Restraint, dieting, and the continuum model of bulimia nervosa

Differentiating types of dietary restraint and their momentary relations with loss-of-control eating

OBJECTIVE

Despite evidence supporting the link between dietary restraint (i.e., attempts at dietary restriction) and loss of control (LOC) eating among individuals with binge-spectrum eating disorders (EDs), some research suggests that dietary restraint may not be linked to LOC eating in all contexts. It is currently unknown how often dietary restraint results in successful dietary restriction, or which types of restraint/restriction confer highest risk for LOC eating. Furthermore, little research has evaluated momentary, temporal associations between dietary restraint and LOC eating. Thus, the present study aimed to (1) characterize dietary restraint and restriction, among individuals with LOC eating, and (2) examine temporal relationships between restraint/restriction and LOC eating within- and between-subjects.

METHOD

The current study recruited adults with binge spectrum EDs (n = 96, 80.4% female) to complete a 7-14-day ecological momentary assessment protocol assessing ED symptoms. Multilevel models and linear regression evaluated within- and between-subjects associations between momentary restraint/restriction and LOC eating, respectively.

RESULTS

Attempted avoidance of enjoyable foods, limiting the amount eaten, and any restraint predicted greater likelihood of LOC eating at the next survey. Attempts to delay eating predicted reduced likelihood of LOC eating at the next survey, though this effect was no longer statistically significant after correcting for multiple comparisons. Diagnostic presentation moderated the association between attempted avoidance of enjoyable foods and LOC eating such that this association was significantly stronger for those on the BN-spectrum.

DISCUSSION

Dietary restraint seems to be more predictive of LOC eating than dietary restriction both within- and between-subjects. Future treatments should target dietary restraint to reduce LOC eating.

PUBLIC SIGNIFICANCE

Some research suggests that dietary restriction (i.e., reduced calorie intake) and restraint (i.e., attempted restriction) may not be linked to LOC eating in all contexts. We found that dietary restraint is more predictive of LOC eating than dietary restriction both within and between individuals. Future treatments should target dietary restraint to reduce LOC eating.

Group differences in binge eating, impulsivity, and intuitive and mindful eating among intermittent fasters and non-fasters

Intermittent fasting (IF) is an increasingly popular diet involving short-term fasting and/or caloric restriction. While published research highlights physiological effects (e.g., weight, body fat) of IF, hardly any research has examined its associations with psychological factors. This study aimed to investigate the relationship between IF and binge eating, impulsivity, intuitive eating, and mindful eating. An undergraduate sample (N = 298) was recruited through a large southwestern university psychology subject pool. The sample was divided into three groups based on IF status: Current IF (n = 70), Past IF (n = 48), and No IF (n = 182). Current IF was negatively associated with lack of perseverance (e.g., "I generally like to see things through to the end"; p < .01) and intuitive eating (p < .05), varying by subscale, compared to the other groups. Notably, Past-IF, but not Current IF, participants were more likely to binge eat than individuals who reported never fasting (p = .03). These findings add credence to the rapidly developing area of research suggesting IF is associated with increased disordered eating behaviors. Notably, the findings from this study are limited due to the lack of diversity sample, such that generalizations can only be made toward White, middle-to-high income, college students. Future longitudinal studies are needed to test the directionality of these relationships.

The Complicated Relationship between Dieting, Dietary Restraint, Caloric Restriction, and Eating Disorders: Is a Shift in Public Health Messaging Warranted?

The origins of theories specifying dietary restraint as a cause of eating disorders can be traced to the 1970s. This paper will present an overview of the origins of dietary restraint theories and a brief historical review of evidence will be summarized. Recent research will be presented, including the results from the CALERIE Phase 1 study, as well as CALERIE Phase 2, which were NIH-sponsored randomized controlled trials. CALERIE 2 provided a test of the effect of two years of caloric restriction (CR) on the development of eating disorder syndromes and symptoms in comparison to a control group that did not alter eating behavior or body weight. The intervention was effective for inducing a chronic (two-year) reduction in total energy expenditure and increased dietary restraint but did not increase symptoms of eating disorders. The results of this recent investigation and other studies have not provided experimental support for conventional dietary restraint theories of eating disorders. These findings are discussed in terms of potential revisions of dietary restraint theory, as well as the implications for a paradigm shift in public health messaging related to dieting.

