Review of the evidence for a sociocultural model of bulimia nervosa and an exploration of the mechanisms of action

The relationship between media exposure and antifat attitudes: the role of dysfunctional appearance beliefs

This study examined the relationship between media exposure, antifat attitudes, and body dissatisfaction, as well as the mediating effect of dysfunctional appearance beliefs. A sample of 112 women completed surveys measuring media exposure, antifat attitudes, body dissatisfaction, and dysfunctional beliefs about appearance. It was found that time spent reading fashion magazines was positively correlated with antifat attitudes and that this relationship was mediated by dysfunctional beliefs about appearance. Measures of antifat attitudes and body dissatisfaction were both found to be correlated with endorsement of dysfunctional beliefs about appearance and body mass index. Results suggest that time spent reading fashion magazines may be related to antifat attitudes through dysfunctional appearance beliefs.

Misperceived pre-pregnancy body weight status predicts excessive gestational weight gain: findings from a US cohort study

BACKGROUND

Excessive gestational weight gain promotes poor maternal and child health outcomes. Weight misperception is associated with weight gain in non-pregnant women, but no data exist during pregnancy. The purpose of this study was to examine the association of misperceived pre-pregnancy body weight status with excessive gestational weight gain.

METHODS

At study enrollment, participants in Project Viva reported weight, height, and perceived body weight status by questionnaire. Our study sample comprised 1537 women who had either normal or overweight/obese pre-pregnancy BMI. We created 2 categories of pre-pregnancy body weight status misperception: normal weight women who identified themselves as overweight ('overassessors') and overweight/obese women who identified themselves as average or underweight ('underassessors'). Women who correctly perceived their body weight status were classified as either normal weight or overweight/obese accurate assessors. We performed multivariable logistic regression to determine the odds of excessive gestational weight gain according to 1990 Institute of Medicine guidelines.

RESULTS

Of the 1029 women with normal pre-pregnancy BMI, 898 (87%) accurately perceived and 131 (13%) overassessed their weight status. 508 women were overweight/obese, of whom 438 (86%) accurately perceived and 70 (14%) underassessed their pre-pregnancy weight status. By the end of pregnancy, 823 women (54%) gained excessively. Compared with normal weight accurate assessors, the adjusted odds of excessive gestational weight gain was 2.0 (95% confidence interval [CI]: 1.3, 3.0) in normal weight overassessors, 2.9 (95% CI: 2.2, 3.9) in overweight/obese accurate assessors, and 7.6 (95% CI: 3.4, 17.0) in overweight/obese underassessors.

CONCLUSION

Misperceived pre-pregnancy body weight status was associated with excessive gestational weight gain among both normal weight and overweight/obese women, with the greatest likelihood of excessive gain among overweight/obese underassessors. Future interventions should test the potential benefits of correcting misperception to reduce the likelihood of excessive gestational weight gain.

Body size preference and body weight perception among two migrant groups of non-Western origin

Objectives

To evaluate body size preference, body weight perception and their relationship with actual weight in two migrant groups of non-Western origin, Turks and Moroccans; additionally, to study the association between body size preference and acculturation.

Design

Cross-sectional study.

Setting

Amsterdam, The Netherlands.

Subjects and methods

Males and females (18–30 years) were randomly selected from the population registry (n 451); participants, or at least one of their parents, were born in Turkey or Morocco. Body size preference was assessed using seven silhouette drawings and body weight perception was assessed by asking participants’ opinion of own weight. Acculturation variables were generation status and two scale measures, cultural orientation and social contacts.

Results

Participants showed preference for a thin body size. The discrepancy between ideal and current size was significant in women but not men (P < 0·001). Perceived current body size was correlated with BMI (Spearman’s correlation coefficient 0·60, P < 0·001 (men) and 0·73, P < 0·001 (women)). Among overweight participants (BMI = 25·0–29·9 kg/m2), 63–82 % of men and 35 % of women perceived themselves as ‘average’. Paying attention to own body weight was associated with a discrepancy between ideal and current size among women and with perceiving oneself as ‘overweight’ among men. Body size preference was not significantly associated with the three acculturation variables.

Conclusion

We did not observe a preference for large body sizes in these two non-Western migrant groups. Similar to Western populations, most women wished to be thinner than they were. This was not the case among men, the majority of whom were also unaware of being overweight.

