The role of family of origin food-related experiences in bulimic symptomatology

A proof-of-concept study applying machine learning methods to putative risk factors for eating disorders: results from the multi-centre European project on healthy eating

BACKGROUND

Despite a wide range of proposed risk factors and theoretical models, prediction of eating disorder (ED) onset remains poor. This study undertook the first comparison of two machine learning (ML) approaches [penalised logistic regression (LASSO), and prediction rule ensembles (PREs)] to conventional logistic regression (LR) models to enhance prediction of ED onset and differential ED diagnoses from a range of putative risk factors.

METHOD

Data were part of a European Project and comprised 1402 participants, 642 ED patients [52% with anorexia nervosa (AN) and 40% with bulimia nervosa (BN)] and 760 controls. The Cross-Cultural Risk Factor Questionnaire, which assesses retrospectively a range of sociocultural and psychological ED risk factors occurring before the age of 12 years (46 predictors in total), was used.

RESULTS

All three statistical approaches had satisfactory model accuracy, with an average area under the curve (AUC) of 86% for predicting ED onset and 70% for predicting AN v. BN. Predictive performance was greatest for the two regression methods (LR and LASSO), although the PRE technique relied on fewer predictors with comparable accuracy. The individual risk factors differed depending on the outcome classification (EDs v. non-EDs and AN v. BN).

CONCLUSIONS

Even though the conventional LR performed comparably to the ML approaches in terms of predictive accuracy, the ML methods produced more parsimonious predictive models. ML approaches offer a viable way to modify screening practices for ED risk that balance accuracy against participant burden.

Retrospective reports of childhood feeding in mother-daughter dyads

Significant research has linked parents' feeding practices to children's eating habits. However, much less is known about how childhood feeding relates to longer-term outcomes such as eating in adulthood. The current study uses retrospective reports from mother-daughter dyads (N = 217) to compare childhood feeding practices and to examine how recalled feeding is related to current eating (emotional eating, intuitive eating, unrestrained eating) and body mass index (BMI) in adult daughters. Mothers and daughters completed the Comprehensive Feeding Practices Questionnaire (CFPQ), subscales from the Three Factor Eating Questionnaire, and the Intuitive Eating Scale. Results of an exploratory factor analysis indicated that mothers and daughters largely had similar factor structures on retrospective reports, with factor loadings varying on four of twelve original CFPQ subscales: monitoring, restriction for health, child control, and modelling. Paired samples t-tests examined mean differences between mother and daughter reports on each subscale; there was no significant difference between mother and daughter reports on six of the 11 scales. Daughters reported significantly higher levels of pressure to eat; mothers reported significantly higher levels of healthy practices, child control, involvement, and unhealthy environment than their daughters recalled. Hierarchical regressions revealed that daughters' reports of specific childhood feeding practices accounted for significant change in unadjusted variance for uncontrolled eating (18.8%), emotional eating (13.1%), intuitive eating (14.7%), and BMI (16.1%). Similarly, regressions revealed that mothers' reports of childhood feeding practices accounted for significant change in unadjusted variance for emotional eating (11.5%) and BMI (11.2%), but not uncontrolled or intuitive eating. Collectively, results lend strong support to the use of retrospective reports on childhood feeding and provide evidence that recalled childhood feeding practices have lasting relations with adult eating behaviors.

Early maladaptive schemas in overweight and obesity: A schema mode model

Obesity is a growing burden in our societies and, although different kinds of treatments are effective in the short time, weight gain often reoccurs in the longer period. One possible explanation might rely on the little comprehension of obese maladaptive schemas, as developed from early life experiences, which might interfere with treatment enduring efficacy. The aim of this study was to investigate early maladaptive schemas, their associated current schema-modes and dysfunctional coping strategies in overweight and obese individuals (N = 48). Results showed that overweight and obese subjects reported more severe insufficient self-control, abandonment, dependence and subjugation schemas, and actual schema-modes (i.e., impulsive and vulnerable child, detached protector), compared against normal-weight controls (N = 37). As well, the former displayed higher dysfunctional eating habits (i.e., bingeing and bulimic symptoms) and more emotional-avoidant coping strategies. Above all schemas, insufficient self-control predicted higher BMI, binge frequency and bulimic symptoms' severity. Furthermore, avoidant coping mediated between specific maladaptive schemas and frequency of bingeing and bulimic symptoms. Our findings illustrate that overweight and obese display more dysfunctional early maladaptive schemas and schema-modes, compared against normal-weight individuals, exhibiting more emotion-avoidant strategies such as over-eating and bingeing, which might stand for a detached self-soother coping mode. The insufficient self-control schema develops from a lack in self-discipline and an inability to tolerate frustration and might be embodied by the impulsive child mode. A deeper comprehension of schemas and modes, as addressed within the Schema Therapy model, might help to understand dysfunctional personality features that might interfere with the long-lasting efficacy of treatment interventions in obesity.