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.

Meeting of Minds around Food Addiction: Insights from Addiction Medicine, Nutrition, Psychology, and Neurosciences

This review, focused on food addiction (FA), considers opinions from specialists with different expertise in addiction medicine, nutrition, health psychology, and behavioral neurosciences. The concept of FA is a recurring issue in the clinical description of abnormal eating. Even though some tools have been developed to diagnose FA, such as the Yale Food Addiction Scale (YFAS) questionnaire, the FA concept is not recognized as an eating disorder (ED) so far and is even not mentioned in the Diagnostic and Statistical Manuel of Mental Disorders version 5 (DSM-5) or the International Classification of Disease (ICD-11). Its triggering mechanisms and relationships with other substance use disorders (SUD) need to be further explored. Food addiction (FA) is frequent in the overweight or obese population, but it remains unclear whether it could articulate with obesity-related comorbidities. As there is currently no validated therapy against FA in obese patients, FA is often underdiagnosed and untreated, so that FA may partly explain failure of obesity treatment, addiction transfer, and weight regain after obesity surgery. Future studies should assess whether a dedicated management of FA is associated with better outcomes, especially after obesity surgery. For prevention and treatment purposes, it is necessary to promote a comprehensive psychological approach to FA. Understanding the developmental process of FA and identifying precociously some high-risk profiles can be achieved via the exploration of the environmental, emotional, and cognitive components of eating, as well as their relationships with emotion management, some personality traits, and internalized weight stigma. Under the light of behavioral neurosciences and neuroimaging, FA reveals a specific brain phenotype that is characterized by anomalies in the reward and inhibitory control processes. These anomalies are likely to disrupt the emotional, cognitive, and attentional spheres, but further research is needed to disentangle their complex relationship and overlap with obesity and other forms of SUD. Prevention, diagnosis, and treatment must rely on a multidisciplinary coherence to adapt existing strategies to FA management and to provide social and emotional support to these patients suffering from highly stigmatized medical conditions, namely overweight and addiction. Multi-level interventions could combine motivational interviews, cognitive behavioral therapies, and self-help groups, while benefiting from modern exploratory and interventional tools to target specific neurocognitive processes.

Disturbed Eating and Body Dysmorphic Symptoms in a Young Adult Sample Are Separable Constructs That Each Show a Mixture of Distributions

Eating disorder and body dysmorphic disorder symptoms overlap and frequently co-occur clinically, yet whether they represent one or more underlying constructs in the general population is unknown. We examined relationships between these symptoms on underlying factor structures and dimensional distributions in a young adult sample of 328 students using the Eating Disorder Examination-Questionnaire (EDE-Q 6.0) and the Dysmorphic Concern Questionnaire (DCQ). We performed factor and hierarchical cluster analyses on pooled items and Gaussian mixture modeling on score distributions. EDE-Q 6.0 and DCQ total scores were correlated (r = 0.53, p < .001). Pooled items demonstrated a three-factor solution; DCQ items separating from two EDE-Q 6.0 factors. Hierarchical clustering yielded a two-cluster solution that separated the two scales. Mixture modeling demonstrated that more than one underlying distribution best fit the data for each scale. These results suggest that the EDE-Q 6.0 and DCQ measure different sets of psychopathological features, despite their tendency to track together. Moreover, eating disorder and body dysmorphic phenotypes each show nonuniform variation from normal to abnormal. This argues against using linear dimensional applications of these scales to assess individuals ranging from mild to severe in symptom severity. Separate scales may be necessary to characterize lower and higher ranges of clinical severity.

