1
|
Sharpe SL. A living experience proposal for the co-occurring diagnosis of avoidant/restrictive food intake disorder and other eating disorders. J Eat Disord 2024; 12:110. [PMID: 39103970 PMCID: PMC11299394 DOI: 10.1186/s40337-024-01073-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 07/29/2024] [Indexed: 08/07/2024] Open
Abstract
The eating and feeding disorder section of the Diagnostic and Statistical Manual of Mental Disorders 5 Text Revision (DSM-5-TR) is organized by a diagnostic algorithm that limits the contemporaneous assignment of multiple eating disorder diagnoses. Avoidant/restrictive food intake disorder (ARFID) is a disturbance in food intake typically associated with lack of interest in food, food avoidance based on sensory characteristics, and/or fear of aversive consequences from eating. According to the DSM-5-TR, an ARFID diagnosis cannot be made when weight or shape disturbances are present, and ARFID cannot be co-diagnosed with other eating disorders characterized by these disturbances. However, emerging evidence from both clinical and lived experience contexts suggests that the co-occurrence of ARFID with multiple other types of eating disorders may be problematically invisibilized by this trumping scheme. The diagnostic criteria for ARFID can contribute to inappropriate diagnosis or exclusion from diagnosis due to excessive ambiguity and disqualification based on body image disturbance and other eating disorder pathology, even if unrelated to the food restriction or avoidance. This harmfully limits the ability of diagnostic codes to accurately describe an individual's eating disorder symptomatology, impacting access to specialized and appropriate eating disorder care. Therefore, revision of the DSM-5-TR criteria for ARFID and removal of limitations on the diagnosis of ARFID concurrent to other full-syndrome eating disorders stands to improve identification, diagnosis, and support of the full spectrum of ARFID presentations.
Collapse
Affiliation(s)
- Sam L Sharpe
- Department of Social Transformation Studies, Kansas State University, 003 Leasure Hall 1128 N. Martin Luther King Jr. Dr, Manhattan, KS, 66506, USA.
| |
Collapse
|
2
|
Goeden AV, Schaefer LM, Crosby RD, Peterson CB, Engel SG, Le Grange D, Crow SJ, Wonderlich SA. Examining the momentary relationships between body checking and eating disorder symptoms in women with anorexia nervosa. Eat Behav 2023; 50:101751. [PMID: 37244020 PMCID: PMC10525023 DOI: 10.1016/j.eatbeh.2023.101751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 04/26/2023] [Accepted: 05/18/2023] [Indexed: 05/29/2023]
Abstract
Body checking is common among individuals with anorexia nervosa (AN) and increases risk for dietary restriction. However, no study has examined whether body checking increases the immediate risk for engaging in other harmful weight loss behaviors, or whether this relationship is moderated by person-level traits. The current study utilized ecological momentary assessment (EMA) to examine whether (a) body checking predicted rapid use of weight loss behaviors, and (b) whether eating-related obsessionality/compulsivity moderated this relationship. Women with full or subthreshold anorexia nervosa (N = 118) completed a measure of eating-related obsessionality/compulsivity at baseline, followed by a 14-day EMA protocol during which they reported on body checking and weight loss behaviors (i.e., exercise, self-induced vomiting, laxative use, skipping meals, and increasing fluid intake). In a series of generalized linear mixed models, within-person effects indicated that momentary body checking significantly predicted subsequent meal skipping and using fluids to curb appetite. Between-person effects indicated that individuals who engage in more frequent body checking also engage in a higher frequency of self-induced vomiting, meal skipping, and use of fluids to curb appetite. An individual's degree of eating-related obsessionality/compulsivity did not moderate any of these relationships. Findings highlight body checking as an immediate precursor of dangerous weight loss behaviors among individuals with AN, and underscore the need for clinicians to address body checking during treatment.
