Test of Stice's dual pathway model: dietary restraint and negative affect as mediators of bulimic behavior

Randomized control trial of a single-session intervention targeting sociocultural pressures of body image in college sorority women

Objective: To assess the effectiveness of a peer-led single-session intervention targeting the sociocultural pressures of body image. Participants: New members of 13 sororities at one university. Methods: Participants were randomized by sorority into the intervention (n = 207) or wait list control (n = 264). Online surveys were administered at baseline and one month to assess social determinants of body image, body image dissatisfaction (BID), and body appreciation. Multiple logistic and linear regression analyses compared changes over time between groups. Results: We observed significant improvements in overall sociocultural pressures of body image (p = .001) and the subscales of Norms (p < .001) and Perceived Norms (p = .009) of eating and exercise behaviors. Change in BID and body appreciation did not differ between groups. Conclusion: A one-hour peer-led community-level intervention can lead to positive changes in sociocultural pressures in new initiates to a sorority.

Helicopter parenting and college student depression: the mediating effect of physical self-esteem

Background

Depression is one of the most common and prevalent mental disorders, and college students are a high-risk group for depression. Helicopter parenting plays an important role in depression, but the mechanism is still ambiguous. Therefore, this study investigates the specific impact and mechanism of helicopter parenting on college students' depression.

Methods

Employing a questionnaire-based approach, we assessed the relationship between helicopter parenting, Physical self-esteem, and depression. The questionnaire comprised three scales: the Helicopter Parenting Scale, Physical Self-Esteem Scale, and Self-Rating Depression Scale. The study sample included 539 university (average age 18.84 ± 1.1 years; 184 males and 355 females).

Results

Helicopter parenting demonstrated significant negative predict with physical self-esteem (β = -0.75, p < 0.001), and positive predict depression (β = 0.33, p < 0.001). Helicopter parenting impacts depression among college students through two channels: solely via physical self-esteem (mediating effect value: 0.66), and through direct influence (effect value: 0.64).

Conclusion

The insights from this study address the two pivotal questions about "why" and "how" helicopter parenting influences depression in college students, offering recommendations for managing depressive moods among college students.

Weight status is associated with clinical characteristics among individuals with bulimia nervosa

Recent studies have found increasing rates of overweight and obesity in bulimia nervosa (BN). However, the relationships between body mass index (BMI) and BN symptoms and other clinically relevant constructs are unknown. Participants (N = 152 adults with BN) were assigned to three groups by BMI: group with no overweight or obesity (NOW-BN; BMI <25; N = 32), group with overweight (OW-BN; BMI ≥25 and <30; N = 66), and group with obesity (O-BN; BMI ≥30; N = 54). We compared the groups on demographics, diet and weight histories, body esteem, BN symptoms, and depression using chi square, analysis of variance, analysis of covariance, and Poisson regression models. The O-BN group was older (d = 0.57) and OW-BN and O-BN groups had greater proportions of race/ethnic minorities than NOW-BN group. The O-BN group was significantly younger at first diet (d = 0.41) and demonstrated significantly higher cognitive dietary restraint (d = 0.31). Compared to NOW-BN, O-BN participants had lower incidence of objective binge eating (incidence rate ratio [IRR] = 4.86) and driven exercise (IRR = 7.13), and greater incidence of vomiting (IRR = 9.30), laxative misuse (IRR = 4.01), and diuretic misuse (d = 2.08). O-BN participants also experienced higher shape (d = 0.41) and weight (d = 0.42) concerns than NOW-BN and OW-BN, although NOW-BN experienced higher shape (d = 0.44) and weight (d = 0.39) concerns than OW-BN. Groups did not differ on depression scores. These results were replicated when examining BMI as a continuous predictor across the full sample, with the exception of objective binge eating and driven exercise, which were not significantly associated with BMI. Individuals with BN and comorbid obesity have distinct clinical characteristics. Existing interventions may need to be adapted to meet clinical needs of these individuals.

Reexamining the restraint pathway as a conditional process among adolescent girls: When does dieting link body dissatisfaction to bulimia?

