Self-Objectification, Disordered Eating and Sexual Orientation in Men

The interplay between disordered eating, depressive symptoms and self-objectification differs between genders and sexual orientations, and merits further study in homosexual and heterosexual men. We examined disordered eating, depressive symptoms and self-objectification in a sample of Israeli heterosexual and homosexual men. Participants were 215 men aged 19-65, 108 of whom were classified by the Kinsey scale as being heterosexual and 107 as homosexual. They completed online measures of self-objectification, disordered eating and depressive symptoms. Heterosexual men reported lower levels of disordered eating and self-objectification than homosexual men, however the difference in depressive symptoms was not statistically significant. Correlations between disordered eating, self-objectification and depressive symptoms when controlling for age, BMI and number of children were all significant, with similar patterns of association for heterosexual and homosexual men. Self-objectification partially mediated the association between sexual orientation and disordered eating. However, contrary to our hypothesis, sexual orientation (homosexual/heterosexual) did not moderate the association between disordered eating and self-objectification. The tendency of homosexual men towards self-objectification is linked to unhealthy eating habits. Self-objectification helps explain the propensity of homosexual versus heterosexual men to develop disordered eating and possibly eating disorders. It should therefore be targeted in prevention and in therapy.

"Women Friendly": A Childbirth Preparation Intervention in Israel for Women with Symptoms of Post-Traumatic Stress Disorder

Pregnant women with symptoms of post-traumatic stress disorder (PTSD), who have experienced traumatic events such as sexual abuse and traumatic births, are particularly vulnerable to experiencing extreme fear of childbirth complications during labor and traumatic deliveries. In this commentary, we review the literature on this group of women and their specific needs during pregnancy and childbirth. We present a childbirth preparation intervention for pregnant women with PTSD symptoms, "Women Friendly", designed in Israel and gradually becoming available in the community and Israeli hospitals. This intervention is intended for women with high levels of fear of childbirth who are unmotivated or unable to undergo traditional psychotherapy that focuses on exposure to and processing of past traumatic event(s). It is based on birth-oriented thinking, principles of positive psychology, and trauma-informed care. In addition to the five sessions offered to pregnant women, medical staff are provided with 19 training sessions on the "Women Friendly" approach. Qualitative and quantitative research should examine the effectiveness of this intervention. Should results be encouraging, this intervention could be more widely implemented in Israel and abroad and applied in broader contexts, such as gynecological check-ups and medical examinations, interventions, and surgery.

Too healthy for their own good: orthorexia nervosa and compulsive exercise in the community

BACKGROUND

The similarities and differences between orthorexia nervosa symptoms (ONs) and the symptoms and correlates of eating disorders listed in the DSM-5 need to be elucidated. ONs were examined in a volunteer community sample in conjunction with compulsive exercise, disordered eating, as well as emotional and behavioral correlates of eating disorders.

METHODS

Participants were 561 adult volunteers (93 men, 17.09%) aged 19-72 (M = 32.7 ± 11), recruited via social media networks. Participants self-reported on the following measures online: Düsseldorf Orthorexia Scale, Compulsive Exercise Test, Retrospective Child Feeding Questionnaire, Experiences in Close Relationships, Difficulties in Emotional Regulation Scale, Toronto Alexithymia Scale, and Eating Disorder Examination Questionnaire 13. Data were downloaded and analyzed in SPSS26 and Amos26.

RESULTS

A theoretical model of the connections between the study variables was tested via SEM and confirmed. The profiles of participants with high, average and low levels of ONs were compared. Participants with the highest levels also scored highest for compulsive exercise, insecure attachment, alexithymia, emotion regulation difficulties, weight and shape concerns, body dissatisfaction, restriction, bingeing, purging and parental feeding practices of concern about child's weight and restricting and monitoring the child's intake of calorie-rich foods.

DISCUSSION

High levels of ONs are related to disordered eating attitudes and behaviors, as well as to emotional and behavioral correlates of eating disorders. It is unclear to what extent these ONs are distinguishable from symptoms of other eating disorders listed in the DSM-5. Longitudinal studies may help to elucidate distinct trajectories and risk factors for ON.

LEVEL OF EVIDENCE

Level III, case-control analytic study.

The psychometric properties of the Varieties of Inner Speech Questionnaire-Revised in Hebrew

Introduction

The Varieties of Inner Speech Questionnaire-Revised (VISQ-R) is a self-report questionnaire designed to measure characteristics of inner speech. In the current study, we adapted and validated a Hebrew version of VISQ-R. Our first hypothesis was that Confirmatory Factor Analysis (CFA) of the Hebrew VISQ-R would confirm the five subscales replicating the factor structure of the original questionnaire. In addition, building on previous findings that inner speech is involved in tasks that require the executive functions we examined the relationship between VISQ-R and self-reported executive functions questionnaire (BRIEF-A). We hypothesized that correlations between subscales of the Hebrew VISQ-R would reveal covariance between BRIEF-A and some but not all inner speech subscales.

Methods

406 participants completed the Hebrew VISQ-R and 280 of them also completed the BRIEF-A.

Results

As hypothesized, CFA confirmed the factor structure revealing the same 5 subscales reported in the original English version, with acceptable internal reliability. Partial support was found for the hypothesized correlations between VISQ-R and BRIEF-A, with covariance of executive functions with some subscales of inner speech (Evaluative, Other-People and Dialogic), and distinct variance with others (Condensed and Positive).

Discussion

These results indicate that the Hebrew version of the VISQ-R has good psychometric properties and that it can be used in future research. The implications concerning the contribution of inner speech for people with difficulties in executive functions are discussed.

Ageism and Type D Personality: The Protective Role of Self-Esteem and Perceived Social Support

Background: This study examined the relationship between Type D personality and ageism in young adults, and evaluated the role of protective and risk factors. Methods: Two hundred and forty-seven community volunteers (M age = 31.8 years) reported online on age-related attitudes, Type D personality, and on measures of well-being. Results: A significant correlation was found between ageist attitudes and the tendency toward Type D personality. Both Type D personality and ageism correlated negatively with all the well-being measures. Perceived social support (PSS) partially down-mediated the association between Type D personality and ageism. A three-way interaction was found among individuals with Type D personality. Low PSS and low self-esteem were associated with an elevation of ageism compared to those with low PSS and high self-esteem. Discussion: The current research suggests that self-esteem and PSS are protective against ageism, and might be good targets for psychological interventions in order to mitigate ageism, particularly among individuals with Type D personality.

Mediating roles of character traits and parenting in the relationship between maternal effortful control and children's conduct problems

Background

Parenting practices are crucial to children's development and are important predictors of children's conduct problems. The aim of the current study was to test the mediating role of mothers' character traits on the relationship between their temperamental self-regulation and their parenting practices, and on their children's conduct problems.

Method

A representative sample of 387 Israeli mothers of kindergarten children was recruited online. They completed questionnaires about their own effortful control (adult temperament questionnaire; ATQ), character traits (temperament and character inventory-revised (TCI-R), big five inventory (BFI)), and parenting practices (coping with children's negative emotions scale; CCNES), as well as conduct problems of their children (strengths and difficulties questionnaire; SDQ). Structural equation models were fitted, testing for direct and indirect connections, once with character traits drawn from the TCI and once with BFI traits.

