A study on the interplay between emerging adulthood and eating disorder symptomatology in young adults

Unhealthy app use and dietary restraint among young adults: The moderating role of body appreciation

OBJECTIVE

Health and fitness apps that integrate wearable-device data have increased in popularity for self-monitoring of body appearance and weight goals. However, limited research has explored their potential to promote unhealthy eating behaviors. This study assessed body appreciation as a moderator of the relationship between health and fitness app use and dietary restraint.

METHODS

A total of 126 young adults (Mage = 20.8 ± 2.2 years, 65.9 % women) completed an online survey incorporating the Three-Factor Eating Questionnaire (TFEQ), Body Appreciation Scale (BAS) and frequency of app usage.

RESULTS

Hierarchical regression analysis revealed that app use significantly and positively predicted dietary restraint, explaining 33.2 % of the variance (R2= 0.33, p < .001), with a combined large effect (f2 = 0.50). Body appreciation moderated this relationship, accounting for an additional 3.2 % of the variance (p = .018). Further analysis indicated for individuals with higher levels of body appreciation (above 2.95; 70.6 % of the sample), app use was significantly associated with dietary restraint.

CONCLUSIONS

Results indicate that dietary restraint was associated with one-third of young adults who use health and fitness apps. Unexpectedly, young adults with high body appreciation who actively engage with these apps report intentions to restrict food intake. It remains unclear whether app-related goal-setting features influence caloric restriction. Incorporating health warnings in apps and personalizing app interactions to discourage extreme goal setting may help protect those individuals at risk of developing eating disorders.

Early intervention for eating disorders

PURPOSE OF REVIEW

Research on early intervention for eating disorders has started to gain traction and examples of this in practice are increasing. This review summarizes findings over the past 3 years, focusing on the clinical effectiveness of early intervention in practice and the barriers and facilitators to its implementation.

RECENT FINDINGS

Recent developments in early intervention for eating disorders can be divided into three broad themes: research that has examined the efficacy of early intervention pathways in practice, research that has informed understanding of the target patient groups of early intervention (via clinical staging models, e.g.), and research that has suggested new ways to progress early intervention, towards becoming a standard part of best practice care.

SUMMARY

Early intervention pathways have shown promising clinical outcomes and are viewed positively by patients, clinicians and other stakeholders. However, more robust trials of their efficacy, effectiveness and cost-effectiveness are needed. Additionally, barriers to early intervention have been identified (e.g. delayed help-seeking); research must now develop and evaluate strategies to address these. Finally, the early intervention models in practice are underpinned partly by clinical staging models for eating disorders, which require further development, especially for eating disorders other than anorexia nervosa.

Prevalence and correlates of disordered eating at a large state university before and after the onset of the COVID-19 pandemic

BACKGROUND

Emerging adulthood is a transitory period in which disordered eating (DE) manifests; collecting data on the prevalence of DE among this population as well as demographic and behavioral correlates are important public health goals.

METHODS

Data from an annual survey of undergraduate students at a large state university from 2019 to 2022 were analyzed, allowing researchers to compare prevalence and correlates before and after the onset of the COVID-19 pandemic using two brief screeners: the SCOFF and Eating Disorder Screener for Primary Care (ESP). We hypothesized that rates of DE would be greater after the onset of COVID-19 as compared to before. We also hypothesized that those identifying as women, reporting higher alcohol or drug use, and contemplating suicide would have greater odds of reporting symptoms consistent with DE.

RESULTS

DE was significantly lower in pre-pandemic years compared to pandemic years: ESP pre = 38.01%(n = 704), pandemic = 48.79%(n = 645), p < 0.001; SCOFF pre = 22.82%(n = 422), pandemic = 31.46%(n = 414), p < 0.001. Logistic regressions showed women and students who contemplated suicide reported significantly greater DE, regardless of screener or time period. Inconsistent relationships were found between DE and current substance use.

CONCLUSION

These findings may inform targeted interventions for those most vulnerable to disordered eating.

A pilot randomized trial of self-compassion writing for young adult women engaged in emotional eating in the context of appearance-related cyberbullying

OBJECTIVE

To investigate the effectiveness of a 10-min self-compassion writing in alleviating body dissatisfaction, self-objectification, and emotional eating in young adult women engaged in emotional eating in the context of appearance-related cyberbullying.

