way of perceiving oneself, as well as eating attitudes and behaviors. An increasing number of studies have highlighted a risky scenario in terms of negative perceptions of one’s body as well as disordered eating and eating disorder patterns in both clinical and general population. With regard to this postulate, this literature review posits two main concepts—perceptual disturbances and dysfunctional eating attitudes and behaviors—in the general and (sub-)clinical populations, to provide an understanding of these phenomena during the COVID-19 pandemic. The main objective of this article is to provide a comprehensive and critical review of published scientific literature about perceptual disturbances (i.e., negative body image, body image disturbances, low body esteem) and dysfunctional eating attitudes and behaviors, including disordered eating (e.g., restrictive eating, binge-eating episodes, overeating, emotional eating) and eating disorders features in community (i.e., general population) and clinical and sub-clinical samples worldwide during the COVID-19 pandemic. The PubMed, ScienceDirect, Ebsco, and Google Scholar databases were searched. The initial search produced 42 references. Scientific publications from March 2020 to April 2022 were included, and among the works compiled, only published research articles have been retained. Purely theoretical papers were also excluded. The final selection consisted of 21 studies, covering both community, clinical (i.e., eating disorder population), and sub-clinical samples. The details of the results are discussed taking into consideration the potential impact of changes in the way we perceive ourselves and interact with others (e.g., the popularity of videoconferencing and the over-use of social network sites due to social isolation) as well as changes in eating attitudes and behaviors, physical activity and exercise (e.g., as an emotional response to the insecurity generated by the pandemic context), in community and (sub-)clinical samples. The discussion sheds light on two outcomes: (1) a summary of findings with methodological considerations; (2) an intervention continuum to deal with the consequences of the COVID-19 pandemic; (3) and a final conclusion.

Binge Eating, Purging, and Restriction Symptoms: Increasing Accuracy of Prediction Using Machine Learning

Eating disorders are severe mental illnesses characterized by the hallmark behaviors of binge eating, restriction, and purging. These disordered eating behaviors carry extreme impairment and medical complications, regardless of eating disorder diagnosis. Despite the importance of these disordered behaviors to every eating disorder diagnosis, our current models are not able to accurately predict behavior occurrence. The current study utilized machine learning to develop longitudinal predictive models of binge eating, purging, and restriction in an eating disorder sample (N = 60) using real-time intensive longitudinal data. Participants completed four daily assessments of eating disorder symptoms and emotions for 25 days on a smartphone (total data points per participant = 100). Using data, we were able to compute highly accurate prediction models for binge eating, restriction, and purging (.76-.96 accuracy). The ability to accurately predict the occurrence of binge eating, restriction, and purging has crucial implications for the development of preventative interventions for the eating disorders. Machine learning models may be able to accurately predict onset of problematic psychiatric behaviors leading to preventative interventions designed to disrupt engagement in such behaviors.

"I don't want them to judge me": Separating out the role of fear of negative evaluation, neuroticism, and low self-esteem in eating disorders

Fear of negative evaluation (FNE) is a transdiagnostic risk factor that has an important role in eating disorder (ED) onset and maintenance, as well as other psychopathologies. However, no research has explored whether FNE has associations with probable ED status when accounting for related vulnerabilities, and whether this relationship changes across gender and weight status. The current study sought out to explore how FNE explains probable ED status above and beyond heightened neuroticism and low self-esteem, with gender and BMI serving as potential moderators of this relationship. Participants were 910 university students (85 % females) aged 18-26 years (M_age = 19.90; SD_age = 2.06) living in Australia, who completed measures of psychological distress, personality, self-esteem, FNE, and ED status. Logistic regression analysis showed that FNE was associated with probable ED status. This relationship was stronger among individuals with underweight and healthy-weight, whilst an interaction with gender was not significant. These findings shed light on the unique role FNE has in probable ED status across gender, which appears to be more pronounced in those with a lower BMI. Therefore, FNE should be considered as a potential target in ED screening and early intervention alongside other important transdiagnostic risk factors.

Body norms, body image, and media in a market-integrating indigenous population in Argentina: A mixed-methods investigation

OBJECTIVE

The aim of this study was to investigate the relationship between media, body norms, and body image among the Qom, a market-integrating indigenous population in Argentina that has historically idealized larger body sizes.

METHODS

With men and women (n = 87), we measured frequency of media/technology use through a Likert-type questionnaire. Using the Stunkard Figure Rating Scale, we asked participants to select the most healthy and ideal body size for their gender, as well as their own body size. We calculated body dissatisfaction as the difference between ideal and own body size. We conducted semi-structured interviews to describe the role of media in body norms and body image.

RESULTS

Media exposure was not significantly associated with perceptions of the "healthiest" or most "ideal" body sizes, nor body dissatisfaction. Men and women perceived categorically "middle-range" body sizes as both healthy and ideal, differing from a similar study in 2010, where larger bodies were favored. Interviews revealed that: media is not recognized as affecting body norms and body image, but is conceptually associated with cultural loss (Theme 1); a "dual stigma" of fatness and thinness is perpetuated by peers, family, and healthcare providers (Theme 2); and body acceptance is highly valued (Theme 3).