Automatic evaluation of body-related images

An affective priming task was used to determine whether females automatically evaluate body-related images, and to establish whether this is moderated by appearance schematicity, thin internalisation, body dissatisfaction, and dietary restraint. In a within participants design, the valence congruence of the prime and target pairs was manipulated, as was the interval between them. Undergraduate females (N=87, Experiment 1 and N=72, Experiment 2) individually selected colour images as the primes. Each prime was presented briefly, followed by a target word which the participant judged as "good" or "bad". The dependent variable was response latency to the target word. Automatic evaluation was evident; responding to congruent pairs was faster than responding to incongruent pairs. The individual difference variables were not related to automaticity. The findings suggest that brief encounters with body-related images are likely to produce automatic affective responses in young women irrespective of body-related concerns.

Cognitive Behaviour Therapy for Eating Disorders

The eating disorders provide one of the strongest indications for cognitive behaviour therapy (CBT). This bold claim arises from two sources: first, the fact that eating disorders are essentially cognitive disorders and second, the demonstrated effectiveness of CBT in the treatment of bulimia nervosa, which has led to the widespread acceptance that CBT is the treatment of choice. In this paper the cognitive behavioural approach to the understanding and treatment of eating disorders will be described. A brief summary of the evidence for this account and of the data supporting the efficacy and effectiveness of this form of treatment will be provided. Challenges for the future development and dissemination of the treatment will be identified.

Emotion recognition, emotional awareness and cognitive bias in individuals with bulimia nervosa

Difficulties recognizing emotion have been reported for eating disordered individuals in relation to perception of emotions in others and emotional self-awareness. It remains unclear whether this is a perceptual or cognitive-affective problem. Clarification is sought and the question of a cognitive bias is addressed when interpreting facially expressed emotions. Twenty participants with bulimia nervosa (BN) and 20 normal controls (NC) were assessed for ability to recognize emotional and neutral expressions. Emotional self-awareness was also assessed. Significant differences were found for emotional self-awareness. For emotional faces, only a poorer recognition of the emotion, surprise, for BN was found. Problems with emotional self-awareness suggest a cognitive-affective disturbance in emotion recognition. Implications for therapy are discussed.

Temperament, mood, dietary restraint, and bulimic symptomatology in college women

The current study examined whether biologically-influenced temperamental traits implicated in the pathogenesis of disordered eating behaviors contribute to their development over and above current negative affect and dietary restraint. Participants (N=276) were undergraduate psychology women who completed the BULIT-R, BDI-II, STAIS, RS, and the MPQ. Temperamental characteristics, particularly increased Negative Emotionality and decreased Positive Emotionality, were significantly associated with increased levels of bulimic symptomatology. Moreover, these dimensions accounted for small, but statistically significant amounts of the variance of bulimic symptomatology over and above current negative affect and dietary restraint. Contrary to expectations, impulsivity did not predict bulimic symptoms. This study provides evidence that temperamental dimensions related to mood rather than impulsivity are associated with bulimic symptomatology and contribute to bulimic symptoms over and above state mood and dietary restraint. Future empirical studies are needed to clarify relationships between temperament and other risk factors for disordered eating.

The specificity of social rank in eating disorder versus depressive symptoms

It has been proposed that an evolutionary approach to understanding rank and social status may contribute to our understanding of eating disorder symptoms. The present study sought to explore the degree to which rank might be related to eating pathology independently of its known association with depression. A non-clinical sample of 74 women completed rank-relevant measures of social defeat, entrapment, submissive behavior and social comparison as well as measures of depressive and eating disorder symptoms. Independently of depressive symptoms, submissive behavior and an unfavorable social comparison predicted eating pathology while social defeat and internal entrapment predicted depressive symptoms. There appears to be a specific role for social rank in relation to eating pathology. However, further research is required to determine precisely what this role is and the degree to which it relates to risk or recovery.

Interindividual differences in emotion regulation

Abstract. In this article, we present a short overview of findings from our current research on interindividual differences in emotion regulation and their consequences for health and well-being. In our research that is based on experimental designs, ambulatory assessment methods as well as cross-sectional surveys, we examine interindividual differences in expectancies, strategies and goals that we assume to be associated with adaptive stress and emotion regulation. Among the interindividual differences in goals and strategies, we focus on functional and dysfunctional dispositional anger-related goals and strategies, and the habitual use of humor, ruminative thinking, and eating behavior as strategies of emotion regulation. With regard to health-related expectancies, possible mechanisms linking dispositional optimism with the perception and receipt of social support are a main area of our current research.