Collapse
Affiliation(s)
- Allyson V Goeden
- Center for Biobehavioral Research, Sanford Research, United States of America; Department of Psychology, University of Wisconsin, La-Crosse, United States of America
| | - Lauren M Schaefer
- Center for Biobehavioral Research, Sanford Research, United States of America; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, United States of America.
| | - Ross D Crosby
- Center for Biobehavioral Research, Sanford Research, United States of America; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, United States of America
| | - Carol B Peterson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, United States of America
| | - Scott G Engel
- Center for Biobehavioral Research, Sanford Research, United States of America; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, United States of America
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, United States of America; Department of Psychiatry and Behavioral Sciences, University of Chicago (Emeritus), United States of America
| | - Scott J Crow
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, United States of America; Department of Psychiatry, Accanto Health, St. Paul Minnesota, United States of America
| | - Stephen A Wonderlich
- Center for Biobehavioral Research, Sanford Research, United States of America; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, United States of America
| |
Collapse
|
3
|
Lowy AS, Rodgers RF, Franko DL, Pluhar E, Webb JB. Body image and internalization of appearance ideals in Black women: An update and call for culturally-sensitive research. Body Image 2021; 39:313-327. [PMID: 34749264 DOI: 10.1016/j.bodyim.2021.10.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 10/11/2021] [Accepted: 10/14/2021] [Indexed: 11/18/2022]
Abstract
Extant research on body image supports sociocultural theories emphasizing the internalization of societal pressures to attain the thin-ideal, as well as other White or Eurocentric ideals that are predominant in mainstream media. While earlier research suggests that Black women are less likely to report body dissatisfaction and thin-ideal internalization compared to women of other racial backgrounds, recent studies argue that most measures of body image and appearance ideals may not be accurate assessments of body dissatisfaction for this population. In this paper, we summarize the literature over the past two decades on body image and appearance ideals among cisgender Black girls and women and discuss the applications of well-established sociocultural theories of body dissatisfaction. We additionally highlight existing gaps in culturally-sensitive theory and assessment tools and consider the benefits of applying intersectionality-informed research. We lastly propose future directions in research, assessment, and intervention to develop more culturally-sensitive approaches to identifying, assessing, and addressing body dissatisfaction among Black girls and women. This paper encourages researchers to apply culturally-sensitive and intersectionality-informed theory to improve efforts in assessing early warning signs of body dissatisfaction and developing effective interventions for this population.
Collapse
Affiliation(s)
- Alice S Lowy
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Rachel F Rodgers
- Department of Applied Psychology, Northeastern University, Boston, MA, USA
| | - Debra L Franko
- Department of Applied Psychology, Northeastern University, Boston, MA, USA
| | - Emily Pluhar
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Jennifer B Webb
- Department of Psychological Science, University of North Carolina at Charlotte, Charlotte, NC, USA
| |
Collapse
|
4
|
Romano KA, Heron KE. Racial differences in overeating, loss of control eating, and binge eating: Extending core tenets of the Cognitive Behavioral Theory of Eating Disorders. Appetite 2020; 153:104747. [PMID: 32454077 DOI: 10.1016/j.appet.2020.104747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 05/15/2020] [Accepted: 05/17/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE The present study examined racial differences in associations among body dissatisfaction, body checking, and dietary restraint relative to overeating, loss of control eating, and binge eating outcomes among college women. METHOD Young adult women (N = 903) at three Mid-Atlantic US institutions completed measures assessing negative body image and eating pathology via an online survey. Structural equation modeling was used to test a model examining associations among body dissatisfaction, body checking, dietary restraint, and disinhibited eating behaviors. Multigroup analyses examined whether these associations differed for women who identified as White (n = 432) versus Black (n = 359). RESULTS More frequent body checking explained associations between elevated body dissatisfaction and more frequent use of all three disinhibited eating outcomes for White and Black women, whereas restraint solely mediated an association between body dissatisfaction and overeating. The assessed constructs generally operated in a similar manner across racial groups. However, stronger associations among body dissatisfaction, restraint, and overeating, and between body checking and loss of control eating were identified for women who identified as White versus Black. CONCLUSIONS Eating disorder programming efforts targeting body checking behavior may prove useful in decreasing White and Black women's disinhibited eating.
Collapse
Affiliation(s)
- Kelly A Romano
- The Virginia Consortium Program in Clinical Psychology, 555 Park Avenue, Norfolk, VA, 23504, USA.