CONCLUSION

In this context, while some body norms have changed over time, the impact of media on body norms and image may be secondary to influences from individuals' social networks, and may be occluded by norms favoring body acceptance.

“Why don’t I look like her?” How adolescent girls view social media and its connection to body image

Background

Adolescent girls appear more vulnerable to experiencing mental health difficulties from social media use than boys. The presence of sexualized images online is thought to contribute, through increasing body dissatisfaction among adolescent girls. Sexual objectification through images may reinforce to adolescent girls that their value is based on their appearance. This study explored how sexualized images typically found on social media might influence adolescent girls’ mental health, in positive and/or negative ways.

Methods

In-depth interviews were conducted with girls aged 14–17 years (n = 24) in Perth, Western Australia. Data were analyzed using thematic analysis.

Results

Participants identified body image as a major concern, reporting negative appearance comparisons when viewing images on social media. Appearance comparisons were perceived to exacerbate adolescent girls’ appearance-based concerns. Comparisons also influenced adolescent girls’ efforts to change their appearance and seek validation on social media. The importance of awareness and education from a younger age about social media and its influence on body image was emphasized, as was the need for strategies to promote positive body image and counteract negative body image.

Conclusion

The findings of this study have important implications for professionals working with adolescent girls and for the development of health promotion programs addressing social media use and body image concerns.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-022-01845-4.

Clinically significant body dissatisfaction: prevalence and association with depressive symptoms in adolescent boys and girls

Body dissatisfaction is distressing and a risk factor for adverse consequences including eating disorders. However, data pertaining to the prevalence of body dissatisfaction in adolescence, a key period for its emergence, are lacking. This is a substantial barrier to tailored assessment and early intervention. This study addresses this gap and provides the prevalence of body dissatisfaction and associations with depressive symptoms and body change strategies. Adolescent boys (n = 367; Mage = 12.8, SD = 0.7) and girls (n = 368; Mage = 12.7, SD = 0.7) completed measures of body dissatisfaction and depressive symptoms with established cut-off levels. They also completed measures of dietary restraint and strategies to increase muscle size. Of boys and girls, 37.9% and 20.7%, respectively experienced moderate, and 6.8% and 19.6% experienced clinically significant body dissatisfaction, with higher rates among girls than boys and among adolescents aged 13 and 14 than aged 12. More than one-quarter of boys (26.70%) and one-third of girls (33.15%) reported subthreshold depressive symptoms or possible, probable or major depressive episodes. Girls revealed a higher prevalence of possible-, probable-, or major depressive episode than boys. Relative to those with no or low body dissatisfaction, adolescents with clinically significant body dissatisfaction were 24 times more likely to also report possible-, probable-, or major depressive episodes. Among boys and girls, clinically significant body dissatisfaction was associated with higher levels of dietary restraint and engagement in strategies to increase muscle size. Greater attention to identification and early intervention for body dissatisfaction is needed, especially for girls.

The relationships between social media exposure, food craving, cognitive impulsivity and cognitive restraint

BACKGROUND

Young adults are increasingly exposed to social media and their image/video-based activities. They use these platforms to share images, videos and advice in different fields like food and nutrition with: recipe ideas, nutritional opinions or specific diets. Along with the rise of digital technologies, the prevalence of eating disorders in young adults continues to grow. The present study analyzes the psychological and eating processes through which exposure to social media may lead to the development of food craving and problematic eating behaviors.

METHODS

A total of 103 young adult men (n = 15) and women (n = 88) answered questionnaires measuring their impulsivity (Barratt Impulsiveness Scale), eating habits (Three-Factor Eating Questionnaire), food craving (Food Cravings Questionnaire-Trait-reduced), and time exposure to social media.

RESULTS

The results showed two significant serial mediations. We found a correlational link between time exposure to social media and food craving scores. This positive relation is indirectly mediated by cognitive impulsivity. We also found a positive correlation between cognitive impulsivity and food craving scores that was mediated by cognitive restraint.

CONCLUSION

A better understanding of the existing links between social media, food craving and eating behaviors such as cognitive restraint could help researchers and clinicians to better guide young adults in their use and appropriation of social media food contents.

Bi-directional associations between depressive symptoms and eating disorder symptoms in early adolescence

Despite frequently co-occurring, the temporal relationship between depression and eating disorder symptoms remains poorly understood. This exploratory study sought to investigate the reciprocal relationship between depressive symptoms and (1) shape and weight dissatisfaction, (2) shape and weight overvaluation, (3) preoccupation with shape or weight, (4) preoccupation with food, (5) dietary restraint and (6) binge eating in early adolescence. Adolescents (N = 1393) aged between 11.4 and 13.9 years (M = 12.50, SD = 0.38) completed the Centre for Epidemiological Depression Scale-Revised and Eating Disorder Examination Questionnaire-Adolescent version at the beginning of secondary school (T1) and 12-months later (T2). Cross-lagged models were created to assess the reciprocal relationship between depressive symptoms and ED symptoms. Depressive symptoms at T1 predicted shape and weight dissatisfaction, shape and weight overvaluation, preoccupation with shape or weight, preoccupation with food, dietary restraint and binge eating at T2. Shape and weight dissatisfaction and binge eating were the only ED symptoms at T1 to predict depressive symptoms at T2. Findings suggest young adolescents who experience depressive symptoms in their first year of secondary school are at-risk of developing ED symptoms over the subsequent 12-month period.