The Continuity/Discontinuity Models of Eating Disorders

Are the eating disorders discrete diagnostic entities or do they fall along one or more continua ranging from normal body weight, eating behavior, and weight concerns to severely disturbed patterns? Researchers have debated this question for at least 30 years and have used numerous creative strategies to examine this and related questions. This body of research is reviewed with particular attention to the more recent use of taxometric methods. Although somewhat mixed, much of the earlier research has been interpreted as supporting the continuity model. However, more recent taxometric research suggests the presence of one or more latent discontinuities, particularly with disorders associated with binge eating. These findings have implications for assessment, treatment, and possible prevention of eating disorders, and may ultimately allow us to better predict who will or will not develop an eating disorder in response to dieting, as well as who will or will not respond to particular treatments for an existing eating disorder.

Dietary restraint: what's the harm? A review of the relationship between dietary restraint, weight trajectory and the development of eating pathology

Dietary restraint has historically been implicated as a risk factor for the development of eating pathology. Despite existing findings, recent research suggests that many individuals are capable of practicing dietary restraint without negative effects. In order to successfully incorporate the positive aspects of dietary restraint into interventions for healthy weight management, a nuanced examination of the relationship between dietary restraint and resulting eating patterns is necessary. Accordingly, the current review seeks to clarify the existing literature with regard to dietary restraint. First, this review examines the construct of dietary restraint and differentiates dietary restraint from related constructs, such as weight loss dieting. Second, it identifies situations in which dietary restraint has been linked with positive outcomes, such as healthy weight management and prevention of eating pathology. Altogether, it appears that dietary restraint can prove a beneficial strategy for those attempting to control their weight, as it does not relate to increased levels of eating pathology when practiced as part of a well-validated weight management programme.

Symptoms of Psychopathology Within Groups of Eating-Disordered, Restrained Eating, and Unrestrained Eating Individuals

OBJECTIVE

While eating-disordered individuals have shown high levels of comorbid psychopathology, there has not been an assessment of these symptoms across groups exhibiting different forms of problematic eating behavior.

METHOD

Using 1,122 participants recruited via Amazon Mechanical Turk, this study examined self-reported differences between controls, restrained eaters, and individuals meeting criteria for binge eating disorder and bulimia nervosa on several measures of psychopathology unrelated to eating.

RESULTS

On nearly all outcome measures, eating-disordered participants had greater symptoms of psychopathology compared to restrained eaters, who had greater levels compared to controls. Among the eating-disordered participants, bulimia nervosa participants had more symptoms of psychopathology than binge eating-disordered participants.

CONCLUSION

Treatment of the populations included in this study may be informed by an understanding of the different amounts of symptoms of comorbid psychopathology that confer additional distress and impairment above and beyond disordered eating behavior.

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

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

Evaluating patterns of weight and body composition change among college women

The prevalence of obesity increases as women move from adolescence to young adulthood, and college women have been identified as a population at risk for unhealthy weight gain. Studies of weight gain in college populations have revealed that significant, variable weight change occurs in as few as eight weeks, but few have included participants beyond their freshman year of college or assessed body composition. The aims of the study were to use a repeated measures design to identify patterns of weight change among college women at all grade levels and to evaluate factors that may predict weight change over a one-year period. Undergraduate college women (N=131) completed measures of physical activity, dietary restraint, living conditions, and body dissatisfaction at baseline, 6-months, and 12-months. Height, weight, and body composition were collected at all assessment periods. Forty-four percent of participants gained at least 3lb, 23% lost at least 3lb, and 33% maintained weight over one year. Weight change was associated with changes in body fat and was not related to baseline BMI or age. There were no significant differences between grade levels, suggesting that future studies should include women at all grade levels. Baseline physical activity, dietary restraint, living conditions, and body dissatisfaction did not predict weight change at one year, nor did they differentiate between individuals in the three weight change categories. Further research is needed to identify the factors associated with weight gain in young adult women, and such studies should not be limited to college freshmen.

Effects of perfectionism and exercise on disordered eating in college students

PURPOSE

This study examined two dimensions of perfectionism (Standards and Discrepancy), two aspects of exercise (cardiovascular and strength), and the interaction of these variables as predictors of disordered eating in female and male college students.

