An integrative model of risk for high school disordered eating

BREATHE-T1D: Using iterative mixed methods to adapt a mindfulness-based intervention for adolescents with type 1 diabetes: Design and development

BACKGROUND

Negative affect is prevalent among adolescents with type 1 diabetes (T1D) and may impact diabetes self-management and outcomes through stress-related behaviors such as disordered eating.

METHODS

We describe the development of and design for the adaptation of a mindfulness-based intervention (MBI) for adolescents with T1D and negative affect. BREATHE-T1D is an MBI designed to target negative affect that has been tailored to address the unique lived experiences of adolescents with T1D. Qualitative interviews with stakeholders and participants were used to inform iterative adaptations to the intervention and control curricula over the course of the study. The primary aim of this paper is to describe the design, development, and protocol of the present pilot feasibility trial.

CONCLUSIONS

Iterative, qualitative methodology throughout the adaptation of an intervention is important for ensuring the resulting intervention is relevant and meaningful for the target population.

CLINICAL TRIAL REGISTRATION NUMBER

NCT05268393.

Longitudinal transactions between negative urgency and fasting predict binge eating

Fasting and negative urgency (the disposition to act rashly when distressed) are risk factors for binge eating. It may be that each influences the other over time to predict binge eating.

OBJECTIVE

This study tested whether (1) fasting predicts binge eating through negative urgency, and (2) negative urgency predicts binge eating through fasting.

METHOD

Path analysis and mediation tests were used to investigate objectives in n = 302 college women assessed three times over eight months. We controlled for each variable at the previous time point, and concurrent negative affect and body mass index at each time point.

RESULTS

Time 1 (T1) fasting predicted elevated negative urgency three months later at Time 2 (T2) and T2 negative urgency predicted increases in binge eating five months later at Time 3 (T3). T2 negative urgency mediated the relationship between T1 fasting and T3 binge eating. T1 negative urgency predicted increases in T2 fasting, which then predicted increases in T3 binge eating. T2 fasting mediated the relationship between T1 negative urgency and T3 binge eating.

DISCUSSION

Findings suggest fasting and negative urgency transact to predict binge eating among college women. Interventions targeting negative urgency may prevent or reduce both fasting and binge eating.

A longitudinal test of problematic alcohol use and binge eating among college women: The moderating role of shame

Problematic alcohol use and binge eating frequently co-occur. High levels of negative affect, negative urgency, and/or shame may increase the likelihood that problematic alcohol use and binge eating co-occur over time.

OBJECTIVE

Examine 1) the temporal relationship between problematic alcohol use and binge eating among college women, who are at high risk for both, and 2) the additive and moderating effects of shared, emotion-based risk factors in models involving both problematic alcohol use and binge eating.

METHOD

In n = 302 college women assessed at two time points across 8 months, we used hierarchical linear regression to invstigate our objectives.

RESULTS

Baseline problematic alcohol use and baseline shame independently predicted increases in follow-up binge eating, controlling for baseline binge eating. In addition, the interaction between problematic alcohol use and shame accounted for further variance in subsequent binge eating (the influence of baseline problematic alcohol use on follow-up binge eating was stronger at higher levels of baseline shame). The reciprocal relationship was not significant: baseline binge eating did not predict follow-up problematic alcohol use independently or in conjunction with risk factors. Neither negative affect nor negative urgency showed predictive effects beyond prior behavior and shame. Results support 1) problematic alcohol use as a prospective risk factor for binge eating, 2) shame as an additive predictor of binge eating, and 3) shame as a positive moderator of binge eating prediction from problem drinking.

CONCLUSION

Addressing shame and problematic alcohol use may be warranted in binge eating interventions for college women.