METHOD

A total of 175 Chinese young adult women (Mage  = 20.90, SD = 1.65) were randomly assigned to one of the three groups: self-compassion, distraction, or control group. At baseline, participants completed assessments of trait and state body dissatisfaction, trait self-objectification, trait self-compassion, emotional eating, and positive and negative affect. Then they needed to recall an appearance-related cyberbullying victimization experience, after which state body dissatisfaction, state self-objectification, and positive and negative affect were measured. After the intervention, participants completed measures of state body dissatisfaction, state self-objectification, positive and negative affect, state self-compassion, and a food-choosing task. At 1-month follow-up, participants completed measures of trait body dissatisfaction, trait self-objectification, trait self-compassion, and emotional eating.

RESULTS

At post-intervention, state body dissatisfaction and negative affect were significantly lower, and positive affect was significantly higher in both the self-compassion and distraction groups compared to control. State self-objectification was significantly lower in the self-compassion group than in the other two groups. At 1-month follow-up, the self-compassion group showed significantly lower levels of body dissatisfaction than the control group.

DISCUSSION

The findings provide initial evidence for the potential of self-compassion writing in reducing state self-objectification and state body dissatisfaction in the context of appearance-related cyberbullying.

PUBLIC SIGNIFICANCE

Appearance-related cyberbullying, a common phenomenon in social networking sites, has been documented to associate with appearance-related concerns and disordered eating in young adult women. However, effective interventions that can reduce these negative associations are scarce. This study preliminarily found that a brief self-compassion writing could be a potential intervention for reducing state self-objectification and state body dissatisfaction in young adult women who had suffered appearance-related cyberbullying.

Cyberbullying victimization and disordered eating behaviors: The mediating roles of self-compassion and self-objectification

Previous studies have demonstrated the correlations between cyberbullying victimization and disordered eating behaviors in adolescents, however, limited attention has been paid to the long-term effects and underlying mechanisms, and studies focused on young adults are scarce. This study explored the association between cyberbullying victimization and disordered eating behaviors and the underlying mechanisms in a sample of young adults using a longitudinal design. A total of 955 Chinese young adults completed the Cyber Victim Subscale of the Cyber Victim and Bullying Scale, the Self-surveillance Subscale of the Objectified Body Consciousness Scale, the Self-compassion Scale-Short Form, and the Dutch Eating Behaviors Questionnaire three times with a 3-months interval. The results indicated that cyberbullying victimization was positively correlated with emotional eating and external eating after six months, but not with restrained eating. Moreover, self-compassion and self-objectification mediated the associations between cyberbullying victimization and the three kinds of disordered eating behaviors, however, in different ways. In the associations of cyberbullying victimization with restrained eating and external eating, the independent mediating effect of self-objectification and the serial mediating effect were significant, while in the association between cyberbullying victimization and emotional eating, only the independent mediating effect of self-compassion was significant. The findings indicated that the relations between cyberbullying with different kinds of disordered eating behaviors might have different mediation mechanisms, which sheds light on the prevention and intervention for disordered eating behaviors associated with cyberbullying in the future.

Potential Triggers for Risking the Development of Eating Disorders in Non-Clinical Higher-Education Students in Emerging Adulthood

Nowadays, eating disorders (ED) among individuals during emerging adulthood have become a crucial challenge to public health, taking into account the fact that the global prevalence of the ED risk in student-aged populations already stands at 10.4% and has been sharply increasing during the COVID-19 pandemic. In all, from 50% to 80% of all the ED cases go undetected or are not correctly diagnosed; moreover, these individuals do not receive specialized treatment. Therefore, early diagnosis detected via screening questionnaires for ED is highly recommended. This study aimed to identify the triggers for ED risk development in emerging-adulthood individuals and to reveal the factors significant not only for ED prevention but also for assessing individuals with subthreshold symptoms. This cross-sectional study provides the results for the ED symptom screening in 1716 Lithuanian higher-education students aged 21.2 ± 3.9, during emerging adulthood. According to the results of this study, 19.2% of students were at risk for ED. Potential risk factors such as sex (odds ratio (OR): 3.1, 95% CI: 1.9-4.9), body weight (self-reported body mass index) (adjusted (A) OR: 1.4; 95% CI: 1.2-1.7) and comorbidities such as smoking (AOR: 2.1; 95% CI: 1.6-2.8), and perceived stress during the pandemic (AOR: 1.4; 95% CI: 1.1-1.8) are involved in anticipating the symptomatology of ED during emerging adulthood. Regular initial screenings with universally adopted questionnaires and further referral to a psychiatrist must be applied to promote both the diagnosis of early-onset symptomatology and the treatment of these ED in student-aged populations. Preventive programs for reducing the prevalence of overweight or obesity among students during emerging adulthood should focus on integration directions for the development of a positive body image.