METHODS

Recruited participants (N=314; n=204 women) completed self-report measures of disordered eating (Eating Attitudes Test), perfectionism (Almost Perfect Scale-Revised; Standards and Discrepancy subscales), and exercise (strength and cardiovascular).

RESULTS

Among women, there was a significant three-way interaction between the two dimensions of perfectionism (Standards and Discrepancy) and cardiovascular exercise. Also among women, there was a significant two-way interaction between the Standards dimension and strength exercise and between the Discrepancy dimension and strength exercise. There were no significant main effects or interactions among men.

CONCLUSIONS

We found some support for the hypotheses that adaptive perfectionism (higher Standards coupled with lower Discrepancy) is a protective factor for disordered eating and that maladaptive perfectionism (higher Standards coupled with higher Discrepancy) is a risk factor, although, only among women who engaged in lower, but not higher, levels of cardiovascular exercise. The findings also suggest that it may be beneficial to consider dimensions of perfectionism and exercise separately when studying disordered eating.

An exploratory investigation of purging disorder

OBJECTIVE

Purging Disorder (PD) is an understudied pattern of behaviors within the Eating Disorder Not Otherwise Specified (EDNOS) category. Such categorization may suggest that PD is not clinically significant as other eating disorders. However, evidence has suggested that PD is associated with significant impairments in psychosocial functioning and well-being. Despite the apparent clinical significance of PD, it remains to be determined if PD is distinct from other clinically significant eating disorders. The present study sought to assess the phenomenology, clinical significance, and distinctiveness of PD.

METHOD

Group scores on measures of eating pathology, body image disturbance, and psychological correlates were compared using MANOVA among a female undergraduate sample (N=94) meeting diagnostic criteria for PD (n=20), Bulimia Nervosa (BN; n=35), restrained eating (n=18), and healthy controls (n=21).

RESULTS

Overall, results indicated the PD group reported less severe symptoms than BN but more severe symptoms than controls. The PD and restraint groups were similar on most variables (including subjective binge behavior), with the exception of perfectionism and hunger.

DISCUSSION

Findings support the conceptualization of PD as existing along a spectrum of bulimic spectrum disorders rather than as a distinct diagnostic category.

Prevalence and correlates of dieting in college women: a cross sectional study

BACKGROUND

Dieting is a common practice among young women, irrespective of age, race, ethnicity, and weight. We aimed to determine the prevalence of dieting and its relationship with eating behavior, body weight, and body mass index (BMI) in college women.

METHODS

This was a cross-sectional survey of female students aged 18-35 years (n = 308). Measures included BMI, restraint, disinhibition, hunger, dieting, weight loss, and perceived weight.

RESULTS

A high percentage of college females consider themselves overweight or obese, despite having a BMI in the normal range. Dieting was practised by 43%, and 32% were avoiding weight gain, despite 78% having a healthy BMI. Women classified themselves as overweight or obese (27%), while only 11% were actually in these categories. Exercise was a common method of weight loss and positive associations were observed between dieting and BMI. Assessment of eating behavior showed that 27% were classified as high-restraint. Restraint and disinhibition were positively correlated with BMI.

CONCLUSION

Despite the widespread availability of nutrition information, there is incongruity in measured and perceived BMI in young educated women. Dieting practices and BMI are associated with restraint and disinhibition. Nutrition professionals should consider educating college women about healthy body weight regardless of their clients' BMI.

Multidimensional perfectionism, depression and relational health in women with eating disturbances

OBJECTIVE

This study investigated multidimensional perfectionism, depression, and relational health and quality across varying severities of eating disorders. The Questionnaire for Eating Disorder Diagnoses (Mintz, O'Halloran, Mulholland, & Schneider, 1997) was used to distinguish clinical, subclinical, and asymptomatic groupings.

METHOD

The sample included 212 women recruited from a university and an eating disorder treatment center.

RESULTS

Results indicated significant differences across all the three groups on perfectionistic discrepancy. All three groups also differed on their level of depressive mood. However, there were no significant group differences on relational health and quality.

DISCUSSION

This study contributes to the understanding of intrapersonal and interpersonal correlates of eating disorders and subclinical eating disturbances. This understanding allows for better identification of vulnerability to eating disorders and offers the potential to design more specialized and effective treatments.