Developmental Trajectories of Boys' Driven Exercise and Fasting During the Middle School Years

Boys appear to engage in eating disorder behavior, particularly nonpurging compensatory behaviors such as driven exercise and fasting, at higher rates than previously thought. Little is known about the development of these behaviors in adolescent boys. In a sample of 631 non-binge eating and non-purging boys studied once in 5th grade and 6 times over the 3 years of middle school (grades 6 through 8), we found that (a) for some youth, driven exercise and fasting were present from grade 6; (b) different boys progressed along different trajectories of engagement in driven exercise and fasting, with some boys engaging in no driven exercise or fasting (65.8 % and 83.5 %, respectively), some boys engaging in driven exercise and fasting throughout middle school (25.2 % and 16.5 %, respectively), and other boys discontinuing engagement in driven exercise (9 %); (c) 5th grade depression, eating expectancies, and thinness expectancies predicted subsequent trajectory group membership; and (d) boys engaging in driven exercise and fasting in 8th grade remained distressed. Boys' engagement in driven exercise and fasting behavior merits the attention of researchers and clinicians.

Integrating eating disorder-specific risk factors into the acquired preparedness model of dysregulated eating: A moderated mediation analysis

Tests of the acquired preparedness model demonstrate that the personality trait of negative urgency (i.e., the tendency to act impulsively when distressed) predicts the expectation that eating alleviates negative affect, and this eating expectancy subsequently predicts dysregulated eating. Although recent data indicate that eating disorder-specific risk factors (i.e., appearance pressures, thin-ideal internalization, body dissatisfaction, dietary restraint) strengthen negative urgency-dysregulated eating associations, it is unclear whether these risk factors impact associations directly or indirectly (i.e., through eating expectancies). The current study used latent moderated structural equation modeling to test moderated mediation hypotheses in a sample of 313 female college students. Eating expectancies mediated the association between negative urgency and dysregulated eating, and the indirect effect of negative urgency on dysregulated eating through eating expectancies was conditional on level of each eating disorder risk factor. Appearance pressures, thin-ideal internalization, body dissatisfaction, and dietary restraint significantly moderated the association between eating expectancies and dysregulated eating, while only dietary restraint moderated the direct effect of negative urgency on dysregulated eating. Findings suggest that the development of high-risk eating expectancies among individuals with negative urgency, combined with sociocultural pressures for thinness and their consequences, is associated with the greatest risk for dysregulated eating.

Family factors and health behaviour of thin adolescent boys and girls

AIM

The aim of this study was to examine prevalence of extreme thinness and thinness in adolescent boys and girls and to study associations between family factors, health behaviour and thinness in boys and girls.

BACKGROUND

Extreme thinness carries high health risks. The family and health behavioural factors related to adolescent thinness have not been studied previously using a nationally representative data.

DESIGN

This is a cross-sectional quantitative study.

METHODS

The nationally representative data were obtained from the Finnish School Health Promotion study conducted in 2013. The sample of this study included 12-17 year old adolescents (n = 71,973) who were categorised as extremely thin, thin and normal weight using international age and gender body mass index (BMI) cut-off points for children and adolescents. Associations with family factors and health behaviour were examined separately for boys and girls using cross-tabulations, Chi-square test and multinomial logistic regression.

RESULTS

Thinness and extreme thinness were more common in girls than in boys. Health behaviour, such as smoking and exercise, were associated with thinness and extreme thinness in both genders. Regarding family factors; low maternal education, family meal and parental knowledge of adolescents' friends and whereabouts were associated with thinness and, or extreme thinness in both boys and girls. However, there were gender differences in the associations.

CONCLUSIONS

It is important for healthcare professionals working with adolescents to be aware of prevalence in thinness and aware of health behaviour and family factors that are associated with thinness and extreme thinness in adolescence.

