Examining a psychosocial interactive model of binge eating and vomiting in women with bulimia nervosa and subthreshold bulimia nervosa

Comparisons between atypical anorexia nervosa and anorexia nervosa: Psychological and comorbidity patterns

OBJECTIVE

Literature comparing "atypical" anorexia nervosa (atypical AN) and anorexia nervosa (AN) suggests these diagnoses share significant similarities in eating disorder (ED) pathology and psychiatric comorbidities. This study evaluated potential differences in ED pathology, psychiatric comorbidity, associated mechanisms (i.e., ED fears and perfectionism), and demographic factors (i.e., ethnicity and age) between individuals with atypical AN and AN.

METHOD

Data from seven protocols were combined for a total 464 individuals diagnosed with atypical AN (n = 215) or AN (n = 249). Between-group differences in ED severity and behaviors, psychiatric comorbidities, ED fears, perfectionism, and demographic factors were assessed using t-tests, Wilcoxon rank-sum tests, and Fisher's exact test.

RESULTS

Participants with atypical AN reported higher levels of overvaluation of weight and shape than those with AN. Participants with AN scored higher on food-related fears (anxiety about eating, food avoidance behaviors, and feared concerns) and fears of social eating, as well as obsessive-compulsive symptoms. Participants with AN were more likely to identify as Asian or Pacific Islander. No other statistically significant differences were found between groups for overall ED severity, ED behaviors, psychiatric comorbidities, general ED fears, perfectionism, or demographic factors.

DISCUSSION

Overall, results support previous literature indicating limited differences between individuals with atypical AN and AN, though individuals with atypical AN reported more overvaluation of weight and shape and those with AN reported higher food and social eating fears and obsessive-compulsive symptoms. Relatively few overall differences between atypical AN and AN highlight the importance of exploring dimensional conceptualizations of AN as an alternative to the current categorical conceptualization.

PUBLIC SIGNIFICANCE

This study assessed differences among individuals with atypical anorexia nervosa and anorexia nervosa in eating disorder severity and behaviors, comorbid psychiatric diagnoses, associated mechanisms, and demographic factors. Few differences emerged, though participants with atypical anorexia nervosa reported more overvaluation of weight and shape, while those with anorexia nervosa reported more food and social eating fears and higher obsessive-compulsive symptoms. Results support exploration of these diagnoses as a spectrum disorder.

The association between eating disorders and perfectionism in adults: A systematic review and meta-analysis

OBJECTIVE

Dimensions of perfectionism are associated with the onset and maintenance of eating disorder pathology in both clinical and non-clinical samples. The aim of this study was to conduct a systematic review and meta-analysis of the association between perfectionism and eating disorders in adults.

METHOD

A literature search was conducted using the PsycINFO, Medline, Scopus, Embase, Web of Science and ProQuest databases. Ninety-five studies met the inclusion criteria and included a total sample of 32,840 participants (clinical eating disorder diagnosis N = 2414, non-clinical N = 30,428). Correlation coefficients (r) for the association between eating disorders and perfectionism were pooled. A meta-analysis to determine the association between two dimensions of perfectionism and eating disorder symptoms was conducted. Subgroup analyses were conducted with studies using clinical samples, and studies using the Eating Disorder Examination Questionnaire.

RESULTS

The pooled effect size for the association between perfectionistic concerns and eating disorder symptoms was r = 0.33 [0.30, 0.37]; and r = 0.20 [0.14, 0.25] for the association between perfectionistic strivings and eating disorder symptoms. In the clinical subgroup analyses the effect sizes were r = 0.40 [0.22, 0.58]; and r = 0.35 [0.26, 0.44] respectively. Medium to high heterogeneity was identified across all subgroup analyses and a significant level of publication bias was also identified.

DISCUSSION

The findings indicate both perfectionistic strivings and perfectionistic concerns have significant associations with eating disorders, and further support the argument that both dimensions of perfectionism are important factors in the prevention and treatment of eating disorders.

Perfectionism and binge eating association: a systematic review and meta-analysis

BACKGROUND

Perfectionism is considered a vulnerability factor for eating disorders. However, the role of perfectionism in binge eating needs clarification due to notably inconsistencies between studies. The purpose to this study was to conduct a systematic review and meta-analysis to estimate the perfectionism-binge eating association.