Experimental effects of chocolate deprivation on cravings, mood, and consumption in high and low chocolate-cravers

This study examined how deprivation of chocolate affects state-level chocolate cravings, mood, and chocolate consumption in high and low trait-level chocolate-cravers. After identifying high and low chocolate cravers (N=58), half of the participants were instructed not to eat any chocolate for 2weeks. This created four experimental groups: deprived high-cravers (n=14), deprived low-cravers (n=14), non-deprived high-cravers (n=15), and non-deprived low-cravers (n=15). Following 2-week deprivation, state-level food cravings, mood, and chocolate intake were measured in a laboratory setting and compared across groups. Analyses revealed that anxiety increased over time for high-cravers (both deprived and non-deprived); state-level chocolate- and food-craving increased over time for both deprived groups and non-deprived high-cravers; non-deprived high-cravers ate the most chocolate; and, high-cravers were more joyful and guilty than low-cravers after eating chocolate in the laboratory. Theoretically, these results suggest that chocolate consumption may be better explained by trait-level of chocolate craving than by deprivation and highlighted significant differences in mood, state-level cravings, and chocolate intake between cravers and non-cravers following deprivation.

The measurement of "eating-disorder-thoughts" and "eating-disorder-behaviors": Implications for assessment and detection of eating disorders in epidemiological studies

To test a theoretically driven second-order factor model of eating disorders, with eating-disordered thoughts and eating-disordered behaviors representing the higher order factors, we conducted a confirmatory factor analysis using a female university student sample (N=1816). The 'Thought' latent construct was comprised of indicators representing fear of fat and dissatisfaction with body shape/weight and the latent construct 'Behavior' was comprised of indicators representing binging, purging and restricting. From the thought and behavior latent factors, composite groups were created by varying the level of thoughts and behaviors (high, moderate, and few/or none). We examined the independent contributions of thoughts and behaviors on a measure of psychopathology (depression). A second-order model of "eating disorder thoughts" and "eating disorder behaviors" was supported by the data, based on model fit, factor loadings, and model parsimony. Mean scores on depression were clinically significant for groups engaged in any level of eating disorder behavior whereas thoughts contributed to risk for depression only at the extreme end. Because of the disproportionate representation of eating disorder thoughts (high) and eating disorder behaviors (low) in non-clinical populations, the measurement and detection of eating disorders may be enhanced by measuring thoughts separate from behaviors.

National athletic trainers' association position statement: preventing, detecting, and managing disordered eating in athletes

OBJECTIVE

To present recommendations for the prevention, detection, and comprehensive management of disordered eating (DE) in athletes.

BACKGROUND

Athletes with DE rarely self-report their symptoms. They tend to deny the condition and are often resistant to referral and treatment. Thus, screenings and interventions must be handled skillfully by knowledgeable professionals to obtain desired outcomes. Certified athletic trainers have the capacity and responsibility to play active roles as integral members of the health care team. Their frequent daily interactions with athletes help to facilitate the level of medical surveillance necessary for early detection, timely referrals, treatment follow-through, and compliance.

RECOMMENDATIONS

These recommendations are intended to provide certified athletic trainers and others participating in the health maintenance and performance enhancement of athletes with specific knowledge and problem-solving skills to better prevent, detect, and manage DE. The individual biological, psychological, sociocultural, and familial factors for each athlete with DE result in widely different responses to intervention strategies, challenging the best that athletics programs have to offer in terms of resources and expertise. The complexity, time intensiveness, and expense of managing DE necessitate an interdisciplinary approach representing medicine, nutrition, mental health, athletic training, and athletics administration in order to facilitate early detection and treatment, make it easier for symptomatic athletes to ask for help, enhance the potential for full recovery, and satisfy medicolegal requirements. Of equal importance is establishing educational initiatives for preventing DE.

Dieting: really harmful, merely ineffective or actually helpful?