Results

In both analyses, the first model presented a significant direct effect between mothers' effortful control and children's conduct problems. When including mother's parenting and character (based on the TCI or on the BFI) in the model, the direct path became insignificant and significant mediation effects were found; specifically, the indirect path through the parenting practices, as well as the mediated mediation path through the parenting practices and character. Moreover, mediation effects were found between mothers' effortful control and parenting practices through some character traits. The selected models showed a good fit (e.g., NFI = 0.985; CFI = 0.997; RMSEA = 0.038).

Discussion

Our findings emphasize the importance of the mother's mature personality characteristics, the mother's actual parental practices, and the crucial value of this path for predicting child behavior outcomes.

Associations of self-repression with disordered eating and symptoms of other psychopathologies for men and women

BACKGROUND

Disordered eating has been found to be associated with constructs involving self-repression, such as selflessness (the tendency to relinquish one's needs for others'), and concern for appropriateness (an alertness to information about social comparison and tendency to vary one's behavior in different social situations). This study aimed to examine associations between these self-repression variables and symptoms of general psychopathology for women and men in a community sample.

METHODS

Two hundred and thirty-six participants (92 men) aged 18-76 (M = 29.11 ± 10.10) volunteered to complete online measures of disordered eating, concern for appropriateness (cross-situational variability and attention to social comparison information), selflessness, and symptoms of depression, anxiety and somatization. Structural equation models were built to assess pathways between the study variables for men and women separately.

RESULTS

A MANOVA 2*7 design showed that women scored significantly higher than men on measures of selflessness, disordered eating and depression. For men, selflessness scores were positively and significantly associated only with depression scores. Cross-situational variability scores were positively associated with depression, somatization and anxiety scores. For women, selflessness scores were positively and significantly associated with depression, disordered eating, somatization and anxiety scores. Cross-situational variability scores were positively and significantly associated with depression, anxiety and somatization scores but not with disordered eating scores. Attention to Social Comparison Information scores were positively and significantly associated only with disordered eating scores.

CONCLUSIONS

Self-repression is more closely linked to psychopathology in women than in men. For men, self-suppression seems to be associated with symptoms of internalizing disorders, but not disordered eating. Even for women, it appears that self-repression is not connected exclusively with disordered eating, but with symptoms of psychopathology in general. Future research should explore why self-suppression plays such a central role in women's psychopathology.

The Eating Disorders Recovery Questionnaire: psychometric properties and validity

PURPOSE

There is no standardized measurement of recovery from an eating disorder (ED). We examined the psychometric properties and construct validity of the "Eating Disorders Recovery Questionnaire" (EDRQ), which defines recovery beyond symptoms to include self-acceptance, social emotional and physical health.

METHODS

Twenty-eight recovery-related items were administered to 978 people (9.5% men) aged 18-76. 172 participants had a current ED diagnosis (AN, BN or BED), 104 had a past ED diagnosis (AN, BN, BED or > one diagnosis), 105 had another past or present ED, and 579 had no lifetime ED. Participants also completed the Eating Disorders Examination Questionnaire, Dresden Body Image Questionnaire-35, Positive and Negative Affect Schedule-Short Form, Patient Health Questionnaire-9, Satisfaction with Life Scale and Positive Eating Scale.

RESULTS

Exploratory and confirmatory factor analyses yielded four factors (CFI = 0.93, RMSEA = 0.07): lack of symptomatic behavior, acceptance of self and body, social and emotional connection, and physical health. Group comparisons showed that currently ill women scored lower on EDRQ and positive indices and higher on negative indices than controls and previously ill women. Previously ill women scored similarly to controls on ED symptomatology, positive body experiences, depression, and positive and negative affect but had lower BMI, life satisfaction and positive eating. The EDRQ-EDEQ correlation was r = 0.67, indicating both overlap and distinct variance.

CONCLUSION

The EDRQ is a valid, reliable measure of ED recovery, defined more broadly than symptom remission. We recommend its incorporation into a standardized operationalization of recovery and its use by consumers, carers and service providers to monitor ED recovery status.

LEVEL OF EVIDENCE

Level III, case-control analytic study.

Eating for numbing: a community-based study of trauma exposure, emotion dysregulation, dissociation, body dissatisfaction and eating disorder symptoms

Objective

The current study tests the relationship between eating disorder (ED) symptoms and trauma exposure. The mechanisms via which trauma is related to ED symptoms have not been sufficiently examined. This study examines the complex role of dissociation and emotional dysregulation in the context of trauma, BMI, ED symptoms and body dissatisfaction (BD). We hypothesized that dissociation and emotional dysregulation would mediate the relationship between trauma exposure and ED symptoms/BD. We further hypothesized that BMI would play a moderating role in this association.

Method

A community sample of 229 (16.2% male) participants, with a mean age of 29.08 ± 10.68 reported online on traumatic events (Life Events Checklist), dissociation (Dissociative Experiences Scale-II), emotional dysregulation (Difficulties in Emotional Regulation Scale), ED symptoms (Eating Disorders Examination-Questionnaire) and BD (Figure Rating Scale).

Results

Participants reported experiencing a mean of 2.87 ± 2.27 traumatic events, with a relatively high percentage (~86%) reporting at least one. The most commonly reported traumatic events were transportation accidents and physical assault. Although frequency of traumatic events did not directly predict ED symptoms, BMI, dissociation, emotional dysregulation and BD did. An SEM model showed that traumatic events predicted ED symptoms indirectly through dissociation, emotional dysregulation and BMI. Dissociation and emotional dysregulation predicted ED symptoms directly. BMI also moderated the association between traumatic events and both ED symptoms and BD.

Conclusions

Therapists treating patients with high BMI or obesity should be aware of these relationships and investigate the possibility that trauma and/or PTSD may underlie the presenting disordered eating or eating disorder.

Attitudes towards eating disorders clinicians with personal experience of an eating disorder

PURPOSE

This study explores the perspectives and opinions towards ED clinicians with lived experience of ED.

METHODS

Three hundred and eighty-five ED clinicians and 124 non-clinicians from 13 countries, between 18 and 76 years of age completed an online survey about attitudes towards ED clinicians with a personal ED history. Almost half the respondents (n = 242, 47.5%) reported a lifetime ED diagnosis. Survey items included ten multiple-choice and three open questions about clinician disclosure, employer hiring practices, and perceived advantages and disadvantages of clinicians with a personal ED history practicing in the ED field. Multiple-choice responses from clinicians with and without a personal ED history were compared with responses from non-clinicians with and without a personal ED history. Open questions were examined using thematic analysis.

RESULTS

Clinicians with no ED history, whose responses often differed from both ED-history groups (clinicians and non-clinicians), were more likely to indicate that clinicians with an ED should not generally treat ED patients, and that clinicians should self-disclose their ED history to employers but not to their patients. Thematic analysis of the open-ended questions revealed that advantages of having clinicians with an ED history include a deep experiential understanding and the ability to be empathic and non-judgmental, whereas disadvantages include the lack of objectivity and the risk of clinicians being triggered.