Is Self-Objectification Related to Interoceptive Awareness? An Examination of Potential Mediating Pathways to Disordered Eating Attitudes

Although there has been considerable empirical support for Objectification Theory ( Fredrickson & Roberts, 1997 ), findings have been mixed regarding self-objectification's relationship to interoceptive awareness, an awareness of one's internal physical and emotional states. We examined whether interoceptive awareness mediated the relationship between self-objectification and disordered eating attitudes, exploring more specifically the relative contributions of difficulties recognizing feelings of hunger and satiety versus emotions. College women ( N = 195) completed measures assessing self-objectification, interoceptive awareness, awareness of emotions, and disordered eating attitudes. Self-objectification correlated significantly more strongly with interoceptive awareness when internal cues about hunger and satiety were assessed. The relationship between self-objectification and disordered eating attitudes was partially mediated by interoceptive awareness. Results revealed that interoceptive awareness may best be captured by a measure that includes lack of awareness of both hunger and satiety and emotional states. Research and clinical implications of these findings are discussed.

Portrayal of body weight on children's television sitcoms: a content analysis

Television programs portray characters with idealized body types that for most viewers are unattainable. These body types have become a common source of comparison for many young viewers who evaluate their own self-worth and bodies based on the models they see on television. This study examines body weight, both in terms of frequency and portrayals, focusing on how preadolescent and adolescent characters' bodies are presented on the sitcoms from three children's television networks. The results indicate that while children's situation comedies have relatively few overweight characters, this small percentage closely parallels national figures. Male and female characters do not differ in their distribution across weight categories. However, when character ethnicity is factored, significant shifts occur. Surprisingly, no differences were observed in the portrayal of physical and mental attributes among weight categories except in social popularity where overweight characters were not as embedded in social networks. Compared to other relevant studies, this research provides some evidence that the treatment and portrayal of overweight characters in children-targeted sitcoms is more positive, equitable, and less stereotypical than in other programming venues and that children are experiencing body type diversity in these fictional portrayals. Nonetheless, above average weight characters still suffer some social marginality and ethnic misrepresentation.

Body dissatisfaction and body change behaviors in Chile: the role of sociocultural factors

With interest in body image and body change behaviors growing around the world, there has been surprisingly little research conducted in Latin America on these issues. In order to gain some understanding of them in this context, this study investigated body image and body change behaviors, and the sociocultural factors that may influence them, among 337 Chilean adolescents aged 12-18 years. Participants completed a questionnaire that assessed BMI, body dissatisfaction, strategies to lose weight and strategies to increase muscle bulk. In addition, perceived pressure from family, peers, and the media to change body shape was evaluated. Results were partially consistent with those reported in Western nations. Girls were found to report greater body dissatisfaction than boys, but no difference was found between males and females in perceived pressure from adults in the family or from older siblings/cousins to lose weight. However, girls experienced higher levels of perceived pressure to lose weight from the media than boys, and boys reported greater perceived pressure from peers to lose weight than girls, and more pressure than girls from all sources to increase muscle bulk. These findings are discussed in relation to research conducted in other contexts, and it is concluded that findings from other locations may not be applied universally.

Dissonance-based Interventions for the prevention of eating disorders: using persuasion principles to promote health

The limited efficacy of prior eating disorder (ED) prevention programs led to the development of dissonance-based interventions (DBIs) that utilize dissonance-based persuasion principles from social psychology. Although DBIs have been used to change other attitudes and behaviors, only recently have they been applied to ED prevention. This article reviews the theoretical rationale and empirical support for this type of prevention program. Relative to assessment-only controls, DBIs have produced greater reductions in ED risk factors, ED symptoms, future risk for onset of threshold or subthreshold EDs, future risk for obesity onset, and mental health utilization, with some effects persisting through 3-year follow-up. DBIs have also produced significantly stronger effects than alternative interventions for many of these outcomes, though these effects typically fade more quickly. A meta-analysis indicated that the average effects for DBIs were significantly stronger than those for non-DBI ED prevention programs that have been evaluated. DBIs have produced effects when delivered to high-risk samples and unselected samples, as well as in efficacy and effectiveness trials conducted by six independent labs, suggesting that the effects are robust and that DBIs should be considered for the prevention of other problems, such as smoking, substance abuse, HIV, and diabetes care.

The Relationship between Negative Communication and Body Image Dissatisfaction in Adolescent Females with Type 1 Diabetes Mellitus

Maladaptive eating attitudes and behaviors are common in adolescent females with Type 1 Diabetes Mellitus (T1DM). This research assessed potential pathways through which individual and familial factors relate to treatment adherence and glycemic control. Seventy-five females with T1DM (aged 11—17 years) and their mothers completed questionnaires regarding communication, diabetes management, and eating attitudes and behaviors. Hierarchical regression analyses found that body image dissatisfaction moderates the relationship between negative communication and maladaptive eating attitudes and behaviors. Treatment adherence mediates the relationship between maladaptive eating attitudes and behaviors and glycemic control. None of the participants endorsed omitting insulin for the purposes of weight management. This study highlights the need to address familial and individual factors along with treatment adherence within this population.