The mediational sequence from body dissatisfaction through dieting to bulimia-often referred to as the "restraint pathway"-has been validated in numerous samples of adolescent girls, but the prevalence rate of bulimic pathology pales in comparison to rates of body dissatisfaction and dieting in this risk group. This discrepancy indicates that the restraint pathway may only apply to adolescent girls possessing certain characteristics or experiencing certain circumstances. Accordingly, the current study examined the moderating roles of thin-ideal internalization, interoceptive deficits, and age by using self-report data from a community sample of 353 middle school (n = 115), high school (n = 112), and college girls (n = 126). We found that (a) body-dissatisfied girls who reported high, versus low, thin-ideal internalization engaged in greater dietary restraint; (b) only dieters who reported high interoceptive deficits and were of college age expressed bulimic symptoms; and (c) the mediating effect pertained only to college girls with high interoceptive deficits, but was strongest for those who reported high, versus low, thin-ideal internalization. These results suggest that the restraint pathway's precision may be fine-tuned through greater sensitivity to potentiating factors and developmental context. Theoretical, empirical, and practical implications are discussed.

The Relative Associations of Body Image Dissatisfaction among Psychiatric Out-Patients in Singapore

Background: Adults with body image dissatisfaction (BID) are more likely to be depressed, anxious, and suicidal when compared to those without intense dissatisfaction over their appearance. The current study aimed to estimate the prevalence and factors associated with BID among out-patients with mental illness in Singapore. Methods: Data was collected from 310 psychiatric out-patients using a self-administered questionnaire. Measurements used were socio-demographic characteristics, Body Mass Index scores, Body Shape Questionnaire, Binge Eating Scale, Eating Attitudes Test, Beck’s Depression Inventory, Beck’s Anxiety Inventory and Alcohol Use Disorders Identification Test. Results: A prevalence of 30.9% of BID was established among psychiatric out-patients in Singapore. Being female, having higher BMI scores, binge eating behavior, eating disorders, and those diagnosed with depression were positively associated with BID. Conclusion: BID is prevalent among those with psychiatric illnesses which could lead to a higher degree of psychological distress and the emergence of eating disorders.

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.

Gender Differences in Risk Factors for Stice’s Bulimia in a Non-Clinical Sample

Some females are at an increased risk of developing bulimia. However, etiological factors and their interplay remain controversial. The present study analyzed Sticefe Model for eating disorders in a non-clinical population by examining gender differences with respect to the following risk factors: body mass index (BMI), body dissatisfaction, perceived social pressure to be thin, body-thin internalization, and dieting behavior. A sample of 162 American college students (64 males and 91 females) was surveyed, and validated scales were used. The Sticey model was tested using Structural Equation Modeling. Our results supported Stice r Dual Pathway Model of bulimic pathology for females but not for males. Females reported significantly higher body dissatisfaction, perceived pressure to be thin and weight-loss oriented behaviors than males (p < .05), but no gender differences were found in their degree of body thin internalization (p > .05), a key predictor of body dissatisfaction (r = .33; p < .01). Participants with higher BMI reported greater social pressure to be thin than those with lower BMI (p < .05). However, females engaged in dietary restraint, the main risk factor for eating disorders, regardless of their BMI (p > .05) although their BMI was significantly lower than males (d = 0,51). The results of this study fail to support the role of BMI as a predictor of dietary restraint in females, the main risk factor of eating disorders. Males may abstain from dietary restraint to gain muscular volume and in turn increase their BMI. Implications are discussed.

Relationship between body dissatisfaction and disordered eating: mediating role of self-esteem and depression