Developmental trajectories of compensatory exercise and fasting behavior across the middle school years

Compensatory exercise and fasting behavior, in the absence of binge eating and purging, appear to be important eating disorder behaviors that are associated with dysfunction, but little is known about these behaviors in youth. We studied the trajectories of their development in non-binge eating and non-purging girls during early adolescence. Using a longitudinal design, we assessed 564 girls six times over the three years of middle school (grades 6 through 8) and developed trajectories specifying different developmental patterns in relation to the behaviors. Prior to this period, when the girls were in 5th grade (elementary school), we assessed risk factors to predict girls' subsequent trajectory group membership. Compensatory exercise trajectory groups included a non-engagement group, a group that increased in the behavior, and a group that decreased in the behavior. There were two fasting trajectory groups, one consistently engaging in the behavior and the other consistently not. Elementary school levels of depression, eating expectancies, and thinness expectancies predicted subsequent trajectory group membership. Risk for compensatory exercise and fasting should be evaluated as early as in 5th grade. Targeted interventions should focus on girls in late elementary school or middle school, as this appears to be a critical developmental and maintenance period for compensatory exercise and fasting behavior.

Using food as reinforcer to shape children's non-food behavior: The adverse nutritional effect doubly moderated by reward sensitivity and gender

PURPOSE

Control rules are parental practices that use food, especially those high in fat or sugar, as an instrumental reinforcer to encourage children to behave in a normative manner in non-food domains. Past laboratory experiments show that repeatedly presenting snacks as a reward or associated with adults' attention, increases children's preference for the presented food. This field study aims to examine whether control rules are associated with children's increased everyday intake of food high in sugar/fat, and whether this effect is moderated by individual differences in neurobehavioral sensitivity to reward and in gender.

DESIGN

207 six- to twelve-year-old children's parents reported the children's everyday dietary intake through a food frequency questionnaire and provided information regarding the children's sensitivity to rewards as well as the frequency of enforcing control rules.

RESULTS

Children who lived in families with a high frequency of using control rules exhibited more daily fat, carbohydrate, and total energy intake than did children whose parents use control rules less often. Furthermore, the effect of control rules on dietary pattern was particularly strong for children with high reward sensitivity, especially boys.

CONCLUSIONS

Control rules have adverse consequences on children's nutrition. The moderating effects of sensitivity to reward and gender are consistent to a reinforcement learning process--associating the high-fat/sugar food consumption with social-affective pleasure resulting from performing behavior desired by parents--through which parental control rules contribute to children's maladaptive dietary patterns.

Bulimic symptom onset in young girls: A longitudinal trajectory analysis

To investigate whether there are different patterns of development for binge eating and purging behavior among preadolescent and early adolescent girls, we conducted trajectory analyses of those behaviors in 938 girls across 8 waves of data from the spring of 5th grade (the last year of elementary school) through the spring of 9th grade (the first year of high school). Analyses revealed 4 separate developmental trajectories for binge eating behavior (labeled none, increasing, decreasing, and high steady) and 3 separate developmental trajectories for purging behavior (labeled none, dabble, and increasing). Fifth grade scores on risk factors that were both transdiagnostic (negative affect and negative urgency) and eating disorder specific (expectancies for reinforcement from eating and from thinness) differentiated among the trajectory groups, in some cases before the groups differed in the target behaviors. These findings are the first, to our knowledge, to examine developmental trajectories for bulimic symptom onset in youth as young as elementary school. Clinical implications are discussed.

A risk and maintenance model for bulimia nervosa: From impulsive action to compulsive behavior

This article offers a new model for bulimia nervosa (BN) that explains both the initial impulsive nature of binge eating and purging, as well as the compulsive quality of the fully developed disorder. The model is based on a review of advances in research on BN and advances in relevant basic psychological science. It integrates transdiagnostic personality risk, eating-disorder-specific risk, reinforcement theory, cognitive neuroscience, and theory drawn from the drug addiction literature. We identify both a state-based and a trait-based risk pathway, and we then propose possible state-by-trait interaction risk processes. The state-based pathway emphasizes depletion of self-control. The trait-based pathway emphasizes transactions between the trait of negative urgency (the tendency to act rashly when distressed) and high-risk psychosocial learning. We then describe a process by which initially impulsive BN behaviors become compulsive over time, and we consider the clinical implications of our model. (PsycINFO Database Record

Parental instrumental feeding, negative affect, and binge eating among overweight individuals

Parental instrumental feeding (i.e., rewarding children with food for perceived correct behaviors and punishing by taking away food for perceived incorrect behaviors) and negative affect are independently associated with binge eating in adulthood. However, less is known about interactions between these variables and binge eating. This study examined the relationship of retrospective reports of parental feeding practices and negative affect to binge eating. Participants were 165 overweight and obese undergraduate students at a large Mid-Atlantic University. High parental instrumental feeding strengthened the relationship between negative affect and binge eating. Also, individuals who reported low parental feeding practices reported similar binge eating regardless of negative affect. These findings suggest that overweight and obese individuals whose parents used more instrumental feeding practices are most likely to engage in binge eating in response to negative affect.

