Tests of an extension of the dual pathway model of bulimic symptoms to the state-based level

Daily instability in body dissatisfaction in individuals with and without eating disorders

Body dissatisfaction (BD) includes negative thoughts and feelings about one's body shape. Although typically assessed as a trait, BD has been found to fluctuate within a day. The present study examined whether daily instability in BD differs according to trait BD, eating disorder (ED) diagnosis, and engagement in maladaptive exercise. Participants with EDs (n = 166) and controls (n = 44) completed a self-report measure of trait BD and reported BD and engagement in maladaptive exercise five times daily for 14 days as part of an ecological momentary assessment protocol. BD instability was calculated as adjusted mean squared successive difference. On average across assessments, participants with EDs reported a 16% change in their BD ratings between consecutive assessments, which was significantly higher than the 12% change in controls. Trait BD was significantly inversely associated with BD instability in individuals with EDs, but not in controls. BD instability did not differ across ED diagnoses or between days with versus without maladaptive exercise. Findings suggest that BD is a dynamic state that varies within a day, especially in participants with EDs. Further research is needed to clarify whether this heightened instability in BD is a clinically relevant factor underlying ED symptoms.

Body dissatisfaction and disordered eating symptoms in children's daily life: Can parents protect against appearance comparison on social media?

Research suggests that body dissatisfaction is common among children. However, it remains largely unknown how body dissatisfaction occurs on a daily basis and which environmental factors are linked to this. The purpose of this study was to examine (1) state body dissatisfaction, dietary restraint, compensatory exercise and loss of control eating among children and its association with upward comparisons via social media and (2) whether trust in parents may attenuate this association. Children from 10 to 12 years old (N = 50) were assessed three times a day during a two-week period. Trust was examined via a baseline questionnaire. State body dissatisfaction, dietary restraint, compensatory exercise, loss of control eating and upward comparisons were examined via Ecological Momentary Assessment (EMA). Multilevel analyses indicated that an a higher level of upward comparison is associated with a higher level of state body dissatisfaction, compensatory exercise and loss of control eating. Trust in father significantly moderated the association between appearance comparison and body dissatisfaction. No evidence was found for the protective role of trust in mother. Future research is necessary to enhance our understanding of state body dissatisfaction among children and of environmental factors that may protect children from the adverse effects of social media.

Beyond Gender: Interoceptive Sensibility as a Key Predictor of Body Image Disturbances

Body image disturbance (BID) involves negative attitudes towards shape and weight and is associated with lower levels of interoceptive sensibility (IS) (the subjective perceptions of internal bodily states). This association is considered a risk factor for developing eating disorders (EDs) and is linked to altered sensorimotor representations of the body (i.e., body schema). BIDs manifest across genders and are currently understudied in men. This study investigated gender-related differences in BID and its relationship to the body schema and IS. Data were collected from 86 men and 86 women. BID was assessed using questionnaires measuring self-objectification, state, and trait body dissatisfaction. IS was measured via the MAIA-2. The body schema was indexed via an embodied mental rotation task. Results showed that women reported higher BID than men across all scales. Gender differences in sub-components of interoceptive sensibility were found. Overall, both gender and interoceptive sensibility predicted BID. However, interoceptive sensibility exhibited its own unique association with BID beyond the influence of gender. BID, IS and gender were not significant predictors of performance in the body schema task. Therefore, while gender predicts differences in BID and interoceptive sensibility, there was no evidence of gender-related differences in body schema.

The Use of Mobile-Based Ecological Momentary Assessment (mEMA) Methodology to Assess Dietary Intake, Food Consumption Behaviours and Context in Young People: A Systematic Review

Mobile-based ecological momentary assessment (mEMA) offers a novel method for dietary assessment and may reduce recall bias and participant burden. This review evaluated mEMA methodology and the feasibility, acceptability and validity as a dietary assessment method in young people. Five databases were searched from January 2008 to September 2021 for studies including healthy young people aged 16–30 years and used mEMA for obtaining dietary intake data, food consumption behaviours and/or contextual factors. Data on the method used to administer mEMA, compliance with recording and validation were extracted. A total of 46 articles from 39 independent studies were included, demonstrating a wide variation in mEMA methods. Signal-contingent prompting (timed notification to record throughout the day) was used in 26 studies, 9 used event-contingent (food consumption triggered recordings), while 4 used both. Monitoring periods varied and most studies reported a compliance rate of 80% or more. Two studies found mEMA to be burdensome and six reported mEMA as easy to use. Most studies (31/39) reported using previously validated questions. mEMA appears to be a feasible and acceptable methodology to assess dietary intake and food consumption in near real time.