Dieting has developed a negative reputation among many researchers and health care professionals. However, ‘dieting’ can refer to a variety of behavioural patterns that are associated with different effects on eating and body weight. The wisdom of dieting depends on what kind of dieting is involved, who is doing it, and why. Thus, depending on what one means by the term, dieting can be quite harmful, merely ineffective or actually beneficial. The present paper considers examples of all three. In particular, we argue that judgements about the desirability of dieting should consider the likely consequences to particular individuals of engaging in, or not engaging in, dieting behaviour.

Core beliefs in dieters and eating disordered women

OBJECTIVE

The current study aimed to investigate the difference in the levels of core beliefs between eating disordered women and those who showed milder forms of symptomatology.

METHODS

Thirty-five eating disordered women, 16 symptomatic dieters, 39 normal dieters and 34 non-clinical comparison women completed questionnaires measuring eating symptomatology (Eating Disorders Inventory [EDI]), core beliefs (Young Schema Questionnaire [YSQ]), depression (The Beck Depression Inventory-II [BDI-II]) and self-esteem (Rosenberg Self-Esteem Inventory [RSE]).

RESULTS

With the exception of Entitlement beliefs, there were significant differences in the levels of core beliefs across all four groups. In particular, symptomatic dieters and eating disordered women differed on 8 YSQ subscales despite showing very similar level of eating symptomatology.

DISCUSSION

The current findings lend support to the discontinuity model that suggests that there are fundamental differences between women with a clinical eating disorder and those with milder eating psychopathology. The clinical and research implications of the present results were discussed.

Impulsiveness and lack of inhibitory control in eating disorders

Eating disorders are considered to lie on a spectrum of disorders with varying degrees of obsessive-compulsive and impulsive traits. Restrictive anorexia nervosa patients (AN-R) are thought to belong to the obsessive pole of the spectrum, and purging-anorexia (AN-P) and bulimia nervosa (BN) patients to the impulsive pole. In this study we have compared impulsive traits in three groups of eating disordered patients (total N=56) and a control group of 83 female students. Information about impulsive traits and lack of inhibitory control was gathered by means of standardized rating scales (Eysenck's Impulsiveness Scale, Barrett's Impulsiveness Scale, and Carver and White's BIS/BAS scale) and a behavioral measure of impulsiveness (stop-go task). On the questionnaires AN-R patients reported to be less impulsive than controls, AN-P and BN patients. In the stop-go task, we did not find significant differences between the different groups. Correlations between self-reported measures of impulsiveness and behavioral measures were not significant.

IN CONCLUSION

Our results from the self-report measures are at odds with the behavioral measures certainly in the AN-R group. Perhaps the latter patients' distorted self-perception and/or self-description may explain this discrepancy.

Effects of a weight maintenance diet on bulimic symptoms in adolescent girls: an experimental test of the dietary restraint theory

It is widely accepted that dieting increases the risk for bulimia nervosa, but there have been few experimental tests of this theory. The authors conducted a randomized experiment with adolescent girls (N=188) to examine the effects of a weight maintenance diet on bulimic symptoms. A manipulation check verified that the diet intervention resulted in weight maintenance and significantly reduced the risk for obesity onset and weight gain observed in assessment-only controls. As hypothesized, the diet intervention resulted in significantly greater decreases in bulimic symptoms and negative affect than observed in controls. These experimental findings, which converge with those from a weight loss diet experiment, appear antithetical to dietary restraint theory and suggest instead that dietary restriction curbs bulimic symptoms.

Categorical versus dimensional models of eating disorders: an examination of the evidence

OBJECTIVE

Eating disorders have been conceptualized as discrete syndromes or categories and as dimensions that differ in degree among individuals. Until recently, researchers have not directly addressed which of these models, categorical versus dimensional, is most valid.

METHODS

The primary objective of this review was to examine the evidence related to the validity of dimensional versus categorical models of eating disorders.

RESULTS

Findings from a series of taxometric studies have suggested that a conceptual representation of eating disorders may involve a latent taxon, related to binge eating (and possibly purging), and one or more dimensions. These studies found that binge eating was identified as a factor that does not occur on a continuum with anorexia nervosa, restricting subtype. Restricting subtype anorexia is continuous with normalcy, however.