Two pathways toward impulsive action: an integrative risk model for bulimic behavior in youth

BACKGROUND

This study provides an integrative review of existing risk factors and models for bulimia nervosa (BN) in young girls. We offer a new model for BN that describes two pathways of risk that may lead to the initial impulsive act of binge eating and purging in children and adolescents.

SCOPE

We conducted a selective literature review, focusing on existing and new risk processes for BN in this select population.

FINDINGS

We identify two ways in which girls increase their risk to begin engaging in the impulsive behavior of binge eating and purging. The first is state-based: the experience of negative mood, in girls attempting to restrain eating, leads to the depletion of self-control and thus increased risk for loss of control eating. The second is personality-based: elevations on the trait of negative urgency, or the tendency to act rashly when distressed, increase risk, particularly in conjunction with high-risk psychosocial learning. We then briefly discuss how these behaviors are reinforced, putting girls at further risk for developing BN.

CONCLUSIONS

We highlight several areas in which further inquiry is necessary, and we discuss the clinical implications of the new risk model we described.

Peer and family influence in eating disorders: a meta-analysis

OBJECTIVE

The aim of the present study was to undertake a systematic review using meta-analysis procedures to assess the relationships between eating disorders and peer and family influence and to evaluate whether gender plays a moderator role in that relationship.

METHOD

PsycINFO, Medline, Web of Science, EPSCO and Embase databases from 1980 to 2010 were searched in June and October 2010. Hand searching of relevant reference sections was also undertaken.

RESULTS

It was possible to obtain 83 effect sizes from the 25 studies selected. Results showed that both peers and family influence dieting behavior, body dissatisfaction and bulimic symptoms in adolescent girls and boys. Furthermore, the analyses of the moderator variables showed that the variability of the effect sizes found was, in some cases, explained by gender, influence type and the country of the sample.

DISCUSSION AND CONCLUSION

These results highlight how daily social interactions can influence unhealthy eating practices in adolescent girls and boys, and suggest that weight-related issues of parents and peers can be transmitted to adolescents.

A longitudinal transactional risk model for early eating disorder onset

The presence of binge eating behavior in early middle school predicts future diagnoses and health difficulties. We showed that this early binge eating behavior can be predicted by risk factors assessed in elementary school. We tested the acquired preparedness model of risk, which involves transactions among personality, psychosocial learning, and binge eating. In a sample of 1,906 children assessed in the spring of fifth grade (the last year of elementary school), the fall of sixth grade, and the spring of sixth grade, we found that fifth grade negative urgency (the personality tendency to act rashly when distressed) predicted subsequent increases in the expectancy that eating helps alleviate negative affect, which in turn predicted subsequent increases in binge eating behavior. This transactional risk process appeared to continue to occur at later time points. Negative urgency in the fall of sixth grade was predicted by fifth grade pubertal onset, binge eating behavior, and expectancies. In turn, it predicted increases in high-risk eating expectancies by the spring of sixth grade, and thus heightened risk.

The relation between parental influence, body image, and eating behaviors in a nonclinical female sample

The purpose of the current study is to create a comprehensive composite measure of parental influence based on previously developed measures to clarify the underlying dimensions of parental influence and to determine the degree to which parental influence relates to body image and dysfunctional weight concerns. Previously published literature was reviewed for measures of parental influence, and items from 22 measures were condensed and combined into a single questionnaire, which was completed by 367 female undergraduate psychology students. Two dimensions emerged from a principle components analysis: Direct Influence, which includes weight and eating related comments, and Modeling, which includes parental modeling of dieting and related behavior. Direct Influence and Modeling were significantly related to eating disturbance, such as drive for thinness and bulimic symptomatology. Overall, the results integrate the previous literature and clarify the underlying dimensions of parental influence. Further, this study provides directions for future research related to the development and maintenance of body image and eating disturbance.

A risk model for preadolescent disordered eating

OBJECTIVE

This study tested this risk model for disordered eating in preadolescent girls: pubertal onset is associated with increases in negative urgency (the personality tendency to act rashly when distressed); negative urgency influences eating disorder symptoms by shaping psychosocial learning (expectancy formation), thus indirectly influencing symptom levels; and many influences on purging are mediated by binge eating.

METHOD

Nine hundred five fifth grade girls completed questionnaire measures of eating pathology, negative urgency, and dieting/thinness and eating expectancies.

RESULTS

Binge eating and purging behaviors were present in fifth grade girls. As anticipated, pubertal status was associated with higher levels of negative urgency, negative urgency was associated with each expectancy measure, quadratic dieting/thinness and eating expectancies were associated with binge eating, and binge eating was associated with purging.