| | - Kristin E Heron
- The Virginia Consortium Program in Clinical Psychology, 555 Park Avenue, Norfolk, VA, 23504, USA; Old Dominion University, 250 Mills Godwin Building, Norfolk, VA, 23529, USA
| |
Collapse
|
5
|
Radix AK, Rinck M, Becker ES, Legenbauer T. The Mediating Effect of Specific Social Anxiety Facets on Body Checking and Avoidance. Front Psychol 2019; 9:2661. [PMID: 30671002 PMCID: PMC6331477 DOI: 10.3389/fpsyg.2018.02661] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 12/11/2018] [Indexed: 11/21/2022] Open
Abstract
Objective: Body checking (BC) and avoidance (BA) form the behavioral component of body image disturbance. High levels of BC/BA have often been documented to hold a positive and potentially reinforcing relationship with eating pathology. While some researchers hypothesize, that patients engage in BC/BA to prevent or reduce levels of anxiety, little is known about the mediating factors. Considering the great comorbidity between eating disorders (ED) and in particular social anxieties, the present study investigated whether socially relevant types of anxiety mediate the relationship between eating pathology and BC/BA. Methods: 83 participants reporting an eating disorder and 323 healthy participants (14–25 years) took part in an online survey. Eating pathology was measured with the Eating Disorder Examination Questionnaire and Body Checking and Avoidance Questionnaire. Trait and social anxiety were assessed by means of the State Trait Anxiety Inventory (STAI-T), the Fear of Negative Evaluation (FNE) and the Social Appearance and Anxiety Scale (SAAS). Separate mediation analyses were carried out with eating pathology as independent variable, BC/BA as dependent variable and STAI, FNE, and SAAS as mediating variables. Results: Anxieties correlated highly positive with eating pathology in both groups. SAAS mediated the relationship between ED pathology and BC/BA in participants with ED and mediated the relationship between ED pathology and BA in healthy participants. FNE mediated the relationship between eating pathology and BA for participants with eating pathology. Discussion: SAAS mediated the relationship between eating pathology and BC/BA. Being afraid of bodily evaluations may represent a particular relevant fear that triggers safety behaviors.
Collapse
Affiliation(s)
- Anne Kathrin Radix
- LWL University Hospital Hamm for Child and Adolescent Psychiatry, Ruhr-University Bochum, Hamm, Germany
| | - Mike Rinck
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Eni Sabine Becker
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Tanja Legenbauer
- LWL University Hospital Hamm for Child and Adolescent Psychiatry, Ruhr-University Bochum, Hamm, Germany
| |
Collapse
|
6
|
Walker DC, White EK, Srinivasan VJ. A meta-analysis of the relationships between body checking, body image avoidance, body image dissatisfaction, mood, and disordered eating. Int J Eat Disord 2018; 51:745-770. [PMID: 29659039 DOI: 10.1002/eat.22867] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 03/08/2018] [Accepted: 03/08/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Body checking (BC) and body image avoidance (BIA) have been proposed as etiological and maintaining mechanisms for eating disorder (ED) pathology. To date, no comprehensive review summarizes the relationships of BC and BIA with ED pathology, body image dissatisfaction, or mood/affect. METHOD Meta-analyses examined the relationships of BC and BIA with ED pathology, body image dissatisfaction, and mood/affect. Gender, publication status, and presence or absence of ED diagnoses were examined as potential moderators. RESULTS Results showed strong relationships between BC and ED pathology (ρ = 0.588) and BC and body image dissatisfaction (ρ = 0.631) and a moderate relationship between BC and mood/affect (ρ = 0.385). Similarly, results showed strong relationships between BIA and ED pathology (ρ = 0.553) and BIA and body image dissatisfaction (ρ = 0.543) and a moderate relationship between BIA and mood/affect (ρ = 0.392). Overall, limited evidence supported publication bias; however, publication bias may exist in the relationship between BIA and body image dissatisfaction in the literature. Subgroup moderator analyses suggested that gender moderates the strength of the relationships between BC and ED pathology, body image dissatisfaction, and mood/affect and between BIA and body image dissatisfaction. DISCUSSION Results are consistent with cognitive-behavioral models of ED pathology that suggest BC and BIA are behavioral expressions of overvaluation of weight and shape. Notably, more published research has investigated BC than BIA. Future studies, incorporating methods such as meta-analytic structural equation modeling, should examine these variables to further test cognitive-behavioral models of ED development and maintenance.