METHOD

Systematic review was performed according to the PRISMA 2020 statement. Four databases (Web of Science, Scopus, PsycINFO and Psicodoc) were searched to identify studies published until September 2022. The literature search yielded 30 published articles (N = 9392) that provided 33 independent estimations of the correlation between the two variables.

RESULTS

Random-effects meta-analysis revealed a small-to-moderate positive average effect size between general perfectionism and binge eating (r₊ = .17) with a large heterogeneity. Perfectionistic Concerns showed a significant small-to-moderate relationship with binge eating (r₊ = .27), whereas Perfectionistic Strivings presented a negligible relationship with binge eating (r₊ = .07). Moderator analyses showed that the age, the type of the sample, the study design, and the tools for assessing both variables were statistically associated with the perfectionism-binge eating effect sizes.

CONCLUSIONS

Our findings suggest that Perfectionism Concerns are closely associated with binge eating symptomatology. This relationship might be moderated by certain variables, especially by the clinical or non-clinical nature of the sample and the instrument employed to assess binge eating.

Quality of Life in Female Users of Antiaging Cosmetic Products / Aesthetic Treatments

Aging is accompanied by physical changes, both at the physiological and appearance levels. The way people perceive these changes has important consequences in general health and quality of life (QoL). This study analyzed the relationship between sociodemographic variables, psychological variables, use of antiaging cosmetic products/ aesthetic treatments, and QoL. This cross-sectional study included a sample of 271 women, aged between 25 and 70 years old, users of antiaging cosmetic products and/or aesthetic services. Participants were assessed on psychological morbidity (Hospital Anxiety and Depression Scale), appearance schemes (Appearance Schemas Inventory - Revised), self-esteem (Rosenberg Self-Esteem Scale), perfectionism (Frost Multidimensional Perfectionism Scale), self-perceptions of aging (Brief Aging Perceptions Questionnaire), and QoL (SF-12v2). Results revealed that being older and having a higher household income was associated with better QoL. The use of facial firming products, hair coloring products, and sunscreen was also associated with better QoL. Psychological morbidity and perfectionism contributed negatively to QoL, while household income contributed positively. Aging perceptions moderated the relationship between self-esteem and QoL. According to findings, intervention programs to reduce psychological morbidity, increase self-esteem, promote more adaptive patterns of perfectionism, and recognize the role of age perception are needed in order to improve women's QoL. The perceived influence of the usage of cosmetic products to prevent/minimize aging signs should be further explored.

Eating Disorders and Sexual Satisfaction: The Mediating Role of Body Image Self-consciousness during Physical Intimacy and Dissociation

Women with eating disorders experience difficulties related to sexual activity, yet little is known about the indirect association between eating disorders and sexual satisfaction. This study examined the indirect association between eating disorders and sexual satisfaction using body image self-consciousness during physical intimacy and dissociation as mediators. Online questionnaires were answered by 985 Israeli women. Of them, 98 were identified as likely to have eating disorders (study group). A matching control group (n = 98) was selected from the remaining respondents. Participants in the study group had significantly higher body image self-consciousness and dissociation than the matched controls, as well as significantly lower sexual satisfaction. The research model revealed that body image self-consciousness during physical intimacy mediates the link between eating disorders and sexual satisfaction, while dissociation does not. Women with eating disorders have higher levels of self-consciousness about their body during sexual activity, which may distract them from their own sexual needs and desires and those of their partners, and this, in turn, is associated with sexual dissatisfaction. Findings highlight the need for improved evidenced-based assessment and management of the sexual satisfaction of women with eating disorders.Abbreviations: ED: eating disorders; AN: anorexia nervosa; BN: bulimia nervosa; BED: binge eating disorder.

Profiles of Sexual Disorders and Eating Disorder Symptoms: Associations With Body Image

BACKGROUND

Although the empirical evidence supporting the co-occurrence of sexual disorders and eating disorders is growing, it is not yet known how often these 2 conditions co-occur, and whether the comorbidities of sexual disorders and eating disorders differ in any specific ways.

AIM

To examine the co-occurrence of sexual disorders and eating disorders.

METHODS

In the current study, we used latent profile analysis to identify distinct profiles of sexual disorders and eating disorder symptoms among a large non-clinical sample of women (n = 985). We also examined how these profiles differed in terms of body image self-consciousness. The study was conducted as an online survey among a convenience sample of Israeli women.