State self-esteem ratings in women with bulimia nervosa and bulimia nervosa in remission

OBJECTIVE

Bulimia nervosa (BN) is associated with low self-esteem. This study was designed to assess whether low self-esteem persists in nondepressed individuals who have recovered from BN (BN-R).

METHOD

Study groups included BN (n = 22), BN-R (n = 20), and healthy controls (n = 42). Participants were medication-free, and none met criteria for current major depression. Assessment instruments included the State Self-Esteem Scale (SSES), a self-rating scale designed to measure state-related changes in self-esteem.

RESULTS

Consistent with previous reports, SSES scores for BN were lower than for controls (p < .001). For BN-R, SSES scores were higher than for BN (p < .001), but lower than for controls (p < .025). For BN-R, scores on the SSES Appearance subscale were inversely correlated with ratings of dietary restraint (p < .005).

CONCLUSION

This study provides new evidence for persistent low self-esteem following recovery from BN. Follow-up studies are needed to assess whether low self-esteem contributes to recurrent dieting and risk for relapse.

Susceptibility for thin ideal media and eating styles

This study examined the relations between susceptibility for thin ideal media and restrained, emotional and external eating, directly and indirectly through body dissatisfaction. Thin ideal media susceptibility, body dissatisfaction and eating styles were measured in a sample of 163 female students. Structural equation modelling was used for analyses, controlling for BMI. Higher susceptibility for thin ideal media was directly related to higher scores on all eating styles, and indirectly related to higher restrained and emotional eating through elevated levels of body dissatisfaction. So, thin ideal media susceptibility was not only related to restraint through body dissatisfaction, but also directly. Emotional eaters might be more vulnerable for negative affect, whereas external eaters might be more sensitive to external cues in general.

Implications of accuracy, sensitivity, and variability of body size estimations to disordered eating

The current study was conducted to investigate the relationships between body size estimations and disordered eating symptomatology. The method of constant stimuli was used to derive three measures of self-perceived body size in 93 women: (1) accuracy of body size estimations (body image distortion); (2) sensitivity in discriminating body size within blocks of trials (body image sensitivity); and (3) variability in making body size estimations between blocks of trials (body image variability). Participants also completed measures of disordered eating. Although body image distortion correlated with dietary restraint and eating concern, body image variability accounted for additional variance in these variables, as well as variance in binge eating. The relationships involving body image variability were found to be mediated by body dissatisfaction and internalization of the thin ideal. Together, these results are consistent with the proposition that body image variability is a significant factor in disordered eating.

Evaluation and comparison of different versions of the Body Shape Questionnaire

The Body Shape Questionnaire (BSQ) is a widely used scale to assess body dissatisfaction. Several short forms of the BSQ have been introduced. In the present study, the full-length 34-item version of the BSQ and seven derivations were evaluated. Factorial validity was analyzed by confirmatory factor analyses in a representative sample of German females (n=1080). Treatment sensitivity was evaluated in a sample of 43 women with bulimia nervosa who completed the BSQ before and after cognitive-behavioral therapy. While fit indices of the full-length version of the BSQ were poor, three of the derivations had reasonable fit. If treatment sensitivity is considered, one of the short forms performed best. This derivation is one of the eight-item versions of the BSQ (suggested abbreviation: BSQ-8C). In conclusion, the present study presents the empirical background for choosing between eight different versions of the BSQ. Thus, it is no longer necessary for researchers and clinicians to make their choice based on subjective criteria. Nevertheless, research on the derivations of the BSQ as stand-alone questionnaires is needed.

Daily hassles and emotional eating in obese adolescents under restricted dietary conditions--the role of ruminative thinking

Emotional eating is conceptualized as eating in response to negative affect or distress and is discussed as a mechanism leading to eating binges. Recent evidence suggests that eating may not only be triggered by negative affect, but also ruminative thinking. We report results of an experience sampling study examining the role of rumination for emotional eating in 16 obese adolescents (M=15.5 years, S.D.=1.4; range 14-17, body mass index M = 31.1 kgm(-2), S.D.=5.5) under restricted dietary conditions. We hypothesized that daily hassles type of stress predicted the individuals' desire to eat, with the predictive value further increased when negative affect and rumination were accounted for. The results of mixed regression modeling were in line with our predictions, suggesting a significant contribution of ruminative thinking to the mechanisms of negative affect induced eating.