Integrating fear of fatness into sociocultural models of body image and eating concerns

To date, sociocultural models of body dissatisfaction and disordered eating have predominantly focused on the pursuit of thinness and have somewhat neglected sociocultural discourse and pressures that increase fear of fatness. Therefore, we tested a model to determine whether sociocultural pressures from media and interpersonal sources were associated with drive for thinness and fear of fatness. We also examined whether beliefs about the controllability of shape and weight were in turn associated with body dissatisfaction and disordered eating. A sample of N = 226 female undergraduate students in the U.S. completed an online survey assessing the variables of interest. After minor modification to the model pathways, the model provided a good fit to the data. Sociocultural influences to pursue thinness and fear fat related to body dissatisfaction and disordered eating through internalization of the thin-ideal and fear of fat. Together, these findings suggest that the pursuit of thinness and fear of fatness are distinct elements in etiologic models of body dissatisfaction and disordered eating. Additional work, including longitudinal research and studies among more diverse groups of individuals, is warranted to further clarify these relationships.

Associations between emotion regulation and remission following cognitive behavioural therapy for adults with bulimia nervosa

OBJECTIVE

Emotion regulation (ER) deficits are associated with illness severity in individuals with bulimia nervosa. We examined whether baseline ER abilities are associated with remission following enhanced cognitive behavioural therapy for eating disorders (CBT-E).

METHOD

Participants (N = 50, 85.0% female) receiving CBT-E completed a measure (yielding a global score and six subscale scores) of ER pre-treatment. Remission was assessed by the Eating Disorder Examination at post-treatment and follow-up. Analyses tested associations between baseline ER and behavioural, cognitive, or full remission at post-treatment and three-month follow-up.

RESULTS

Lower global ER abilities, measured by the Difficulties in Emotion Regulation Scale, were associated with lower likelihood of behavioural and full, but not cognitive, remission at post-treatment. Specifically, individuals low in emotional clarity and impulse control were less likely to be behaviourally remitted. Those low in emotional acceptance, awareness, clarity, or strategies to manage emotion were less likely to be fully remitted. Global ER scores were not associated with any remission type at follow-up.

DISCUSSION

Baseline ER deficits were associated with lower likelihood of behavioural or full remission at post-treatment. However, ER was less associated with remission at follow-up, indicating that ER is most important during treatment. Findings highlight a need for targeted treatments aimed at improving ER.

Validation of the inflexible eating questionnaire in a large sample of Chinese adolescents: psychometric properties and gender-related differential item functioning

PURPOSE

The aim of this study was to provide preliminary psychometric evidence for the Chinese version of the Inflexible Eating Questionnaire (C-IEQ) among a large sample of Chinese adolescents.

METHODS

For testing the psychometric properties of the C-IEQ, a total of 2241 (M_age = 13.91 years; 46.4% boys) adolescents from mainland China responded to the survey. Confirmatory factor analysis (CFA) was used to examine the factor structure of the C-IEQ. Measurement invariance by gender was examined by both multi-group CFA and differential item functioning (DIF). Convergent validity of the C-IEQ was assessed via examining the correlations between the C-IEQ scores and theoretically related constructs (e.g., orthorexia nervosa symptomatology, eating disorder symptomatology, and body image inflexibility).

RESULTS

The unidimensional structure with correlated errors of the C-IEQ showed good model fit (χ² = 1674.05, df = 44, p < 0.001; CFI = 0.93; TLI = 0.91; RMSEA = 0.13; SRMR = 0.06). The C-IEQ had an adequate internal consistency (α = 0.89) and demonstrated strong measurement invariance across genders. Moreover, the scores of the C-IEQ showed significant correlations with theoretically correlated constructs: orthorexia nervosa symptomatology (girls; r = 0.53 p < 0.001, boys; r = 0.45 p < 0.001), eating disorder symptomatology (girls; r = 0.32 p < 0.001, boys; r = 0.25 p < 0.001) body image inflexibility (girls; r = 0.41 p < 0.001, boys; r = 0.36 p < 0.001), suggesting good convergent validity of the C-IEQ.