CONCLUSION

Further research informing guidelines for ED clinicians with a personal ED history, their colleagues and employers are needed to protect and empower the significant minority of ED professionals with "lived experience" of EDs.

LEVEL OF EVIDENCE

Level III, case-control analytic study.

Studying Dynamics of Human Information Gathering Behaviors Using Social Robots

A novel social interaction is a dynamic process, in which participants adapt to, react to and engage with their social partners. To facilitate such interactions, people gather information relating to the social context and structure of the situation. The current study aimed to deepen the understanding of the psychological determinants of behavior in a novel social interaction. Three social robots and the participant interacted non-verbally according to a pre-programmed “relationship matrix” that dictated who favored whom. Participants' gaze was tracked during the interaction and, using Bayesian inference models, resulted in a measure of participants' social information-gathering behaviors. Our results reveal the dynamics in a novel environment, wherein information-gathering behavior is initially predicted by psychological inflexibility and then, toward the end of the interaction, predicted by curiosity. These results highlight the utility of using social robots in behavioral experiments.

Eating Disorder Examination Questionnaire (EDE-Q-13): expanding on the short form

OBJECTIVE

The Eating Disorders Examination-Questionnaire (EDE-Q) is widely used but time-consuming to complete. In recent years, the advantages and disadvantages of several brief versions have therefore been investigated. A seven-item scale (EDE-Q-7) has excellent psychometric properties but excludes items on bingeing and purging. This study aimed to evaluate a thirteen-item scale (EDE-Q-13) including items on bingeing and purging.

METHOD

Participants were 1160 (188 [11.4%] males) community volunteers of mean age 28.79 ± 9.92. They completed the full EDE-Q in Hebrew, as well as measures of positive body experience, social and emotional connection, life satisfaction, positive and negative affect and positive eating. The six EDE-Q items about bingeing and purging, recoded to correspond to the response categories of the other EDE-Q questions, were added to the EDE-Q-7, resulting in the EDE-Q-13.

RESULTS

Confirmatory factor analysis confirmed the hypothesized EDE-Q-13 structure, including the bingeing and purging subscales. Strong positive correlations were found between the EDE-Q-13 and the original EDE-Q scores. The EDE-Q-13 showed convergent validity with related measures.

CONCLUSIONS

The EDE-Q-13 in Hebrew is a brief version of the EDE-Q that includes bingeing and purging subscales and has satisfactory psychometric properties. Its use in clinical and research contexts is encouraged.

A longitudinal study of maternal feeding and children's picky eating

This study aimed to estimate the rate of persistent picky eating (PE) in children 3-8 years of age, and to characterize children with PE and their mothers. From a base sample of 1055 mothers of children 3.4 ± 1.3 years old, we selected those who described their children as picky eaters (PEs; n = 185, 17.5%) for a longitudinal study. 109 PE dyads participated, as well as a matched comparison group of dyads without PE (n = 106). At T1 mothers self-reported on trait anxiety, perfectionism, attachment style; as well as on the child's behavioral problems, their temperament, and their executive function. The participants were re-evaluated twice, at two-year intervals (T2 and T3). At T2 the mothers self-reported on their personality, on their child feeding practices, and reported their child's eating behavior. At T3 the mothers self-reported on their feeding style and the children self-reported on a pictorial frequent food questionnaire. PE persisted throughout T2 and T3 in 22.5% of T1 PE children in the longitudinal study, or in 3.94% of the base sample. The child characteristics that distinguished the PE and non-PE groups at T1 predicted 9-10% of the variance of T3 PE. Maternal feeding practices at T2 contributed 1-2% to the explained variance. It can be concluded that for the overwhelming majority of children, PE is a passing phase. Maternal feeding practices have limited long-term influence on children's PE. Unless PE is persistent and severe, parents would best be advised to relax their feeding efforts.

Potential Risk and Protective Factors for Eating Disorders in Haredi (ultra-Orthodox) Jewish Women

Little is known scientifically about eating disorders (EDs) in the Haredi (Jewish ultra-Orthodox) community. This paper aims to describe Haredi culture, review available peer-reviewed research on EDs in the Haredi community and discuss possible risk and protective factors for these disorders in a culturally informed way. A literature search for 2009-2019 yielded 180 references of which only nine were studies on ED in the Haredi community. We describe these and use them as a basis for discussion of possible risk and protective factors for ED in Haredi women. Risk factors may include the centrality of food, poverty, rigid dress codes, the importance of thinness for dating and marriage, high demands from women, selflessness and early marriage and high expectations from women. Protective factors may include faith, Jewish laws governing eating and food that encourage gratitude and mindful eating, and body covering as part of modesty laws that discourage objectification. Ways of overcoming the current barriers to research in the Haredi community should be sought to advance ED prevention and treatment in this population.

Weight gain, feeding and eating in the first year of life of babies of smoking and non-smoking mothers

Babies of mothers who smoke during pregnancy tend to be born underweight but are at risk for pediatric obesity. Maternal feeding practices, maternal disordered eating, and child temperament were assessed as potential mediators of early weight gain in babies of smoking and non-smoking mothers. The BMIs of babies of 88 smoking and 107 non-smoking mothers were recorded at birth and reported one year later. Mothers self-reported on disordered eating and child feeding practices, and on their infants' temperament. Babies of smoking mothers had lower BMI at birth but not at age one. For babies of non-smoking but not for those of smoking mothers, BMI at birth predicted BMI at age one. Smoking mothers' disordered eating and pressure for children to eat predicted their babies' BMI at age one. In the non-smoking group only, there were significant correlations between babies' temperamental difficulties and babies' BMI at age one. In contrast to non-smoking mothers, smoking mothers tend to pressure their babies to eat, and not to feed them in response to their distress. This interim picture may provide insight into the transition of the children of smoking mothers from underweight newborns to children classified as overweight.

Active and passive procrastination in terms of temperament and character

Background

While passive procrastination is usually associated with distress and dysfunction active procrastination may be an effective coping style. To test this possibility, we examined passive and active procrastination in terms of temperament, character, and emotional intelligence (EI), as well as by a short-term longitudinal study.

Methods

Adult community volunteers (N = 126) self-reported twice in an online short-term longitudinal study. At baseline on active and passive procrastination, as well as on the temperament and character inventory of personality (TCI-140) and EI. At first testing, they were asked to freely describe three personal goals and to make action plans to achieve each within the next two weeks. Two weeks later they reported on progress on their personal goals (PPG).

Results

PPG correlated positively with active procrastination and negatively with passive procrastination. Dividing the participants into median splits on active and passive procrastination resulted in four groups: Active, Passive, Active-Passive, and Non-Procrastinators. Analysis of variance showed that active procrastinators had an advantage in temperament and character traits as well as EI. Active procrastinators were also higher than the other groups on personality profiles i.e. combinations of traits; dependable temperament and well-developed character.