Collapse
Affiliation(s)
| | - Emily K White
- Department of Psychiatry & Psychology, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | | |
Collapse
|
7
|
Nikodijevic A, Buck K, Fuller-Tyszkiewicz M, de Paoli T, Krug I. Body checking and body avoidance in eating disorders: Systematic review and meta-analysis. EUROPEAN EATING DISORDERS REVIEW 2018. [DOI: 10.1002/erv.2585] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Alexandra Nikodijevic
- Melbourne School of Psychological Sciences; University of Melbourne; Melbourne VIC Australia
| | - Kimberly Buck
- Melbourne School of Psychological Sciences; University of Melbourne; Melbourne VIC Australia
- Southern Synergy, Department of Psychiatry; Monash University; Dandenong VIC Australia
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology; Deakin University; Geelong VIC Australia
- Center for Social and Early Emotional Development; Deakin University; Geelong VIC Australia
| | - Tara de Paoli
- Melbourne School of Psychological Sciences; University of Melbourne; Melbourne VIC Australia
| | - Isabel Krug
- Melbourne School of Psychological Sciences; University of Melbourne; Melbourne VIC Australia
| |
Collapse
|
8
|
Ordaz DL, Schaefer LM, Choquette E, Schueler J, Wallace L, Thompson JK. Thinness pressures in ethnically diverse college women in the United States. Body Image 2018; 24:1-4. [PMID: 29172060 PMCID: PMC5869119 DOI: 10.1016/j.bodyim.2017.11.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 11/14/2017] [Accepted: 11/15/2017] [Indexed: 11/19/2022]
Abstract
While research consistently supports the negative impact of thinness pressures on body image, this work has primarily utilized White samples in the United States, limiting generalizability to other ethnicities. Further, limited research has examined ethnic differences in thinness pressures from distinct sociocultural influences. This study examined distinct sources of thinness pressures in 598 White, 135 Black, and 131 Hispanic college women in the United States. Mean levels of thinness pressures significantly differed across ethnicity, with Black women generally reporting the lowest levels of each pressure. Additionally, distinct sources of thinness pressures were more highly related to negative outcomes within ethnic groups. For White women, each source was salient for disordered eating. For Black women, family pressure was particularly salient for appearance evaluation. For Hispanic women, family pressure was particularly salient for disordered eating and appearance evaluation. Findings suggest possible ethnic differences in the relative salience of some pressures over others.
Collapse
Affiliation(s)
- D Luis Ordaz
- Department of Psychology, University of South Florida, United States.
| | - Lauren M Schaefer
- Department of Psychology, University of South Florida, United States
| | - Emily Choquette
- Department of Psychology, University of South Florida, United States
| | - Jordan Schueler
- Department of Psychology, University of South Florida, United States
| | - Lisa Wallace
- Department of Psychology, University of South Florida, United States
| | - J Kevin Thompson
- Department of Psychology, University of South Florida, United States
| |
Collapse
|
9
|
Solomon-Krakus S, Sabiston CM. Body checking is associated with weight- and body-related shame and weight- and body-related guilt among men and women. Body Image 2017; 23:80-84. [PMID: 28886393 DOI: 10.1016/j.bodyim.2017.08.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 08/07/2017] [Accepted: 08/15/2017] [Indexed: 10/18/2022]
Abstract
This study examined whether body checking was a correlate of weight- and body-related shame and guilt for men and women. Participants were 537 adults (386 women) between the ages of 17 and 74 (Mage=28.29, SD=14.63). Preliminary analyses showed women reported significantly more body-checking (p<.001), weight- and body-related shame (p<.001), and weight- and body-related guilt (p<.001) than men. In sex-stratified hierarchical linear regression models, body checking was significantly and positively associated with weight- and body-related shame (R2=.29 and .43, p<.001) and weight- and body-related guilt (R2=.34 and .45, p<.001) for men and women, respectively. Based on these findings, body checking is associated with negative weight- and body-related self-conscious emotions. Intervention and prevention efforts aimed at reducing negative weight- and body-related self-conscious emotions should consider focusing on body checking for adult men and women.
Collapse
Affiliation(s)
- Shauna Solomon-Krakus
- Faculty of Kinesiology & Physical Education, University of Toronto, Harbord Street, Toronto, Ontario M5S 2W6, Canada
| | - Catherine M Sabiston
- Faculty of Kinesiology & Physical Education, University of Toronto, Harbord Street, Toronto, Ontario M5S 2W6, Canada.