CONCLUSION

The C-IEQ showed good psychometric properties in a sample of Chinese adolescents and can be used in future studies to assess eating-specific psychological inflexibility among Chinese adolescents.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

The Relationship Between Women’s Negative Body Image and Disordered Eating Behaviors During the COVID-19 Pandemic: A Cross-Sectional Study

Recent studies have shed light on how the COVID-19 pandemic changed our lives, and most of them have documented its detrimental effect on eating habits. Until now, the effects of this global crisis on negative body image and its association with disordered eating behaviors remain largely understudied. This study aimed to investigate changes in frequency of disordered eating behaviors (i.e., restrictive eating, emotional eating, and overeating) and negative body image (i.e., shape and weight concern, and body dissatisfaction) among a community sample of women during the COVID-19 pandemic (October 2020–May 2021). Furthermore, we explored the possible relation between body image-related variables and changes in the frequency of disordered eating behaviors in the context of the pandemic. A total of 161 self-identified female participants enrolled in an online-based survey. Descriptive statistics showed that women did not report clinically significant levels of weight and body shape concerns, but participants reported being dissatisfied with their body. One sample Wilcoxon Signed Rank tests revealed a tendency toward an increasing of the frequency of all disordered eating behaviors during the COVID-19 pandemic. Multinomial logistic regressions showed that weight concerns predicted an overall increase in the frequency of restrictive eating behaviors, whereas higher body dissatisfaction was associated with a moderate self-perceived increase in the frequency of emotional eating. These results shed light on a risk pattern of phenomena in a non-clinical sample of women, as they represent the key risk factors for the development of eating disorders. Findings could have implications for designing and implementing prevention programs.

The Complicated Relationship between Dieting, Dietary Restraint, Caloric Restriction, and Eating Disorders: Is a Shift in Public Health Messaging Warranted?

The origins of theories specifying dietary restraint as a cause of eating disorders can be traced to the 1970s. This paper will present an overview of the origins of dietary restraint theories and a brief historical review of evidence will be summarized. Recent research will be presented, including the results from the CALERIE Phase 1 study, as well as CALERIE Phase 2, which were NIH-sponsored randomized controlled trials. CALERIE 2 provided a test of the effect of two years of caloric restriction (CR) on the development of eating disorder syndromes and symptoms in comparison to a control group that did not alter eating behavior or body weight. The intervention was effective for inducing a chronic (two-year) reduction in total energy expenditure and increased dietary restraint but did not increase symptoms of eating disorders. The results of this recent investigation and other studies have not provided experimental support for conventional dietary restraint theories of eating disorders. These findings are discussed in terms of potential revisions of dietary restraint theory, as well as the implications for a paradigm shift in public health messaging related to dieting.

Social Media Use and Body Dissatisfaction in Adolescents: The Moderating Role of Thin- and Muscular-Ideal Internalisation

Internalisation of appearance ideals moderates the relationship between exposure to media images and body dissatisfaction. To date, the role of thin- and muscular-ideal internalisation in the context of social media remains under explored, particularly for boys. As such, we aimed to explore how social media use (Instagram and Snapchat) was related to body dissatisfaction, and whether thin- and muscular-ideal internalisation would moderate this relationship in a sample of 1153 adolescent boys and girls (55.42% males; M_age = 13.71, SD = 1.14). As hypothesised, social media use, and thin- and muscular ideal internalisation were positively correlated with body dissatisfaction in both genders. In moderation analyses, thin-ideal internalisation emerged as the only variable that had a significant effect on body dissatisfaction in both genders. Additionally, the influence of social media use on body dissatisfaction was moderated by muscular-ideal internalisation in boys, whereby for boys with high muscular-ideal internalisation, greater social media use was associated with greater body dissatisfaction. The two-way (muscular x thin-ideal internalisation) and three-way interaction (social media use x thin-ideal internalisation x muscular-ideal internalisation) effects on body dissatisfaction were non-significant. These findings emphasise the importance of considering the sociocultural environment (i.e., new media influences) as frameworks for understanding body dissatisfaction and suggest targeting of internalisation of appearance ideals in body dissatisfaction prevention programs.

Bidirectional relationships between intuitive eating and shape and weight overvaluation, dissatisfaction, preoccupation, and fear of weight gain: A prospective study

Using a prospective design, we investigated possible bi-directional relationships between intuitive eating and four empirically distinct components of negative body image: overvaluation (judgements of self-worth contingent upon weight/shape), dissatisfaction (general discontent with weight/shape), preoccupation (ruminative thinking about weight/shape), and fear of weight gain. We assessed adult women at baseline (T1) and four-month follow-up (T2), as prior work has demonstrated that this time lag is sufficient to detect change in intuitive eating scores. After adjusting for T1 intuitive eating scores and demographic confounds, higher T1 dissatisfaction was the only body image component to significantly predict lower T2 intuitive eating scores in both univariate and multivariate models. Higher T1 intuitive eating scores also significantly predicted lower scores on each of the four negative body image components at T2. Findings suggest that general body discontent may be one of the more important body image variables that lead to decreases in intuitive eating principles. Present findings also add to a growing body of evidence demonstrating the potentially adaptive role of intuitive eating on psychological health indices.

Elevated cognitive dietary restraint mediates the relationship between greater impulsivity and more frequent binge eating in individuals with binge-spectrum eating disorders

PURPOSE

The current study aimed to examine the relationships between impulsivity, dietary restraint, and binge eating frequency in individuals with binge-spectrum eating disorders.