MAIN OUTCOME MEASURES

For sexual disorders we used the Arizona Sexual Experience Scale, and for eating disorders we used the Eating Disorders Inventory 2.

RESULTS

Latent profile analysis revealed 4 profiles: no disorder (low levels of sexual disorders and eating disorder symptoms), eating disorder symptoms (low levels of sexual disorders and high levels of eating disorder symptoms), sexual disorders (high levels of sexual disorders and low levels of eating disorder symptoms), and comorbidity (high levels of both sexual disorders and eating disorder symptoms). Women in the comorbidity group had significantly more body image self-consciousness during sexual activity than did women in the other groups.

CONCLUSION

The 4 profiles identified in the study support the co-occurrence of sexual disorders and eating disorder symptoms, yet also raise many clinical considerations. Limitations of the study, directions for future research, and clinical implications are discussed. Gewirtz-Meydan A, Spivak-Lavi Z. Profiles of Sexual Disorders and Eating Disorder Symptoms: Associations With Body Image. J Sex Med 2021;18:1364-1373.

What are people's experiences of orthorexia nervosa? A qualitative study of online blogs

PURPOSE

Orthorexia nervosa (ON) is a proposed new eating disorder, used to describe a pathological obsession with healthy or 'clean' eating. Although some quantitative research has been carried out in ON, very little qualitative work has been published to date to explore individual experiences of ON. Thus, this study aimed to explore individuals' personal experiences of ON, as described in online blogs.

METHODS

Fifteen women bloggers, who self-identified as having ON, consented for their blog entries to be analysed in this study. Forty pre-existing blog entries describing the first-person experiences of ON were analysed using thematic analysis.

RESULTS

Three key themes were discussed: (1) initial motivations for a healthier lifestyle, (2) fuelling the problem-social influences, and: (3) when healthy becomes unhealthy. Bloggers described the role of social messages, comparison with others around ideas of 'healthiness', as well as confusion around diagnosis as factors influencing their disordered eating. They also described the exacerbating impact of perfectionism and perceived control, as well as a confirmatory cycle of fear and avoidance. For some bloggers, increased physical symptoms in response to feared foods provided confirmation for these fears, further exacerbating food avoidance.

CONCLUSION

Whilst the debate around the diagnosis of ON continues, these bloggers' accounts suggest that ON is experienced as a legitimate, debilitating disorder, worthy of clinical and research investigation. This study provides evidence of some of the potential triggers and maintaining factors for this disordered eating style.

LEVEL OF EVIDENCE

Level V, qualitative descriptive study.

Body Esteem as a Common Factor of a Tendency Toward Binge Eating and Sexual Dissatisfaction Among Women: The Role of Dissociation and Stress Response During Sex

BACKGROUND

Several studies have suggested a relevant overlap between eating disorders and sexual dysfunction involving the emotional component of body image esteem and dissociative experiences.

AIM

To evaluate the common maintaining factors of sexual dysfunction and vulnerability to pathologic eating behaviors and their relation to a physiologic stress response.

METHODS

In the present cross-sectional study, we evaluated a non-clinical sample of 60 heterosexual women (25-35 years old) for dissociation during sex with a partner, body image disturbance, and tendency toward pathologic eating behaviors. We also evaluated the stress-induced hypothalamic-pituitary-adrenal axis activation in response to a sexual stimulus and its association with binge eating and dissociation.

OUTCOMES

Participants completed the Clinician-Administered Dissociative States Scale, the Sexual Satisfaction Scale-Women, the Body Esteem Scale for Adolescents and Adults, and the Eating Attitudes Test Short Version. Furthermore, we assessed cortisol levels before, during, and after exposure to explicit sexual stimuli shown within a laboratory setting.

RESULTS

Dysfunctional body image esteem and a tendency toward binge-eating behaviors were associated with greater sexual distress in women. In particular, body esteem was significantly associated with greater dissociation during sex with a partner. Moreover, women who reported greater dissociation during sex with a partner and a tendency toward binge-eating behaviors showed higher levels of cortisol in response to sexual stimuli.