The powerful effect of body image inflexibility on the explanation of eating psychopathology severity

PURPOSE

Feelings of shame and social comparison focused on physical appearance have been identified as important risk factors for the engagement in disordered eating behaviours. Further, recent studies have emphasized the role of body-image psychological (in)flexibility in the association between several risk factors and eating psychopathology. The current study intended to explore, in two different path models, the effects of external shame, physical appearance-related social comparison, and body image inflexibility on the explanation of eating psychopathology severity.

METHODS

This study follows a cross-sectional design and was conducted in a sample of 776 emerging-adult women, aged between 18 and 28, who completed an online battery of self-report measures. Path analyses were conducted using a structural equation modeling.

RESULTS

Model 1's results showed that external shame and unfavourable social comparison based on physical appearance directly accounts for 26% of the variance in disordered eating. In turn, when body image inflexibility is introduced as a mediator in the relationship presented in Model 1, variance in disordered eating increases to 60% (Model 2). These results suggest that both external shame and unfavourable physical appearance-related social comparison have an impact on disordered eating behaviours. However, when body image inflexibility is introduced, the mentioned relationships change and reveal that psychological inflexibility is a significant mediator of these associations.

CONCLUSION

These findings seem to demonstrate that body image inflexibility is a key process for the engagement in disordered eating, so the promotion of psychological flexibility focused on one's body is crucial for the prevention and treatment of disordered eating behaviours and attitudes.

LEVEL OF EVIDENCE

Level IV: Cross-sectional study.

Using apps to self-monitor diet and physical activity is linked to greater use of disordered eating behaviors among emerging adults

Use of weight-related self-monitoring (WRSM) apps is common among emerging adults, as are weight and shape concerns. The present study aimed to examine (1) whether emerging adult use of dietary-focused (e.g., MyFitnessPal) and physical activity-focused (e.g., Fitbit) WRSM apps was associated with weight-control and muscle-building behaviors, including commonly recommended/conventional behaviors and disordered behaviors and (2) whether prior use of weight-control and muscle-building behaviors in adolescence might explain such relationships. Data were collected as part of the EAT (Eating and Activity over Time) 2010-2018 study (n = 1446) and analyzed using gender-stratified logistic regression models adjusted for demographic characteristics and body mass index. Among women and men, physical activity- and dietary-focused app use were associated with greater adjusted prevalence of disordered weight-control behaviors (e.g., fasting, purging), and disordered muscle-building behaviors (e.g., using steroids). Physical activity- and dietary-focused app use were also associated with a higher adjusted prevalence of commonly recommended weight-control and conventional muscle-building behaviors (e.g., exercising, changing eating habits), but only among those who were also engaging in disordered behaviors. The observed associations remained statistically significant in models that further adjusted for adolescent use of the respective behaviors. Findings suggest that emerging adults who use physical activity- and dietary-focused WRSM apps are more likely to engage in disordered weight-control and muscle-building behaviors and that associations are not explained by engagement in these behaviors during adolescence. Future research is needed to examine if there are aspects of WRSM apps that could be modified to reduce potential harm.

Validation of the Greek ORTO-15 questionnaire for the assessment of orthorexia nervosa and its relation to eating disorders symptomatology

PURPOSE

The aim of the study was the validation of the Greek version of the ORTO-15 questionnaire. An additional aim was to explore the relation between orthorexic and eating disorder behaviors in a sample of Greek students.

METHODS

ORTO-15 was translated and adapted in the Greek language. After its final version was drafted, its test-retest reliability was checked. Then, the questionnaire was administered to 120 students of psychology along with EAT-26. Additionally, demographics, BMI and information related to eating disorders were collected.