Sociocultural attitudes towards appearance and body dissatisfaction among adolescent girls in Croatia

Four hundred and seventy-one girls and young women aged 14 to 23 were surveyed regarding their awareness and internalization of the thin ideal and body dissatisfaction. Measures included the Body Shape Questionnaire (BSQ) and the Sociocultural Attitudes towards Appearance Questionnaire (SATAQ). These young women were found to express a large degree of body dissatisfaction which was significantly related to the internalization and awareness of the thin ideal. Multiple analysis of variance (ANOVA) was applied in order to determine the effects of age, awareness and internalization on body image using body mass index (BMI) as covariate. It was concluded that the girls with high scores on the internalization and awareness scales were the most dissatisfied with their bodies. The present study suggests that the awareness and adoption of the thin body ideal and high body dissatisfaction are a part of the process of globalization, which is now present in most cultures and nations.

Level of religiosity and disordered eating psychopathology among modern-orthodox Jewish adolescent girls in Israel

OBJECTIVE

To examine the relation between level of religiosity, grade level, self-esteem, and level of disordered eating-related psychopathology among Modem Orthodox Jewish adolescent girls in Israel.

METHOD

The sample consisted of 320 Jewish religious adolescent schoolgirls in the 9th to 12th grades of middle and high schools. The girls completed the Eating Disorder Inventory-2 (EDI-2) and the religious questionnaire based on Guttman's instrument.

RESULTS

The more religious the student, the less eating-related psychopathology was found. The youngest students (grade 9) were found to be the least religious and to have the highest eating-related psychopathology.

DISCUSSION

The results are discussed in terms of the possibility that level of religiosity might to some extent protect adolescent girls against developing body dissatisfaction and disordered eating pathology. A high level of religiosity is associated with less emphasis on the physical attractiveness of women and less pressure for their success and achievement outside the home.

Subtyping adolescents with bulimia nervosa

Cluster analyses of eating disorder patients have yielded a "dietary-depressive" subtype, typified by greater negative affect, and a "dietary" subtype, typified by dietary restraint. This study aimed to replicate these findings in an adolescent sample with bulimia nervosa (BN) from a randomized controlled trial and to examine the validity and reliability of this methodology. In the sample of BN adolescents (N=80), cluster analysis revealed a "dietary-depressive" subtype (37.5%) and a "dietary" subtype (62.5%) using the Beck Depression Inventory, Rosenberg Self-Esteem Scale and Eating Disorder Examination Restraint subscale. The "dietary-depressive" subtype compared to the "dietary" subtype was significantly more likely to: (1) report co-occurring disorders, (2) greater eating and weight concerns, and (3) less vomiting abstinence at post-treatment (all p's<.05). The cluster analysis based on "dietary" and "dietary-depressive" subtypes appeared to have concurrent validity, yielding more distinct groups than subtyping by vomiting frequency. In order to assess the reliability of the subtyping scheme, a larger sample of adolescents with mixed eating and weight disorders in an outpatient eating disorder clinic (N=149) was subtyped, yielding similar subtypes. These results support the validity and reliability of the subtyping strategy in two adolescent samples.

What does viewing a pro-anorexia website do? An experimental examination of website exposure and moderating effects

OBJECTIVE

This study experimentally examined the effects of viewing a pro-anorexia website.

METHOD

Following construction of a prototypic pro-anorexia website, 235 female undergraduates were randomly assigned to view either the pro-anorexia website or one of two comparison websites related to female fashion (using average-sized models) or home décor. Post-website affect, cognitions, and behavioral expectations were examined along with moderator effects.

RESULTS

Study participants exposed to the pro-anorexia website had greater negative affect, lower social self-esteem, and lower appearance self-efficacy post-website than those who viewed a comparison website. Additionally, they perceived themselves as heavier, reported a greater likelihood of exercising and thinking about their weight in the near future, and engaged in more image comparison. Minimal support was found for moderator effects.

CONCLUSION

Results provide an empirical basis for concern (expressed by clinicians, researchers, the media) that pro-anorexia websites are a troubling new form of thin-ideal exposure that warrants further examination.

Binge antecedents in bulimic syndromes: an examination of dissociation and negative affect

OBJECTIVE

We conducted a naturalistic study to examine negative affect and dissociative experiences as antecedents to binge episodes.

METHOD

Using handheld computers, 33 women with bulimic syndromes provided ongoing self-reports on eating behaviors, affects, and dissociative experiences over 7- to 29-day intervals.

RESULTS

Multilevel modeling analyses indicated that negative affect and dissociation were elevated prior to binge episodes. In addition, antecedent effects of dissociation on bingeing were independent of those attributable to negative affect.

CONCLUSION

Our results are consistent with models of binge eating that assign a causal role to negative mood and altered self-awareness. As such, our findings imply that binge eating is a multiply determined behavior linked to diverse cognitive and affective processes.

Sociocultural pressures, thin-ideal internalization, self-objectification, and body dissatisfaction: could feminist beliefs be a moderating factor?