The purpose of this study was to investigate the hypothesis that the effect of body dissatisfaction on disordered eating behavior is mediated through self-esteem and depression. If the effect of body dissatisfaction on disordered eating can be explained by self-esteem and depression, treatment may benefit from focusing more on self-esteem and depression than body dissatisfaction. We also hypothesized body image importance to be associated with lower self-esteem, stronger symptoms of depression, and more disordered eating. The results showed that the effect of body dissatisfaction on disorder eating was completely mediated, whereas the effect of body image importance was partly mediated. Both self-esteem and depression were significant mediators. Body image importance and self-esteem had a direct effect on restrained eating and compensatory behavior. Depression had a direct effect on binge eating. This effect was significantly stronger among women. Depression also had a direct effect on restrained eating. This effect was positive among women, but negative among men. The results support emotion regulation and cognitive behavioral theories of eating disorders, indicating that self-esteem and depression are the most proximal factors, whereas the effect of body dissatisfaction is indirect. The results point out the importance of distinguishing between different symptoms of bulimia. Depression may cause binge eating, but compensatory behavior depends on self-esteem and body image importance. The results suggest that women may turn to both binge eating and restrained eating to escape awareness of negative emotions, whereas men focus on eating to a lesser extent than women. Existing treatment focuses on eating behavior first and mechanisms such as self-esteem and depression second. The results from this study suggest that an earlier focus on self-esteem and depression may be warranted in the treatment of disordered eating.

Body weight dissatisfaction: a comparison of women with and without eating disorders

OBJECTIVE

Body dissatisfaction is present in a majority of women without eating disorders (EDs), and almost all women with EDs. We compared body dissatisfaction in women with and without EDs to determine at which BMI women are content with their weight, and to determine if body dissatisfaction is affected by the presence of purging behaviours.

METHODS

We assessed women, age 18 to 55 with an ED (N=431) and without an ED (N=719) using the discrepancy between their current and desired BMI. This measure of body weight dissatisfaction (BWD) has been validated as being representative of overall body dissatisfaction. We also measured perceptions of (i) Body Appearance and (ii) Body Image to confirm our results.

RESULTS

Women with and without EDs wished to lose weight until very low weights were achieved (BMI 15-16 kg/m(2) and BMI 18-19 kg/m(2) respectively). BWD is higher in women with EDs (median 1.77, IQR 0-4.61) than women without EDs (median 0.85, IQR 0-1.80, p<0.001). Purging behaviours in women with EDs were associated with lower BMIs to achieve body satisfaction (BMI 15-16 kg/m(2)) than women who did not purge (16-17 kg/m(2)).

CONCLUSIONS

Body weight dissatisfaction is highly prevalent amongst women with and without EDs. Understanding body weight dissatisfaction in women with EDs and its association with purging may assist in the prevention, detection and treatment of these disorders. Women with EDs should be informed that body weight dissatisfaction will not resolve with the cessation of their disorder, as it is prevalent within the general population.

Testing the original and the extended dual-pathway model of lack of control over eating in adolescent girls. A two-year longitudinal study

Stice's (1994, 2001) dual pathway model proposed a mediational sequence that links body dissatisfaction to lack of control over eating through dieting and negative affect. Van Strien et al. (2005) extended the negative affect pathway of the original dual pathway model by adding two additional intervening variables: interoceptive deficits and emotional eating. The purpose of this study was to test and compare the original and extended model using prospective data. Both types of loss of control over eating (i.e., subjective and objective binge eating) were evaluated. Data collected from 361 adolescent girls, who were interviewed and completed self-report measures annually over a 2-year period, were analysed using structural equation modeling. Although both models provided a good fit to the data, the extended model fit the adolescent girls' sample data better and accounted for a greater proportion of variance in binge eating than the original model. All proposed mediational pathways of both models were supported and all indirect effects examined through bootstrap procedure were significant. Although our results confirmed the validity of both models and extended previous findings to an early- to middle adolescent group, the bi-directional relationship between dietary restriction and negative affect suggests that the association between these key risk factors for binge eating are more complex than outlined in both the original and extended dual-pathway models.

Associations Between Fear of Negative Evaluation and Eating Pathology During Intervention and 12-Month Follow-up

Fear of negative evaluation, a core feature of social anxiety disorder, has been prospectively related to eating pathology over and above other established risk factors, suggesting that it may be an important cognitive risk factor for eating disorders. The present study examined reciprocal longitudinal relations among fear of negative evaluation and eating disorder risk factors using a female undergraduate sample (N=82) enrolled in an eating disorder prevention program. Cross-lagged panel analysis revealed that fear of negative evaluation was a determinant of subsequent body dissatisfaction and eating disorder symptoms. Fear of negative evaluation also predicted subsequent thin-ideal internalization among participants with high BMI, but not among those with low BMI. Fear of negative evaluation did not predict future dietary restraint or negative affect but was itself predicted by prior levels of thin ideal internalization, body dissatisfaction, dietary restraint, and negative affect. Findings suggest that fear of negative evaluation may be a useful target for reducing body image concerns and maladaptive eating behavior.