Modified Dual Pathway Model for Binge Eating: The Role of Emotion Dysregulation

We tested a modification of the dual pathway model using two sequential mediators between body dissatisfaction and binge eating: restricted eating and difficulties in emotion regulation replacing negative affect. A total of 435 college students completed an online survey. Results from path analyses indicated that the relationship between body dissatisfaction and binge eating was not mediated by restricted eating for neither women nor men. However, this relationship was mediated first by restricted eating and then by difficulties in emotion regulation for women only. Moreover, this relationship was mediated by difficulties in emotion regulation for both women and men. A post hoc analysis indicated that the above mediation results were still significant after adding negative affect into the model. No mediations through negative affect were significant. Clinical implications include the conceptualization and intervention of eating concerns within an emotion dysregulation framework.

State versus trait weight, shape, and eating concerns: Disentangling influence on eating behaviors among sexual minority women

This study examined the relative influence of trait and state weight, shape, and eating concerns on dysregulated eating in the daily lives of sexual minority women with overweight and obesity. This study is a secondary analysis of data from an Ecological Momentary Assessment (EMA) study of 55 sexual minority women with overweight/obesity. Trait shape, weight, and eating concerns were assessed at baseline. For the following five days, participants used a smartphone to report state weight/shape concerns, overeating, and binge eating five times daily. Women who endorsed higher levels of trait weight, shape, and eating concerns at baseline reported more frequent state weight/shape concerns in daily life. Trait eating concerns were associated with higher odds of binge eating during EMA, but trait weight/shape concerns were unrelated to future dysregulated eating. In daily life, state weight/shape concerns was associated with greater risk for over/binge eating at the concurrent EMA prompt, the subsequent EMA prompt, and over the course of a full day, independent of trait concerns. State weight and shape concerns may play an important role in predicting dysregulated eating in daily life among sexual minority women of higher body weight.

State-Based Markers of Disordered Eating Symptom Severity

Recent work using naturalistic, repeated, ambulatory assessment approaches have uncovered a range of within-person mood- and body image-related dynamics (such as fluctuation of mood and body dissatisfaction) that can prospectively predict eating disorder behaviors (e.g., a binge episode following an increase in negative mood). The prognostic significance of these state-based dynamics for predicting trait-level eating disorder severity, however, remains largely unexplored. The present study uses within-person relationships among state levels of negative mood, body image, and dieting as predictors of baseline, trait-level eating pathology, captured prior to a period of state-based data capture. Two-hundred and sixty women from the general population completed baseline measures of trait eating pathology and demographics, followed by a 7 to 10-day ecological momentary assessment phase comprising items measuring state body dissatisfaction, negative mood, upward appearance comparisons, and dietary restraint administered 6 times daily. Regression-based analyses showed that, in combination, state-based dynamics accounted for 34-43% variance explained in trait eating pathology, contingent on eating disorder symptom severity. Present findings highlight the viability of within-person, state-based dynamics as predictors of baseline trait-level disordered eating severity. Longitudinal testing is needed to determine whether these dynamics account for changes in disordered eating over time.

Body image states in everyday life: Evidence from ecological momentary assessment methodology

This review highlights the contributions of Professor Thomas Cash to the scholarship of body image experiences in daily life, including his influence on subsequent research in this field. Cash's arguments for capturing a broad range of state-based body image experiences have been heeded, with recent studies exploring positive body image constructs as well as the more studied negative body image experiences. Appearance comparisons are the most commonly studied contextual influence on body image, and they seem to have a consistent effect. However, the experiences of body image in sexual contexts, and among adolescents, those who are pregnant, or have other physical characteristics that may increase the salience of appearance warrant further attention. Findings generally support Cash's contention that trait body image relates to likelihood and level of experience of body image in daily life, though the moderating effects of trait aspects on state-based relationships remains unclear. The discussion concludes with consideration of the impact of assessment schedules on obtained results. It is also discussed how accumulated knowledge regarding state-based body image experiences may be leveraged in treatment contexts, particularly in light of clear evidence that repeated assessment of body image in daily life increases self-awareness of one's body image characteristics.