Theory and research suggest that sociocultural pressures, thin-ideal internalization, and self-objectification are associated with body dissatisfaction, while feminist beliefs may serve a protective function. This research examined thin-ideal internalization and self-objectification as mediators and feminist beliefs as a moderator in the relationship between sociocultural pressures to meet the thin-ideal and body dissatisfaction. Female undergraduate volunteers (N=195) completed self-report measures assessing sociocultural influences, feminist beliefs, thin-ideal internalization, self-objectification, and body dissatisfaction. Multisample structural equation modeling showed that feminist beliefs moderate the relationship between media awareness and thin-ideal internalization, but not the relationship between social influence and thin-ideal internalization. Research and clinical implications of these findings are discussed.

Eating disorders across the lifespan

Eating disorders have traditionally been considered afflictions of adolescents and young women. Recent evidence, however, suggests that eating disorders often occur across the life span. Although the incidence of these disorders among mid-life and older women appears to be on the rise, it is not clear if this reflects a true increase in prevalence, better recognition among clinicians, or both. This paper presents an overview of the etiology and treatment of eating disorders, with particular emphasis on developmental factors impacting older women. Recommendations for the treatment of eating disorders among older women are offered. An emerging clinical literature suggests various lines of research that are needed to explore the development and treatment of eating disorders in older women.

Emotional reactions following exposure to idealized bodies predict unhealthy body change attitudes and behaviors in women and men

OBJECTIVE

We explored the extent to which changes in emotional states following exposure to images of idealized bodies predict unhealthy body change attitudes and behaviors in women and men, and whether particular psychological traits mediate these effects.

METHOD

One hundred thirty-three women and 93 men were assessed for unhealthy attitudes and behaviors related to body weight and muscles using the Eating Disorder Inventory-2 (EDI-2), the Obligatory Exercise Questionnaire, and the strategies to increase muscles subscale of the Body Change Inventory. Psychological traits assessed included body dissatisfaction (EDI-2), internalization of the thin/athletic ideal (Sociocultural Attitudes Towards Appearance Questionnaire-3), body comparison (Body Comparison Scale), self-esteem (Rosenberg Self-Esteem Inventory), depression (Beck Depression Inventory-II), and identity confusion (Self-Concept Clarity Scale). Participants were then exposed to photographs of thin female models and muscular male models, and visual analogue scales were used to measure changes in postexposure state body dissatisfaction, anger, anxiety, and depression.

RESULTS

Postexposure increases in state anger, anxiety, depression, and body dissatisfaction correlated with drive for thinness and disordered eating symptomatology in women, while postexposure increases in state body dissatisfaction correlated with muscle development in men. Analyses revealed that internalization and body comparison mediated these relationships, with trait body dissatisfaction, trait depression, self-esteem, and self-concept/identity confusion serving as mediators for women only.

CONCLUSION

These results are indicative of gender differences in: (a) reactions to idealized bodies; (b) psychological traits that predispose individuals to experience these reactions; and (c) types of body change behavior that are associated with these reactions.

The frequency, nature, and effects of naturally occurring appearance-focused social comparisons

This research examined the effects of naturally occurring appearance-focused social comparisons on women's affect, body satisfaction, and weight-related cognitions. During their daily activities, women reporting body dissatisfaction (n=53) and women reporting body satisfaction (n=34) recorded their reactions to comparison information. Body-dissatisfied women engaged in more comparisons and a greater proportion of upward comparisons than body-satisfied women. Upward comparisons were associated with an increase in negative affect, body dissatisfaction, and thoughts of exercising for both groups; however, body-dissatisfied women experienced a greater increase in thoughts of dieting following upward comparisons. The daily effects of comparison information on body-dissatisfied women were examined; upward comparisons were associated with increases in daily negative affect, body dissatisfaction, and weight-related cognitions.

Why do normal weight young women look for diet-therapy? Findings from a pilot study in a clinical and non-clinical population

The behavioural factors that drive a normal weight woman to embark on a diet and to look for nutritional support in weight loss clinics are still not completely understood. A pilot cross-sectional study was carried out in 70 young (age range: 18-35 yr), normal weight women attending a weight loss clinic in South of Italy (Naples). They were compared to a population of 94 normal weight students (age range:17-23 yr) who had never attended a weight loss clinic. Subjects with eating disorders have been excluded. Weight and height were measured and body mass index (BMI) was calculated. Eating behaviour was assessed using a validated Italian version of the Eating Disorders Inventory (EDI) questionnaire. The two groups were matched for BMI (22.4 vs 22.1 kg/m2), smoking and physical activity. Students were more educated and less likely to be on a diet at the time of the study. Students had statistically significant lower scores for drive for thinness, body dissatisfaction, inadequacy and interpersonal disrupt. The bulimia scale was the only significant predictor (p<0.05) of BMI in the patients' group; body dissatisfaction (p<0.05) predicted BMI in the control group. This study has shown that weight concern and health awareness are not the only factors that lead a normal weight woman to look for nutritional counselling but there is an underlying substrate of psychological and social distress behind the request, which should be properly assessed before starting any nutritional therapy in the clinical practice.