CLINICAL IMPLICATIONS

These results support further research based on trans-diagnostic treatments targeted to dissociation and body image esteem, which could lessen sexual dysfunction and vulnerability to pathologic eating behaviors.

STRENGTHS AND LIMITATIONS

Despite the small sample and self-reported questionnaires, this is the first study to consider the association of the stress response during sexual stimuli with sexual distress and with pathologic eating behaviors adopting a dimensional approach.

CONCLUSION

Body uneasiness and dissociation represented factors underlying pathologic eating behaviors and sexual dysfunction. Women reporting a tendency toward binge-eating episodes and dissociation during sexual experiences represented a subpopulation with a higher stress response during sexual stimuli. Castellini G, Lo Sauro C, Ricca V, Rellini AH. Body Esteem as a Common Factor of a Tendency Toward Binge Eating and Sexual Dissatisfaction Among Women: The Role of Dissociation and Stress Response During Sex. J Sex Med 2017;14:1036-1045.

Perfectionism and Contingent Self-Worth in Relation to Disordered Eating and Anxiety

Perfectionism has been proposed as a transdiagnostic risk factor linked to eating disorders and anxiety. In the current study, we examine domains of contingent self-worth as potential moderators of the relationships between maladaptive perfectionism and disordered eating and anxiety using two waves of data collection. Undergraduate females (N = 237) completed online surveys of the study's core constructs at two points separated by about 14 months. At a bivariate level, maladaptive perfectionism was positively associated with disordered eating and anxiety. Maladaptive perfectionism and both appearance and relationship contingent self-worth interacted to predict increases in disordered eating. Neither of the interactive models predicted change in anxiety. Findings highlight maladaptive perfectionism as a transdiagnostic construct related to both disordered eating and anxiety. Interactive findings suggest that targeting maladaptive perfectionism and contingent self-worth (appearance, relationship) in prevention and treatment efforts could mitigate risk for the development or increase of disordered eating.

A Sisyphean task: experiences of perfectionism in patients with eating disorders

BACKGROUND

Despite the theoretical links between eating disorders and perfectionism, the definition of perfectionism in practice is complicated. The present study explored descriptions and experiences of perfectionism described by a transdiagnostic sample of patients.

METHODS

In-depth, semi-structured interviews were carried out with 15 patients. The interviews were analyzed by Thematic Analysis. A comparison between the patients' scorings on the Eating Disorder Inventory-Perfectionism scale was also performed.

RESULTS

Seven themes were found: The origins of perfectionism, Top performance, Order and self-control, A perfect body, Looking good in the eyes of others, A double-edged coping strategy, and A Sisyphean task. The women in this study did not emphasize weight and body as the main perfectionistic strivings. Core descriptions were instead order, self-control and top performances. All of the participants described the awareness of reaching perfectionism as impossible. Scorings of self-oriented perfectionism was significantly higher compared to socially prescribed perfectionism. No differences in the narratives related to perfectionism scores or eating disorder diagnoses were found.

CONCLUSIONS

The results showed that psychometric measures do not always capture the patients' definitions of perfectionism, but regarding that perfectionism serves as a means to regulate affects and may lead into an exacerbation of the eating disorder, and the development of obsessive-compulsive symptoms, it is important to investigate the personal definitions of perfectionism.

Social appearance anxiety and dietary restraint as mediators between perfectionism and binge eating: A six month three wave longitudinal study

Binge eating is related to perfectionism and restrained eating. However, the mechanisms underlying these relationships are not well understood. It is possible that social anxiety, specifically social appearance anxiety (i.e., the fear of overall appearance evaluation), influences the relationship between binge eating, perfectionism, and dietary restraint. In the current study (N = 300 women), we tested the relationship between dietary restraint, social appearance anxiety, concern over mistakes (a component of perfectionism), and binge eating in prospective data (three time points: at baseline, at two month, and at six month follow up). We found that social appearance anxiety, dietary restraint, and concern over mistakes each predicted binge eating at baseline. Only social appearance anxiety prospectively predicted binge eating when accounting for all variables. Further, in the tested model, social appearance anxiety mediated the relationship between concern over mistakes and binge eating across six months. On the contrary, dietary restraint did not mediate the relationship between concern over mistakes and binge eating in the tested model. The finding that social appearance anxiety served as a mediator between concern over mistakes and binge eating, but that dietary restraint did not, implies that social appearance anxiety may be a more salient prospective predictor of binge eating than dietary restraint. Intervening on social appearance anxiety may be important in the treatment and prevention of binge eating.