DISCUSSION

It is important and feasible to develop risk models for preadolescent eating disordered behaviors. Our model that integrates puberty, personality, and psychosocial learning appears promising.

A risk model for disordered eating in late elementary school boys

The authors tested the following risk model for disordered eating in late elementary school-age boys: Pubertal status is associated with increases in negative urgency, that is, the tendency to act rashly when distressed; high levels of negative urgency then influence binge eating through psychosocial learning; and binge eating influences purging. A sample of 908 fifth-grade boys completed questionnaire measures of puberty, negative urgency, dieting/thinness and eating expectancies, and eating pathology. Eating disorder symptoms were present in these young boys: 10% reported binge eating and 4.2% reported purging through self-induced vomiting. Each hypothesis in the risk model was supported. Boys this young do in fact engage in the maladaptive behaviors of binge eating and purging; it is crucial to develop explanatory risk models for this group. To this end, it appears that characteristics of boys, including their pubertal status, personalities, and psychosocial learning, help identify boys at risk.

The acquired preparedness model of risk for bulimic symptom development

The authors applied person-environment transaction theory to test the acquired preparedness model of eating disorder risk. The model holds that (a) middle-school girls high in the trait of ineffectiveness are differentially prepared to acquire high-risk expectancies for reinforcement from dieting or thinness; (b) those expectancies predict subsequent binge eating and purging; and (c) the influence of the disposition of ineffectiveness on binge eating and purging is mediated by dieting or thinness expectancies. In a three-wave longitudinal study of 394 middle-school girls, the authors found support for the model. Seventh-grade girls' scores on ineffectiveness predicted their subsequent endorsement of high-risk dieting or thinness expectancies, which in turn predicted subsequent increases in binge eating and purging. Statistical tests of mediation supported the hypothesis that the prospective relation between ineffectiveness and binge eating was mediated by dieting or thinness expectancies, as was the prospective relation between ineffectiveness and purging. This application of a basic science theory to eating disorder risk appears fruitful, and the findings suggest the importance of early interventions that address both disposition and learning.

Family influence on disordered eating: the role of body image dissatisfaction

Research has linked an appearance-focused family culture (including parental commentary about weight/size) with increased disordered eating and body image dissatisfaction in daughters. Since body image dissatisfaction is also a risk factor for disordered eating, body image dissatisfaction may contribute to the link between family focus on appearance and disordered eating. This correlational study included a sample of 268 college women who completed the Family Influence Scale, Bulimia Test - Revised, Body Shape Questionnaire, and a series of items about their parents' comments about their weight/size. Both family appearance focus and daughters' body image dissatisfaction predicted increased disordered eating in daughters. Additionally, body image dissatisfaction partially mediated the influence of family appearance focus on daughters' disordered eating. No specific type of parental comments regarding weight/size emerged as a superior predictor of eating disturbance, but encouragement to control weight/size was a stronger predictor of body dissatisfaction than other types of parental comments.

Interpersonal influences on late adolescent girls' and boys' disordered eating

Perceived socio-cultural pressure to be thin has an important impact on disordered eating during early and middle adolescence, but less is known about late adolescence. Most prospective studies included only girls, and less is known about the influence on boys. This study investigated interpersonal influences on changes in late adolescent boys' and girls' symptoms of disordered eating over one year. Participants were a community sample of late adolescents 16-19 years of age (N=199; 49.75% girls), their mothers, and friends. Structural equation modeling revealed that interpersonal pressure to be thin and criticism about appearance predicted increases in disordered eating over time. Late adolescents', mothers' and friends' reports of pressure were associated with disordered eating at Time 1 and Time 2. Further, adolescents' perceptions and friends' reports of pressure to be thin predicted changes in disordered eating over time. Findings underscore the significance of interpersonal relationships for disordered eating during late adolescence in both girls and boys.

Female emotional eaters show abnormalities in consummatory and anticipatory food reward: a functional magnetic resonance imaging study

OBJECTIVE

To test the hypothesis that emotional eaters show greater neural activation in response to food intake and anticipated food intake than nonemotional eaters and whether these differences are amplified during a negative versus neutral mood state.

METHOD

Female emotional eaters and nonemotional eaters (N = 21) underwent functional magnetic resonance imaging (fMRI) during receipt and anticipated receipt of chocolate milkshake and a tasteless control solution while in a negative and neutral mood.

RESULTS

Emotional eaters showed greater activation in the parahippocampal gyrus and anterior cingulate (ACC) in response to anticipated receipt of milkshake and greater activation in the pallidum, thalamus, and ACC in response to receipt of milkshake during a negative relative to a neutral mood. In contrast, nonemotional eaters showed decreased activation in reward regions during a negative versus a neutral mood.