Eating disorders and alcohol use: group differences in consumption rates and drinking motives

Alcohol use and drinking motives were investigated among college women divided into four probable eating disorder groups: Bulimia Nervosa, purging subtype (BN n=16) Binge Eating Disorder (BED n=30) Eating Disorder, Not Otherwise Specified (EDNOS n=85) and Non-Eating Disordered Controls (NEDC n=252). Participants completed questionnaires that assessed eating behaviors and attitudes, motives for drinking alcohol, quantity and frequency of alcohol use, and binge drinking. The BED group reported greater weekend alcohol consumption and binge drinking than the EDNOS and NEDC groups. The BN and BED groups were significantly more likely to endorse Coping as a drinking motive than the EDNOS and NEDC groups. The NEDC group was more likely to endorse Mood Enhancement than the EDNOS group. These results offer one explanation for the relationship between eating and alcohol use disorders. Women with eating disorders may use alcohol to cope with negative affect, analogous to findings that women with eating disorders report binge eating to regulate negative affect [Mizes, J. S. (1985). Bulimia: A review of its symptomatology and treatment. Advances in Behavior Research and Therapy, 7, 91-142].

Disordered eating related behaviors among Arab schoolgirls in Israel: an epidemiological study

OBJECTIVE

To examine the prevalence of disordered eating attitudes and behaviors among three religious subgroups of Arab schoolgirls in Israel (Moslems, Druze, and Christians).

METHOD

The sample consisted of 1,131 Arab schoolgirls in Israel, including 922 (81.5%) Moslem, 125 (11.1%) Christian, and 84 (7.4%) Druze adolescents, in the 7-12th grades. The sample was drawn from urban and rural residential settings from all parts of Israel using a clusters sampling method.

RESULTS

The Christian subgroup had a significantly lower total eating disorder inventory-2 (EDI-2) score than the Druze and Moslem subgroups, which had similar total EDI-2 scores. Significant differences were found between the three religious subgroups in all subscales, except in drive for thinness (DT), bulimia, body dissatisfaction, and asceticism. A total of 154 (13%) Arab schoolgirls scored higher than the cut-off point of >>14 on the EDI-DT subscale.

CONCLUSION

The results are discussed in light of the differences between the Christian, Druze, and Moslem subgroups and in terms of various aspects of Arab culture in Israel.

Food intake affects state body image: impact of restrained eating patterns and concerns about eating, weight and shape

Body image disturbances play a significant role in the development of eating disorders. Since body image can vary in diverse contexts, the aim of the present experiment was to investigate whether it is affected by recent food intake. Fifty-seven females without clinically relevant eating disorders were randomly assigned to an experimental group (EG, n=28) that consumed a milkshake while watching a neutral film and a control group (CG, n=29) that only viewed the movie. Before and after the tasks, participants filled in the "Body Image States Scale" and the "Mood Questionnaire" and indicated their own "actual", "felt" and "ideal" body dimensions with a digital distortion technique based on a photograph of themselves. It was shown that after milkshake consumption, state body dissatisfaction as well as the discrepancy between "actual-ideal" and "felt-ideal" body size estimations was higher in the EG than in the CG. Judgements of the "actual", "felt" and "ideal" body dimensions and of mood were not affected. Further analyses revealed that the effect of milkshake consumption on body image and mood was higher the more the participants displayed restrained eating or eating, weight and shape concerns in general. Clinical implications are discussed.

Negative affect as a mediator between body dissatisfaction and extreme weight loss and muscle gain behaviors

Negative affect has been found to mediate the relationship between body dissatisfaction and bulimia. However, it is unknown if this relationship also applies to disordered eating, excessive exercise and strategies to increase muscle for men or women. The aim of this study was to investigate whether negative and positive affect mediate the relationship between body dissatisfaction, and these body change strategies. Respondents were 93 men and 97 women (age range: 18-25 years), who completed measures of body dissatisfaction, positive and negative affect and body change strategies to lose weight or increase muscles. Body dissatisfaction was associated with strategies to lose weight, dietary restraint and bulimia for both genders. Negative affect mediated the relationship between dissatisfaction with muscles and strategies to lose weight, dietary restraint and bulimia for women only. The results confirm previous findings related to the association between negative affect and disordered eating for women. They also demonstrate the need to further investigate the impact of negative affect on body change strategies, particularly among men, and those strategies related to increasing muscles.