Conclusions

Active procrastination can be an adaptive and productive coping style. It is associated with dependable temperament, well-developed character, and high emotional intelligence and predicts meeting personal goals.

Can Recovery From an Eating Disorder Be Measured? Toward a Standardized Questionnaire

Background: There is a clear need for a standardized definition of recovery from eating disorders (EDs) and for self-report instruments to assess where individuals with an ED are situated at a given point of time along their process of illness and recovery. It has been acknowledged that psychological and cognitive symptoms are important to recovery in addition to physical and behavioral indices. This study proposes a 28-item multidimensional questionnaire encompassing the main features of recovery from ED, derived from the endorsement of different criteria by people with a lifetime ED diagnosis, family members and ED clinicians. Methods: Participants were 213 volunteers over the age of 18 (118 people with a lifetime ED diagnosis, 58 healthy family members of people with EDs and 37 ED clinicians), who completed the ED-15 and indicated online how important they thought each of 56 criteria were for recovery from an ED. Results: Four factors were identified in an exploratory factor analysis: Lack of Symptomatic Behavior (LSB), Acceptance of Self and Body (ASB), Social and Emotional Connection (SEC), and Physical Health (PH). Confirmatory factor analysis using the seven highest loading items from each subscale confirmed the structure validity of a shortened version of this questionnaire, the Eating Disorders Recovery Endorsement Questionnaire (EDREQ), which had excellent goodness-of-fit indices. Despite a few between-group differences, there was general agreement that LSB was most salient to recovery, followed by ASB, SEC, and PH in that order. Conclusion: Despite the absence of a standardized definition of recovery from ED, there is a general consensus about its components. The EDREQ is a psychometrically sound questionnaire containing items that people with an ED history, their family members and therapists all define as important components of recovery. The inclusion of emotional and psychosocial aspects of recovery in addition to symptomatic and medical aspects is important to expand treatment goals and the concept of recovery from EDs beyond symptom relief and the absence of disease markers. As a clinical tool, the EDREQ stands to assist in setting and refining therapeutic goals throughout therapy, and in establishing standardized, comparable norms for recovery levels in research.

"Silence! The body is speaking" - a correlational study of personality, perfectionism, and self-compassion as risk and protective factors for psychosomatic symptoms distress

The current study examined the role of personality traits on psychosomatic distress (PD) and tested the hypothesis that the association between perfectionism and PD would be moderated by self-compassion. One hundred and seventy-three community volunteers, of whom 24.9% were men, mean age 31.52 ± 13.29, reported online on the DS14, a measure of Type D personality, on the TCI-140, a measure of temperament and character, on the Frost multidimensional perfectionism scale, on the short form of the self-compassion scale and on the SOMS-7 for psychosomatic symptoms. We defined psychosomatic distress as the product of the symptom count and severity rating score of the SOMS-7. The hierarchical linear regression model that included all the personality variables as well as the interaction term between self-compassion and perfectionism accounted for 25% of the variance in PD. The interaction between perfectionism and self-compassion entered into the model in the last block was highly protective. High self-compassion moderated the effect of perfectionism on PD. Our finding correspond with the notion that personality can enhance PD but can also mitigate it. Protective personality traits, such as self-compassion, might be good targets for psychological intervention.

Lives on the Line: The Online Lives of Girls and Women With and Without a Lifetime Eating Disorder Diagnosis

This study aimed to compare the scope, internet use patterns, and degree of online need satisfaction of girls and women with and without a lifetime eating disorder (ED) diagnosis. Participants were 122 females aged 12-30, 53 with a lifetime ED diagnosis recruited via a hospital-based treatment program, and 69 age-matched controls recruited via normative social media sites. Participants completed questionnaires assessing disordered eating, body image, positive and negative affect, general distress, and life satisfaction, and completed an online survey about the scope of their internet use, the frequency of watching and posting pictures and videos, online friendships and social comparison, fulfillment of needs online, and mood after internet use. All questionnaire scores differed significantly between groups in the expected directions. Whereas overall, ED and control groups spent similar amounts of time online (6.21, SD = 5.13), they spent this time differently. ED participants reported devoting 56.7% of their online time to eating, weight and body image, versus 29.1% for controls, and spent significantly more time than controls on forums and blogs (t = -5.3, p < 0.0001, Cohen's d = 0.87). They also engaged more often in social comparison (t = 3.6, p < 0.005, Cohen's d = 0.65), had a higher online-offline friend ratio (t = 3.7, p < 0.0001, Cohen's d = 0.65), and more online friends with ED (t = 5.4, p < 0.0001, Cohen's d = 0.89). In comparison to controls, ED participants reported that their use of forums and blogs gave them more eating- and weight-related advice, and a greater sense of belonging, social support, and safety resulting from anonymity, with effect sizes of 0.63-0.96. However, they also reported more negative affect after posting online. Most online behaviors and patterns correlated positively with measures of symptomatology and negatively with measures of psychological health, in both groups. Internet use was rarely addressed in therapy. Professionals, families and friends should help people with disordered eating and EDs to broaden the scope of their internet use. They should invest less in food- and weight-related forums/blogs, expand their "real life" social lives and develop their interpersonal skills, so that their legitimate needs can be satisfied face-to-face, rather than virtually. Clinicians should address the online lives of their ED clients in therapy.

An exploratory study of adolescent response to fluoxetine using psychological and biological predictors

Background

Not enough is known about predicting therapeutic response to serotonin-specific reuptake inhibitors, and specifically to fluoxetine. This exploratory study used psychological and biological markers for (retrospective) prediction of treatment-response to fluoxetine in depressed and/or anxious adolescents.

Methods

Forty-one consecutive adolescent outpatients with a primary diagnosis of severe affective and/or anxiety disorders were assessed and treated with an open-label 8-week trial of fluoxetine. Type D personality was assessed with the 14-item questionnaire, the DS14. In addition, TNFα, IL-6, and IL-1b were measured pre- and post-treatment.

Results

There was an elevation of Type D personality in patients, compared to the adolescent population rate. Post-treatment, 44% of patients were classified as non-responders; the relative risk of non-response for Type D personality patients was 2.8. Binary logistic regression predicting response vs. non-response showed a contribution of initial TNFα levels as well as Type D personality to non-response.

Conclusions

In this exploratory study, the most significant contributor to non-response was Type D personality. However, the measurement of Type D was not prospective, and thus may be confounded with psychiatric morbidity. The measurement of personality in psychiatric settings may contribute to the understanding of treatment response and have clinical utility.

Ever since I can remember myself: Implications of attachment and perceived maternal feeding practices on adult women's body dissatisfaction

BACKGROUND

Research indicates that women with an eating disorder are more insecurely attached than those without. Over-restrictive maternal feeding practices in childhood are associated with elevated BMI and more disordered eating in adult women.

GOALS

The goal of the current study was to examine the extent to which the two insecure attachment styles contribute to women's body dissatisfaction indices and to examine their role in moderating the influence of restrictive maternal child feeding practices.