METHODS

Secondary data analysis was conducted on baseline data from three ongoing or recently completed clinical trials. 148 participants diagnosed with a DSM-5 eating disorder characterized by binge eating were administered a clinical interview to assess dietary restraint and binge eating frequency and completed a self-report measure of trait impulsivity.

RESULTS

Mediation analyses found that increased dietary restraint mediated the relationship between higher impulsivity, particularly greater positive urgency and sensation-seeking, and more frequent binge eating episodes.

CONCLUSION

While more research using momentary assessment methods is necessary to confirm our findings, results from the current study call attention to the potential role of dietary restraint in the impulsivity-binge eating relationship for individuals with binge-spectrum eating disorders.

LEVEL OF EVIDENCE

Level V descriptive study.

Prospective associations between childhood social communication processes and adolescent eating disorder symptoms in an epidemiological sample

Deficits in social cognition and communication, the processes associated with human social behavior and interaction, have been described in individuals with eating disorder psychopathology. The current study examined whether social communication characteristics present in middle childhood (ages 8-14) were associated with eating disorder behaviors, cognitions, and diagnoses across adolescence (ages 14-18) in a large, population-based sample. Participants (N = 4864) were children enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC), a population-based, prospective study of women and their children. Regression methods tested prospective associations between social functioning using a facial emotion recognition task and parentally reported social communication symptoms (or difficulties), measured by the Social Communication Disorder Checklist (SCDC), with eating disorder symptoms and diagnoses. Misattribution of faces as sad or angry at age 8.5 was associated with purging and anorexia nervosa diagnosis at age 14, respectively, among girls. Furthermore, autistic-like social communication difficulties during middle childhood were associated with bulimia nervosa symptoms during adolescence among both girls and boys. Results did not support global associations between measured social communication deficits and eating disorder risk in this sample, but specific difficulties with facial emotion recognition and social communication may enhance the risk for disordered eating behaviors.

Using an app to count calories: Motives, perceptions, and connections to thinness- and muscularity-oriented disordered eating

The number of people counting calories through apps is increasing, yet concerns have been raised that this could trigger symptoms of eating disorders. Although associations between calorie tracking and eating disorder symptomatology have been identified, further research is needed to understand motives for, and the perceived impact of, using a calorie tracking app. This study addressed these gaps with data collected from 1357 adults. A high percentage of participants (n = 964; 71%) had used a calorie tracking app; 531 participants (39%) reported currently using a calorie tracking app. Prior users reported higher levels of thinness- and muscularity-oriented disordered eating than non-users. Those using a calorie tracking app for weight-control/shape reasons were more likely to report that the app had contributed to several eating disorder symptoms (i.e., food preoccupation, all-or-none thinking around food, food anxiety, purging behaviours) than those using an app for health/disease prevention reasons. Engaging in a calorie tracking app for weight/shape reasons was associated with higher perceived helpfulness of calorie tracking app ratings and higher symptom severity. Findings suggest that underlying motives may be important to consider in research investigating the use of calorie tracking apps, as well as for health professionals working with clients engaging in these dietary monitoring tools.

Binge eating behavior in a sample of Lebanese Adolescents: Correlates and Binge Eating Scale validation

BACKGROUND

Binge eating disorder is a common eating disorder among the adolescent population. The available literature in the Middle East in general, and Lebanon specifically, is relatively scarce and/or outdated. The objectives of this study were to (1) validate the Binge Eating Scale (BES) for use in Lebanese adolescents, and (2) assess correlates of binge eating behavior among this population.

METHODS

A cross-sectional study conducted between May and June 2020, enrolling 555 adolescents between the ages of 15-18 years old from all Lebanese governorates. The Binge Eating Scale was used to screen for the presence/absence of binge eating.

RESULTS

A confirmatory factor analysis revealed that the one-factorial model fits the data best. The results of a linear regression, taking the binge eating score as the dependent variable, showed that higher body dissatisfaction, more alcohol use disorder, higher depression, vomiting to lose weight and starving to lose weight were significantly associated with more binge eating. Higher self-esteem was significantly associated with less binge eating.

CONCLUSION

The Arabic Version of the BES scale seems to be a reliable tool to be used in Lebanese adolescents for the assessment of binge eating. More body dissatisfaction, lower self-esteem, increased depressive symptoms were associated with more binge eating. We hope this tool will be a reliable one to be used in epidemiological studies and research about eating behaviors/disorders. The results showed that higher body dissatisfaction, higher depression, vomiting to lose weight and starving to lose weight were significantly associated with more binge eating. Our study also showed that the Binge Eating Scale is an adapted and validated tool to be used among Lebanese adolescents for the assessment of binge eating. We hope that the study results will help clinicians in the screening and management of Binge Eating behaviors among Lebanese adolescents.