Examining the role of urgency in predicting binge size in bulimia nervosa

Greater binge size within bulimia nervosa is associated with elevated distress and impairment. Theoretical models posit that emotion dysregulation predicts binge eating, but little research has investigated the potential for dispositional traits that reflect difficulty in emotion regulation to predict binge size among women with bulimia nervosa. Research supports that negative urgency, the tendency to act rashly when feeling distressed, is associated with binge eating behavior among individuals with bulimia nervosa. Relatively fewer studies have explored associations between binge eating and positive urgency, the tendency to act rashly when feeling extreme positive affect. The urgency traits may predict greater binge size within bulimia nervosa. The current study sought to examine negative urgency and positive urgency as predictors of test meal intake in a sample of 50 women, n = 21 with bulimia nervosa and n = 29 healthy controls. Dispositional levels of positive urgency, negative urgency, positive affect, and negative affect were measured prior to a laboratory binge eating paradigm. Participants in the bulimia nervosa group scored higher on negative urgency, positive urgency, and negative affect than participants in the control group. Across participants, lower levels of negative affect were associated with greater test meal intake. Elevated levels of positive urgency predicted significantly greater test meal intake, but only for participants with bulimia nervosa. No other dispositional traits predicted test meal intake when the interaction of positive urgency and group was included in the model. Findings suggest positive urgency is an underappreciated, but potentially important, risk factor for greater binge size in bulimia nervosa.

An investigation of associations between parenting and binge eating across pubertal development in pre-adolescent and adolescent female participants

OBJECTIVE

Puberty is a period of increased risk for the development of binge eating in female adolescents. Although developmental changes in autonomy-seeking behaviors and body weight and shape may influence both parenting styles and binge eating during puberty, studies have yet to examine how parenting practices may be differentially associated with youth outcomes depending on developmental stage. The current study examines whether interactions between puberty and parenting are associated with higher levels of binge-eating symptoms during/after puberty in female youth.

METHODS

Analyses used cross-sectional data from a previous study of disordered eating and puberty in 999 female youth (ages 8-16) and their parents from the Michigan State University Twin Registry. Youth self-reported binge eating, pubertal development, and perceived parental care and overprotection. Both parents and youth reported on parent-child conflict. Mixed linear models were used to examine whether pubertal development moderates the strength of associations between parenting (parent-child conflict, parental care, and parental overprotection) and offspring binge eating.

RESULTS

Although higher levels of parental overprotection and conflict, and lower levels of parental care were all significantly associated with binge eating, none of the associations were significantly moderated by pubertal development or age.

DISCUSSION

The quality of the parent-child relationship is significantly associated with binge eating in female youth regardless of developmental stage, highlighting the need for targeting harmful parenting strategies during adolescent eating disorder intervention.

PUBLIC SIGNIFICANCE

This is the first study to examine whether parenting/binge-eating associations in female participants differ across pubertal development. In a large population-based sample, we found lower parental care, higher parent-child conflict, and higher parental overprotection were all associated with higher levels of binge eating. Notably, associations did not differ across pubertal stage or age, suggesting that parenting is significantly associated with binge eating, regardless of developmental stage.

Pathways of personality and learning risk for addictive behaviors: A systematic review of mediational research on the Acquired Preparedness model

OBJECTIVE

The Acquired Preparedness (AP) model proposes that impulsive personality traits predispose some individuals to learn certain behavior-outcome associations (expectancies), and that these expectancies in turn influence the escalation of risky behaviors. This theory has been applied to the development of behaviors such as drinking, drug use, gambling, and disordered eating. In the current study, we aimed to summarize empirical tests of this model over the 20 years since it was proposed.

METHOD

We used a descriptive approach to summarize tests of mediation across 50 studies involving n=21,715 total participants.

RESULTS

We observed a consistent effect of personality on expectancies (median effect size = .22), of expectancies on behavior (.24), and a small mediated effect (.05) of personality on behavior via expectancies. Impulsive traits that involve positive or negative affect showed the most consistent support for AP, as did positive expectancies. Most studies testing AP focused on alcohol, but research on other behaviors also showed support for AP.

CONCLUSIONS

The literature appears to support a small mediated effect consistent with the AP model. Future research should continue to clarify which AP pathways are most influential in explaining risky behaviors, and supplement correlational research with experimental and quasi-experimental designs.