Moving beyond self-report data collection in the natural environment: A review of the past and future directions for ambulatory assessment in eating disorders

OBJECTIVE

In recent years, ecological momentary assessment (EMA) has been used to repeatedly assess eating disorder (ED) symptoms in naturalistic settings, which has allowed for increased understanding of temporal processes that potentiate ED behaviors. However, there remain notable limitations of self-report EMA, and with the rapid proliferation of technology there are ever-increasing possibilities to improve ambulatory assessment methods to further the understanding and treatment of EDs. Therefore, the purpose of this review was to (a) systematically review the studies in EDs that have utilized ambulatory assessment methods other than self-report, and (b) provide directions for future research and clinical applications.

METHOD

A systematic literature search of electronic databases was conducted, and data regarding study characteristics and methodological quality were extracted.

RESULTS

The search identified 17 studies that used ambulatory assessment methods to gather objective data, and focused primarily on autonomic functioning, physical activity, and cognitive processes in ED and control groups.

DISCUSSION

Together the literature demonstrates the promise of using a range of ecologically valid ambulatory assessment approaches in EDs, though there remains limited research that has utilized methods other than self-report (e.g., wearable sensors), particularly in recent years. Going forward, there are several technology-enhanced momentary assessment methods that have potential to improve the understanding and treatment of EDs.

Trait body image flexibility as a predictor of body image states in everyday life of young Australian women

The present study evaluated whether individuals with varying levels of trait body image flexibility differ in the severity, variability, and correlates of state body dissatisfaction experienced in their daily lives. One hundred and forty-seven women completed a baseline measure of trait body image flexibility, followed by a 7-day ecological momentary assessment phase in which participants self-reported state body dissatisfaction, disordered eating behavior, drive for thinness, and appearance comparisons at 10 semi-random intervals daily. Higher trait body image flexibility predicted lower average scores, less frequent reporting of high state body dissatisfaction, and less variability in their state body dissatisfaction ratings. Individuals with higher trait body image flexibility were also less likely to engage in a range of behaviors and cognitions previously shown to produce body dissatisfaction, including upward appearance comparisons, drive for thinness, binge eating, and dieting. However, few of these state-based relationships involving body dissatisfaction and these related behaviors and cognitions were moderated by trait body image flexibility. Overall, this pattern of findings suggests that body image flexible individuals may have less negative body image because they are less inclined to engage in behaviors and cognitions in their daily lives that encourage negative body image.

Do women with greater trait body dissatisfaction experience body dissatisfaction states differently? An experience sampling study

The present study evaluated the relation of key features of state body dissatisfaction experiences - inertia, instability from moment-to-moment, and average level across time-points - to trait body dissatisfaction and/or eating disorder risk. Participants included 161 women who completed measures of trait body dissatisfaction and disordered eating pathology, and then completed reported state body dissatisfaction and contextual influences (binge eating, dietary restraint, exercise, and appearance comparison behaviors) 6 times daily for 7 days. Results indicated that individuals with elevated trait body dissatisfaction were reliably different from those with healthier body image in terms of average state body dissatisfaction ratings, but not for inertia or instability. State mean and trait body dissatisfaction uniquely predicted eating pathology, although their predictive accuracy for clinical caseness was comparable. Cost vs. benefit of using state body image data for understanding trait body image and eating pathology is discussed.

When does behavior follow intent? Relationships between trait level dietary restraint and daily eating behaviors

BACKGROUND

The relationship between self-report trait level restriction and daily engagement in restriction behaviors is not well understood, and as a result the usefulness of such trait level measures is unclear. The present study aimed both to examine the validity of self-reported trait dietary restraint behaviors, and to examine the respective relationships among self-reported trait dietary restraint intentions and behaviors and both restrained and disinhibited eating at the daily level.