| |
Collapse
|
10
|
Legenbauer T, Martin F, Blaschke A, Schwenzfeier A, Blechert J, Schnicker K. Two sides of the same coin? A new instrument to assess body checking and avoidance behaviors in eating disorders. Body Image 2017; 21:39-46. [PMID: 28285178 DOI: 10.1016/j.bodyim.2017.02.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 02/12/2017] [Accepted: 02/13/2017] [Indexed: 11/19/2022]
Abstract
Body checking (BC) and avoidance behaviors (BA) are the dominant behavioral features of body image disturbances (BID) that characterize most individuals with eating disorders (EDs). Whereas BC can be reliably assessed, a valid assessment tool for BA is lacking, preventing an adequate assessment of BID differences across different EDs (anorexia nervosa, AN; bulimia nervosa, BN; binge eating disorder, BED). A total of 310 women with EDs and 112 nonclinical controls completed measures of BC-, BA- and ED-related symptoms. BA did not differentiate between EDs, whereas BC did: it was highest in AN and BN, and lowest in BED. Multivariate analyses also discriminated AN from BN based on BC. Given that results are of preliminary nature, evidence is promising that EDs can be discriminated from healthy controls and that differential BID profiles for the behavioral component among ED subgroups exist. However, replication of the factor structure remains open within ED subsamples.
Collapse
Affiliation(s)
- Tanja Legenbauer
- LWL University Hospital of the Ruhr-University Bochum for Child and Adolescent Psychiatry, Hamm, Germany.
| | - Franziska Martin
- LWL University Hospital of the Ruhr-University Bochum for Child and Adolescent Psychiatry, Hamm, Germany
| | - Ariane Blaschke
- Psychosomatic Hospital St. Franziska-Stift, Bad Kreuznach, Germany
| | - Anne Schwenzfeier
- LWL University Hospital of the Ruhr-University Bochum for Child and Adolescent Psychiatry, Hamm, Germany
| | - Jens Blechert
- Centre of Cognitive Neuroscience and Department of Psychology, University of Salzburg, Austria
| | - Katja Schnicker
- Johannes Gutenberg-University Mainz, Department of Clinical Psychology and Psychotherapy, Eating Disorder Outpatient Unit, Mainz, Germany
| |
Collapse
|
11
|
Rodríguez-Arauz G, Ramírez-Esparza N, Smith-Castro V. Food attitudes and well-being: The role of culture. Appetite 2016; 105:180-8. [DOI: 10.1016/j.appet.2016.05.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 04/07/2016] [Accepted: 05/18/2016] [Indexed: 10/21/2022]
|
12
|
Martín J, Padierna A, Unzurrunzaga A, González N, Berjano B, Quintana JM. Predictors of change in psychosocial impairment secondary to an eating disorder. Psychiatry Res 2016; 243:161-7. [PMID: 27400219 DOI: 10.1016/j.psychres.2016.04.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 01/12/2016] [Accepted: 04/15/2016] [Indexed: 10/21/2022]
Abstract
Eating disorders (ED) can significantly impair psychosocial health in patients. However, no published studies have so far used a standardized and specific instrument to evaluate predictive factors in ED-related psychosocial impairment. This prospective cohort study involved 177 patients receiving outpatient treatment for an ED at baseline and 115 patients at the 1-year follow-up. Patients completed three self-administered questionnaires: the Clinical Impairment Assessment (CIA), the Eating Attitudes Test-12 (EAT-12), and the Health-Related Quality of Life in ED-short form (HeRQoLED-s). Descriptive statistics, ANOVA, chi-square, and Fisher's exact test were applied to examine intervariable relationships. Multivariate linear regression was used to determine predictors of change in CIA scores. An improvement was reported by patients with restrictive anorexia nervosa (AN) compared to those with purgative AN. In the multivariate analysis, employment status, subtype of ED, and the bulimia and food preoccupation factor of the EAT-12 were significant predictors of change in the CIA scores.
Collapse
Affiliation(s)
- Josune Martín
- Research Unit, Galdakao-Usansolo Hospital, Barrio Labeaga s/n, Galdakao 48960, Bizkaia, Spain; Health Services Research on Chronic Diseases Network - REDISSEC, Galdakao, Spain.