Psychological distress as a mediator in the relationships between biopsychosocial factors and disordered eating among Malaysian university students

The mechanism linking biopsychosocial factors to disordered eating among university students is not well understood especially among Malaysians. This study aimed to examine the mediating role of psychological distress in the relationships between biopsychosocial factors and disordered eating among Malaysian university students. A self-administered questionnaire measured self-esteem, body image, social pressures to be thin, weight-related teasing, psychological distress, and disordered eating in 584 university students (59.4% females and 40.6% males). Body weight and height were measured. Structural equation modeling analysis revealed that the partial mediation model provided good fit to the data. Specifically, the relationships between self-esteem and weight-related teasing with disordered eating were mediated by psychological distress. In contrast, only direct relationships between body weight status, body image, and social pressures to be thin with disordered eating were found and were not mediated by psychological distress. Furthermore, multigroup analyses indicated that the model was equivalent for both genders but not for ethnic groups. There was a negative relationship between body weight status and psychological distress for Chinese students, whereas this was not the case among Malay students. Intervention and prevention programs on psychological distress may be beneficial in reducing disordered eating among Malaysian university students.

The dual-pathway and cognitive-behavioural models of binge eating: prospective evaluation and comparison

To evaluate and compare the dual-pathway, original cognitive-behavioural, and enhanced "transdiagnostic" cognitive-behavioural models of binge eating, using prospective data from a pre-adolescent sample. Models were tested using multilevel longitudinal structural equation modelling. Participants were 236 children (48% male) aged between 8 and 13 years at baseline, who were interviewed annually over a 2-year period. Binge eating was assessed using the Child Eating Disorder Examination. The dual-pathway and enhanced cognitive-behavioural models provided an acceptable fit to the data, whereas the original cognitive-behavioural model did not. Partial support is provided for the prospective validity of the dual-pathway and enhanced cognitive-behavioural models of binge eating in childhood. Results suggest that body dissatisfaction and weight and shape over-evaluation may both contribute to dieting behaviour in youth, and that dieting and affect-related difficulties both require consideration in theories of binge eating development.

The Alcohol Intervention Training Program (AITP): a response to alcohol misuse in the farming community

BACKGROUND

Farm men and women in Australia have higher levels of problematic alcohol use than their urban counterparts and experience elevated health risks associated with excessive alcohol consumption. The Sustainable Farm Families (SFF) program has worked successfully with farm men and women to address health, well- being and safety and has identified that further research and training is required to understand and address alcohol misuse behaviours. This project will add an innovative component to the program by training health professionals working with farm men and women to discuss and respond to alcohol-related physical and mental health problems.

METHODS/DESIGN

A mixed method design with multi-level evaluation will be implemented following the development and delivery of a training program (The Alcohol Intervention Training Program {AITP}) for Sustainable Farm Families health professionals. Pre-, post- and follow-up surveys will be used to assess both the impact of the training on the knowledge, confidence and skills of the health professionals to work with alcohol misuse and associated problems, and the impact of the training on the attitudes, behaviour and mental health of farm men and women who participate in the SFF project. Evaluations will take a range of forms including self-rated outcome measures and interviews.

DISCUSSION

The success of this project will enhance the health and well-being of a critical population, the farm men and women of Australia, by producing an evidence-based strategy to assist them to adopt more positive alcohol-related behaviours that will lead to better physical and mental health.

