Global self-esteem as contingent on body satisfaction among patients with bulimia nervosa: lack of diagnostic specificity?

Negative Religious Coping Predicts Disordered Eating Pathology Among Orthodox Jewish Adolescent Girls

Recent research suggests the importance of exploring religious and spiritual factors in relation to the continuum of disordered eating. This continuum ranges from mild disordered eating behaviors and attitudes to moderate levels of disordered eating pathology (DEP) through full-blown clinical levels of eating disorders (EDs). The current study is the first to explore the role that religious coping (both positive and negative) plays in the development DEP, which is considered a risk factor for the development of EDs. In addition, the study aims to describe levels of DEP among a non-clinical sample of 102 Orthodox Jewish adolescent females. Participants completed a questionnaire measuring religious coping strategies, DEP and self-esteem. Results indicated that greater use of negative religious coping was associated with higher levels of DEP. Mediation analyses suggested that greater negative religious coping is related to lower levels of self-esteem, which accounts for higher levels of DEP. Furthermore, findings revealed relatively lower overall levels of DEP among this sample, compared to similar populations in Israel and the USA. These results suggest that a strong religious and spiritual identity may serve as a protective factor against DEP.

Predictors and moderators of psychological changes during the treatment of adolescent bulimia nervosa

This study examined predictors of psychological change among 80 adolescents with bulimia nervosa (BN) participating in a randomized-controlled trial comparing family-based treatment (FBT) to supportive psychotherapy (SPT). Psychological outcomes (cognitive eating disorder pathology, depression, and self-esteem) were explored at baseline, post-treatment, and 6-month follow-up. Multi-level growth models examined predictors of rate of change in psychological outcomes and moderators of treatment effects. All psychological outcomes improved through 6-month follow-up (moderate to large effect sizes) across both treatments. Overall, few significant predictors were identified. Older adolescents had faster change in self-esteem relative to younger adolescents (p = 0.03). Adolescents taking psychotropic medication at baseline had faster change in eating concerns relative to adolescents not taking medication (p = 0.02). Age (p = 0.02) and baseline purging severity (p = 0.03) moderated the relationship between treatment condition and change in eating concerns, where younger adolescents and individuals with high baseline purging had greater change when treated with FBT relative to SPT. Age and purging did not significantly moderate change in other psychological outcomes. Bulimic symptom improvement did not predict change in psychological symptoms. Generally, FBT and SPT were equally efficacious with respect to psychological improvement, although FBT may be more efficacious in younger adolescents and those with more frequent purging.

Body-related social comparison and disordered eating among adolescent females with an eating disorder, depressive disorder, and healthy controls

The purpose of this study was to investigate the association between body-related social comparison (BRSC) and eating disorders (EDs) by: (a) comparing the degree of BRSC in adolescents with an ED, depressive disorder (DD), and no psychiatric history; and (b) investigating whether BRSC is associated with ED symptoms after controlling for symptoms of depression and self-esteem. Participants were 75 girls, aged 12–18 (25 per diagnostic group). To assess BRSC, participants reported on a 5-point Likert scale how often they compare their body to others’. Participants also completed a diagnostic interview, Eating Disorders Inventory-2 (EDI-2), Beck Depression Inventory-II (BDI-II), and Rosenberg Self-Esteem Scale (RSE). Compared to adolescents with a DD and healthy adolescents, adolescents with an ED engaged in significantly more BRSC (p ≤ 0.001). Collapsing across groups, BRSC was significantly positively correlated with ED symptoms (p ≤ 0.01), and these associations remained even after controlling for two robust predictors of both ED symptoms and social comparison, namely BDI-II and RSE. In conclusion, BRSC seems to be strongly related to EDs. Treatment for adolescents with an ED may focus on reducing BRSC.

Direct and indirect forms of non-suicidal self-injury: evidence for a distinction

Non-suicidal self-injury (NSSI) involves deliberate acts (such as cutting) that directly damage the body but occur without suicidal intent. However, other non-suicidal behaviors that involve people mistreating or abusing themselves but that do not deliberately and directly damage bodily tissue may have much in common with NSSI. Such 'indirect' methods of self-injury might include involvement in abusive relationships, substance abuse, risky or reckless behavior, or eating disordered behavior. Using a community sample (N=156) we compared individuals engaging in NSSI (n=50), indirect (non-suicidal) self-injurers (n=38), and healthy controls (n=68) on a range of clinical and personality characteristics. As predicted, non-suicidal self-injurers and indirect self-injurers showed more pathology than healthy controls on all measures. Comparisons of the NSSI and the Indirect self-injury groups revealed no significant differences on measures of dissociation, aggression, impulsivity, self-esteem, negative temperament, depressive symptoms, and borderline personality disorder. However, compared to people who engaged only in indirect forms of self-injury, those who engaged in NSSI were more self-critical, had higher scores on a measure of suicide proneness, and had a history of more suicide attempts. The findings suggest that NSSI and indirect self-injury are best viewed as separate and distinct clinical phenomena.

Parental divorce and disordered eating: an investigation of a gene-environment interaction

OBJECTIVE

We investigated gene-environment interactions (GxE) for associations between parental divorce and disordered eating (DE).

