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Birgegård A, Isomaa R, Monell E, Bjureberg J. Validation of the eating pathology symptoms inventory (EPSI) in Swedish adolescents. J Eat Disord 2024; 12:68. [PMID: 38802891 PMCID: PMC11129359 DOI: 10.1186/s40337-024-01027-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/21/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Eating disorders (ED) are associated with symptoms across body image, disordered eating, and exercise-related domains, and while predominantly affecting females, ED in males is also a significant concern. However, popular self-report methods insufficiently capture male presentations. This study aimed (1) to validate the first Swedish translation of the Eating Pathology Symptoms Inventory (EPSI), which was designed to overcome limitations in previous measures, and (2) compare genders gender-specific manifestations of eating pathology, depression, and anxiety in Swedish high-school students. METHODS Participants were 359 high-school students (47% males) aged 17.0 years (range 15-21). RESULTS Confirmatory factor analysis and correlation patterns showed support for the 8-factor structure and convergent validity, but poorer discriminant validity may suggest caution in interpreting single scales as evidence of ED pathology. Gender comparisons were broadly consistent with previous research. CONLUSIONS The Swedish EPSI may be used to asses ED symptoms, but caution is suggested in interpreting some scales in isolation as indicative of ED pathology.
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Affiliation(s)
- Andreas Birgegård
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Rasmus Isomaa
- Wellbeing Services County of Ostrobothnia, Vasa, Finland
- Faculty of Education and Welfare Studies, Åbo Akademi University, Vasa, Finland
| | - Elin Monell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Johan Bjureberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Pictor LE, Laboe AA, Dillon K, Frank M, Gavuji M, Krawczyk A, Schaumberg K. A pilot randomized trial of the body advocacy movement: a novel, dissonance-based intervention designed to target fear of weight gain and anti-fat bias in young adults. Eat Disord 2024:1-20. [PMID: 38557300 DOI: 10.1080/10640266.2024.2332823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
The Body Advocacy Movement (BAM) is a novel, cognitive-dissonance-based intervention designed to target fatphobia and anti-fat bias as mechanisms to drive reductions in eating disorder (ED) risk. Previous dissonance-based programs (i.e. the Body Project; BP) have successfully targeted thin-ideal internalization as an intervention mechanism. As burgeoning research indicates that fatphobia and anti-fat bias may play a central role in the maintenance of ED pathology, a focused intervention designed to target these constructs could bolster prevention efforts. The aims of this pilot study include confirming acceptability and feasibility of BAM and developing preliminary estimates of its effects on intervention targets, along with benchmarking these effects against the BP intervention. BAM was found to be accepted by participants and feasible to facilitate in a peer-led model. Preliminary results from 50 participants (BAM: N = 26; BP: N = 24) reveal small-to-moderate pre-to-post intervention effects on fatphobia, anti-fat bias, thin-ideal internalization, and eating pathology, which dissipated at 8-week follow-up. The BAM intervention has the potential to supplement the existing suite of ED prevention programs by specifically targeting anti-fat bias, though additional testing in larger and more diverse samples is necessary to clarify its impact on both hypothesized risk mechanisms and ED outcomes.
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Affiliation(s)
- Lauren E Pictor
- Department of Psychiatry, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - A A Laboe
- Department of Psychiatry, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - K Dillon
- Department of Psychiatry, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - M Frank
- Department of Psychiatry, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - M Gavuji
- Department of Psychiatry, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - A Krawczyk
- Department of Psychiatry, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Katherine Schaumberg
- Department of Psychiatry, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Manwaring JL, Blalock DV, Rienecke RD, Le Grange D, Mehler PS. A descriptive study of treatment-seeking adults with avoidant/restrictive food intake disorder at residential and inpatient levels of care. Eat Disord 2024; 32:13-28. [PMID: 37534949 DOI: 10.1080/10640266.2023.2241266] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
Most research on avoidant/restrictive food intake disorder (ARFID) has been with children and adolescents, while the limited research on adults with ARFID has been in the domain of outpatient treatment. This descriptive study sought to explore psychological characteristics (N = 45; measured with self-report questionnaires) and physiological characteristics (N = 66; e.g. vital signs, bloodwork) at admission for 66 adults with ARFID seeking residential and inpatient levels of care. While adults with ARFID presented with significant food restriction as well as mild depressive symptoms, high anxiety symptoms, and impaired quality of life, patients presented with mostly normal physiology, except for low bone density, and trivial abnormalities in serum creatinine and hepatic enzymes. Patients in this sample were most likely to endorse fear of aversive consequences, especially those for whom ARFID symptoms had first arisen in adulthood. These results note the psychological impairment and relative physiological normalcy of treatment-seeking adults with ARFID at the outset of residential and inpatient treatment, identifying future treatment and outcome research priorities in this understudied population.
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Affiliation(s)
- Jamie L Manwaring
- ACUTE Center for Eating Disorders and Malnutrition at Denver Health, Denver, Colorado, USA
- Department of Medicine, University of Colorado School of Medicine, Denver, Colorado, USA
- Eating Recovery Center and Pathlight Behavioral Health Centers, Denver, Colorado, USA
| | - Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Renee D Rienecke
- Eating Recovery Center and Pathlight Behavioral Health Centers, Denver, Colorado, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
- Department of Psychiatry and Behavioral Neurosciences, The University of Chicago, Chicago, Illinois, USA
| | - Philip S Mehler
- ACUTE Center for Eating Disorders and Malnutrition at Denver Health, Denver, Colorado, USA
- Department of Medicine, University of Colorado School of Medicine, Denver, Colorado, USA
- Eating Recovery Center and Pathlight Behavioral Health Centers, Denver, Colorado, USA
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Dougherty EN, Johnson NK, Badillo K, Haedt-Matt AA. Sleep reactivity is associated with social anxiety and disordered-eating behaviors in college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:2280-2285. [PMID: 34469257 DOI: 10.1080/07448481.2021.1967359] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 07/17/2021] [Accepted: 08/06/2021] [Indexed: 06/13/2023]
Abstract
Objective: Investigate whether sleep reactivity was associated with social anxiety and disordered-eating behaviors in a college population. Participants: One hundred ninety-eight college-age men and women. Methods: Participants completed self-report measures of social anxiety, disordered-eating behaviors and sleep reactivity. Results: Sleep reactivity was associated with greater dietary restriction and purging, controlling for social anxiety but it was not associated with binge eating. Sleep reactivity was associated with elevated symptoms of social anxiety, controlling for disordered-eating behaviors. Conclusions: The results suggest that sleep reactivity represents a shared correlate of disordered-eating behaviors and social anxiety that may partially explain their co-occurrence. Interventions to help college students high in sleep reactivity effectively manage stress and regulate their sleep may aid in the prevention and treatment of social anxiety and disordered-eating behaviors.
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Affiliation(s)
| | - Nicole K Johnson
- Department of Psychology, Illinois Institute of Technology, Chicago, Illinois, USA
| | - Krystal Badillo
- Department of Psychology, Illinois Institute of Technology, Chicago, Illinois, USA
| | - Alissa A Haedt-Matt
- Department of Psychology, Illinois Institute of Technology, Chicago, Illinois, USA
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5
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Coniglio KA, Davis L, Sun J, Loureiro N, Selby EA. Detecting pathological exercise in college men: An investigation using latent profile analysis. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:2258-2262. [PMID: 34415230 DOI: 10.1080/07448481.2021.1965612] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 07/23/2021] [Accepted: 07/30/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Pathological exercise is a dangerous behavior often observed in eating disorders. Data investigating associated characteristics of pathological exercise in men are lacking, despite college men and women being at equally elevated risk for developing eating disorders. PARTICIPANTS Two hundred and twenty-four college men who exercise regularly completed a series of self-report questionnaires. METHODS Latent profile analysis was used to identify empirically-derived homogenous subgroups of regular exercisers based on severity of other eating disorder attitudes and behaviors. Profiles were also compared on differences in exercise motivation and general psychopathology (i.e., depression, anxiety). RESULTS Fit indices indicated a three-profile solution. Profiles described an eating psychopathology group, a low psychopathology group, and a high exercise frequency group without eating disorder features. CONCLUSIONS Pathological exercise cannot be identified using exercise frequency alone. Other features like body dissatisfaction and exercise motivation style are relevant in identifying pathological exercise behavior in college men.