An investigation of the relationship between fear of negative evaluation and bulimic psychopathology

The current study examined fear of negative evaluation (FNE), the core fear associated with social anxiety, in the context of the dual pathway model of the etiology of bulimia nervosa. Our primary aim was to improve the understanding of the development of bulimic psychopathology. We investigated the relationships between FNE, the risk factors of the dual pathway model and bulimic symptoms using path analysis in a sample of female undergraduates (N=210). The inclusion of FNE increased the predictive ability of the model to account for 49% of the variance in bulimic symptoms compared to previous findings in which the model accounted for 33% of the variance. Additionally, FNE was related to several risk factors of the dual pathway model including the pressure to be thin, thin-ideal internalization and negative affect, as well as contributing directly to bulimic symptoms. These findings suggest that FNE may increase the risk for developing established risk factors of the model, as well as bulimic symptoms, and that targeting FNE in prevention programs may be useful in circumventing this serious disorder.

The effect of attachment insecurity in the development of eating disturbances across gender: the role of body dissatisfaction

The present study examined the effects of insecure attachment on the development of negative body image as a contributing factor to the development of disturbed eating patterns in male and female university students. Participants were nonclinical male (n = 100) and female (n = 381) university students. Administering self-report questionnaires, the authors assessed demographic information (gender, age), anthropometric data (Body Mass Index [BMI], age), romantic attachment (ECRS-R; R. C. Fraley, N. G. Waller, & K. A. Brennan, 2000), body dissatisfaction (BSQ), and disturbed eating (EAT-26). The authors found body dissatisfaction to fully mediate the relationship between attachment anxiety and disordered eating in women. Body dissatisfaction mediated anxious attachment and dieting in men. In addition, attachment avoidance had a direct impact on eating behaviors for both genders, without the mediation of any variables measured in this study. The findings of the present study suggest that the anxiety and avoidance dimensions of attachment insecurity affect eating behaviors differently, and the effects are different across genders. The authors discuss results in the context of therapeutic interventions design.

Symptoms of disordered eating, body shape, and mood concerns in male and female Chinese medical students

OBJECTIVE

This cross-sectional study explored the prevalence of disordered eating attitudes, body shape concerns, and social anxiety and depressive symptoms in male and female medical students in China.

METHOD

Four hundred eighty-seven students from Central South University (Hunan Province, Changsha City, China) completed the following self-report measures: Eating Attitudes Test-26, Eating Disorders Assessment Questionnaire, Body Shape Questionnaire, Swansea Muscularity Attitudes Questionnaire, Social Interaction Anxiety Scale, and the Self-Rating Depression Scale.

RESULTS

A comparatively lower rate of at-risk eating attitudes (2.5%) and eating disorders (0.90%) were found compared to those reported in other studies. Significantly more female (3.2%) than male (1.2%) students had abnormal eating attitudes with 4 female students meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for bulimia nervosa. Significant relationships were observed between eating attitudes, body shape concern, social anxiety, depression, and body mass index. For females, the most significant correlate of distorted eating attitudes was body shape concern, whereas for male students, social anxiety and concern with muscle size and shape were most strongly correlated with distorted eating attitudes.

Impact of a healthy body image program among adolescent boys on body image, negative affect, and body change strategies

This study evaluated the effectiveness of a healthy body image program. In total, 421 adolescent boys completed a five-session intervention program or a wait list control group. There were no differences between the intervention and the control group at post-intervention or any of the follow-up times. Boys in the intervention group who were one standard deviation above the mean on body dissatisfaction at baseline, demonstrated a reduction in negative affect in the intervention group at post-test and 6 months follow-up. Prevention programs need to target boys who are at risk of adopting health risk behaviors, rather than being universally applied.

Can we apply the dual-pathway model of overeating to a population of weight-preoccupied overweight women?

OBJECTIVE

The aim of the study is to verify the applicability of the dual-pathway model among weight-preoccupied overweight women and to document the restraint pathway, the negative affect pathway, and the possibility of a direct pathway from body dissatisfaction to overeating.

METHOD

Structural equations were performed to test the model on baseline data of 153 weight-preoccupied overweight women recruited to participate in a randomized trial.

RESULTS

Findings suggest that the model obtains satisfactory fit. Although the restraint pathway is partially supported, the negative affect pathway is confirmed. A third pathway linking directly body dissatisfaction to overeating is also evidenced.