DISCUSSION

Results suggest that emotional eating is related to increased anticipatory and consummatory food reward, but only during negative mood.

Family factors in the development of disordered eating: integrating dynamic and behavioral explanations

Previous studies exploring the dynamic (e.g., enmeshment, disengagement, rigidity, communication difficulties, overprotectiveness) and behavioral (e.g., parental modeling of eating behavior and attitudes toward weight, parental criticism and teasing, parental encouragement to diet) influences of the family on disordered eating behaviors have yielded mixed results. However, past research explored these different aspects of the family environment in isolation. The present study extended previous research by testing a prediction model in which the effects of family dynamics on the development of eating disorders operate through family food-related experiences. A total of 268 single college women completed the Eating Attitudes Test - Revised, Bulimia Test - Revised, Parental Bonding Instrument - II, Family Adaptability and Cohesion Scales - II, Parent Adolescent Communication Scale - Adolescent Form, Family Influence Scale, and Family Experiences Related to Food Questionnaire. Structural Equation Modeling revealed that both family dysfunction and negative family food-related experiences were associated with increased disordered eating. Results indicated that negative family food-related experiences mediated the relationship between family dysfunction and disordered eating. Discussion focuses on implications for the assessment and treatment of eating disorders.

The correlation of Chinese mothers' eating attitudes and psychological characteristics with their children's eating attitudes, as well as the gender effect on eating attitudes of children

OBJECTIVE

No study has examined the connection between the mothers' weight concerns, their psychological characteristics as well as their educational level and their children's weight concerns in China. Nor has the gender effect on the eating attitudes of pre- to post-pubertal Chinese children been explored (aged 10-13).

METHOD

The children (girls N=138, boys N=103) were given a Chinese version of the EDI-C. Their mothers completed a Chinese version of the EDI-2. The Bivariate's (Pearson) correlation was used to examine the relationship between the mothers' weight concerns, psychological characteristics and educational level with their children's weight concerns. An Independent-Samples Ttest was conducted to comparing the EDI-C subscales of the girls and boys groups.

RESULTS

Regarding the mothers' and children's eating attitudes, there was a significant correlation between the mothers' weight concerns as well as their psychological characteristics with their children's eating attitudes. No significant relationship was found between the mothers' educational level and the children's eating attitudes. According to the scores of the EDI-C questionnaire, there was no general significant gender difference between Chinese children (aged 10-13). However, a differential gender effect on the body dissatisfaction of children was found for the subgroup of elders (aged 13) indicating a differential developmental dynamic.

CONCLUSIONS

The Chinese mothers' weight concerns and their psychological characteristics correlated with their children's eating attitudes. A gender effect on the Chinese children's eating attitudes (aged 13) was established.

Associations among family-of-origin food-related experiences, expectancies, and disordered eating

OBJECTIVE

The study reported here integrates research on family-of-origin learning experiences and adult eating/thinness expectancies in the study of risk for eating disordered behavior.

METHOD

A sample of women manifesting a wide range of eating disordered behaviors (n = 66) were compared in their retrospective reports of family learning, current eating and dieting expectancies, and current eating disordered behaviors.

RESULTS

History of food-related teasing from friends and family, negative maternal modeling, and friends' criticism of eating all related to both adult disordered behavior and adult eating and thinness expectancies. Tests of mediation supported the putative mediation by expectancies of the relationships between early experiences and adult disordered behavior.

CONCLUSION

Family-of-origin learning experiences may influence adult eating disordered behavior by contributing to the formation of expectancies for reinforcement from eating and from thinness.