METHODS

283 women between the ages of 18-42 (mean=25.04; SD=3.53) sampled through social networking completed an online self-report, including the Figure Rating Scale (from which Self-Ideal comparison was calculated), retrospective child feeding questionnaire (RCFQ), the experience in close relationship (ECR) questionnaire, and the EDI's Drive for Thinness and Body Dissatisfaction subscales.

RESULTS

Insecure-anxious attachment positively predicted Drive for Thinness, Body Dissatisfaction and Self-Ideal Disparity. However, insecure-avoidant attachment did not predict indices of body dissatisfaction. Recalled over-controlling maternal childhood feeding behaviors were associated with Drive for Thinness, Body Dissatisfaction and greater Self-Ideal body image disparity. Significant interactions between attachment styles, maternal childhood feeding behaviors, and body dissatisfaction indices emerged.

CONCLUSIONS

In the presence of restrictive feeding practices in childhood, insecure attachment styles moderate women's adult body dissatisfaction indices. Avoidant attachment style plays a protective role while anxious attachment style exacerbates body dissatisfaction indices.

The EDE-Q in Hebrew: Structural and Convergent/Divergent Validity in a Population Sample

BACKGROUND

The Eating Disorders Examination Questionnaire (EDE-Q), originally written in English, is used to screen for and help diagnose eating disorders (EDs). The purpose of this study was to test a Hebrew version for structural validity, for convergent validity, and screening properties in a non-clinical community sample in Israel.

METHOD

The EDE-Q was translated into Hebrew, with permission, and administered online with other well-used self-report instruments to 292 community volunteers (18% male).

RESULTS

Exploratory and confirmatory factor analyses largely confirmed the original factor structure, although weight and shape concerns converged into a single factor. Results indicate good convergent validity and screening properties.

CONCLUSIONS

The favorable psychometric properties of the EDE-Q found in this study add the Hebrew version to a growing list of EDE-Q translations valid in diverse cultures. This important instrument is now available to Israeli clinicians and researchers and should be used and further explored with larger and more diverse populations.

Editorial: New Horizons in the Classification, Biology and Management of Eating Disorders

BACKGROUND

The Dresdner Körperbildfragebogen (DKB- 35) is a positive and comprehensive measure of the relationship with the body. Written and used in German the original has good psychometric qualities. The goal of the current study was to translate it into Hebrew and then test its psychometric qualities.

METHOD

292 adult community volunteers self-reported online on the DKB-35 as well as on the Satisfaction with Life Scale and the Eat-26. The data were exported into and analyzed in SPSS 21.0.

RESULTS

Structural validity, reliability and convergent and divergent validity of the Hebrew DKB-35 was demonstrated. All five original sub-scales: Body- Acceptance, Vitality, Body-Narcissism, Physical-Contact, and Sexual-Fulfillment were recovered.

CONCLUSIONS

The DKB-35 in Hebrew can be used in the context of mental health and the process of recovery from eating disorders. Address.

Distinctive personality profiles of fibromyalgia and chronic fatigue syndrome patients

OBJECTIVE

The current study is an innovative exploratory investigation, aiming at identifying differences in personality profiles within Fibromyalgia Syndrome (FMS) and Chronic Fatigue Syndrome (CFS) patients.

METHOD

In total, 344 participants (309 female, 35 male) reported suffering from FMS and/or CFS and consented to participate in the study. Participants were recruited at an Israeli FM/CFS patient meeting held in May 2013, and through an announcement posted on several social networks. Participants were asked to complete a research questionnaire, which included FMS criteria and severity scales, and measures of personality, emotional functioning, positivity, social support and subjective assessment of general health. In total, 204 participants completed the research questionnaire (40.7% attrition rate).

RESULTS

A cluster analysis produced two distinct clusters, which differed significantly on psychological variables, but did not differ on demographic variables or illness severity. As compared to cluster number 2 (N = 107), participants classified into cluster number 1 (N = 97) showed a less adaptive pattern, with higher levels of Harm Avoidance and Alexithymia; higher prevalence of Type D personality; and lower levels of Persistence (PS), Reward dependence (RD), Cooperation, Self-directedness (SD), social support and positivity.

CONCLUSION

The significant pattern of results indicates at least two distinct personality profiles of FM and CFS patients. Findings from this research may help improve the evaluation and treatment of FM and CFS patients, based on each patient's unique needs, psychological resources and weaknesses, as proposed by the current trend of personalized medicine.

Is type-D personality trait(s) or state? An examination of type-D temporal stability in older Israeli adults in the community

Background. Type D personality was suggested as a marker of poorer prognosis for patients of cardiovascular disease. It is defined by having a score of 10 or more on both sub-scales of the DS14 questionnaire, Social Inhibition (SI) and Negative Affectivity (NA). As Type D was designed to predict risk, its temporal stability is of prime importance.

Methods. Participants in the current study were 285 community volunteers, who completed the DS14, and other personality scales, at a mean interval of six years.

Results. The prevalence of Type D did not change. The component traits of Type D showed rank order stability. Type D caseness temporal stability was improved by using the sub-scales product as a criterion. Logistic hierarchical regression predicting Type D classification from Time1 demonstrated that the best predictors were Time1 scores on NA and SI, with the character trait of Cooperation, and the alexithymia score adding some predictive power.

Conclusions. The temporal stability of the component traits, and of the prevalence of Type D were excellent. Temporal stability of Type D caseness may be improved by using a product threshold, rather than the current rule. Research is required in order to formulate the optimal timing for Type D measurement for predictive purposes.

Sugarcoated isolation: evidence that social avoidance is linked to higher basal glucose levels and higher consumption of glucose

Objective: The human brain adjusts its level of effort in coping with various life stressors as a partial function of perceived access to social resources. We examined whether people who avoid social ties maintain a higher fasting basal level of glucose in their bloodstream and consume more sugar-rich food, reflecting strategies to draw more on personal resources when threatened. Methods: In Study 1 (N = 60), we obtained fasting blood glucose and adult attachment orientations data. In Study 2 (N = 285), we collected measures of fasting blood glucose and adult attachment orientations from older adults of mixed gender, using a measure of attachment style different from Study 1. In Study 3 (N = 108), we examined the link between trait-like attachment avoidance, manipulation of an asocial state, and consumption of sugar-rich food. In Study 4 (N = 115), we examined whether manipulating the social network will moderate the effect of attachment avoidance on consumption of sugar-rich food. Results: In Study 1, fasting blood glucose levels corresponded with higher attachment avoidance scores after statistically adjusting for time of assessment and interpersonal anxiety. For Study 2, fasting blood glucose continued to correspond with higher adult attachment avoidance even after statistically adjusting for interpersonal anxiety, stress indices, age, gender, social support and body mass. In Study 3, people high in attachment avoidance consume more sugar-rich food, especially when reminded of asocial tendencies. Study 4 indicated that after facing a stressful task in the presence of others, avoidant people gather more sugar-rich food than more socially oriented people. Conclusion: Results are consistent with the suggestion that socially avoidant individuals upwardly adjust their basal glucose levels and consume more glucose-rich food with the expectation of increased personal effort because of limited access to social resources. Further investigation of this link is warranted.