A systematic review of the existing models of disordered eating: Do they inform the development of effective interventions?

Despite significant advances in the development of prevention and treatment interventions for eating disorders and disordered eating over the last decade, there still remains a pressing need to develop more effective interventions. In line with the 2008 Medical Research Council (MRC) evaluation framework from the United Kingdom for the development and evaluation of complex interventions to improve health, the development of sound theory is a necessary precursor to the development of effective interventions. The aim of the current review was to identify the existing models for disordered eating and to identify those models which have helped inform the development of interventions for disordered eating. In addition, we examine the variables that most commonly appear across these models, in terms of future implications for the development of interventions for disordered eating. While an extensive range of theoretical models for the development of disordered eating were identified (N=54), only ten (18.5%) had progressed beyond mere description and to the development of interventions that have been evaluated. It is recommended that future work examines whether interventions in eating disorders increase in efficacy when developed in line with theoretical considerations, that initiation of new models gives way to further development of existing models, and that there be greater utilisation of intervention studies to inform the development of theory.

Perfectionism, weight and shape concerns, and low self-esteem: Testing a model to predict bulimic symptoms

Previous studies have tested multivariate models of bulimia pathology development, documenting that a confluence of perfectionism, body dissatisfaction, and low self-esteem is predictive of disordered eating. However, attempts to replicate these results have yielded controversial findings. The objective of the present study was to test an interactive model of perfectionism, weight and shape concerns, and self-esteem in a sample of patients affected by Eating Disorder (ED). One-hundred-sixty-seven ED patients received the Structured Clinical Interview for DSM-IV Axis I (SCID-I), and they completed the Eating Disorder Examination Questionnaire (EDE-Q), the Rosenberg Self-Esteem Scale (RSES), and the Multidimensional Perfectionism Scale (MPS-F). Several mediation analysis models were fit to test whether causal effects of concern over weight and shape on the frequency of bulimic episodes were mediated by perfectionism and moderated by low levels of self-esteem. Contrary to our hypotheses, we found no evidence that the causal relationship investigated was mediated by any of the dimensions of perfectionism. As a secondary finding, the dimensions of perfectionism, perceived criticism and parental expectations, were significantly correlated with the presence of bulimic symptoms. The validity of the interactive model remains controversial, and may be limited by an inadequate conceptualization of the perfectionism construct.

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

How perfectionism and ineffectiveness influence growth of eating disorder risk in young adolescent girls

While perfectionism is widely considered to influence risk for eating disorders, results of longitudinal studies are mixed. The goal of the current study was to investigate a more complex model of how baseline perfectionism (both high personal standards and self-critical evaluative concerns) might influence change in risk status for eating disorders in young adolescent girls, through its influence on ineffectiveness. The study was conducted with 926 girls (mean age of 13 years), and involved three waves of data (baseline, 6- and 12-month follow-up). Latent growth curve modelling, incorporating the average rate at which risk changed over time, the intercept (initial status) of ineffectiveness, and baseline perfectionism, was used to explore longitudinal mediation. Personal standards was not supported as contributing to risk but results indicated that the higher mean scores on ineffectiveness over the three waves mediated the relationship between higher baseline self-critical evaluative concerns and both measures of eating disorder risk. The relationship between concern over mistakes and change in risk was small and negative. These results suggest the usefulness of interventions related to self-criticism and ineffectiveness for decreasing risk for developing an eating disorder in young adolescent girls.

Perseveration moderates the relationship between perfectionism and binge eating: a multi-method daily diary study

Theory and evidence suggest perfectionism is associated with binge eating. Few studies test conditions under which this association is particularly strong. To better understand the perfectionism-binge eating connection, the present study introduced perseveration as a moderator. A sample of 317 undergraduates completed a computerized Stroop task, baseline self-report measures of perfectionism (i.e., doubts about actions) and binge eating, and self-report daily diary measures of binge eating. Perseveration was defined in terms of reaction time difficulties when consecutive trials required a change of response relative to consecutive trials not requiring a change. Results indicated high levels of doubts about actions were especially related to high levels of binge eating for participants high (versus low) in perseveration. Findings suggest perfectionistic, nagging self-doubts, combined with a tendency to get stuck on thoughts or behaviors, may contribute to increased binge eating-a habitual behavior linked with difficulties in self-regulation.