DISCUSSION

The dual-pathway model of overeating seems to be representative of the reality of weight-preoccupied overweight women, which could be pointed as a population in need of clinical attention, particularly considering the dramatically increasing rates of obesity.

The role of body image and disordered eating as risk factors for depression and suicidal ideation in adolescents

There is much empirical literature on factors for adolescent suicide risk, but body image and disordered eating are rarely included in these models. In the current study, disordered eating and body image were examined as risk factors for suicide ideation since these factors are prevalent in adolescence, particularly for females. It was hypothesized that disordered eating and body image, in addition to depressive symptoms, would contribute to suicide ideation. It was also hypothesized that these relationships would be stronger for females than for males. Structural equation modeling was used to test a model of risk for suicide ideation incorporating the above factors in a sample of 392 high school students. Results indicated that disordered eating contributed to both suicide ideation and depressive symptoms, while body image only contributed to depressive symptoms. Depressive symptoms contributed to suicide ideation. The model was found to be cross-validated with males and females, and no gender differences emerged. Implications of these findings and their importance in constructing future models of adolescent suicide risk are discussed.

Temperament, mood, dietary restraint, and bulimic symptomatology in college women

The current study examined whether biologically-influenced temperamental traits implicated in the pathogenesis of disordered eating behaviors contribute to their development over and above current negative affect and dietary restraint. Participants (N=276) were undergraduate psychology women who completed the BULIT-R, BDI-II, STAIS, RS, and the MPQ. Temperamental characteristics, particularly increased Negative Emotionality and decreased Positive Emotionality, were significantly associated with increased levels of bulimic symptomatology. Moreover, these dimensions accounted for small, but statistically significant amounts of the variance of bulimic symptomatology over and above current negative affect and dietary restraint. Contrary to expectations, impulsivity did not predict bulimic symptoms. This study provides evidence that temperamental dimensions related to mood rather than impulsivity are associated with bulimic symptomatology and contribute to bulimic symptoms over and above state mood and dietary restraint. Future empirical studies are needed to clarify relationships between temperament and other risk factors for disordered eating.

Body image and suicidal ideation in adolescents

Data from 231 adolescents (mean age=15.7, SD=1.39) were collected from a public school setting in the United States. Participants completed several measures, including those assessing depression, hopelessness, past suicidal behavior, body image, and current suicidal ideation. It was hypothesized that depression, hopelessness, past suicidal behavior, and body image (a risk factor seldom examined) would significantly predict current suicidal ideation and that there would be gender differences for body image. Regression analyses indicated that all risk factors including body image were significant predictors of current suicidal ideation for the whole sample. For both males and females, body image offered a unique contribution to the measurement of suicide ideation above and beyond the other risk factors, with body attitudes/feelings being the strongest predictor. Results encourage the inclusion of body image as a variable in risk models for adolescent suicidal ideation, as it likely accounts for additional variance above and beyond traditional risk factors.

Why do normal weight young women look for diet-therapy? Findings from a pilot study in a clinical and non-clinical population

The behavioural factors that drive a normal weight woman to embark on a diet and to look for nutritional support in weight loss clinics are still not completely understood. A pilot cross-sectional study was carried out in 70 young (age range: 18-35 yr), normal weight women attending a weight loss clinic in South of Italy (Naples). They were compared to a population of 94 normal weight students (age range:17-23 yr) who had never attended a weight loss clinic. Subjects with eating disorders have been excluded. Weight and height were measured and body mass index (BMI) was calculated. Eating behaviour was assessed using a validated Italian version of the Eating Disorders Inventory (EDI) questionnaire. The two groups were matched for BMI (22.4 vs 22.1 kg/m2), smoking and physical activity. Students were more educated and less likely to be on a diet at the time of the study. Students had statistically significant lower scores for drive for thinness, body dissatisfaction, inadequacy and interpersonal disrupt. The bulimia scale was the only significant predictor (p<0.05) of BMI in the patients' group; body dissatisfaction (p<0.05) predicted BMI in the control group. This study has shown that weight concern and health awareness are not the only factors that lead a normal weight woman to look for nutritional counselling but there is an underlying substrate of psychological and social distress behind the request, which should be properly assessed before starting any nutritional therapy in the clinical practice.