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Affiliation(s)
- Kathryn A Coniglio
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Lauren Davis
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Jasmine Sun
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Natalia Loureiro
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Edward A Selby
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
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Trolio V, Racine SE. Exploring latent profiles of disordered eating using an indicator of dietary restriction in an undergraduate sample of men and women. Int J Eat Disord 2023; 56:1603-1613. [PMID: 37158655 DOI: 10.1002/eat.23985] [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: 11/23/2022] [Revised: 04/20/2023] [Accepted: 04/26/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Latent class or latent profile analysis (LPA) studies in patients with eating disorders consistently identify a low-weight, restrictive eating subgroup that does not endorse weight/shape concerns. To date, similar studies in samples unselected for disordered eating symptoms have not identified a high restriction-low weight/shape concerns group, which may be due to a lack of inclusion of measures of dietary restriction. METHOD We conducted an LPA using data from 1623 college students (54% female) recruited across three different studies. The Eating Pathology Symptoms Inventory Body Dissatisfaction, Cognitive Restraint, Restricting, and Binge Eating subscales were used as indicators, and body mass index, gender, and dataset were covaried. Purging, excessive exercise, emotion dysregulation, and harmful alcohol use were compared across resulting clusters. RESULTS Fit indices supported a 10-class solution, including five disordered eating groups (largest to smallest): "Elevated General Disordered Eating", "Body Dissatisfied Binge Eating," "Most Severe General Disordered Eating," "Non-Body Dissatisfied Binge Eating," and "Non-Body Dissatisfied Restriction." The "Non-Body Dissatisfied Restriction" group scored as low on other measures of traditional eating pathology and harmful alcohol use as non-disordered eating groups but scored as high on a measure of emotion dysregulation as other disordered eating groups. DISCUSSION This study is the first to identify a latent restrictive eating group that does not endorse traditional disordered eating cognitions in an unselected sample of undergraduate students. Results underscore the importance of using measures of disordered eating behaviors without implied motivation to capture overlooked problematic eating patterns in the population that are distinct from our "traditional" understanding of disordered eating. PUBLIC SIGNIFICANCE We identified a group of individuals with high levels of restrictive eating but low body dissatisfaction and intent to diet in an unselected adult sample of men and women. Results underscore the need to investigate restrictive eating outside of the traditional lens of body shape concerns. Findings also suggest that individuals with nontraditional eating difficulties may struggle with emotion dysregulation, putting them at risk of poor psychological and relational outcomes.
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Affiliation(s)
- Vittoria Trolio
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Sarah E Racine
- Department of Psychology, McGill University, Montreal, Quebec, Canada
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Forney KJ, Rogers ML, Grillot CL, Pucci G, Joiner TE, Keel PK. Testing replicability of the relationship between weight suppression and binge eating in three non-clinical samples varying in lifetime weight history. Eat Behav 2023; 50:101784. [PMID: 37515999 DOI: 10.1016/j.eatbeh.2023.101784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 05/05/2023] [Accepted: 07/21/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVE Increased weight suppression, the difference between an individual's highest and current weight at present height, predicts binge eating among eating disorder samples. Less is known about this relationship in non-clinical samples of individuals with a history of higher weight. METHODS Lifetime highest BMI was tested as a moderator of the relationship between weight suppression and binge eating in three independent samples (N = 1740). RESULTS At the bivariate level, weight suppression was not associated with binge eating in any sample (p's ≥ 0.20). Lifetime highest BMI moderated the relationship between weight suppression and binge eating in Sample 1 (p = .04), such that greater weight suppression was associated with lower binge eating among those with a history of higher weight (i.e., BMI = 40 kg/m2). In Samples 2 and 3, the lifetime highest BMI by weight suppression interaction term was not significant and dropped from the model (p's = 0.10-0.12). Accounting for age, gender, and lifetime highest BMI, greater weight suppression was associated with lower binge eating scores (p's < 0.04). A meta-analysis combining results revealed a small but significant interaction effect (r = 0.07, p = .02). CONCLUSIONS Findings highlight the importance of investigating the generalizability of eating disorder risk and maintenance theories across the weight spectrum. Weight loss may not increase risk for binge eating among those with a history of higher weight. Future work should replicate and extend this finding using longitudinal designs. More research is needed to elucidate which weight loss motivations and/or behaviors are most closely linked to binge eating.
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Affiliation(s)
- K Jean Forney
- Department of Psychology, Ohio University, Athens, OH, USA.
| | - Megan L Rogers
- Department of Psychology, Texas State University, San Marcos, TX, USA
| | | | | | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Pamela K Keel
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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Bohrer BK, Chen Y, Christensen KA, Forbush KT, Thomeczek ML, Richson BN, Chapa DAN, Jarmolowicz DP, Gould SR, Negi S, Perko VL, Morgan RW. A pilot multiple-baseline study of a mobile cognitive behavioral therapy for the treatment of eating disorders in university students. Int J Eat Disord 2023; 56:1623-1636. [PMID: 37213077 PMCID: PMC10765960 DOI: 10.1002/eat.23987] [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: 11/21/2022] [Revised: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE Eating disorders (EDs) are serious psychiatric disorders associated with substantial morbidity and mortality that are prevalent among university students. Because many students do not receive treatment due to lack of access on university campuses, mobile-health (mHealth) adaptations of evidence-based treatments represent an opportunity to increase treatment accessibility and engagement. The purpose of this study was to test the initial efficacy of Building Healthy Eating and Self-Esteem Together for University Students (BEST-U), which is a 10-week mHealth self-guided cognitive-behavioral therapy (CBT-gsh) app that is paired with a brief 25-30-min weekly telehealth coaching, for reducing ED psychopathology in university students. METHOD A non-concurrent multiple-baseline design (N = 8) was used to test the efficacy of BEST-U for reducing total ED psychopathology (primary outcome), ED-related behaviors and cognitions (secondary outcomes), and ED-related clinical impairment (secondary outcome). Data were examined using visual analysis and Tau-BC effect-size calculations. RESULTS BEST-U significantly reduced total ED psychopathology and binge eating, excessive exercise, and restriction (effect sizes ranged from -0.39 to -0.92). Although body dissatisfaction decreased, it was not significant. There were insufficient numbers of participants engaging in purging to evaluate purging outcomes. Clinical impairment significantly reduced from pre-to-post-treatment. DISCUSSION The current study provided initial evidence that BEST-U is a potentially efficacious treatment for reducing ED symptoms and ED-related clinical impairment. Although larger-scale randomized controlled trials are needed, BEST-U may represent an innovative, scalable tool that could reach greater numbers of underserved university students than traditional intervention-delivery models. PUBLIC SIGNIFICANCE Using a single-case experimental design, we found evidence for the initial efficacy of a mobile guided-self-help cognitive-behavioral therapy program for university students with non-low weight binge-spectrum eating disorders. Participants reported significant reductions in ED symptoms and impairment after completion of the 10-week program. Guided self-help programs show promise for filling an important need for treatment among university students with an ED.