Les cognitions et leur évaluation dans les troubles des conduites alimentaires

Cognitions are of crucial importance in the -aetiology and the maintenance of eating disorders. Dysfunctional cognitions in eating disorders are related to body image, self-esteem and feeding. The aim of this paper is to review the actual knowledge in this area. First, we will display -cognitive models in eating disorders. Cognitive factors in -eating disorders are logical errors, cognitive slippage and conceptual complexity. Eating disorder patients seem to have a deficient cognitive development. Some cognitive models stipulate that eating disorder patients may develop organised cognitive structures schemas concerning the issues of weight and its implications for the self. These schemas can account for the persistence and for the understanding the "choice of the eating disorder symptomatology. Cognitive pheno-mena of interest are self-schema, weight-related schema and weight-related self-schema. The maintenance model of ano-rexia nervosa argued that, initially there is an extreme need to control eating which is supported by low self-esteem. The maintenance of the disorder is reinforced by three mechanisms: dietary restriction enhances the sense of being in control; aspects of starvation encourage further dietary restriction; concerns about shape and weight encourage restriction. The development and maintenance of bulimic symptomatology are explained by placing a high value on attaining an idealised weight and body shape accompanied by inaccurate beliefs. The cognitive model of specific family of origin experiences puts forward the development of -maladaptative expectancies for eating and thinness. Second, we discuss distortions in information processing. a) In feeding laboratories, bulimics show a wide range of caloric intake and a disruption of circadian feeding patterns. In overeating bulimics, large meals occurred mainly during afternoon and evening with high fat and carbohydrate intake, but the majority of meals were of normal size and frequency. Responsivity to food cues indicates that bulimics were more responsive to sight, smell and taste of their favourite binge food, and a greater responsivity was associated with increasing -cue salience. Eating disorder patients appear to have internalised a mediated social rule concerning "good food" and make drastic selections thus removing the possibility of choice of foodstuffs. b) Experimental processes: temporal factors in the processing of threat seem to be of importance in patients with high levels of eating psychopathology. There is no evidence for preattentive processing biases among anorectics. Changes in information processing speed after treatment were not linked to treatment condition or treatment response. c) Judgement and emotions: in eating disorder patients, distortions of depressogenic nature are found that influence the cognitive style; thoughts about eating, weight and shape are characterised by negative affective tone; negative emotions could account for bulimic behaviour; anxiety and distress are correlated to thought control strategies. Information treating seems to be impaired in a non-homogeneous way. d) Cognitive schemas are seriously maladaptive and not well investigated. In eating disorder patients, core beliefs are absolute, unconditional and dichotomous cognitions about oneself and the world. There are only few studies in this field moreover showing controversial results. Core beliefs can explain links between personality disorders and eating psychopathology. Pathological core beliefs have to be taken in to account because they influence the outcome and the efficacy of cognitive behavioural therapy. Third, the last part of this paper summarises actually available rating scales eva-luating distorted cognitions in eating disorders. There are different methods for evaluation: specific and non-specific self-report questionnaires, thought-sampling procedures, -methods derived from cognitive psychology. The Mizes Anorectic Cognition questionnaire (MAC) is a well-known self-rating scale with good psychometric properties. The revised form of the MAC appears to be an improvement in the area of internal consistency, sensitivity, and reliability. It is obvious that there is no particular rating scale referring to specific cognitions on food.

IN CONCLUSION

the main result of this literature review reflects that the cognitive treatment in eating disorders is altered in a specific way on an emotional basis and on self-representation.

Parental rearing behaviours and eating disorders: the moderating role of core beliefs

OBJECTIVE

Core beliefs have been shown to mediate between eating psychopathology and dysfunctional parent-daughter interactions. However, the possible moderating role of core beliefs has been neglected. This study aimed to explore the hypothesis that core beliefs serve as moderator variables in the relationship between recalled parental rearing behaviours and eating psychopathology.

METHOD

Sixty-six women with a current eating disorder completed self-report measures of parental rearing behaviours, core beliefs, and eating psychopathology.

RESULTS

Three core beliefs were found to moderate the relationship between paternal rejection and aspects of eating psychopathology. The predictive validity of paternal rejection on aspects of eating symptomatology was found to decrease as dysfunctional core beliefs increased.

DISCUSSION

When levels of social isolation, vulnerability to harm, and self-sacrifice core beliefs were high, recalled parental relationships were no longer relevant to current eating psychopathology. The findings provide further evidence that core beliefs are important factors in eating disorder psychopathology and may be clinically useful in identifying targets for treatment.

Factors related to severity of vomiting behaviors in bulimia nervosa

Assessments of the severity of vomiting (weekly frequency), depressive and eating-related psychopathology, anger level and management, and personality dimensions were used to characterize patients with bulimia nervosa binge purging type (BN-BP). The sample comprised 130 outpatients with BN and 130 control women. The Eating Disorder Inventory-2 (EDI-2), the State-Trait Anger Expression Inventory, the Beck Depression Inventory, and the Temperament and Character Inventory (TCI) were administered to all patients. The Self-Directedness dimension of the TCI and the Bulimia subscale of the EDI-2 were the strongest predictors of the severity of bulimic behavior; anger levels and anger expression were not so strongly related to illness severity. A more severe form of bulimic symptomatology probably has substrata in specific character deficits (low Self-Directedness on the TCI) and particular psychopathological features (high bulimia on the EDI-2). Patients with a high frequency of vomiting need specific therapeutic interventions to enhance the character dimension of Self-Directedness.