Negative affect as a mediator between body dissatisfaction and extreme weight loss and muscle gain behaviors

Negative affect has been found to mediate the relationship between body dissatisfaction and bulimia. However, it is unknown if this relationship also applies to disordered eating, excessive exercise and strategies to increase muscle for men or women. The aim of this study was to investigate whether negative and positive affect mediate the relationship between body dissatisfaction, and these body change strategies. Respondents were 93 men and 97 women (age range: 18-25 years), who completed measures of body dissatisfaction, positive and negative affect and body change strategies to lose weight or increase muscles. Body dissatisfaction was associated with strategies to lose weight, dietary restraint and bulimia for both genders. Negative affect mediated the relationship between dissatisfaction with muscles and strategies to lose weight, dietary restraint and bulimia for women only. The results confirm previous findings related to the association between negative affect and disordered eating for women. They also demonstrate the need to further investigate the impact of negative affect on body change strategies, particularly among men, and those strategies related to increasing muscles.

The Stice model of overeating: Tests in clinical and non-clinical samples

The present study tested the dual pathway model of Stice [. A review of the evidence for a sociocultural model of bulimia nervosa and an exploration of the mechanisms of action. Clinical Psychology Review, 14, 633-661 and . A prospective test of the dual-pathway model of bulimic pathology: mediating effects of dieting and negative affect. Journal of Abnormal Psychology, 110, 124-135.] in a non-clinical sample of female adolescents and a clinical sample of female eating disorder patients. The model assumes that negative affect and restrained eating mediates the link between body dissatisfaction and overeating. We also tested an extended version of the model postulating that negative affect and overeating are not directly related, but indirectly through lack of interoceptive awareness and emotional eating. Structural equation modelling was used to test our models. First, in the two samples, body dissatisfaction and drive for thinness were associated with overeating/binge eating. In both clinical and adolescent sample, we found support for the negative affect pathway and not for the restraint pathway. Lack of interoceptive awareness and emotional eating appear to (partly) explain the association between negative affect and overeating. Emotional eating was much more strongly associated with overeating in the clinical than in the adolescent sample. In sum, we found substantial evidence for the negative affect pathway in the dual pathway model. The link between body dissatisfaction and overeating in this respect might be explained by the fact that negative affect, due to body dissatisfaction, is related to a lack of awareness of personal feelings and to eating when dealing with negative emotions, which on its turn is associated with overeating.

Sociocultural influences on body image and body changes among adolescent boys and girls

In 2 studies, the authors evaluated the role of parents, peers, and the media in body image and body-change strategies among adolescent boys and girls. The respondents for Study 1 (423 boys and 377 girls) completed the Body Image and Body Change Inventory (L. A. Ricciardelli & M. P. McCabe, 2002) and the Perceived Sociocultural Influences on Body Image and Body Change Questionnaire (M. P. McCabe & L. A. Ricciardelli, 2001b). Body mass index and age were also included in the analyses. Regression analyses demonstrated that sociocultural influences and feedback from the participant's best male friend were important predictors for all body-change strategies among boys. For girls, sociocultural influences and feedback from the participant's best female friend and mother were important predictors for body-change strategies. The most consistent predictor of weight loss, weight gain, and strategies to increase muscles was body-image importance. In Study 2, the authors examined the influence of the same sociocultural variables, as well as negative affect and puberty on body image and body-change strategies among a second group of 199 boys and 267 girls. The results demonstrated that a broad range of sociocultural influences predicted body-change strategies for boys and girls, with negative affect also having a unique influence for boys but not for girls. Puberty played a minor role, once other sociocultural variables were entered into the regression equation. The implications of these findings are discussed.

Role of body dissatisfaction in the onset and maintenance of eating pathology: a synthesis of research findings

OBJECTIVE

Recent findings implicate body dissatisfaction in the development and maintenance of eating pathology. This paper reviews theory and empirical findings regarding the putative origins and consequences of body dissatisfaction because recent findings have not been synthesized or critically evaluated and because these findings have key etiologic and prevention implications.