Mirror, mirror on the wall: how women learn body dissatisfaction

Extensive research indicates that exposure to media as well as pressure and modeling by sociocultural agents, such as peers and family, are predictive of the development of body image dissatisfaction (BID). This influence is mediated by social comparison and internalization of the thin-ideal. In the current study we assessed comparisons between participants and other women with whom they were in close relationships, (e.g. mother, sister and close female friend), and hypothesized that these would influence women's BID and drive-to-thinness. 283 women between the ages of 18-42 (mean=25.04; SD=3.53) sampled through social networking completed an online self-report which included the original Figure Rating Scale, which yielded self-ideal disparity, as well as a modified version comparing self to mother, self to sister closest-in-age, and self to best friend and then were asked to directly compare themselves to these women. In addition they completed the EDI-2's drive-for-thinness and body dissatisfaction subscales, and reported on Body Mass Index (BMI). Results indicate that comparisons to mothers, sisters, and best friend, were all associated with self-ideal disparity. BMI only slightly mediated this effect. Comparison to sister and to best friend, but not to mother, influenced drive-for-thinness and body dissatisfaction. Positive correlations were found between direct and indirect comparisons to others. Comparison to best friend was the most influential on body ideal. We conclude that comparison to others in close proximity greatly influences women's body ideal and may have a formative role in the development of women's body dissatisfaction. While women cannot choose their mother and sister closest in age, they do choose their best friend; and it is interesting that the comparison to the best friend is so influential.

Personality Traits Moderate Attribute Framing Effects

Previous research on attribute framing effects focused on context-specific variables that moderate it. This research examined whether two personality traits, namely agreeableness and conscientiousness, moderate the effect of attribute framing on the perceived fairness of allocation criteria. Two experiments showed that attribute framing affected the perceived fairness of allocation criteria for participants who score high on these personality traits. In contrast, participants who score low on these personality traits were relatively immune to attribute framing effect. Critically, these personality traits did not moderate the effect of attribute framing on evaluations in a nondistributive justice scenario. These findings are consistent with the possibility that highly agreeable and highly conscientious people are more sensitive to social issues, and, consequently, are more susceptible to attribute framing in scenarios that involve distributive justice. Theoretical implications are discussed and future research is suggested.

Behavioral addictions in euthymic patients with bipolar I disorder: a comparison to controls

BACKGROUND

Bipolar disorder may be associated with a hypersensitive behavioral approach system and therefore to increased reward sensitivity. The objective of this study is to explore the interrelationships between bipolar disorder, behavioral addictions, and personality/temperament traits in a group of euthymic outpatients with bipolar I disorder and in a group of comparison subjects.

METHODS

Fifty clinically stable patients and 50 comparison subjects matched for age, sex, and educational level were administered the Temperament and Character Inventory-140 and the Behavioral Addiction Scale.

RESULTS

The patient group scored significantly higher than comparison subjects for two benign behavioral addictions (music, shopping) as well as for smoking. Comparison subjects scored higher on two harmful behavioral addictions (drugs, alcohol). Novelty Seeking was positively correlated with harmful addictions, and Cooperativeness was negatively correlated with harmful addictions, in both groups.

DISCUSSION

The hypersensitive behavioral approach system model of bipolar disorder would predict higher levels of various addictions in bipolar patients as compared to controls. In this study, this was true for three behavioral addictions, whereas controls showed higher levels of behavioral addiction to drugs and alcohol. This may be because the patients in this study are stable, have received considerable psychoeducation, and are relatively adherent to their medication recommendations. Temperament and character traits may play roles both as risk and protective factors regarding behavioral addictions.

Nothing gained: an explorative study of the long-term effects of perceived maternal feeding practices on women's and men's adult BMI, body image dissatisfaction, and disordered eating

The objective of the studies presented here was the prediction of adult body mass index (BMI), body image dissatisfaction, and disordered eating from recalled maternal child feeding practices. Studies 1 and 2 sampled women from the community, and found that recalled childhood feeding practices predicted both current BMI and current disordered eating. Daughters whose mothers pressured them to eat as children had lower BMIs as adults. The more a mother was concerned about her daughter's weight as a child, and the more she restricted fatty food intake, the less the woman was satisfied with her current body image. Disordered eating of adult women was positively related to their mothers' restriction of their fatty food intake as children, and negatively related to the mothers' monitoring of their food intake as children. Combining the samples and subdividing them into four BMI intervals showed that the obese women were higher on all but one of the recalled maternal child feeding practices, as well as on disordered eating and body dissatisfaction. Age was found to be positively related to BMI and drive for thinness, but not to body dissatisfaction or disordered eating, with older women having higher BMI and more drive for thinness. Study 3 sampled adult men from the community and found that recalled maternal child feeding practices predicted adult BMI and disordered eating for men, as well as for women. Considerable sex differences were found for all study variables. Recollection of maternal child feeding practices may have a formative role in the development of body image, disordered eating, and BMI for men and women, even into adulthood.

The psychometric properties of the Retrospective Child Feeding Questionnaire in Hebrew

The objective of this study was to develop the Retrospective Child Feeding Questionnaire (RCFQ), and to assess its structural validity. In its original version, the CFQ was constructed to measure current practices of maternal feeding of children. For the present study, the CFQ was translated into Hebrew by translation, independent back-translation, and revision, and was then reworded to assess a retrospective assessment of maternal child feeding practices by adults. A large community sample of volunteers (N=406) was recruited and administered the RCFQ, and self-reported on body satisfaction, disordered eating, and body mass. The structural validity of the RCFQ was established by exploratory and confirmatory factor analysis for men and women. Some measure of construct validity is provided by correlational analysis. The RCFQ is structurally robust, and useful in assessing early influences on adult BMI, eating behavior, and body dissatisfaction.

The psychological costs and benefits of being highly persistent: personality profiles distinguish mood disorders from anxiety disorders

BACKGROUND

The personality trait of Persistence is highly valued by conscientious overachievers, but it has both psychological costs and benefits. The interactions among multiple personality factors influencing the development of mood and anxiety disorders have been confounded in prior clinical samples, but can be disentangled in terms of their underlying brain circuitry and influence on perception of emotional stimuli.

METHODS

285 individuals who represented the full range of personality variation in a large sample of adult volunteers from the general community of Israel were selected for follow-up by psychiatric interviews, cognitive testing, and medical examinations. The Temperament and Character Inventory (TCI) measured profiles of traits that distinguished individuals with diagnoses of mood and/or anxiety disorders using linear discriminant analysis and non-linear profile analysis.

RESULTS

High Harm Avoidance and low Self-directedness strongly distinguished people with mood and/or anxiety disorders from those with neither. High Persistence distinguished people with only anxiety disorders from those with mood disorders. High Persistence was associated with greater health and happiness overall, but also led to more negative emotions than in people with low Persistence unless they were both unusually tolerant of frustration (i.e., low in Harm Avoidance) and self-accepting of personal limitations (i.e. high in Self-directedness).