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Affiliation(s)
- Brittany K. Bohrer
- Department of Psychiatry, University of California San Diego Health Eating Disorders Center for Treatment and Research, San Diego, California, USA
| | - Yiyang Chen
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
| | - Kara A. Christensen
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - Kelsie T. Forbush
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
| | | | | | | | | | - Sara R. Gould
- Children’s Mercy Hospital, Kansas City, Missouri, USA
| | - Sonakshi Negi
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
| | - Victoria L. Perko
- University of New Mexico Health Science Center, Albuquerque, New Mexico, USA
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Kells MR, Davis HA, Todorov S, Wildes JE. Health literacy and eating disorder pathology in women with food insecurity: A preliminary cross-sectional study. Eat Behav 2023; 49:101727. [PMID: 37099830 DOI: 10.1016/j.eatbeh.2023.101727] [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: 11/15/2022] [Revised: 02/28/2023] [Accepted: 04/05/2023] [Indexed: 04/28/2023]
Abstract
Food insecurity (FI), or limited consistent access to food, is associated with eating disorder (ED) pathology; however, the underlying mechanisms of this relationship remain unclear. Health literacy, or the ability to comprehend and apply health-related information to decision making, is linked to FI and has implications for outcomes across a broad range of diagnoses. The purpose of this study was to examine associations between health literacy and ED symptoms in a sample of 99 women with FI. Linear regression tested cross-sectional associations between scores on The Newest Vital Sign (NVS), a measure of health literacy, and scores on the Eating Pathology Symptom Inventory (EPSI) and behaviors reported in the Eating Disorder Diagnostic Interview (EDDI). Logistic regression examined the likelihood of ED diagnosis in relation to NVS score. The sample mean (SD) age was 40.3 (14.3) years, and participants self-identified as 54.5 % White, 30.3 % Black, and 13.8 % other. Respondents self-reported 13.1 % marginal, 28.3 % low, and 58.6 % very low food security. Mean NVS score was 4.45, and significantly higher for White compared to Black individuals (F = 3.96, p = .02, η2 = 0.76), but not between other groups. No difference in NVS score by FI status was observed. EPSI Body Dissatisfaction was positively associated with NVS score. No associations were found between remaining EPSI subscales, eating behaviors, or ED diagnosis. White women, but not other groups, were found to have significant negative relationship between NVS and EPSI restricting. Future longitudinal research including components of health literacy related to eating in individuals with FI is warranted.
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Affiliation(s)
- Meredith R Kells
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA; School of Nursing, University of Rochester, Rochester, NY, USA.
| | - Heather A Davis
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA; Virginia Polytechnic Institute and State University, Department of Psychology, Blacksburg, VA, USA
| | - Sophia Todorov
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Jennifer E Wildes
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
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Withnell SJ, Bodell LP. Does suppressing weight improve body satisfaction? A longitudinal analysis in undergraduate men and women. Body Image 2023; 45:126-132. [PMID: 36870187 DOI: 10.1016/j.bodyim.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 03/06/2023]
Abstract
Young adults with high body dissatisfaction may engage in disordered eating to reduce their weight, believing that weight loss will improve body satisfaction. Yet, limited research has examined whether suppressing weight contributes to improved body satisfaction in nonclinical samples. Undergraduate students (N = 661; 81.2% female) completed three surveys over a six-month period. Longitudinal mixed-effect models investigated whether weight suppression was associated with change in body dissatisfaction. Body dissatisfaction was higher on average among women, and greater weight suppression was associated with greater body dissatisfaction across genders. Among women, higher baseline weight suppression was related to higher body dissatisfaction across time; however, neither baseline weight suppression nor change in weight suppression were associated with change in body dissatisfaction. Among men, higher baseline weight suppression was related to increased body dissatisfaction over time. However, greater increases in weight suppression were associated with improvements in body dissatisfaction. Thus, the impact of weight suppression on body image outcomes may differ by gender. Findings suggest that when men become more weight suppressed, their body dissatisfaction decreases; however, changes in weight may not impact body dissatisfaction in women. Findings may inform educational programs challenging diet and weight loss myths, particularly for women.
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Affiliation(s)
| | - Lindsay P Bodell
- Department of Psychology, University of Western Ontario, Canada.
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11
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Finch JE, Xu Z, Baker JH. Understanding comorbidity between eating disorder and premenstrual symptoms using a network analysis approach. Appetite 2023; 181:106410. [PMID: 36460121 PMCID: PMC9790037 DOI: 10.1016/j.appet.2022.106410] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/02/2022]
Abstract
Eating disorder symptoms are associated with ovarian hormones and fluctuate predictably across the menstrual cycle. However, the specific symptoms that underlie these associations remain unclear. The current study aims to examine which specific eating disorder and premenstrual symptoms confer risk and maintain comorbidity using network analysis. Eating disorder and premenstrual symptoms were measured using the Eating Pathology Symptoms Inventory and the Daily Record of Severity of Problems, respectively, in a large sample of young adult females. Network analysis was used to explicate the structure of eating and premenstrual symptom networks separately and together. Eating disorder networks replicated previous literature and identified body dissatisfaction as a core feature, but was unique in identifying monitoring calories as an additional core feature. Central symptoms identified in the premenstrual symptom network were symptoms interference with daily life and activities and negative emotions brought on by hormone changes. Bridge symptoms between networks were identified as relating to eating behaviors, interference with daily activities, joint and muscle pain, and negative emotions brought on by hormone changes. This study suggests that the links between eating disorder and premenstrual symptoms extend past their individual effects on eating behavior and are indicative of a shared underlying mechanism.
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Affiliation(s)
- Jody E Finch
- Department of Psychology, Georgia State University, P.O. Box 5010, Atlanta, GA, 30302-5010, USA.
| | - Ziqian Xu
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB #7160, 101 Manning Drive, Chapel Hill, NC, 27599-7160, USA
| | - Jessica H Baker
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB #7160, 101 Manning Drive, Chapel Hill, NC, 27599-7160, USA
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Koltun KJ, Bird MB, Lovalekar M, Martin BJ, Mi Q, Nindl BC. Changes in eating pathology symptoms during initial military training in men and women and associations with BMI and injury risk. Eat Behav 2023; 48:101687. [PMID: 36463664 DOI: 10.1016/j.eatbeh.2022.101687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Abstract
Nutritional fitness, which comprises food choices, meal timing, and dietary intake behaviors, is an important component of military service member health and performance that has garnered recent attention. This study utilized generalized linear mixed effects modeling (GLMM) to investigate changes in eating pathology symptoms in men and women during initial military training (Marine Corps Officer Candidates School (OCS)). Associations among eating pathology, musculoskeletal injury risk and BMI were also assessed. This investigation includes data from the Eating Pathology Symptoms Inventory (EPSI) and BMI at the start of OCS (n = 598: Male n = 469, Female n = 129) and end of the 10-week program (n = 413: Male n = 329, Female n = 84), and injury surveillance throughout. At baseline, female candidates presented with greater body dissatisfaction, binge eating, purging, and restricting, but lower negative attitudes toward obesity compared to male candidates (p < 0.001). Eating symptoms changed during military training indicated by decreased body dissatisfaction in women (p = 0.003), decreased excessive exercise and negative attitudes toward obesity in men (p < 0.001), decreased cognitive restraint (p < 0.001), restricting (p < 0.001), purging (p = 0.013), and muscle building (p < 0.001) and increased binge eating (p < 0.001) in both sexes. Changes in restricting were significantly related to changes in BMI during training (p < 0.05). The likelihood of future injury was 108 % higher in female candidates than males and decreased by 5 % for each unit increase in excessive exercise. Eating attitudes and behaviors change during military training environments and are associated with military health and readiness outcomes including BMI and injury risk.