Hourglass Body Shape Ideal Scale and disordered eating

Disordered eating research has long considered the negative consequences of internalizing sociocultural appearance ideals (e.g., thin ideal, muscular ideal). However, the implications of internalizing a curvy or "hourglass" body shape remains unclear. The Hourglass Body Shape Ideal Scale (HBSIS) is a new self-report questionnaire that was developed and evaluated to appropriately measure the extent women subscribe to an hourglass body shape ideal. The measure was administered to a community and undergraduate sample of women via two separate online studies. Study 1 (N = 916) provided support for the factor structure as well as the convergent and discriminant validity of the HBSIS. The HBSIS was correlated with measures of appearance orientation, overweight preoccupation, and disordered eating. HBSIS was associated with disordered eating even after controlling for age, BMI, thin ideal and muscular ideal internalization. Further, higher HBSIS scores were associated with increased likelihood of having clinical levels of disordered eating symptoms. There were no racial and ethnic group differences on HBSIS. Study 2 (N = 195) replicated the factor structure of Study 1, in addition to its convergent and discriminant validity. The HBSIS allows for more precise examination of appearance-ideal internalization, capturing a unique construct understudied within eating pathology literature.

3D visualisation of psychometric estimates for the ideal male body

Psychological concerns are frequently indexed by psychometric questionnaires but the mental representations that they seek to quantify are difficult to visualise. We used a set of questionnaires designed to measure men's concept of their bodies including: the Drive for Muscularity Scale (DMS; McCreary & Sasse, 2000), the Perceived Sociocultural Pressures Scale (PSPS; Stice, Nemeroff, & Shaw, 1996a), the Body Appreciation Scale (BAS-2; Tylka & Wood-Barcalow, 2015), and the Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ-3; Thompson, van den Berg, Roehrig, Guarda, & Heinberg, 2004). We combined their use with an interactive 3D modelling programme to allow men to create computer-generated representations of their ideal bodies. We used a principal component analysis to extract those shape components of our participants' CGI ideal bodies that were predicted by the questionnaires and reconstructed the body shapes that these questionnaires were capturing. Moving from the lowest to the highest score on both the DMS and SATAQ corresponded with changes in muscularity, particularly muscle mass and definition. This approach allows us to demonstrate the actual body features that are being captured by a particular questionnaire.

Self-compassion explains substantially more variance in eating disorder psychopathology and associated impairment than mindfulness

This study aimed to (1) examine the unique role of mindfulness and self-compassion on eating disorder (ED) psychopathology and functional impairment, and (2) compare levels of mindfulness and self-compassion between health controls and individuals categorized with bulimia nervosa (BN), and binge-eating disorder (BED). Data were analyzed from 1101 community-based participants, of which 145 met criteria for BN, 150 for BED, and 286 for healthy controls. Results from a series of multiple regressions revealed that self-compassion accounted for substantially more variance in ED psychopathology and functional impairment than mindfulness in the total sample and across the three subgroups, at times explaining 20 times more variance than mindfulness. Results remained unchanged when excluding the mindfulness subscale from the Self-Compassion Scale. When comparing these variables across the three study groups, results showed that self-compassion and mindfulness levels were lowest in the BN group, followed by the BED group, and then the healthy control group. Findings overall suggest that non-judgmental awareness may be less important in explaining levels of ED psychopathology than the nature of one's interaction with emotionally charged, negative experiences. Findings also point to possible priority intervention targets in indicated prevention and treatment programs.

The Body Acceptance by Others Scale: An assessment of its factorial validity in adults from the United Kingdom

The construct of body acceptance by others (i.e., the degree to which an individual perceives acceptance for their appearance by others) is central to conceptual models of positive body image and adaptive eating styles. It is typically measured using the 10-item Body Acceptance by Others Scale (BAOS; Avalos & Tylka, 2006), but emerging research has suggested that a unidimensional model of BAOS scores may be unstable. Here, we examined the factor structure of BAOS scores in a sample of adults from the United Kingdom (N = 1148). Exploratory factor analyses indicated that BAOS scores reduced to two dimensions in women, of which only a primary 6-item factor was stable. In men, all 10 items loaded onto a primary factor. However, the results of confirmatory factor analyses indicated that both models of BAOS scores had poor fit. Although both the unidimensional 10-item and 6-item models had adequate internal consistency, our results are suggestive of factor structure instability. We conclude by suggesting ways in which future research could revise the BAOS to improve its factorial stability and validity.

Evaluation of the relationships between dietary restraint, emotional eating, and intuitive eating moderated by sex

Intuitive eating involves attention to feelings putatively related to hunger and satiety to guide eating choices. This adaptive eating style has been linked to a number of positive physical and psychological outcomes. Interestingly, women tend to report lower levels of intuitive eating compared to men. It has been hypothesized that sociocultural pressures or dieting could be contributing factors to this sex discrepancy. The current study aimed to explore whether sex moderates the relationship between either dietary restraint and intuitive eating, or between emotional eating and intuitive eating. Assessments were administered to a sample of college males and females (N = 478) as part of a larger study of eating behaviors. Moderation analyses indicated that higher dietary restraint was more strongly associated with lower levels of intuitive eating in women than in men. Emotional eating also had a stronger negative association with intuitive eating in women compared to men. Additionally, relationships between dietary restraint/emotional eating and a component of intuitive eating, "eating for physical rather than emotional reasons", was stronger for women compared to men. These findings suggest that dietary restraint and emotional eating may serve as barriers in the implementation of an intuitive eating style, especially for women. Prevention and intervention efforts should target those high in dietary restraint and emotional eating.