| | - Angel Padierna
- Department of Psychiatry, Galdakao-Usansolo Hospital, Barrio Labeaga s/n, Galdakao 48960, Bizkaia, Spain; Health Services Research on Chronic Diseases Network - REDISSEC, Galdakao, Spain
| | - Anette Unzurrunzaga
- Research Unit, Galdakao-Usansolo Hospital, Barrio Labeaga s/n, Galdakao 48960, Bizkaia, Spain; Health Services Research on Chronic Diseases Network - REDISSEC, Galdakao, Spain
| | - Nerea González
- Research Unit, Galdakao-Usansolo Hospital, Barrio Labeaga s/n, Galdakao 48960, Bizkaia, Spain; Health Services Research on Chronic Diseases Network - REDISSEC, Galdakao, Spain
| | - Belén Berjano
- Department of Psychiatry, Galdakao-Usansolo Hospital, Barrio Labeaga s/n, Galdakao 48960, Bizkaia, Spain
| | - José M Quintana
- Research Unit, Galdakao-Usansolo Hospital, Barrio Labeaga s/n, Galdakao 48960, Bizkaia, Spain; Health Services Research on Chronic Diseases Network - REDISSEC, Galdakao, Spain
| |
Collapse
|
13
|
Claudat K, White EK, Warren CS. Acculturative Stress, Self-Esteem, and Eating Pathology in Latina and Asian American Female College Students. J Clin Psychol 2015; 72:88-100. [DOI: 10.1002/jclp.22234] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
14
|
Schaefer LM, Thibodaux LK, Krenik D, Arnold E, Thompson JK. Physical appearance comparisons in ethnically diverse college women. Body Image 2015; 15:153-7. [PMID: 26453998 DOI: 10.1016/j.bodyim.2015.09.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 08/17/2015] [Accepted: 09/08/2015] [Indexed: 01/01/2023]
Abstract
Research demonstrates ethnic differences in rates of body dissatisfaction and disordered eating. Appearance comparison frequency is related to these outcomes, however, research has not examined possible ethnic differences in levels of appearance comparisons nor their relation to body dissatisfaction and disordered eating. The current study examined the frequency of appearance comparisons and the strength of the relationships between appearance comparisons, appearance evaluation, and disordered eating among White, Black, and Hispanic women. Measures of appearance comparison, appearance evaluation, and disordered eating were administered to 895 college women. Compared with White and Hispanic women, Black women reported fewer appearance comparisons, more positive appearance evaluation, and lower levels of disordered eating. Associations between examined variables were generally weaker among Black women. Results suggest that the reduced frequency and impact of appearance comparisons may contribute to more positive appearance evaluation and reduced levels of disordered eating among Black women.
Collapse
Affiliation(s)
- Lauren M Schaefer
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Lia K Thibodaux
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Daniel Krenik
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Elysse Arnold
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | - J Kevin Thompson
- Department of Psychology, University of South Florida, Tampa, FL, USA.
| |
Collapse
|
15
|
White EK, Claudat K, Jones SC, Barchard KA, Warren CS. Psychometric properties of the Body Checking Questionnaire in college women. Body Image 2015; 13:46-52. [PMID: 25621731 DOI: 10.1016/j.bodyim.2014.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 12/18/2014] [Accepted: 12/25/2014] [Indexed: 10/24/2022]
Abstract
While the Body Checking Questionnaire (BCQ; Reas et al., 2002) is the most commonly-used measure of body checking behaviors, findings on the factor structure in nonclinical samples are mixed. This study investigated the factor structure and psychometric properties of the BCQ among nonclinical college women. In Study 1 (n=326), an exploratory factor analysis indicated factors corresponding to (a) behavioral and (b) visual checking. In Study 2 (n=1013), a confirmatory factor analysis revealed adequate fit for these factors, better than the original or total score solutions. Scales based upon the two factors demonstrated good internal consistency, convergent validity with measures of eating pathology, and sensitivity for detecting at-risk eating pathology. Results suggest an alternate two-factor solution that differs from the original three-factor solution.
Collapse
Affiliation(s)
- Emily K White
- Department of Psychology, University of Nevada, Las Vegas, 4505 Maryland Parkway, MS5030, Las Vegas, NV 89154, USA.