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Affiliation(s)
- Kristen J Koltun
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, 3860 S. Water St., Pittsburgh, PA 15203, USA.
| | - Matthew B Bird
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, 3860 S. Water St., Pittsburgh, PA 15203, USA
| | - Mita Lovalekar
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, 3860 S. Water St., Pittsburgh, PA 15203, USA
| | - Brian J Martin
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, 3860 S. Water St., Pittsburgh, PA 15203, USA
| | - Qi Mi
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, 3860 S. Water St., Pittsburgh, PA 15203, USA
| | - Bradley C Nindl
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, 3860 S. Water St., Pittsburgh, PA 15203, USA
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Forney KJ, Horvath SA, Pucci G, Harris ER. Elevated fullness and bloating as correlates of eating pathology: Implications for screening. Eat Disord 2022; 31:375-387. [PMID: 36409019 DOI: 10.1080/10640266.2022.2141705] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A minority of individuals with eating disorders report being asked about their eating by health care professionals; delayed detection of eating disorders may contribute to poorer outcomes. The current study investigated common meal-related gastrointestinal symptoms (i.e., elevated fullness and bloating) as correlates of eating pathology that may be more readily disclosed to health professionals and indicate the need to assess for eating pathology. The current study also tested the hypothesis that elevated fullness and bloating are more strongly linked to eating pathology among those with higher body dissatisfaction. 281 university students (70.1% female, 84.3% white) completed gastrointestinal symptom and eating pathology assessments. Elevated fullness and bloating were each associated with increased purging, restrictive eating behaviors, and likelihood of having an eating disorder. Elevated fullness and bloating were more strongly linked to purging and probable eating disorder diagnosis with higher, relative to lower, body dissatisfaction. However, body dissatisfaction did not moderate the relationship between gastrointestinal symptoms and restrictive eating behaviors. Results indicate that elevated fullness and bloating are correlates of eating pathology. Healthcare professionals should consider and/or assess for eating pathology when elevated fullness and bloating are reported; further assessment of body dissatisfaction may be helpful in identifying purging behaviors.
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Affiliation(s)
- K Jean Forney
- Department of Psychology, Ohio University, Athens, Ohio 45701 United States
| | - Sarah A Horvath
- Department of Psychology, Ohio University, Athens, Ohio 45701 United States
| | - Gabriella Pucci
- Department of Psychology, Ohio University, Athens, Ohio 45701 United States
| | - Emma R Harris
- Department of Psychology, Ohio University, Athens, Ohio 45701 United States
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14
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Forbush KT, Swanson TJ, Chen Y, Siew CSQ, Hagan KE, Chapa DAN, Tregarthen J, Wildes JE, Christensen KA. Generalized network psychometrics of eating-disorder psychopathology. Int J Eat Disord 2022; 55:1603-1613. [PMID: 36053836 PMCID: PMC10108623 DOI: 10.1002/eat.23801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 07/01/2022] [Accepted: 07/01/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE As network models of eating disorder (ED) psychopathology become increasingly popular in modeling symptom interconnectedness and identifying potential treatment targets, it is necessary to contextualize their performance against other methods of modeling ED psychopathology and to evaluate potential ways to optimize and capitalize on their use. To accomplish these goals, we used generalized network psychometrics to estimate and compare latent variable models and network models, as well as hybrid models. METHOD We tested the structure of the Eating Pathology Symptoms Inventory (EPSI) and Eating Disorder Examination-Questionnaire (EDE-Q) in Recovery Record, Inc. mobile phone application users (N = 6856). RESULTS Although all models fit well, results favored a hybrid latent variable and network framework, which showed that ED symptoms fit best when modeled as higher-order constructs, rather than direct symptom-to-symptom connections, and when the relationships between those constructs are described as a network. Hybrid models in which latent factors were modeled as nodes within a network showed that EPSI Purging, Binge Eating, Cognitive Restraint, Body Dissatisfaction, and Excessive Exercise had high importance in the network. EDE-Q Eating Concern and Shape Concern were also important nodes. Results showed that the EPSI network was highly stable and replicable, whereas the EDE-Q network was not. DISCUSSION Integrating latent variable and network model frameworks enables tests of centrality to identify important latent variables, such as purging, that may promote the spread of ED psychopathology throughout a network, allowing for the identification of future treatment targets.
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Affiliation(s)
- Kelsie T. Forbush
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
| | - Trevor J. Swanson
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
| | - Yiyang Chen
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
| | - Cynthia S. Q. Siew
- Department of Psychology, National University of Singapore, Singapore, Singapore
| | - Kelsey E. Hagan
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | | | | | - Jennifer E. Wildes
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois, USA
| | - Kara A. Christensen
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
- Department of Psychology, University of Nevada Las Vegas, Las Vegas, Nevada, USA
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15
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Sahlan RN, Blomquist KK, Bodell LP. Psychometric properties of the Farsi version of the Eating Pathology Symptoms Inventory (F-EPSI) among Iranian University men and women. J Eat Disord 2022; 10:67. [PMID: 35534863 PMCID: PMC9082464 DOI: 10.1186/s40337-022-00587-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Limited research has validated eating pathology assessments in Iranian men and women. The purpose of the current study was to translate and validate a Farsi version of the Eating Pathology Symptoms Inventory (F-EPSI) in Iranian university students. METHODS Men (n = 279) and women (n = 486) completed questionnaires including the F-EPSI. RESULTS Confirmatory factor analysis (CFA) indicated that the F-EPSI had an acceptable fit to the data and supported the eight-factor model. The scale was partially invariant across genders. Men reported higher scores on Excessive Exercise and Muscle Building subscales, and women reported higher scores on Body Dissatisfaction and Restricting subscales. The F-EPSI subscales had good 5- to 6-month test-retest reliability. The F-EPSI demonstrated convergent validity with clinical impairment, eating pathology, and body mass index (BMI). Finally, individuals scoring above the Clinical Impairment Assessment (CIA) cutoffs reported higher scores on the F-EPSI subscales, further supporting convergent validity of the scale. CONCLUSION Findings suggest that the F-EPSI will enable researchers to examine eating pathology symptoms among men and women in Iran.
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Affiliation(s)
- Reza N Sahlan
- Department of Clinical Psychology, Iran University of Medical Sciences, Tehran, Iran
| | | | - Lindsay P Bodell
- Department of Psychology, University of Western Ontario, 361 Windermere Road, London, ON, N6A 3K7, Canada.
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16
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Shope MM, Freeman AJ, Culbert KM. Elucidating early pubertal timing effects on disordered eating symptoms in young adult women. Eat Behav 2022; 45:101602. [PMID: 35219033 DOI: 10.1016/j.eatbeh.2022.101602] [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: 04/27/2021] [Revised: 02/04/2022] [Accepted: 02/08/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Early pubertal timing increases risk for disordered eating (DE) in females, but the extent to which associations persist after puberty and are relevant to all types of DE symptoms is unclear. Factors that link pubertal timing and DE also remain unknown, although leading theories posit that adiposity and body-focused psychosocial factors play a key role. Thus, this study examined pubertal timing effects on several types of DE symptoms in young adult women and evaluated whether body mass index (BMI), pressures for thinness, thin-ideal internalization, and/or history of weight-based teasing account for such associations. METHODS This study included a racially and ethnically diverse sample of 342 female college students (Mage = 20.44, SD = 3.46). Women retrospectively reported their age at onset of menses, which served as the pubertal timing indicator, and completed self-report questionnaires on DE symptoms, perceived pressures for thinness, thin-ideal internalization, and history of weight-based teasing. BMI was calculated from height/weight measurements. RESULTS Earlier pubertal timing was associated with body dissatisfaction and binge eating, but not other DE symptoms (dieting, excessive exercise, muscle building) in young adult women. BMI accounted for pubertal timing effects on body dissatisfaction, whereas none of the examined factors explained pubertal timing effects on binge eating. CONCLUSIONS Earlier pubertal timing may exert long-term effects on only some DE symptoms in women, and the etiologic factors underlying pubertal timing effects on DE outcomes may differ across symptom types.