Prospective Pathways to Depressive Symptoms and Disordered Eating in Adolescence: A 7-Year Longitudinal Cohort Study

Eating pathology and depressive symptoms increase during adolescence, yet predictive pathways remain predominantly unexplored, despite their implications for prevention. The present study aimed to identify shared risk factors for eating pathology and depressive symptoms by evaluating an adapted Dual-Pathway Model of disordered eating, which postulated that higher BMI would predict disordered eating and depressive symptoms via pathways between body dissatisfaction, later BMI, depressive symptoms, and visible indicators of puberty (breast development for girls, height for boys). The participants were 8915 children (49% girls) from the Avon Longitudinal Study of Parents and Children, a population-based cohort study of British children, who were assessed at different intervals between the age of 7 to 14 years. Path analyses revealed that, for girls, childhood BMI exerted indirect effects on disordered eating via body dissatisfaction, depressive symptoms, and more advanced breast development, with indirect pathways identified to depressive symptoms via earlier depressive symptoms and more advanced breast development. For boys, childhood BMI had indirect effects on disordered eating via later BMI and body dissatisfaction, while only earlier depressive symptoms were found to have an independent and direct effect on adolescent depressive symptoms. This study reveals shared and independent risk factors for eating pathology and depressive symptoms in adolescence and suggests targets for preventative interventions, including higher BMI, body dissatisfaction, and depressive symptoms, in addition to advanced breast development, for girls.

Prospective associations between childhood neuropsychological profiles and adolescent eating disorders

OBJECTIVE

Cross-sectional associations between eating disorders (EDs) and deficits in neuropsychological functioning have been well documented; however, limited research has examined whether neuropsychological functioning is prospectively associated with EDs. The current study investigated prospective associations between neuropsychological functioning in childhood (ages 8 and 10) and ED behaviours and disorders in adolescence (at ages 14, 16, and 18 years) in a population-based sample.

METHOD

Participants (N = 4,803) were children enrolled in the Avon Longitudinal Study of Parents and Children, a population-based, prospective study of women and their children. Regression methods tested associations between facets of neuropsychological functioning (attention, working memory, and inhibition) and eating disorder symptoms and diagnoses.

RESULTS

Better scores on working memory tasks in childhood were associated with decreased risk of fasting but increased risk of excessive exercise during adolescence. Better inhibitory control was associated with decreased risk for disordered eating at age 14, and attentional difficulties were associated with increased risk for binge eating disorder during adolescence among boys but not girls.

CONCLUSIONS

Neuropsychological functioning may enhance risk for disordered eating behaviours in specific ways. Overall, effect sizes were small, and results did not support global associations between neuropsychological differences and ED risk in this sample.

Expectancies about the Effects of Cannabis Use on Eating Disorder Symptoms

Background: Substance use, specifically cannabis use, is common among individuals with eating disorder (ED) symptoms; however, few studies have specifically explored the relation between EDs and cannabis use. Purpose: The present study examined expectancies about the impact of cannabis on cognitive, affective and behavioral ED symptoms. Additionally, this study explored associations between cannabis-related expectancies, cannabis use and cannabis-related problems. Methods: Cannabis users with ED symptoms (N = 137) reported on frequency of cannabis use, cannabis-related problems and expectancies about the impact of cannabis on ED symptoms, Results: Participants expected cannabis to decrease restrictive eating, compensatory behaviors, and preoccupation with body shape and weight and fear of eating and weight gain. In contrast, cannabis was expected to increase binge-eating behaviors. Expectancies about the impact of cannabis use on ED symptoms were not associated with more frequent cannabis use nor were they associated with cannabis-related problems. Conclusions: These findings suggest that individuals believe cannabis will improve some ED symptoms; however, these expected improvements are not associated with increased cannabis use and problems. Future research should examine cannabis expectancies in clinical populations and should further explore the association between cannabis expectancies, use, and ED symptoms longitudinally.

Thin-ideal internalization: How much is too much?