METHOD

Participants were 1,810 female twins from the Michigan State University Twin Registry and the Minnesota Twin Family Study. The Minnesota Eating Behaviors Survey was used to assess DE. We tested for GxE by comparing the heritability of DE in twins from divorced versus intact families. It was hypothesized that divorce would moderate the heritability of DE, in that heritability would be higher in twins from divorced than twins from intact families.

RESULTS

As expected, the heritability of body dissatisfaction was significantly higher in twins from divorced than intact families. However, genetic influences were equal in twins from divorced and intact families for all other forms of DE.

DISCUSSION

Although divorce did not moderate heritability of most DE symptoms, future research should replicate GxEs for body dissatisfaction and identify factors underlying this unique relationship.

Bulimic symptoms, cognitions, and body dissatisfaction in women with major depressive disorder

OBJECTIVE

The goals of this study were to assess eating disorder symptoms in depressed women with no history of eating disturbance and to evaluate the clinical significance of these symptoms relative to those reported by women with bulimia spectrum disorder.

METHOD

Participants were 63 women with major depressive disorder (MDD) (n = 19), bulimia spectrum disorder (n = 20), or no history of MDD or eating disorder (n = 24). Measures included diagnostic interviews and self-report questionnaires designed to assess diagnostic criteria for bulimia nervosa, subthreshold eating disorder symptoms, dysfunctional attitudes about appearance, and body dissatisfaction.

RESULTS

There were no significant differences between depressed and bulimic women on shape concerns, appearance overvaluation, or body dissatisfaction. Depressed women endorsed significantly more subthreshold eating disorder symptoms, dysfunctional attitudes about appearance, and body dissatisfaction than did control subjects.

DISCUSSION

Eating disorder symptoms may be associated with depression in women in the absence of comorbid eating disorder diagnoses.

Changes in body image during cognitive-behavioral treatment in women with bulimia nervosa

The purposes of this study were: (1) to examine multidimensional aspects of body image of individuals with bulimia nervosa (BN) at pre-treatment, post-treatment, and at follow-up, compared to a group of participants without BN; and (2) to investigate whether measures of body image predicted outcome at post-treatment and follow-up. The clinical sample consisted of 109 females with BN who were enrolled in a 12-week cognitive-behavioral group treatment program. Participants were assessed at baseline, at the completion of treatment, and at 1- and 6-month follow-up visits. The 82 females who comprised the non-bulimic sample were assessed at comparable time intervals. At baseline, the participants with BN reported greater body dissatisfaction and overestimated body size to a significantly greater degree than the comparison group, and reported a significantly smaller ideal size relative to perceived size. Results at the end of treatment indicated significant improvement in self-reported attitudinal disturbance and size overestimation, with continued reductions at follow-up. Logistic regression analyses did not demonstrate a predictive relationship between body image measures at baseline and outcome at post-treatment or follow-up, or between post-treatment and follow-up. Implications for treatment include specifying the source of body image-related distress and enhancing treatment efforts for perceptual and attitudinal aspects of body image.

Eating disorders in adolescents and young adults

Adolescence and young adulthood mark the convergence of substantial biologic and social change. Individuals differ in their innate capacity to tolerate change. Research suggests that some of the personality characteristics that are fundamental to individuals with eating disorders may render them particularly vulnerable to the impact of a changing body and changing social demands. The fact that eating disorders emerge primarily during adolescence and often run a protracted course can deprive the afflicted individual of the core social, emotional, and biologic developmental processes that normally occur during this time of life.

Relationship between depression and body dissatisfaction in women diagnosed with bulimia nervosa

OBJECTIVE

Body dissatisfaction and depression have consistently demonstrated a positive association in women. This study sought to determine the independence of this association from bulimic symptomatology among women diagnosed with bulimia nervosa.

METHOD

Participants were 101 women who completed a controlled treatment study of bulimia nervosa and participated in follow-up assessments 10 years later.

RESULTS

Findings indicated that baseline levels of depression were independent of and superior to bulimic symptoms in prospectively predicting body dissatisfaction at follow-up assessment.

DISCUSSION

Findings suggest that depression may be a better prognostic indicator of body dissatisfaction than bulimic symptoms in women diagnosed with bulimia nervosa. A model in which depression represents a contributing factor for the maintenance of body dissatisfaction is discussed.

Self-verification and bulimic symptoms: do bulimic women play a role in perpetuating their own dissatisfaction and symptoms?

OBJECTIVE

It is suggested that self-verification theory may provide insight as to why bulimic symptoms often persist for years, sometimes even despite intervention. In an effort to meet basic needs for self-confirmation, bulimic women may invite the very responses they fear (e.g., negative feedback about appearance), and thus propagate their symptoms. It was thus predicted that interest in negative feedback would be correlated with body dissatisfaction and bulimic symptoms, and that interest in negative feedback would serve as a risk factor for development of later symptoms, via the mediating effects of increased body dissatisfaction.

METHOD

Seventy-nine undergraduate women completed self-report assessments of interest in negative feedback, bulimic symptoms, and body dissatisfaction.

RESULTS AND DISCUSSION

Results supported the prediction that, despite serious concerns about body appearance, bulimic women were interested in the very feedback that would aggravate these concerns. Moreover, interest in negative feedback appeared to serve as a risk factor for development of later symptoms, via the mediating effects of increased body dissatisfaction. The clinical implications of these findings are discussed.