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Affiliation(s)
- Megan M Shope
- Department of Psychology, University of Nevada, Las Vegas, United States of America
| | - Andrew J Freeman
- Department of Psychology, University of Nevada, Las Vegas, United States of America; Division of Child and Family Services, Department of Health and Human Services, State of Nevada, United States of America
| | - Kristen M Culbert
- Department of Psychology, University of Nevada, Las Vegas, United States of America; Department of Psychology, Michigan State University, United States of America.
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17
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Watson D, Levin-Aspenson HF, Waszczuk MA, Conway CC, Dalgleish T, Dretsch MN, Eaton NR, Forbes MK, Forbush KT, Hobbs KA, Michelini G, Nelson BD, Sellbom M, Slade T, South SC, Sunderland M, Waldman I, Witthöft M, Wright AGC, Kotov R, Krueger RF. Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): III. Emotional dysfunction superspectrum. World Psychiatry 2022; 21:26-54. [PMID: 35015357 PMCID: PMC8751579 DOI: 10.1002/wps.20943] [Citation(s) in RCA: 72] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The Hierarchical Taxonomy of Psychopathology (HiTOP) is a quantitative nosological system that addresses shortcomings of traditional mental disorder diagnoses, including arbitrary boundaries between psychopathology and normality, frequent disorder co-occurrence, substantial heterogeneity within disorders, and diagnostic unreliability over time and across clinicians. This paper reviews evidence on the validity and utility of the internalizing and somatoform spectra of HiTOP, which together provide support for an emotional dysfunction superspectrum. These spectra are composed of homogeneous symptom and maladaptive trait dimensions currently subsumed within multiple diagnostic classes, including depressive, anxiety, trauma-related, eating, bipolar, and somatic symptom disorders, as well as sexual dysfunction and aspects of personality disorders. Dimensions falling within the emotional dysfunction superspectrum are broadly linked to individual differences in negative affect/neuroticism. Extensive evidence establishes that dimensions falling within the superspectrum share genetic diatheses, environmental risk factors, cognitive and affective difficulties, neural substrates and biomarkers, childhood temperamental antecedents, and treatment response. The structure of these validators mirrors the quantitative structure of the superspectrum, with some correlates more specific to internalizing or somatoform conditions, and others common to both, thereby underlining the hierarchical structure of the domain. Compared to traditional diagnoses, the internalizing and somatoform spectra demonstrated substantially improved utility: greater reliability, larger explanatory and predictive power, and greater clinical applicability. Validated measures are currently available to implement the HiTOP system in practice, which can make diagnostic classification more useful, both in research and in the clinic.
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Affiliation(s)
- David Watson
- Department of Psychology, University of Notre Dame, South Bend, IN, USA
| | | | - Monika A Waszczuk
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | | | - Tim Dalgleish
- Medical Research Council, Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Michael N Dretsch
- US Army Medical Research Directorate - West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, WA, USA
| | - Nicholas R Eaton
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Miriam K Forbes
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Kelsie T Forbush
- Department of Psychology, University of Kansas, Lawrence, KS, USA
| | - Kelsey A Hobbs
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Giorgia Michelini
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - Brady D Nelson
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Martin Sellbom
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Tim Slade
- Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia
| | - Susan C South
- Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA
| | - Matthew Sunderland
- Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia
| | - Irwin Waldman
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Michael Witthöft
- Department for Clinical Psychology, Psychotherapy, and Experimental Psychopathology, University of Mainz, Mainz, Germany
| | - Aidan G C Wright
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - Robert F Krueger
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
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18
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Bicaker E, Racine SE. Protection versus risk? The relative roles of compassionate and uncompassionate self-responding for eating disorder behaviors. Eat Behav 2022; 44:101592. [PMID: 34920209 DOI: 10.1016/j.eatbeh.2021.101592] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 11/14/2021] [Accepted: 11/30/2021] [Indexed: 12/14/2022]
Abstract
Research demonstrates the protective role of self-compassion for eating disorder symptoms. However, studies investigating self-compassion most often use the Self-Compassion Scale, which aggregates the distinct but related constructs of compassionate and uncompassionate self-responding. This study examined differential associations of compassionate and uncompassionate self-responding with positive and negative affect and with a range of eating disorder behaviors (i.e., binge eating, purging, dietary restriction, and excessive exercise). Participants were 547 undergraduate students (59% women, Mage = 20.49, SDage = 1.83) who completed measures of self-compassion, trait affect, and eating disorder behaviors. Compassionate and uncompassionate self-responding were moderately negatively correlated (rs = -0.41 and -0.33, among women and men, respectively). Compassionate self-responding was more strongly related to positive affect, and uncompassionate self-responding was more strongly related to negative affect. Among women, uncompassionate self-responding was related to all eating disorder behaviors controlling for compassionate self-responding, whereas compassionate self-responding was not uniquely related to any eating disorder behavior. Among men, a similar pattern emerged, except that only compassionate self-responding related uniquely to excessive exercise. Results are consistent with studies showing that the presence of uncompassionate self-responding might outweigh the absence of compassionate self-responding in explaining psychopathology. Findings highlight the potential importance of primarily targeting uncompassionate self-responding in eating disorder interventions.
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Affiliation(s)
- Ege Bicaker
- Department of Psychology, McGill University, Montreal, Canada
| | - Sarah E Racine
- Department of Psychology, McGill University, Montreal, Canada.
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19
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'Feeling fat' is associated with specific eating disorder symptom dimensions in young men and women. Eat Weight Disord 2021; 26:2345-2351. [PMID: 33389705 DOI: 10.1007/s40519-020-01074-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 11/13/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE 'Feeling fat,' the somatic experience of having excess body weight that is not fully explained by true adiposity, correlates with eating pathology in clinical and non-clinical samples. It is unknown whether 'feeling fat' more strongly relates to specific eating disorder symptom dimensions that typically characterize anorexia nervosa, bulimia nervosa, and/or binge eating disorder. Understanding the significance of 'feeling fat's relationship with specific eating disorder symptom dimensions-cognitive restraint, dietary restriction, binge eating, and purging-may suggest its relevance to particular forms of eating pathology and elucidate treatment directions for addressing 'feeling fat'. METHODS Questionnaires were completed by 989 undergraduates (54.3% female). RESULTS Path analyses indicated significant associations between feeling fat and all symptom dimensions; these paths were not moderated by gender. The best fitting model was the model including paths from 'feeling fat' to all symptom dimensions; no other model had equivalent fit. CONCLUSION 'Feeling fat' relates to all examined symptoms of eating disorders in a mixed-gender non-clinical population. These results indicate that 'feeling fat' is associated with multiple core symptoms of eating pathology, pointing to 'feeling fat's significance to eating pathology maintenance across the spectrum of eating pathology. Future research should compare the influence of 'feeling fat' on these symptoms in mixed-gender clinical samples. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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20
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Richson BN, Forbush KT, Chapa DA, Gould SR, Perko VL, Johnson SN, Christensen KA, Swanson TJ, Tregarthen J. Measurement invariance of the Eating Pathology Symptoms Inventory (EPSI) in adolescents and adults. Eat Behav 2021; 42:101538. [PMID: 34247036 PMCID: PMC8518978 DOI: 10.1016/j.eatbeh.2021.101538] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 06/22/2021] [Accepted: 06/29/2021] [Indexed: 11/25/2022]
Abstract
Adolescence is a common period for eating disorder (ED) onset. The availability of psychometrically sound measures of ED psychopathology enables clinicians to accurately assess symptoms and monitor treatment outcomes continuously from adolescence and adulthood. The purpose of this study was to assess if the Eating Pathology Symptoms Inventory (EPSI) is invariant across adolescents and adults. Participants (N = 29,821) were adolescent (n = 5250) and adult (n = 24,571) users of the Recovery Record (RR) mobile phone application who provided EPSI responses through the application. Measurement invariance testing was conducted to assess invariance of the EPSI Body Dissatisfaction, Restricting, Excessive Exercise, Purging, Cognitive Restraint, and Binge Eating scales across adolescents (age 13 through 17) and adults (age 18 and older). Findings indicated that all EPSI factors administered in the RR app replicated in both adolescent and adult users. The EPSI factor structure was largely equivalent in adolescents and adults, demonstrating evidence for configural and metric invariance, as well as some evidence for scalar invariance. Our results indicated that EPSI scales measured the same constructs across development. Clinicians and researchers may benefit from utilizing the EPSI to measure ED psychopathology in adolescents and for continued progress monitoring into adulthood.