RESULTS

The Greek version of the ORTO-15 questionnaire showed acceptable internal consistency (Cronbach's a 0.7). Factor analysis produced a three-factor model similar to the original English version of the questionnaire. The correlation of ORTO-15 and EAT-26 revealed that higher measurements in the diet and bulimia EAT-26 scale were related to increased orthorexic symptomatology. Finally, there was no significant correlation between the 3 factors of the ORTO-15 (emotional, rational and behavioral) and age, education or Body Mass Index.

CONCLUSIONS

This study is the first attempt to assess orthorexia nervosa in a Greek student population. ORTO-15 was found to be a reliable tool for the measurement of orthorexia in Greece. Finally, in accordance with other studies, orthorexic symptoms were partially related to eating disorder symptomatology, thus raising the question of possible similarities and overlap between the two clinical constructs.

LEVEL OF EVIDENCE

Level V, Cross-sectional descriptive study.

Measuring perfectionism, impulsivity, self-esteem and social anxiety: Cross-national study in emerging adults from eight countries

This study assessed the measurement invariance of selected self-report measures of perfectionism, impulsivity, self-esteem and social anxiety in samples of emerging adults from eight different countries. Participants (N = 6272) completed the Multidimensional Perfectionism Scale (MPS), the UPPS-P Impulsive Behavior Scale, the 5-item Rosenberg Self-Esteem Scale (5-item RSES) and the Social Interaction Anxiety Scale (SIAS-6). Multigroup confirmatory factor analysis was run to examine cross-measure equivalence. Evidence for structural invariance was found for all questionnaires, while weak invariance was supported only for the 5-item RSES and the SIAS-6, and a partial weak invariance was found for the MPS and the UPPS-P. No measure achieved strong invariance. Strict invariance was achieved for the 5-item RSES, whereas only a partial strict invariance was supported for the MPS, UPPS-P and SIAS-6. These results suggest that perfectionism, impulsivity, self-esteem, and social anxiety are subjected to linguistic/cultural influence as well as to the effects of socio-demographic variables and can be evaluated by using the selected measures in eight different countries worldwide - but results should be interpreted with caution.

Eating Disorders During Emerging Adulthood: A Systematic Scoping Review

Background: Eating disorders (EDs) during the transition to adulthood can derail social, psychological, and vocational development. Effective treatment is of paramount importance, yet young adults' treatment needs are typically less well met than those of adolescents. In recent years, there has been a considerable shift in how developmental psychologists understand the transition to adulthood, with this life-phase reconceptualized as "emerging adulthood" (EA) (~18-25 years). Engagement with burgeoning developmental research is likely key to providing more effective care for young people experiencing EDs. Aims: To review ED research which has utilized the concept of EA, and to assess the usefulness of this concept for ED research and practice. Methods: A systematic scoping review was conducted in accordance with the Joanna Briggs Institute guidelines for scoping reviews. Three databases (Psychinfo, PubMed, Embase) were searched for papers which explicitly focused on EDs during EA. No restrictions as to publication type, language, study design, or participants were applied. Included studies were assessed for developmental "informedness," and findings were qualitatively synthesized. Results: Thirty-six studies (N = 25,475) were included in the review. Most studies used quantitative methodologies, were cross-sectional in design and focused on identifying psychological and social factors which contribute to etiology of EDs. Many studies (N = 22) used well-defined samples of emerging adults (EAs); few studies (N = 8) included developmental measures relevant to EAs. Findings indicate that whilst factors implicated in EDs in adolescence and adulthood are relevant to EAs, EA-specific factors (e.g., identity exploration) may also contribute. Conventional ED services and treatments present difficulties for EAs, whilst those adapted to EAs' needs are feasible, acceptable, and more effective than treatment-as-usual. Directions for future research and clinical implications are discussed. Conclusion: Existing research indicates that the EA concept is relevant for understanding EDs during the transition to adulthood, and ED services should implement adaptations which exploit the opportunities and overcome the challenges of this developmental stage. EA is currently an underused concept in ED research, and future engagement with the developmental literature by both researchers and clinicians may be key to understanding and treating EDs during transition to adulthood.