LIMITATIONS

Subjects were volunteers over 40 years of age at assessment.

CONCLUSIONS

People who are highly persistent (i.e., persevering, ambitious, perfectionistic) are more likely to have anxiety disorders than mood disorders, even when they have other traits increasing risk for both (i.e., high Harm Avoidance and low Self-directedness). High Persistence increases both positive and negative emotions in most people. However, high Persistence reduces negative emotions and increases positive emotions if a person is easy-going (i.e., "happy-go-lucky" when low in both Harm Avoidance and Self-directedness).

Personality and the perception of health and happiness

BACKGROUND

Health is a state of physical, mental, and social well-being. Personality traits measure individual differences in adaptive functioning and mental health, but little is known about how well personality accounts for health's affective aspects (i.e., "happiness") and its non-affective aspects (i.e., "wellness") in the general population.

METHODS

1102 volunteer representatives of the Sharon area of Israel completed the Temperament and Character Inventory (TCI), the Positive and Negative Affect Scale (PANAS), the Satisfaction with Life Scale (SWLS), the Multidimensional Scale of Perceived Social Support (PSS), and the subjective health assessment of the General Health Questionnaire (GHQ). Multidimensional personality profiles were used to evaluate the linear and non-linear effects of interactions among dimensions on different aspects of well-being.

RESULTS

Self-directedness was strongly associated with all aspects of well-being regardless of interactions with other dimensions. Cooperativeness was strongly associated with perceived social support, and weakly with other aspects of well-being, particularly when Self-directedness was low. Self-transcendence was strongly associated with positive emotions when the influence of the other character dimensions was taken into account. Personality explained nearly half the variance in happiness and more than one-third of the variance in wellness.

LIMITATIONS

Our data are cross-sectional and self-reported, so they are subject to personal perceptual bias.

CONCLUSIONS

The emotional, social, and physical aspects of well-being are interdependent, but specific configurations of TCI Self-directedness, Cooperativeness, and Self-transcendence influence them differentially. Interactions among different combinations of character traits have strong effects on the perception of both wellness and happiness.

The Psychometric Properties of the TCI-140 in Hebrew

The internal reliability as well as structural, convergent, and divergent validity of the Temperament and Character Inventory, brief 140-item version (TCI-140) in Hebrew were examined. The TCI-140 was translated, independently backtranslated, and revised. A total of 1102 community volunteers, over the age of 40, completed the TCI-140 and measures of emotional function, smoking, physical and sexual activity, medical diagnoses, and medical family history. Structural validity and internal reliability were assessed by scale reliability and exploratory and confirmatory factor analysis (CFA); convergent and discriminant validity by correlation with measures of emotional function and health behavior. The temperament trait of Harm Avoidance correlated positively with negative emotion and Alexithymia; and negatively with positive affect, well-being, subjective health assessment, and social support, while the reverse was true for Reward Dependence. The TCI character traits of Self-Directedness and Cooperation were correlated with better subjective feeling and more health behavior. The CFA for Temperament did not support the theoretical and empirical structure found for the English version; the CFA for character gave strong confirmation to the theoretical and empirical structure. The TCI-140 in Hebrew will be useful in assessing normal personality, as well as issues of psychopathology and health.

The Psychometric Properties of the DS14 in Hebrew and the Prevalence of Type D Personality in Israeli Adults

Objectives: To examine the psychometric properties of the 14-item Type D Scale (DS14) in Hebrew, and to estimate the prevalence of Type D personality (high negative affectivity and social inhibition) in Israeli adults. Methods: 1,350 consecutive community volunteers were recruited and completed questionnaires that included the DS14, the 140-item Temperament and Character Inventory (TCI-140), the Toronto Alexithymia Scale-20 (TAS-20), the Positive and Negative Affect Scale (PANAS), social support, well-being, assessment of smoking behavior, physical and sexual activity, known medical diagnoses, and family history of coronary heart disease (CHD). Results: The structural validity, as demonstrated by exploratory and confirmatory factor analysis, and the internal reliability of the DS14 was acceptable. Overall prevalence of Type D was 24.1%; individuals of Type D versus non-D were significantly higher in self-reported rates of hypertension, CHD diagnosis, and first-degree relatives diagnosed with CHD. They were also elevated for TCI-140 Harm Avoidance, as well as negative affect, alexithymia, and significantly lower in TCI-140 Novelty Seeking, Reward Dependence, Persistence, Self-Directedness, and Cooperativeness, as well as in subjective well-being, social support, and positive affect. Conclusion: The DS14 in Hebrew has good psychometric qualities, supporting cross-cultural validity.

Promotion of Well-Being in Person-Centered Mental Health Care

An understanding of the mechanisms of personality development provides a systematic way to promote health as an integrated state of physical, mental, social, and spiritual well-being. Individual differences in personality are causal antecedents of the full range of psychopathology. The maturation with integration of personality appears to be an important mechanism by which diverse modalities of treatment promote wellness and reduce illness. First, the authors review the relationship between personality and a wide range of psychiatric disorders. Second, the authors evaluate the impact of character structure on a wide range of measures of well-being, including positive emotions, negative emotions, life satisfaction, perceived social support, and perceived health. Third, the authors describe a practical and inexpensive clinical method for facilitating the maturation and integration of personality based on an understanding of the processes of human thought, which underlie changes in personality and well-being.

Diagnosing ADHD in Israeli adults: the psychometric properties of the adult ADHD Self Report Scale (ASRS) in Hebrew

This paper argues for the importance of diagnosing ADHD in adults, while acknowledging the many attendant difficulties. The paper presents results from two studies implementing the Adult ADHD Self Report Screen (ASRS) in Hebrew. The Hebrew version of the ASRS as approved by the World Health Organization is appended to this paper. The first of the two studies used a paper and pencil version of the ASRS (ASRS_PP) and the second used a computer administered version (ASRS_C). A subset of the participants in the two studies was given both versions. The Hebrew ASRS had excellent test-retest reliability. It had good internal consistency in both forms. Support for the validity of the Hebrew ASRS is given by the significantly higher scores of adults with ADHD versus those without, on both versions of the ASRS and on all of its subscales. The sensitivity of the raw sum of all 18 items was significantly higher than that of the 6-item screen suggested by the authors of the ASRS. The sensitivity and specificity of the ASRS in Hebrew should be further examined in future studies including clinically referred participants. The benefit of using the ASRS as part of the diagnostic process for adult ADHD is discussed.

Self-monitoring in anorexia nervosa

BACKGROUND

A possible connection between Mark Snyder's concept of self-monitoring and anorexia nervosa (AN) has not previously been examined.

AIMS

We hypothesized that AN symptomatology correlates positively with the Other-Directedness aspect of Snyder's self-monitoring construct and negatively with its Extraversion aspect.