DISCUSSION

These findings should be viewed as preliminary evidence that may have implications for the etiology, assessment, prevention, and treatment of eating disorders.

Screening for eating disorders and high-risk behavior: caution

OBJECTIVE

The current study reviews the state of eating disorder screens.

METHODS

Screens were classified by their purported screening function: identification of cases with (a) anorexia nervosa only; (b) bulimia nervosa only; (c) eating disorders in general; (d) partial syndrome, eating disorder not otherwise specified (EDNOS), or subclinical; (e) not a-d but at high risk. Information is presented on development, psychometric properties, and external validation (e.g., sensitivity, specificity, positive predictive values, and negative predictive values).

RESULTS

Screens differ widely with regard to objective, psychometric properties and the validation methodology used. Most screens that identify cases are not appropriate for the identification of at-risk behaviors. Little data on the external validity of screens are available.

DISCUSSION

Screens should be used with caution. A sequential procedure, in which subjects identified as being at risk during the first stage is followed by more specific diagnostic tests during the second stage, might overcome some of the limitations of the one-stage screening approach.

Self-regulation of energy intake in the prevention and treatment of obesity: is it feasible?

The prevalence of obesity in developed countries has been steadily increasing. Comprehensive lifestyle change programs for the treatment of obesity have garnered considerable empirical support, but most weight lost in lifestyle interventions is regained within several years. The outcome of obesity prevention programs has also been disappointing. One reason for this state of affairs may be that most weight control programs are based on an assumption of equipotentiality of their intervention components. That is, obesity prevention and treatment programs consist of a multitude of behavioral, cognitive, nutritional, physical activity, and interpersonal techniques, all of which are assumed to be of roughly equal importance in weight control. However, there is considerable evidence that our evolutionary heritage has made most humans highly sensitive to the availability and nature of food in the environment. It therefore may be unrealistic to expect that enhancing self-regulatory skills will be sufficient to overcome the combined influence of our appetitive predispositions and the obesigenic environment. However, there is growing evidence that weight control interventions that focus on the availability, structure, composition, and portion size of foods in the diet improve long-term weight control. Concerted efforts to change the availability and nature of foods at both the individual and population level may hold considerable promise for the treatment and prevention of obesity.

A test of the continuity perspective across bulimic and binge eating pathology

OBJECTIVE

This article examines the continuity/discontinuity perspective of eating pathology among 375 women seeking treatment.

METHODS

Participants were categorized into five separate groups: obese nonbingers, subthreshold binge eating disorder (BED), BED, subthreshold bulimics, and bulimics. We tested whether differences in core eating pathology (drive for thinness, body dissatisfaction, current body image, body image ideal) and psychiatric symptoms (depression, interoceptive awareness) differentiated the groups quantitatively (supporting the continuity perspective) or qualitatively (supporting the discontinuity perspective).

RESULTS

Our results, overall, supported the continuity perspective of eating pathology. A discriminant function analysis using the eating pathology and psychiatric symptom variables as predictor variables found that one primary factor differentiated the five groups on both core eating pathology and psychiatric variables.

DISCUSSION

The implications of testing this model within a treatment-seeking sample are discussed.

Relationship of gender and eating disorder symptoms to reported cravings for food: construct validation of state and trait craving questionnaires in Spanish

Using confirmatory factor analysis, we cross-validated the factor structures of the Spanish versions of the State and Trait Food Cravings Questionnaires (FCQ-S and FCQ-T; ) in a sample of 304 Spanish college students. Controlling for eating disorder symptoms and food deprivation, scores on the FCQ-T were higher for women than for men, but no sex differences were observed on the FCQ-S. Eating disorder symptomatology was predictive of trait cravings, whereas food deprivation was predictive state cravings. Trait cravings, but not state cravings, were more strongly associated to symptoms of anorexia and bulimia nervosa than with other psychopathology. We suggest that cravings can be conceptualized as multidimensional motivational states and that our data support the hypothesis that food cravings are strongly associated with symptoms of bulimia nervosa.