Internalization of the thin-ideal is a risk factor for eating disorders that frequently persists into recovery and increases patient risk for relapse. Addressing thin-ideal internalization as a core element of eating disorder prevention and treatment produces significant reductions in eating pathology. However, research has not yet quantified levels of thin-ideal internalization that may signal increased versus decreased risk for disordered eating. To address this gap in the literature, receiver operating characteristic (ROC) curve analysis was used to identify a thin-ideal internalization cutoff score that signified clinically-meaningful eating disorder pathology. 787 college women (age M = 20.17, SD = 2.41; BMI M = 23.58, SD = 5.29) were classified as "healthy" (N = 717) or those with significant disordered eating (N = 70) using established clinical cutoffs for the Eating Disorder Examination-Questionnaire. ROC curve analysis was used to test the performance of the Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4) Internalization: Thin/Low Body Fat subscale in predicting disordered eating status, and to identify a cutoff score that maximized sensitivity and specificity to discriminate between healthy and disordered eating samples. Mean SATAQ-4 internalization scores were 3.29 (SD = 0.92) and 4.27 (SD = 0.62) for healthy and disordered eating participants, respectively. The SATAQ-4 internalization scores were good predictors of disordered eating status (area under the curve = 0.81, 95% CI: 0.76-0.86). The optimal cutoff of 3.78 (measured on a 1-5 Likert scale) yielded a sensitivity of 0.81 and specificity of 0.64. Overall, results provide preliminary support for the discriminant validity of SATAQ-4 thin internalization scores and suggest that even moderate levels of thin-ideal internalization may be predictive of clinically-significant eating pathology. It may be important for prevention and intervention work to actively seek to reduce internalization levels below this clinical cutoff, though future work is needed to bear this out.

Comparing internalization of appearance ideals and appearance-related pressures among women from the United States, Italy, England, and Australia

Researchers have observed variation in levels of body image disturbance and eating pathology among women from different Western countries. Examination of cross-cultural differences in the established risk factors (i.e., thin-ideal internalization, muscular-ideal internalization, and appearance pressures from family, peers, and media) for negative outcomes may help to elucidate the prominence of specific risk factors within a given Western society and guide associated interventions. Women from the United States (US), Italy, England, and Australia completed the Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4). Analysis of covariance controlling for age and BMI indicated significant cross-country differences for all SATAQ-4 subscales. Results typically indicated higher levels of appearance-ideal internalization and appearance pressures in the US and lower levels in Italy; however, associated effect sizes were generally small. A medium effect of country was observed for peer-appearance pressures, which were highest in the US compared with all other countries. Repeated-measures analysis of variance and paired samples t tests conducted within each country identified thin-ideal internalization and media appearance pressures as the predominant risk factors for all four countries. Overall, findings suggest more cross-country similarities than differences, and highlight the importance of delivering interventions to address thin-ideal internalization and media appearance pressures among women from Western backgrounds.Level of evidence Descriptive study, Level V.

Factor structure and psychometric properties of the Inflexible Eating Questionnaire in a sample of adult women

The Inflexible Eating Questionnaire (IEQ) is a recently developed measure that assesses an individual's inflexible adherence to rigid eating rules, along with the tendency to respectively feel empowered or distressed when such rules are or are not followed. At present, evidence supporting the unidimensional structure and psychometric properties of the IEQ is limited to one specific sample of Portuguese adults. Establishing whether the IEQ is a valid and reliable measure in a different sample and by an independent research team is needed. We sought to examine the factor structure and psychometric properties of the IEQ in large sample (n = 1000) of Australian female adults. A unidimensional structure was replicated and evidence of internal consistency (α = .89) was found. IEQ scores were significantly and moderately correlated with various eating restraint measures and intuitive eating, providing evidence of convergent validity. IEQ scores also predicted incremental variance in global eating disorder symptomatology and psychosocial impairment after controlling for intuitive eating, flexible control, and rigid dietary control. Present findings offer further support for the validity and reliability of the IEQ in a non-clinical sample of women. A brief measure that assesses the inflexible adherence to eating rules may be valuable for validating current models of eating disorder psychopathology. Furthermore, incorporating the IEQ into the assessment of future randomized trials of eating disorder prevention or treatment programs may be beneficial for elucidating these interventions mechanisms of change.

Typology of patients with behavioral addictions or eating disorders during a one-year period of care: Exploring similarities of trajectory using growth mixture modeling coupled with latent class analysis

OBJECTIVES

Addictions are not restricted to substance-use disorders, and it is now widely recognized that they also include behavioral addictions. Certain individuals with eating disorders also experiment their disorder as an addiction. The objective was to identify typologies of patients presenting with various behavioral addictions or eating disorders according to their evolution within the framework of care, and to specify the factors associated with the differential clinical trajectories.

METHODS

We included 302 patients presenting with problem gambling, sexual addiction, compulsive buying, excessive videogame use or eating disorders. The patients completed a multiaxial assessment through a face-to-face structured interview and self-administered questionnaires, including sociodemographic and addiction-related characteristics, psychiatric and addictive comorbidities and several psychological characteristics. The assessment was performed at inclusion and then repeated after 6 and 12 months. The statistical analysis included a combination of growth mixture models and latent class analysis.

RESULTS

We identified five classes of patients with different profiles related to their trajectories during a one-year period of specialized care: "complex patients", "patients with impulsive psychological functioning", "patients with cooperative psychological functioning", "patients with immature psychological functioning," and "patients with resilient psychological functioning".

CONCLUSIONS

The typology obtained brings interesting findings to propose patient-centered care strategies adapted to these disorders. Because the typology was independent from the type of disorder, it supports the general concept of behavioral addictions, and the similarities between eating disorders and behavioral addictions. The relevance of this model should be further examined in future studies.