METHOD

194 women with a history of AN were classified as currently ill (n = 17), partially recovered (n = 106) and recovered (n = 71).These women and 100 female controls with no history of an eating disorder completed Snyder's Self-Monitoring Scale (SMS) and the Eating Attitudes Test-26 (EAT-26). ;Other-Directedness' and ;Acting and Extraversion'subscales were derived from an exploratory factor analysis of the Hebrew version of the SMS. Mean total and subscale scores were compared across groups, and correlations were calculated between EAT-26 scores and SMS total and subscale scores.

RESULTS

Both subscales of the SMS correlated significantly with total scores but not with one another. As expected, AN symptomatology and EAT-26 scores were associated positively with Other-Directedness yet negatively with Acting and Extraversion, rendering the correlation with total SMS scores insignificant.

CONCLUSION

Different aspects of Snyder's self-monitoring construct correlate in opposite directions with eating pathology and AN symptomatology. AN appears to be associated with high Other-Directedness but low Acting and Extroversion.

Protective self-presentation style: association with disordered eating and anorexia nervosa mediated by sociocultural attitudes towards appearance

OBJECTIVE

We tested the hypothesis that a protective self-presentation style (Lennox and Wolfe, 1984) is associated with eating pathology and anorexia nervosa (AN) and that this association is mediated by sociocultural attitudes towards appearance emphasizing the thin ideal.

METHOD

We compared the protective-presentation style of women with AN (N=17), partially recovered women (N=110), fully recovered women (N=73), and female controls (N=374).

RESULTS

Ill women had a more protective self-presentation style than partially or fully recovered women, who in turn had a more protective self-presentation style than controls. Sociocultural attitudes towards appearance fully mediated the association between protective self-presentation and disordered eating.

CONCLUSIONS

Protective self-presentation may therefore be a risk factor for AN and/or a prognostic factor. Implications for therapy and prevention are discussed.

The Psychometric Properties of the Revised Self-Monitoring Scale (RSMS) and the Concern for Appropriateness Scale (CAS) in Hebrew

We examined the factor structure, reliability, and construct validity of a Hebrew translation of Lennox and Wolfe’s Revised Self-Monitoring Scale (RSMS) and Concern for Appropriateness Scale (CAS) in a large Israeli population sample. A total of 1,294 individuals (1,010 females and 284 males), divided into two samples, completed the RSMS, the CAS, the Tridimensional Personality Questionnaire Harm Avoidance Scale, and the Rosenberg Self-Esteem Scale. With the exception of RSMS Item 12, the total and subscale structure of the English versions of the scales was replicated in both samples. Internal consistencies compared very favorably with those of the original scales. The CAS and the RSMS were moderately correlated yet appeared to be distinct, correlating as expected in opposite directions with harm avoidance and self-esteem. Confirmatory factor analysis justified the use of the RSMS and the CAS as separate scales with two subscales in each. Whereas the fit of our data to the RSMS was very good, the fit to the CAS was far less satisfactory, apparently because items tended to load onto both subscales. The Hebrew translation of the RSMS, and, to a lesser extent, that of the CAS, appear to be psychometrically sound instruments.

The relationship between selflessness levels and the severity of anorexia nervosa symptomatology

This study examined the relationship of selflessness, the tendency to ignore one's own needs and interests and serve others, to the severity of anorexia nervosa (AN) symptomatology. Measures of selflessness, perfectionism, obsessiveness, self-esteem, disordered eating, body dissatisfaction, drive for thinness and general symptomatology were completed by 205 women with a history of AN (ANh) in various stages of illness and recovery (42 ill, 90 partially recovered and 78 recovered) and 238 female controls. The ANh women's scores on the Selflessness Scale declined significantly as the severity of current pathology decreased. Recovered anorexics scored similarly to female controls. Assertion of one's own needs and interests may be an integral component of recovery from AN, and should be emphasized in therapy.

Anorexia nervosa, perfectionism, and dopamine D4 receptor (DRD4)

The dopamine D4 receptor (DRD4), a well-characterized, polymorphic gene, is an attractive candidate for contributing risk to disordered eating and anorexia nervosa (AN). We tested association using UNPHASED for 5 DRD4 polymorphic loci, 3 promoter region SNPs (C-521T, C-616G, A-809G), the 120 bp promoter region tandem duplication and the exon III repeat, in 202 AN trios and 418 control families. Since perfectionism characterizes AN, we tested these five loci for association with the Child and Adolescent Perfectionism Scale (CAPS) in the AN and control groups. Single locus analysis showed significant association between the 'C' C-521T allele and AN. Haplotype analysis also showed significant association, particularly a 4-locus haplotype (exon III&120 bp repeat&C-521T&A-809G). Association was also observed between DRD4 and CAPS scores both for AN and control subjects. The insulin-like growth factor 2 (IGF2) and the arginine vasopressin 1a receptor (AVPR1a), previously shown to be associated with disordered eating, were also associated with CAPS scores. Three genes associated with AN were also associated with perfectionism. Personality traits are potential endophenotypes for understanding the etiology of eating disorders and one of the several pathways to eating pathology may be mediated by the impact of DNA sequences on perfectionism.

Association of the low-activity COMT 158Met allele with ADHD and OCD in subjects with velocardiofacial syndrome

Velocardiofacial syndrome (VCFS) is caused by a microdeletion in chromosome 22 and is a risk factor for the development of schizophrenia and other psychiatric disorders. The catechol-O-methyltransferase (COMT), residing in the 22q11.2 microdeletion region, is a major candidate gene for genetic susceptibility to neuropsychiatric disorders in VCFS. Individuals with VCFS carrying the low-activity allele (COMTL) are expected to have the lowest possible COMT activity since they have only a single copy of the gene. We explored the possibility that COMTL is associated with psychiatric disorders commonly found in VCFS. Fifty-five unrelated individuals with VCFS underwent psychiatric evaluation and were genotyped for the COMT 158Val/Met polymorphism coding for COMT high/low-activity alleles. The COMTL allele was significantly more prevalent in VCFS subjects with attention deficit hyperactivity disorder (ADHD) (73.9% vs. 33.3%, OR 5.67, chi2=7.76, p=0.005) and obsessive-compulsive disorder (OCD) (78.6% vs. 33.3%, OR 7.33, chi2=7.24, p=0.007) than in the control group (VCFS subjects without OCD, ADHD and schizophrenia/schizoaffective (SZ/SZaff) disorder). The results of this study suggest that greatly reduced COMT activity, as expected in VCFS COMTL individuals may be a risk factor for psychiatric sequelae in this population. Future longitudinal studies focusing on additional COMT polymorphic sites and other candidate genes from the deleted region will elucidate the molecular pathways leading to schizophrenia and other psychiatric disorders in VCFS.

The Blatt and the Cloninger models of personality and their relationship with psychopathology

This paper presents in brief the Blatt and the Cloninger theories of personality and their relationship to depression and to psychopathology. Each of the theories is described, the theoretical foundations of the theory are presented, the theory's view on personality stability, on the relationship between personality and psychopathology, the theory's efficacy at predicting depression from personality measures, the theory's explanation for sex differences in depression, the measures derived from the theories, and theory productivity. The paper concludes with an analysis of commonalities of, and points of disagreement between the two theories.