Dieting frequency among college females: association with disordered eating, body image, and related psychological problems

OBJECTIVE

To examine associations between dieting frequency and eating disorder behaviors, body satisfaction, and related factors.

METHOD

Females (N=345) whose average age and body mass index (BMI) were 20.58 and 21.79, respectively, were grouped into three categories of lifetime dieting frequency (never, 1-5 times, or 6 or more times) and matched on current BMI across categories.

RESULT

Positive associations were found between dieting frequency and eating disorder symptoms and related problems such as body dissatisfaction, current body size perception, depression, exercise preoccupation, and feelings of ineffectiveness and insecurity. Dieting frequency was inversely associated with self-esteem, ideal body size, emotional regulation, and impulse control.

DISCUSSION

Independent of current BMI, frequency of dieting behaviors is strongly associated with negative emotions and problematic behaviors. As this study is correlational in nature, future longitudinal studies should ascertain the sequence of onset of these experiences.

Correlates of subjective and objective binge eating in binge-purge syndromes

OBJECTIVE

Research has begun to challenge the idea that a large amount of food is a diagnostically relevant distinction in classifying binge eating. This study examined the relationship between both objective and subjective (i.e., feeling out of control while eating an appropriate amount of food) binge eating frequency and factor analytically derived measures of dieting and psychopathology.

METHOD

Participants were 40 women who were admitted for inpatient treatment for bulimia nervosa, anorexia nervosa, binge-purge type, or eating disorder not otherwise specified with binge-purge symptoms.

RESULTS

Controlling for subjective binge frequency, neither the psychopathology nor the dieting factors were related to objective binge frequency. Controlling for objective binge frequency, dieting, but not psychopathology, was related to subjective binge frequency. There was no correlation between frequency of subjective and objective binge eating.

DISCUSSION

The results are discussed in light of research on restrained eating. Implications for diagnosis and the role of loss of control in defining binge behavior are also discussed.

Continuum and linearity hypotheses on the relationship between psychopathology and eating disorder symptomatology

This article discusses various notions of continuity and discontinuity relating to eating disorders, and suggests that current research on the subject is implicitly based on hypotheses on linearity. In this study, we tested these hypotheses by asking 265 female participants to complete the Eating Attitude Test (EAT) and Eating Disorder Inventory (EDI). We found a linear increase in psychological disturbances from normalcy to the milder forms of disordered eating, but a sharp and non-linear increase among the women with more severe signs of eating disorders. The results indicate that neither linearity nor non-linearity alone sufficiently describes the relationship between predisposing factors and eating disorder symptomatology.

Neuroticism and conscientiousness as predictors of emotional, external, and restrained eating behaviors

OBJECTIVE

We investigated the extent to which different forms of eating behavior as assessed by the Dutch Eating Behaviour Questionnaire are related to facets of the Big Five personality domains.

METHOD

Respondents were 167 psychology students (126 females and 41 males) who volunteered for the study.

RESULTS

Body mass index (BMI) and gender had significant main effects on eating behaviors. These results were moderated by a significant BMI x Gender interaction on emotional eating. Eating behaviors were significantly related to the personality facets associated with Neuroticism and Conscientiousness.

DISCUSSION

The results are discussed with reference to previous research on eating behaviors and the nature of Neuroticism and Conscientiousness.

A prospective test of the dual-pathway model of bulimic pathology: mediating effects of dieting and negative affect

Because there have been few longitudinal investigations of integrative etiological theories of bulimia nervosa, this study prospectively tested the dual-pathway model using random regression growth curve models and data from a 3-wave community sample of adolescent girls (N = 231). Initial pressure to be thin and thin-ideal internalization predicted subsequent growth in body dissatisfaction, initial body dissatisfaction predicted growth in dieting and negative affect, and initial dieting and negative affect predicted growth in bulimic symptoms. There was prospective evidence for most of the hypothesized mediational effects. Results are consistent with the assertion that pressure to be thin, thin-ideal internalization, body dissatisfaction, dieting, and negative affect are risk factors for bulimic pathology and provide support for the dual-pathway model.