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Affiliation(s)
| | | | | | - Sara R. Gould
- Eating Disorders Center, Children’s Mercy, Kansas City, Leawood, KS, USA
| | | | - Sarah N. Johnson
- Department of Psychology, University of Kansas, Lawrence, KS, USA
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21
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Perko VL, Forbush KT, Christensen KA, Richson BN, Chapa DAN, Bohrer BK, Griffiths S. Validation of the factor structure of the Eating Pathology Symptoms Inventory in an international sample of sexual minority men. Eat Behav 2021; 42:101511. [PMID: 34004456 PMCID: PMC10042082 DOI: 10.1016/j.eatbeh.2021.101511] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 02/28/2021] [Accepted: 04/18/2021] [Indexed: 11/29/2022]
Abstract
Sexual minority individuals are at greater risk for the development of eating-disorder (ED) psychopathology. Despite the importance of understanding ED symptoms in sexual minority men, most ED measures were developed and validated in heterosexual, young adult, white women. The psychometric properties of ED measures in diverse populations remain largely unknown. The purpose of this study was to test: 1) whether the eight-factor structure of the Eating Pathology Symptoms Inventory (EPSI) replicated in sexual minority men and 2) group-level mean differences between gay and bisexual men on the eight EPSI scales. International participants (N = 722 sexual minority men from 20 countries) were recruited via the Grindr smartphone application. Confirmatory factor analysis (CFA) was completed using a weighted least square mean and variance adjusted estimator. Group differences in eating pathology between gay and bisexual men were tested using independent samples t-tests. The CFA model fit was good on all fit indices (CFI/TLI > 0.90, RMSEA < 0.06). Gay and bisexual men only differed on the EPSI Binge Eating scale. The results of this investigation suggest that the EPSI may be a useful tool for understanding eating pathology in this population. Using psychometrically sound assessment tools for sexual minority men is a vital piece of treatment planning and clinical decision making. The current study fills an important gap in the clinical and research literature by testing the validity and psychometric properties of a commonly used ED measure in sexual minority men.
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Affiliation(s)
- Victoria L Perko
- University of Kansas, Department of Psychology, Lawrence, KS 66045, USA
| | - Kelsie T Forbush
- University of Kansas, Department of Psychology, Lawrence, KS 66045, USA.
| | | | - Brianne N Richson
- University of Kansas, Department of Psychology, Lawrence, KS 66045, USA
| | | | - Brittany K Bohrer
- UC San Diego Health Eating Disorders Center for Treatment and Research, Department of Psychiatry, San Diego, CA 92121, USA
| | - Scott Griffiths
- University of Melbourne, Department of Psychology, Parkville, VIC 3010, Australia
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22
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Cusack CE, Christian C, Drake JE, Levinson CA. A network analysis of eating disorder symptoms and co-occurring alcohol misuse among heterosexual and sexual minority college women. Addict Behav 2021; 118:106867. [PMID: 33639368 DOI: 10.1016/j.addbeh.2021.106867] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/27/2021] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
Eating disorders and alcohol misuse are common problems among college women. Individually, both have high prevalence rates and are associated with a significant economic burden. Yet eating disorders and alcohol misuse also frequently present simultaneously, which may increase symptom severity and related impairment. These associations are especially important to test in sexual minority populations, as symptoms may present differently, and the prevalence and personal cost of these disorders may be even higher for this group. The present study (N = 1072 undergraduate college women) used network analysis to identify pathways, central symptoms, and bridge symptoms across alcohol misuse and eating disorder symptoms. A network comparison test was used to determine if the network structure differed between heterosexual women (n = 923) and sexual minority women (n = 149). For the overall network, cognitive restraint, excessive exercise, and frequency of binge drinking, were the most central symptoms. Bridge symptoms included drinking in the morning, purging, alcohol-related guilt, and muscle building. Heterosexual and sexual minority women did not differ significantly in network structure or global strength. Regardless of sexual orientation, prevention efforts for eating disorders and alcohol misuse among college women should target central and bridge symptoms.
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23
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Liebman RE, Becker KR, Smith KE, Cao L, Keshishian AC, Crosby RD, Eddy KT, Thomas JJ. Network Analysis of Posttraumatic Stress and Eating Disorder Symptoms in a Community Sample of Adults Exposed to Childhood Abuse. J Trauma Stress 2021; 34:665-674. [PMID: 33370465 DOI: 10.1002/jts.22644] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 11/13/2020] [Accepted: 11/16/2020] [Indexed: 11/08/2022]
Abstract
Posttraumatic stress disorder (PTSD) and eating disorders (EDs) are individually debilitating and highly comorbid conditions. Childhood abuse is a prominent risk factor for PTSD and ED symptoms both individually and as a comorbid syndrome (PTSD-ED). There may be a functional association between comorbid PTSD-ED symptoms whereby disordered eating behaviors are used to avoid trauma-related thoughts and feelings. The current study used a network analytic approach to examine key associations between PTSD and ED symptom subscales (i.e., PCL-5 and EPSI, respectively) in a community sample of 120 adults who endorsed at least one experience of childhood abuse (i.e., physical, sexual, or emotional abuse; witnessing domestic violence). Participants completed an anonymous online survey using Amazon's Mechanical Turk Prime. We used three network analysis indices (i.e., strength centrality, key players, and bridge symptoms) to identify symptoms that may maintain the comorbid PTSD-ED network. The results indicated that reexperiencing symptoms had the highest strength centrality in the PTSD-ED network and bridged the PTSD and ED clusters. For ED, cognitive restraint was a bridge to all PTSD symptoms. Hyperarousal, negative alterations in cognitions and mood (NACM), and purging were key players, indicating they are integral to the network structure. If replicated in prospective studies, these results may indicate that reexperiencing and cognitive restraint are core drivers of PTSD-ED comorbidity, whereas hyperarousal, NACM, and purging may be downstream consequences maintaining the comorbid condition. Concurrent treatments that address PTSD and ED symptoms simultaneously may result in the best outcomes.