Latent profile and latent transition analyses of eating disorder phenotypes in a clinical sample: a 6-year follow-up study

The DSM-IV classification of Eating Disorders (EDs) identifies clinical entities showing considerable overlap and diagnostic instability across time. Latent profile analysis (LPA) allows the identification of underlying groups of individuals according to their patterned responses across a set of features. LPA was applied to data regarding EDs symptoms of a clinical sample of 716 EDs patients, with a current DSM-IV diagnosis of threshold and subthreshold EDs. Latent transition analysis (LTA) was used to examine the longitudinal stability of the obtained profiles. The latent profiles were compared for psychopathological variables and long-term outcomes (recovery, relapse), based on a 6-year follow-up after a cognitive behavioural treatment. Five different phenotypes were identified: "severe binging", "moderate binging", "restricted eating", "binge and moderate purging", and "binge and severe purging". The relevance of this characterization was confirmed by the differences in terms of psychopathological features and outcomes. Over the long term, a three-profile solution was adopted, clustering the subjects into "binge eating", "binge eating and purging", and "restricted eating". Latent profiles showed a moderate stability over the 6-year period, with probability estimates of stability within status over time of 0.57 for "binge eating", 0.40 for "binge eating and purging", and 0.41 for "restricted eating". The implications for DSM 5 were discussed, and the relative high rate of transition within phenotypes confirmed the significant instability of EDs phenomenology.

The role of perfectionism in body dissatisfaction

BACKGROUND

Body dissatisfaction is a robust risk factor for disordered eating and is thought to be especially problematic in the presence of high levels of perfectionism. The aim of the current study was to investigate what types of perfectionism were associated with body dissatisfaction. Participants were 1083 women aged 28 to 40 years, with a mean age of 35 years (SD=2.11). Self-reports on perfectionism (using the Frost Multidimensional Perfectionism Scale), weight, height, desired weight, and current and ideal figural stimuli were analysed for the current study. Two measures of body dissatisfaction were utilised: discrepancy between the current and desired weight, and discrepancy between the current and ideal figural stimuli.

RESULTS

Linear regressions controlling for current body mass index (BMI)/current silhouette examined the relationship between desired BMI/silhouette and simultaneous entry of the 6 subscales of the perfectionism measure. A lower desired BMI was associated with higher levels of Concern over Mistakes and Organisation, and a smaller ideal silhouette was associated with higher levels of Concern over Mistakes and Doubt about Actions and Organisation.

CONCLUSIONS

These findings confirm the pertinence of different dimensions of perfectionism to body dissatisfaction, and suggest avenues to explore in terms of universal prevention work.

Body size over-estimation in women with anorexia nervosa is not qualitatively different from female controls

Over-estimation of body size is a cardinal feature of anorexia nervosa (AN), usually revealed by comparing individuals who have AN with non-AN individuals, the inference being that over-estimation is pathological. We show that the same result can be reproduced by sampling selectively from a single distribution of performance in body size judgement by comparing low BMI individuals with normal BMI individuals. Over-estimation of body size in AN is not necessarily pathological and can be predicted by normal psychophysical biases in magnitude estimation. We confirm this prediction in a dataset from a morphing study in which 30 women with AN and 137 control women altered a photograph of themselves to estimate their actual body size. We further investigated the relative contributions of sensory and attitudinal factors to body-size overestimation in a sample of 166 women. Our results suggest that both factors play a role, but their relative importance is task dependent.

Different moderators of cognitive-behavioral therapy on subjective and objective binge eating in bulimia nervosa and binge eating disorder: a three-year follow-up study

BACKGROUND

Different studies considered the mechanisms involved in the maintenance of binge eating in bulimia nervosa (BN) and binge eating disorder (BED), suggesting different pathways. The present 3-year follow-up study evaluated the relationships between psychopathological variables, and objective and subjective binge eating episodes in the two syndromes.

METHODS

85 BN and 133 BED patients were studied. Objective and subjective binge eating, and psychopathological data were collected in a face-to-face interview, and by means of different self-reported questionnaires. The same assessment was repeated at baseline (T0), at the end of an individual cognitive-behavioral treatment (T1), and 3 years after the end of treatment (T2).