Similarities and differences between women and men on eating disorder risk factors and symptom measures

Researchers studying eating disorders in men often use eating disorder risk and symptom measures that have been validated only on women. Using a sample of 215 college women and 214 college men, we report on the validity of doing so with a set of measures chosen to reflect a wide range of risk factors and symptoms. The Bulimia Test-revised (BULIT-R), the restraint scale (RS), the three-factor eating questionnaire (TFEQ), the Eating Expectancy Inventory, and the eating attitudes test (EAT) all had the same factor structures for both genders, and tests of invariance showed that factor loadings, factor variances, and intercorrelations among factors were equivalent across gender. A modified Structured Clinical Interview for DSM-IV anorexic symptoms questionnaire did not perform adequately for either gender. Men produced slightly less reliable scores on virtually all measures, with the result that Pearson-based estimates of correlations among the measures were slightly lower for men. Men had lower scores on symptom and risk measures, but not on other eating measures.

Media Effects on Expectancies: Exposure to Realistic Female Images as a Protective Factor

Although frequent exposure to very thin female models is likely the norm for American women, exposure to attractive, average-weight models is likely unusual and may therefore be influential. The authors hypothesized that women at risk for eating disorders who are exposed to attractive, average-weight models would endorse fewer expectancies for reinforcement from thinness than would other women. The hypothesis was confirmed: High-risk women exposed to average-weight model images were less likely to endorse thinness/restricting expectancies than those who were exposed to thin models or to control images. Media exposure to realistic female images appears to lessen the relationship between at-risk status and subsequent endorsement of thinness/restricting expectancies and may therefore disrupt the risk process.

If you are good you can have a cookie: How memories of childhood food rules link to adult eating behaviors

OBJECTIVE

The aim of this study was to determine whether memories of parental rules about food during childhood are linked to adult eating behaviors.

METHOD

An adult community sample (N=122) (56% female, 44% male) with a mean age of 44.6 years completed self-report measures of weight and dieting history, current eating patterns, and recollection of different types of rules about food from their parents. Three types of food rules were assessed: (a) rules which restrict intake of certain foods, (b) rules which encourage food intake, and (c) rules where food is used to reward or punish behavior.

RESULTS

Binge eating and dietary restraint in adulthood are significantly related to participants' recollection of their parents using food to control their behavior in childhood. These results held true regardless of body mass index (BMI), ethnicity, age, or childhood weight status.

DISCUSSION

This study suggests that some childhood food rules may have a long-lasting impact on eating behaviors. Further research on the impact of using food to reward and punish children's behavior is needed to inform recommendations to parents regarding the use of food for behavioral control.

Expectancy influences the operation of personality on behavior

The authors investigated the moderating effect of expectancies on personality for 2 different addictive behavior processes: (a) drinking and (b) binge eating and purging characteristic of bulimia nervosa. Study 1 found that positive expectancies for social facilitation from drinking moderated the effect of extraversion on drinking behavior among undergraduate men and women. Study 2 found that the expectancy that eating will help manage negative affect moderated the effect of trait urgency on bulimic symptoms among undergraduate women. Thus, the relationships of the trait risk factors to these 2 addictive behaviors are stronger if one also holds certain expectancies for reinforcement from those behaviors.

Parent and child report of family functioning in a clinical child and adolescent eating disorders sample

OBJECTIVE

To investigate parent and self-report of family dysfunction in children and adolescents with eating disorders. Further, to investigate family functioning differences across the eating disorders diagnostic groups; anorexia nervosa, eating disorders not otherwise specified (EDNOS) and bulimia nervosa, and between the restricting and binge-purge eating disorders behavioural subtypes.

METHODS

The Family Adjustment Device General Functioning Scale (FAD-GFS) was administered to 100 children and their parents who presented consecutively at an eating disorders assessment clinic. DSM-IV eating disorders diagnoses in this group included 42 children diagnosed with anorexia nervosa, 26 with EDNOS, 12 with bulimia nervosa and 20 diagnosed as having no eating disorder.

RESULTS

Both the parent and child FAD-GFS report demonstrated high internal consistency supporting the suitability of this instrument for research with this sample. Parent and child reports were moderately positively correlated. Total scores for all eating disorders diagnostic categories were significantly higher than community norms. Anorexia nervosa, EDNOS and bulimia nervosa groups did not significantly differ on parent or child reports. FAD-GFS profiles for restricters and binge-purgers suggest higher levels of family dysfunction in the families of binge purgers.

CONCLUSIONS

The FAD-GFS has suitable psychometric properties for use as a summary instrument with young people diagnosed with an eating disorder. However, more informative instruments assaying a greater range of constructs, especially in the impulsive, dyscontrol domain, are required to investigate differences among eating disorders diagnostic groups and behavioural subtypes.