Emotional, external, restrained eating and overweight in Dutch adolescents

The purpose of this study was to determine how emotional, external and restrained eating behavior and other health-related lifestyle factors were associated with being overweight in adolescents. Moreover, demographic and ethnic differences in eating behavior have been examined. The respondents were 10,087 Dutch adolescents aged 11-16 years (M= 13.0, SD= 0.8). Self-reported eating behavior was measured with the DEBQ. Health-related lifestyle was determined by physical activity, breakfasting, fruit consumption and snacking. High restrained, and low external eating were positively associated with being overweight, whereas no significant association between emotional eating and being overweight was found for girls, and a negative association for boys. Adolescents who ate breakfast on a daily basis were less likely to be overweight than those who ate breakfast irregularly or never. Being overweight was positively associated with fruit consumption for girls and negatively with physical activity for boys.

Do friends share similar body image and eating problems? The role of social networks and peer influences in early adolescence

This study examined the role of friendship networks and peer influences in body image concern, dietary restraint, extreme weight loss behaviours (EWLBs) and binge eating in a large community sample of young adolescent females. Based on girls' self-reported friendship groups, social network analysis was used to identify 173 friendship cliques. Results indicated that clique members shared similar scores on measures of dieting, EWLB and binge eating, but not body image concern. Average clique scores for dieting, EWLB and binge eating, were also correlated significantly with clique averages on measures of perceived peer influence, body mass index and psychological variables. Multiple regression analyses indicated that perceived peer influences in weight-related attitudes and behaviours were predictive of individual girls' level of body image concern, dieting, EWLB use and binge eating. Notably, an individual girl's dieting and EWLB use could be predicted from her friends' respective dieting and EWLB scores. Findings highlight the significance of the peer environment in body image and eating problems during early adolescence.

The contribution of peer and media influences to the development of body satisfaction and self-esteem in young girls: a prospective study

This study aimed to prospectively examine the role of peer and media influences in the development of body satisfaction (incorporating the desire for thinness and satisfaction with appearance) in young girls, as well as the relationship between body satisfaction and self-esteem. A sample of 97 girls 5-8 years of age completed individual interviews at Time 1 and 1 year later at Time 2. Linear panel analyses found that Time 1 perception of peers' desire for thinness was temporally antecedent to girls' desire for thinness, appearance satisfaction, and self-esteem 1 year later. In addition, the watching of appearance-focused television programs was temporally antecedent to appearance satisfaction. Finally, girls' desire for thinness was found to temporally precede low self-esteem. Thus, as early as school entry, girls appear to already live in a culture in which peers and the media transmit the thin ideal in a way that negatively influences the development of body image and self-esteem.

Psychosocial and physical impairment in overweight adolescents at high risk for eating disorders

OBJECTIVE

Many overweight adolescents display elevated risk for the development of eating disorders, as seen in higher rates of weight/shape concerns and disordered eating behaviors, but the extent of impairment in this subset of high-risk adolescents has not been explored.

RESEARCH METHODS AND PROCEDURES

Eighty-one overweight adolescents (63% girls) presenting for an Internet-based weight loss program were assessed at baseline using the Eating Disorder Examination Questionnaire, the Depression, Anxiety, and Stress Scale, and the Pediatric Quality of Life questionnaire. Adolescents who earned elevated scores on both the Weight Concern and Shape Concern subscales of the Eating Disorder Examination Questionnaire were considered at high risk for the development of eating disorders (56.8%).

RESULTS

Comparisons of high- and normal-risk groups revealed that high-risk adolescents reported higher levels of depression [F(3,76) = 5.75, p = 0.019], anxiety [F(3,76) = 5.67, p = 0.020], and stress [F(3,75) = 8.50, p = 0.005], and greater impairments in physical health [F(3,77) = 10.7, p = 0.002], emotional functioning [F(3,77) = 5.3, p = 0.024], and social functioning [F(3,77) = 10.0, p = 0.002]. There were no differences in school functioning [F(3,77) = 1.5, p = 0.219]. Among the high-risk adolescents, over half (52.2%) reported binge eating at least once in the past month.

DISCUSSION

Results suggest that overweight adolescents at high risk for the development of eating disorders also experience elevated levels of negative affect, impairment in health-related quality of life, and eating disturbances, although prospective data are needed to determine the directionality between eating disorder pathology and general psychopathology. Further research is warranted to evaluate whether behavioral weight loss interventions should be enhanced for this high-risk subset.