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Affiliation(s)
- Rachel E Liebman
- Faculty of Health, York University, Toronto, Canada.,Department of Psychology, Ryerson University, Toronto, Canada
| | - Kendra R Becker
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Kathryn E Smith
- Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, Los Angeles, California, USA
| | - Li Cao
- Sanford Center for Biobehavioral Research, Fargo, North Dakota, USA
| | - Ani C Keshishian
- Department of Psychology, University of Louisville, Louisville, Kentucky, USA
| | - Ross D Crosby
- Sanford Center for Biobehavioral Research, Fargo, North Dakota, USA
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer J Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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24
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Abstract
Pathological exercise behavior is pervasive in eating disorder psychopathology, yet minimal treatment guidance exists for extinguishing it as little is known about how to differentiate pathological from healthy exercise. The purpose of this study was to characterize pathological exercise in terms of motivation to increase the specificity with which both pathological and healthy exercise is described and to inform treatment interventions. Latent profile analysis characterized homogenous groups based on exercise motivation in two samples: college women (n = 200) and women with eating psychopathology (n = 211). These profiles were compared on levels of eating and general psychopathology and emotion dysregulation. Three profiles emerged describing sedentary, pathological exercise, and athlete groups in the first sample, and five profiles describing neutral, sedentary, weight loss, athlete, and pathological exercise groups emerged in the second sample. Findings indicate that motivation style is salient in defining pathological exercise and may, therefore, be a clinically useful treatment target.
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25
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Horvath SA, Kolp HM, Andersen CV, Johnson EE, Racine SE, Borsari B, Stuart GL, Gidycz CA, Shorey RC. Emotion dysregulation moderates the relationship between alcohol use and eating pathology among heavy-drinking college men. J Clin Psychol 2021; 77:1763-1775. [PMID: 33971020 DOI: 10.1002/jclp.23157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 04/02/2021] [Accepted: 04/12/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES There is limited research examining the relationship between alcohol use and eating pathology in men or factors that may moderate this association. The current study investigated the relationship between alcohol use and eating pathology, and examined emotion dysregulation as a moderator of this association, among heavy-drinking college men. METHOD Men mandated to receive an alcohol intervention (N = 88; average age = 19 years) completed questionnaires related to alcohol use, emotion dysregulation, and eating pathology. RESULTS Results demonstrated positive relationships between alcohol use and some eating pathology, and a significant interaction between alcohol use and emotion dysregulation. However, results were contrary to hypotheses, such that there was a positive relationship between alcohol use and eating pathology at low levels of emotion dysregulation. CONCLUSION Future studies should continue to examine the overall presentation of eating pathology in men and investigate factors that may impact the relationship between alcohol use and eating pathology.
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Affiliation(s)
- Sarah A Horvath
- Department of Psychology, Ohio University, Athens, Ohio, USA
| | - Haley M Kolp
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | | | - Ellen E Johnson
- Department of Psychology, Ohio University, Athens, Ohio, USA
| | - Sarah E Racine
- Department of Psychology, McGill University, Montreal, Qubec, Canada
| | - Brian Borsari
- Department of Psychiatry, University of California, San Francisco, California, USA
| | - Gregory L Stuart
- Department of Psychology, University of Tennessee, Knoxville, Tennessee, USA
| | | | - Ryan C Shorey
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
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26
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Dreier MJ, Coniglio K, Selby EA. Mapping features of pathological exercise using hierarchical-dimensional modeling. Int J Eat Disord 2021; 54:422-432. [PMID: 33185893 DOI: 10.1002/eat.23406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/23/2020] [Accepted: 10/24/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Pathological exercise is common among those with eating disorders and has typically been characterized as excessive, compulsive, or compensatory in nature. Little is known about how pathological exercise is associated with other eating disorder behaviors or personality traits, or whether these associations differ between men and women. METHOD We used hierarchical dimensional modeling in three samples, including college women (N = 205), women with eating psychopathology (N = 268), and college men (N = 235), to examine latent associations between pathological exercise and eating disorder psychopathology, namely compulsivity, emotion regulation, and body dissatisfaction. RESULTS Using Goldberg's (2006) "bass-ackwards" method, we identified separate 10-factor solutions (women) or an 11-factor solution (men). A distinct muscle building factor arose in the three-factor solution for men, and it also notably arose in the six- and eight-factor solutions for community and college women, respectively, highlighting an important understudied motivation factor in both healthy and pathological exercise. Each solution accounted for 64.8% (college women), 51.9% (women with eating psychopathology), and 43.9% (college men) of the variance in excessive exercise, respectively. DISCUSSION Findings indicate that pathological exercise is associated with different psychological traits (e.g., poor emotion regulation, compulsivity) across populations, and such differences may necessitate unique treatment approaches tailored accordingly.
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Affiliation(s)
- Melissa J Dreier
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kathryn Coniglio
- Department of Psychology, Rutgers University, Piscataway, New Jersey, USA
| | - Edward A Selby
- Department of Psychology, Rutgers University, Piscataway, New Jersey, USA
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Yoon C, Simone M, Mason SM, Neumark-Sztainer D. A single summative global scale of disordered eating attitudes and behaviors: Findings from Project EAT, a 15-year longitudinal population-based study. Eat Behav 2020; 39:101418. [PMID: 32866851 PMCID: PMC7704841 DOI: 10.1016/j.eatbeh.2020.101418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 07/20/2020] [Accepted: 08/11/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The Project EAT Disordered Eating Attitudes and Behaviors (DEAB) scale was created from disordered eating attitudes and behaviors that tend to interrelate. To examine the appropriateness of the scale, we assessed the fit (i.e., how well a single latent factor fits a set of interrelated disordered eating attitudes and behaviors) and the convergent validity over time. METHOD Five interrelated disordered eating attitudes and behaviors were assessed in a longitudinal cohort (Project EAT, age 11 to 18 in 1998-1999, N = 1492). Confirmatory factor analysis examined the appropriateness of the DEAB scale. To examine whether individual variables function differently in relation to the latent construct across time, two models were compared: one requiring indicator-level factor loadings to remain equivalent across three time points (baseline [EAT-I], five-year follow-up [EAT-II], and 15-year follow-up [EAT-IV]), and the second allowing the factor loadings to vary over time. To examine the convergent validity, Pearson correlation with body satisfaction, self-esteem, depressive symptoms, and BMI was compared across time. RESULTS The fit indices for a single factor structure supported the use of the DEAB scale over time (standardized loadings: 0.60-0.87, 0.67-0.89, 0.59-0.77 at EAT-I, II, and IV respectively). As hypothesized, compared to fewer number of disordered eating attitudes and behaviors, greater number of attitudes and behaviors was associated with lower body satisfaction and self-esteem, and greater depressive symptoms and BMI (p < .01). DISCUSSION The Project EAT DEAB scale can be used as a proxy to measure the severity of disordered eating attitudes and behaviors over time in population-based studies.