METHODS

A sample of 109 women (M_age = 24.72, SD = 4.15) completed a self-report trait level measure of dietary restraint before providing EMA data on their daily engagement in dietary restraint and disinhibited eating behaviors, as well as mood, over a period of 7 days. Multilevel hurdle models were used to test the relationship between trait levels of dietary restraint, and daily level reports of restraint and disinhibited eating behaviors.

RESULTS

Trait restraint behavior was a consistent predictor of daily presence and frequency of restraint behaviors. In contrast, trait restraint intentions was not a predictor of daily restraint behaviors, however it did predict daily frequency of overeating. In addition, daily negative affect emerged as a predictor of comfort eating, but was not predictive of restraint behaviors.

CONCLUSIONS

Findings confirm the usefulness of assessments of self-reported trait dietary restraint behaviors as a method of capturing dieting behaviors. In contrast, trait level dietary restraint intentions was a poor predictor of eating outcomes and more research on the way that restraint intentions affect eating behaviors is warranted.

A Person-by-Situation Account of Why Some People More Frequently Engage in Upward Appearance Comparison Behaviors in Everyday Life

Although the influence of stable, trait-like factors (such as trait body dissatisfaction and appearance internalization) on instances of appearance comparison has been well documented, the additive and interactive influence of contextual factors (such as one's current body satisfaction) on comparison behaviors is unknown. Therefore, the present study tested a Person×Situation model in which both state and trait body image variables interacted to predict engagement in various forms of comparison (upward, downward, and lateral). Participants included 161 women who completed a baseline measure of trait body dissatisfaction and internalization, and then completed, via an iPhone app, an ecological momentary assessment phase in which they reported momentary experiences of mood and comparison behaviors at up to 6 random times per day for 7days. Multilevel analyses revealed that upward comparisons (comparisons against more attractive people) were more likely for individuals with heightened trait and/or state negative body image, but these predictive effects of state and trait on appearance comparisons appear largely independent of each other. Furthermore, neither state nor trait body image variables were related to the other forms of comparison, and time lag at the state-level between predictor and outcome did not seem to influence the strength of these associations. Present findings are consistent with the notion that how an individual feels in the moment about their appearance may influence engagement in deleterious appearance behaviors. However, further testing is needed to confirm these causal hypotheses.

Applicability of the dual pathway model in normal and overweight binge eaters

Binge eating is a significant problem in both eating disordered and community populations alike. Extensive support exists for the dual pathway model of binge eating in both adolescent and adult clinical and nonclinical populations. However, the restrained eating pathway to binge eating in particular has failed to be confirmed in some studies. In particular, the dual pathway model may not be applicable to overweight binge eaters. The current study examined the applicability of the dual pathway model in a sample of healthy and overweight binge eaters. A total of 260 (115 healthy weight; 145 overweight or obese) adult binge eaters completed an online survey. Mediation analyses indicated support for both the dietary restraint and negative affect pathways in the healthy weight sample but only the latter pathway was supported in the overweight sample. Therefore, the full dual pathway model may only be applicable to healthy weight binge eaters.

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.

Assessing the roles of impulsivity, food-related cognitions, BMI, and demographics in the dual pathway model of binge eating among men and women

The dual pathway model is a widely accepted model of binge eating that focuses on the role of sociocultural factors, negative affect, and dietary restraint. However, less is known about demographic (e.g., gender and ethnicity) differences in the model and the role of other variables in the model. To further our understanding of the dual pathway model of binge eating, the current study examined the role of demographics (i.e., gender, race, BMI, parental education and obesity), impulsivity, and food-related cognitions in the dual pathway model. A sample of college students completed a battery of measures. Multi-group structural equation modeling was used to evaluate the dual pathway model separately for men and women. Results supported the dual pathway model of binge eating among men and women, and also supported food-related cognitions as an important variable prior to binge eating. In other words, body shame was associated with more dietary restraint and negative affect, and in turn, dietary restraint and negative affect were associated with increased negative food-related cognitions. Then, food-related cognitions predicted binge eating. Additionally impulsivity was related to body shame, negative affect, and food-related cognitions, but was unrelated to binge eating after controlling for the other variables. Racial differences existed among women in BMI and body shame, but there were no racial differences among men. Our results suggest that the dual pathway model adequately explains binge eating among men and women, but that food-related cognitions may be an imporant anteceden to binge eating.