RESULTS

At baseline, BN and BED patients showed different emotions associated with binge eating: anger/frustration for BN and depression for BED patients. Objective binge eating frequency reduction across time was associated with lower impulsivity and shape concern in BN patients, and with lower emotional eating and depressive symptoms in BED patients. Lower subjective binge eating frequency at baseline predicted recovery, in both BN and BED patients. Recovery was associated with lower impulsivity and body shape concern at baseline for BN patients, and lower depression and emotional eating for BED patients.

CONCLUSIONS

Eating psychopathology, psychiatric comorbidity, impulsivity and emotional eating have a different pattern of association with objective and subjective binge eating in BN and BED patients, and they act as different moderators of treatment. A different target of intervention for these two syndromes might be taken into account, and subjective binge eating deserves an accurate assessment.

Emotional eating in anorexia nervosa and bulimia nervosa

OBJECTIVES

The relationship between emotional states and eating behaviors is complex, and emotional eating has been identified as a possible factor triggering binge eating in bulimia nervosa (BN) and binge eating disorder. Few studies considered emotional eating in patients with anorexia nervosa.

METHODS

The present study evaluated the clinical correlates of emotional eating in 251 eating-disordered (EDs) subjects (70 AN restricting type, 71 AN binge eating/purging type, 110 BN purging type) and in a group of 89 healthy control subjects. Subjects were assessed by means of a clinical interview (Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) and several self-reported questionnaires, including the Emotional Eating Scale (EES).

RESULTS

No significant differences were found between the 3 EDs groups in terms of EES total score, and all patients with ED showed higher EES scores compared with control subjects. Emotional eating was associated with subjective binge eating in AN binge eating/purging type and with objective binge eating in patients with BN. Among patients with AN restricting type, emotional eating was associated with restraint, but this association was lost when controlling for fear of loss of control over eating, which was the principal determinant of restraint.

CONCLUSION

Emotional eating and fear of loss of control over eating are significantly associated with specific eating attitudes and behaviors, according to the different diagnoses. Emotional eating is a relevant psychopathologic dimension that deserves a careful investigation in both anorectic and bulimic patients.

Identity and eating disorders (IDEA): a questionnaire evaluating identity and embodiment in eating disorder patients

BACKGROUND

In this paper we tested the hypothesis that persons with eating disorders (EDs) are affected by disturbances of the way they experience their own body (embodiment) and shape their personal identity, assuming that the various kinds of anomalies of eating behavior are consequences thereof.

SAMPLING AND METHODS

We developed and validated a new self-reported questionnaire named IDEA (IDentity and EAting disorders), which was administered to 147 ED patients and 187 healthy controls. Test-retest reliability, internal consistency, psychopathological correlates, and concurrent validity were evaluated. A factor analysis was performed to verify the distribution of items into subscales.

RESULTS

The questionnaire showed good test-retest reliability, and internal consistency. IDEA scores were specifically associated with ED psychopathology, and they did not show any correlation with sociodemographic and general clinical variables. Four factors were extracted, which were related to the following phenomena: 'feeling oneself only through the gaze of the other and defining oneself only through the evaluation of the other', 'feeling oneself only through objective measures', 'feeling extraneous from one's own body', and 'feeling oneself through starvation'.

CONCLUSIONS

IDEA represents a multidimensional, brief, versatile, easy-to-perform instrument for clinical evaluation, assessing abnormalities in lived corporeality, and of personal identity, which appeared to be specifically associated with the core features of ED psychopathology. The main limitations of the study are the cross-sectional design. Also, it is impossible to ascertain whether the domains we assessed are specific traits of patients with EDs, or state-related features. To answer this question, a longitudinal study is needed.

Perfectionism and its relation to overevaluation of weight and shape and depression in an eating disorder sample

OBJECTIVE

To examine the relative association between psychopathology (depression and overevaluation of weight and shape) and measures of perfectionism and self-criticism in an eating disorder sample.

METHOD

Participants (n = 39) completed measures of independent variables (perfectionism and self-criticism) and dependent variables (depression and overevaluation of weight and shape).