| | - Kim Claudat
- Department of Psychology, University of Nevada, Las Vegas, 4505 Maryland Parkway, MS5030, Las Vegas, NV 89154, USA
| | - Sarah C Jones
- Department of Psychology, University of Nevada, Las Vegas, 4505 Maryland Parkway, MS5030, Las Vegas, NV 89154, USA
| | - Kimberly A Barchard
- Department of Psychology, University of Nevada, Las Vegas, 4505 Maryland Parkway, MS5030, Las Vegas, NV 89154, USA
| | - Cortney S Warren
- Department of Psychology, University of Nevada, Las Vegas, 4505 Maryland Parkway, MS5030, Las Vegas, NV 89154, USA
| |
Collapse
|
16
|
El Ansari W, Dibba E, Stock C. Body image concerns: levels, correlates and gender differences among students in the United Kingdom. Cent Eur J Public Health 2014; 22:106-17. [PMID: 25230539 DOI: 10.21101/cejph.a3944] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS This cross-sectional study aimed to determine the socio-demographic, lifestyle and well-being variables that are associated with body image concerns (BIC) and whether these associations differed between female and male students. METHODS A cross-sectional survey; 3,706 undergraduate students (2,699 females, 765 males) from seven universities in the UK completed a self-administered questionnaire that assessed socio-demographic, lifestyle, well-being and BIC based on the Body Shape Questionnaire developed by Cooper et al. Multifactorial logistic regression analysis examined the odds ratios for the association between four increasing levels of BIC as the dependent variables (no BIC, mild BIC, moderate BIC and marked BIC) on the one hand, and the socio-demographic (gender, age, year at university), lifestyle (physical activity, nutrition) and mental well-being variables (quality of life, perceived stress, perceived health, depressive symptoms) on the other. RESULTS More females (35%) than males (8%) reported being moderately or markedly concerned with their body image. For both genders, BIC was associated with a higher level of depressive symptoms and to variable extents, with nutrition and year at university. Females' BICs were exclusively associated with low perceived health, higher perceived stress, studies in general as a stressor, and low physical activity. In contrast, males' BIC were found to be exclusively associated with low quality of life and with older age. CONCLUSIONS Health promoting strategies and activities should address the co-occurrence of depressive symptoms and BIC and should moreover pay attention to the gender-specific correlates of BIC for tailoring evidence based interventions for females and for males.
Collapse
|
17
|
Rakhkovskaya LM, Warren CS. Ethnic identity, thin-ideal internalization, and eating pathology in ethnically diverse college women. Body Image 2014; 11:438-45. [PMID: 25079012 DOI: 10.1016/j.bodyim.2014.07.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 07/05/2014] [Accepted: 07/06/2014] [Indexed: 10/25/2022]
Abstract
Although much research suggests that ethnic identity is positively correlated with psychological health for ethnic minority women, research examining ethnic identity's relationships to thin-ideal internalization, weight concerns, and eating concerns is sparse. Consequently, this study examined these relationships in European American, African American, Latina, and Asian American college women (N=816). As expected, univariate analyses of variance indicated that European American women scored lowest on ethnic identity and highest on eating and weight concerns, whereas African American women scored lowest on thin-ideal internalization. Hierarchical regression analyses indicated that ethnic identity was negatively associated with eating and weight concerns, while body mass index and thin-ideal internalization were positively associated. Ethnic identity moderated the relationship between thin-ideal internalization and eating concerns such that the relationship was stronger for participants with lower ethnic identity. These results suggest ethnic identity may be a direct or interactive protective factor against eating concerns in ethnically diverse college women.
Collapse
Affiliation(s)
- Liya M Rakhkovskaya
- Department of Psychology, University of Nevada, Las Vegas, NV, United States
| | - Cortney S Warren
- Department of Psychology, University of Nevada, Las Vegas, NV, United States.
| |
Collapse
|
18
|
The influence of social anxiety on the body checking behaviors of female college students. Body Image 2014; 11:458-63. [PMID: 25123084 DOI: 10.1016/j.bodyim.2014.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 05/31/2014] [Accepted: 07/19/2014] [Indexed: 11/22/2022]
Abstract
Social anxiety and eating pathology frequently co-occur. However, there is limited research examining the relationship between anxiety and body checking, aside from one study in which social physique anxiety partially mediated the relationship between body checking cognitions and body checking behavior (Haase, Mountford, & Waller, 2007). In an independent sample of 567 college women, we tested the fit of Haase and colleagues' foundational model but did not find evidence of mediation. Thus we tested the fit of an expanded path model that included eating pathology and clinical impairment. In the best-fitting path model (CFI=.991; RMSEA=.083) eating pathology and social physique anxiety positively predicted body checking, and body checking positively predicted clinical impairment. Therefore, women who endorse social physique anxiety may be more likely to engage in body checking behaviors and experience impaired psychosocial functioning.
Collapse
|