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Affiliation(s)
- Cynthia Yoon
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55454, USA.
| | - Melissa Simone
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota 55454, USA
| | - Susan M. Mason
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota 55454, USA
| | - Dianne Neumark-Sztainer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota 55454, USA
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Chapa DAN, Kite BA, Forbush KT, Tregarthen JP, Argue S. Eating-disorder psychopathology and driven exercise change models: A latent change score analysis. Int J Eat Disord 2020; 53:2013-2025. [PMID: 33141971 DOI: 10.1002/eat.23392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/29/2020] [Accepted: 09/29/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Approximately 50% of people with eating disorders (EDs) engage in driven exercise to influence their weight or shape and/or to compensate for loss-of-control eating. When present, driven exercise is associated with a lower quality-of-life, longer hospital stays, and faster rates-of-relapse. Despite the seriousness of driven exercise, most treatments for EDs do not target maladaptive exercise behaviors directly. Given the large proportion of patients with an ED who engage in driven exercise and its effect on treatment outcomes, it is critical to understand what predicts change in driven exercise. The purpose of this study was to test whether ED symptoms prospectively predicted change in driven exercise and vice versa. METHOD Participants were Recovery Record (RR) users (N = 4,568; 86.8% female) seeking treatment for an ED. Participants completed the Eating Pathology Symptoms Inventory (EPSI) monthly for 3 months. RESULTS In the full sample, dynamic bivariate latent change score analyses indicated that high levels of dietary restraint and restricting prospectively predicted reductions in driven exercise. Among persons with anorexia nervosa (AN), high levels of binge eating predicted increased driven exercise. Among persons with bulimia nervosa (BN), high levels of body dissatisfaction predicted increased driven exercise. Among persons with binge-eating disorder (BED), high levels of binge eating, purging, and restricting predicted reductions in driven exercise. DISCUSSION Results highlight changes that may predict increased or decreased driven exercise relative to other ED symptoms for AN, BN, and BED groups. These preliminary findings could inform future research on ED treatment efforts to manage driven exercise.
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Affiliation(s)
| | - Benjamin A Kite
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
| | - Kelsie T Forbush
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
| | | | - Stuart Argue
- Recovery Record, Inc, Palo Alto, California, USA
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29
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Culbert KM, Shope MM, Sisk CL, Klump KL. Low testosterone is associated with dysregulated eating symptoms in young adult men. Int J Eat Disord 2020; 53:1469-1479. [PMID: 32643144 DOI: 10.1002/eat.23320] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Extant animal and human data indicate that natural variation in circulating levels of testosterone may contribute to differential risk for dysregulated eating among males. Indeed, testosterone ablation in postpubertal male rodents results in stimulatory effects on sweet-taste preferences, and lower levels of circulating testosterone in adolescent boys have been found to predict dysregulated eating symptoms during mid-to-late puberty. Nonetheless, no prior study has examined whether lower testosterone is associated with dysregulated eating in adulthood. The current study examined this possibility. METHOD Participants were 154 young adult men (ages = 18-33) from a large Southwestern University. The Eating Disorder Examination Questionnaire, Eating Pathology Symptoms Inventory, and Loss of Control Over Eating Scale were used to assess three types of dysregulated eating symptoms: eating concerns, binge eating, and loss-of-control eating. Afternoon saliva samples were assayed for testosterone using high-sensitive enzyme immunoassays. RESULTS Consistent with animal data and prior research in adolescent boys, men with lower testosterone reported significantly higher levels of dysregulated eating symptoms even after controlling for depressive symptoms, body mass index, and age. DISCUSSION Lower testosterone concentrations might serve as a sex-specific biological factor that contributes to dysregulated eating among men.
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Affiliation(s)
- Kristen M Culbert
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Megan M Shope
- Department of Psychology, University of Nevada, Las Vegas, Nevada, USA
| | - Cheryl L Sisk
- Neuroscience Program, Michigan State University, East Lansing, Michigan, USA
| | - Kelly L Klump
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
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30
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Chapa DAN, Hagan KE, Forbush KT, Clark KE, Tregarten JP, Argue S. Longitudinal trajectories of behavior change in a national sample of patients seeking eating-disorder treatment. Int J Eat Disord 2020; 53:917-925. [PMID: 32275088 DOI: 10.1002/eat.23272] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/18/2020] [Accepted: 03/18/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Rapid response to treatment, indicated by substantial decreases in eating-disorder (ED) symptoms within the first 4-6 weeks of treatment, is the most reliable predictor of treatment outcomes for EDs. However, there is limited research evaluating short-term longitudinal trajectories of ED symptoms during treatment. Thus, it is difficult to know which aspects of ED psychopathology are slow or fast to change. The purpose of this study was to elucidate three-month trajectories of ED psychopathology during treatment and test whether ED diagnosis influenced the direction and rate of change. METHOD Participants were Recovery Record users seeking treatment for an ED (N = 4,568; 86.8% female). Participants completed the Eating Pathology Symptoms Inventory once per month for 3 months. RESULTS Latent growth curve models indicated that ED diagnosis influenced the rate of ED behavior change. Anorexia nervosa was associated with faster reductions in cognitive restraint, excessive exercise, restricting, yet slower reductions in body dissatisfaction, and binge eating. Bulimia nervosa was associated with faster reductions in binge eating, cognitive restraint, excessive exercise, and purging. Binge-eating disorder was associated with faster reductions in body dissatisfaction and binge eating, yet slower reductions in restricting. CONCLUSIONS Our results have implications for future research by providing initial information about the direction and rate of ED change over the course of treatment. If clinicians and researchers know which ED symptoms are slow to change, on average, across diagnostic groups, treatment protocols could be adjusted to target slow changing symptoms more quickly, and therefore improve ED treatment outcomes.
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Affiliation(s)
| | - Kelsey E Hagan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Kelsie T Forbush
- Department of Psychology, University of Kansas, Lawrence, KS, USA
| | - Kelsey E Clark
- Department of Psychology, University of Kansas, Lawrence, KS, USA
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Suissa-Rocheleau L, Benning SD, Racine SE. Associations between self-report and physiological measures of emotional reactions to food among women with disordered eating. Int J Psychophysiol 2019; 144:40-46. [DOI: 10.1016/j.ijpsycho.2019.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 07/12/2019] [Accepted: 08/11/2019] [Indexed: 11/29/2022]
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32
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Becker KR, Keshishian AC, Liebman RE, Coniglio KA, Wang SB, Franko DL, Eddy KT, Thomas JJ. Impact of expanded diagnostic criteria for avoidant/restrictive food intake disorder on clinical comparisons with anorexia nervosa. Int J Eat Disord 2019; 52:230-238. [PMID: 30578644 PMCID: PMC7191972 DOI: 10.1002/eat.22988] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 11/09/2018] [Accepted: 11/13/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Avoidant/restrictive food intake disorder (ARFID) and anorexia nervosa (AN) are restrictive eating disorders. There is a proposal before the American Psychiatric Association to broaden the current DSM-5 criteria for ARFID, which currently require dietary intake that is inadequate to support energy or nutritional needs. We compared the clinical presentations of ARFID and AN in an outpatient sample to determine how a more inclusive definition of ARFID, heterogeneous for age and weight status, is distinct from AN. METHODS As part of standard care, 138 individuals with AN or ARFID completed an online assessment battery and agreed to include their responses in research. RESULTS Individuals with ARFID were younger, reported earlier age of onset, and had higher percent median BMI (%mBMI) than those with AN (all ps < .001). Individuals with ARFID scored lower on measures of eating pathology, depression, anxiety, and clinical impairment (all ps < .05), but did not differ from those with AN on restrictive eating (p = .52), and scored higher on food neophobia (p < .001). DISCUSSION Allowing psychosocial impairment to be sufficient for an ARFID diagnosis resulted in a clinical picture of ARFID such that %mBMI was higher (and in the normal range) compared with AN. Differences in gender distribution, age, and age of onset remained consistent with previous research. Both groups reported similar levels of dietary restriction, although ARFID can be distinguished by relatively higher levels of food neophobia. Currently available measures of eating pathology may capture certain ARFID symptoms, but highlight the need for measures of impairment relative to ARFID.
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Affiliation(s)
- Kendra R. Becker
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Ani C. Keshishian
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital
| | - Rachel E. Liebman
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | | | - Shirley B. Wang
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital,Department of Psychology, Harvard University, Boston, Massachusetts
| | - Debra L. Franko
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital,Northeastern University, Boston, Massachusetts
| | - Kamryn T. Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Jennifer J. Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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