RESULTS

Simultaneous multiple regression analyses suggest that clinical perfectionism has a unique association with depression. Self-criticism and clinical perfectionism had a stronger association with overevaluation of weight and shape than other measures of perfectionism.

DISCUSSION

Clinical perfectionism and self-criticism may be of more relevance than existing measures of multidimensional perfectionism in terms of explaining maintenance of depression and overevaluation of weight and shape.

Diagnostic crossover and outcome predictors in eating disorders according to DSM-IV and DSM-V proposed criteria: a 6-year follow-up study

OBJECTIVE

To evaluate in a 6-year follow-up study the course of a large clinical sample of patients with eating disorders (EDs) who were treated with individual cognitive behavior therapy. The diagnostic crossover, recovery, and relapses were assessed, applying both Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and the DSM-V proposed criteria. Patients with EDs move in and out of illness states over time, display frequent relapses, show a relevant lifetime psychiatric comorbidity, and migrate between different diagnoses.

METHOD

A total of 793 patients (including anorexia nervosa, bulimia nervosa, binge eating disorder, and EDs not otherwise specified) were evaluated on the first day of admission, at the end of treatment, 3 years after the end of treatment, and 3 years after the first follow-up. Clinical data were collected through a face-to-face interview; diagnosis was performed by means of the Structured Clinical Interview for DSM-IV and the Eating Disorder Examination Questionnaire was applied.

RESULTS

A consistent rate of relapse and crossover between the different diagnoses over time was observed. Mood disorders comorbidity has been found to be an important determinant of diagnostic instability, whereas the severity of shape concern represented a relevant outcome modifier. Using the DSM-V proposed criteria, most patients of EDs not otherwise specified were reclassified, so that the large majority of ED patients seeking treatment would be included in full-blown diagnoses.

CONCLUSIONS

Among EDs, there are different subgroups of patients displaying various courses and outcomes. The diagnostic instability involves the large majority of patients. An integration of categorical and dimensional approaches could improve the psychopathological investigation and the treatment choices.

Use of Rasch methodology to develop a short version of the health related quality of life for eating disorders questionnaire: a prospective study

Background

To confirm the internal structure of the Health Related Quality of Life for Eating Disorders version 2 questionnaire (HeRQoLEDv2) and create and validate a shortened version (HeRQoLED-S).

Methods

324 patients with eating disorders were assessed at baseline and one year later (75.6% of whom responded). We performed a confirmatory factor analysis of the HeRQoLEDv2 using baseline data, and then a Rasch analysis to shorten the questionnaire. Data obtained at year one was used to confirm the structure of the HeRQoLED short form and evaluate its validity and reliability.

Results

Two latent second-order factors -- social maladjustment and mental health and functionality -- fit the data for the HeRQoLEDv2. Rasch analysis was computed separately for the two latent second-order factors and shortened the HeRQoLEDv2 to 20 items. Infit and outfit indices were acceptable, with the confirmatory factor analysis of the HeRQoLED short form giving a root mean square error of approximation of 0.07, a non-normed fit index and a comparative fit index exceeding 0.90. The validity was also supported by the correlation with the convergent measures: the social maladjustment factor correlated 0.82 with the dieting concern factor of the Eating Attitudes Test-26 and the mental health and functionality factor correlated -0.69 with the mental summary component of the Short Form-12. Cronbach alphas exceeded 0.89.

Conclusions

Two main factors, social maladjustment and mental health and functionality, explain the majority of HeRQoLEDv2 scores. The shortened version maintains good psychometric properties, though it must be validated in independent samples.

Perfectionism dimensions, appearance schemas, and body image disturbance in community members and university students

The present study examined the relationship between a self-presentational style involving an extreme need to conceal perceived imperfections from others and body image disturbance (BID). Findings from both a community and a university sample indicated that nondisplay of imperfection (i.e., concerns over behavioral displays of imperfections to others) predicted BID beyond self-imposed perfectionistic expectations and other contributors to BID. Mediational analyses suggested that dysfunctional appearance schemas represent one possible mechanism through which nondisplay of imperfection influences BID. In contrast to earlier work on perfectionism and BID, which emphasized the role of self-imposed perfectionistic expectations, the current study offers a novel view of the connection between perfectionism and BID. That is, rather than striving to achieve perfection, the present study suggests that individuals with BID are characterized by a strong need to avoid appearing imperfect to others.