METHODS

A computer-assisted literature review was conducted to locate relevant prospective and experimental studies.

RESULTS

There is evidence that perceived pressure to be thin, thin-ideal internalization and elevated body mass, but not early menarche, increase the risk for subsequent body dissatisfaction. There is also consistent support for the assertion that body dissatisfaction is a risk factor for eating pathology and that this relation is mediated by increases in dieting and negative affect.

CONCLUSIONS

This review provides support for the claim that sociocultural processes foster body dissatisfaction, which in turn increase the risk for bulimic pathology, and suggests that prevention and treatment interventions might be enhanced by focusing greater attention on body image disturbances.

Body dissatisfaction and binge eating in obese women: the role of restraint and depression

OBJECTIVE

This study examined the association between body dissatisfaction and binge eating, and the mediating role of restraint and depression among obese women.

RESEARCH METHODS AND PROCEDURES

Participants were obese women taking part in a cognitive-behavioral treatment program who completed self-report measures at baseline (n = 89) and post-treatment follow-up (n = 69).

RESULTS

At baseline, body dissatisfaction was strongly correlated with binge eating score. This was partly a direct effect and partly mediated by depression. No mediating effect of restraint was observed. Over the treatment period, a reduction in body dissatisfaction was associated with a reduction in binge-eating score. As in the cross-sectional data, there was evidence for mediation by change in depression with the greatest improvement in binge eating among those who became more restrained and less depressed.

DISCUSSION

These results suggest that it would be valuable to address psychological well-being, and especially body image, as part of the management of binge-eating behavior in obesity.

Dietary restraint and negative affect as mediators of body dissatisfaction and bulimic behavior in adolescent girls and boys

Stice's dual pathway model of dietary restraint and negative affect was examined in both adolescent girls and boys. Self-report measures assessing body dissatisfaction, dietary restraint, negative affect and bulimic behavior were administered to 267 girls and 199 boys aged between 12 and 16 years. The findings for the girls were consistent with Stice's model, in that they indicated that both dietary restraint and negative affect mediated the relationship between body dissatisfaction and bulimic behavior. For the boys who desired a thinner body size, only negative affect was found to mediate the relationship between body dissatisfaction and bulimic behavior. On the other hand, for boys who desired a larger body size, both body dissatisfaction and dietary restraint were found to exert an independent effect on bulimic behavior. As boys can aspire to two contrasting and seemingly opposite body size ideals, the findings highlight that the relationship between body dissatisfaction, dietary restraint, negative affect and bulimic behavior are more complex in males than in females. Further research using longitudinal designs is needed in order to test the directional and bidirectional nature of the observed interrelationships.

Factorial validity of the Bulimia Test-Revised in adolescent boys and girls

The present study examined the psychometric properties and principal components structure of the Bulimia Test Revised (BULIT-R; [Thelen, M.H., Farmer, J., Wonderlich, S. & Smith, M. (1991). A revision of the Bulimia Test: the BULIT-R. Psychological Assessment, 3, 119-124.]) using a sample of early adolescent males and females. Three hundred and six girls (mean age = 13.66; S.D. = 1.12) and 297 boys (mean age = 13.89: S.D. = 1.13) from grades 7-10 completed the BULIT-R as part of a larger study investigating disordered eating in early adolescence. In comparison to the 5 factors identified in adult female samples, the factor analysis identified four similar factors for adolescent boys and girls: bingeing, control, normative weight loss (dieting and exercise) and extreme weight loss behaviors (vomiting, diuretics and laxatives). The findings highlight similarities between boys and girls and differences in the factorial nature of the BULIT-R for adult and adolescent samples. The BULIT-R also demonstrated good reliability with adolescent samples and adequate concurrent validity with the DFT, DEBQ and binge eating as defined by the DSM-IV criteria. The emergence of bingeing and control as two distinct factors is an important distinction that needs to be considered when attempting to provide accurate incidence rates of binge eating and bulimic symptomatology in adolescents.