The interaction between affective lability and eating expectancies predicts binge eating

Both affective lability and eating expectancies have been found to predict binge eating. There is the additional possibility that the joint effect of affective lability and eating expectancies incurs further risk: perhaps expectancies for affective relief from eating operate more strongly in those experiencing frequent, rapid shifts in emotion. In the current study, we tested whether such a joint effect predicts binge eating prospectively in college students. We assessed affective lability, eating expectancies, and binge eating in 358 college students at two time points during the first year of college (e.g., December and April). The interaction of affective lability and eating expectancies in December predicted binge eating 4 months later in April. The influence of eating expectancies on binge eating was stronger at higher levels of affective lability. Findings offer support to the hypothesis that risk factors may transact to further elevate risk for eating disorder behaviors.Clinical implicationsThe interaction of affective lability and eating expectancies predicts binge eatingRisk factors may interact to further increase binge eatingIdentification of co-occurring risk factors may have vital treatment implications.

The effects of puberty on associations between mood/personality factors and disordered eating symptoms in girls

OBJECTIVE

Negative and positive urgency, anxiety, and depressive symptoms are significant factors of disordered eating (DE) symptoms in early adolescence through young adulthood. However, it is unclear how puberty-a critical developmental milestone that is associated with increased risk for DE symptoms-affects the relationship between these factors and DE symptoms, given that the role of pubertal status has rarely been considered in relation to these associations. Thus, the present study examined whether puberty moderates associations between mood/personality factors and DE in pre-adolescent and adolescent girls.

METHOD

Participants included 981 girls (aged 8-16 years) from the Michigan State University Twin Registry. Mood/personality factors, pubertal status, and DE were assessed with self-report questionnaires.

RESULTS

Puberty significantly moderated associations between several factors (negative urgency, positive urgency, trait anxiety, depressive symptoms) and the cognitive symptoms of DE (e.g., shape/weight concerns, body dissatisfaction). Associations between mood/personality factors and cognitive DE were stronger in girls with more advanced pubertal status. By contrast, no significant moderation effects were detected for mood/personality-dysregulated eating (e.g., binge eating, emotional eating) associations.

DISCUSSION

Findings identify pubertal development as an important moderator of mood/personality-DE symptom associations, especially for cognitive DE symptoms that are known to predict the later onset of clinical pathology.

Reward Learning Through the Lens of RDoC: a Review of Theory, Assessment, and Empirical Findings in the Eating Disorders

PURPOSE OF REVIEW

Reward-related processes may represent important transdiagnostic factors underlying eating pathology. Using the NIMH Research Domain Criteria as a guide, the current article reviews theories, behavioral and self-report assessments, and empirical findings related to reward learning in the eating disorders.

RECENT FINDINGS

Data from behavioral tasks suggest deficits in reinforcement learning, which may become more pronounced with increasing disorder severity and duration. Self-report data strongly implicate positive eating and thinness/restriction expectancies (an element of reward prediction error) in the onset and maintenance of eating pathology. Finally, self-report measures of habit strength demonstrate relationships with eating pathology and illness duration; however, behavioral task data do not support relationships between eating pathology and a propensity towards general habit development. Existing studies are limited, but provide preliminary support for the presence of abnormal reward learning in eating disorders. Continued research is needed to address identified gaps in the literature.

The relationship of the UPPS model of impulsivity on bulimic symptoms and non-suicidal self-injury in transgender youth

OBJECTIVE

This brief report examined the relationship of negative urgency (the tendency to act rashly in response to negative emotional states), (lack of) perseverance, (lack of) premeditation, and sensation seeking in association with non-suicidal self-injury (NSSI) and symptoms of bulimia nervosa (BN) in a sample of treatment-seeking transgender (TG) youth.

METHOD

Eighty-six TG youth with a mean age of 17 (sd = 3.2) agreed to participate in the study. The majority of our sample identified as TG male (n = 60) with 20 participants identifying as TG female and 6 identifying as non-binary. The racial ethnic breakdown of our sample was 8.2% Black, 8.2% Multi-racial, 1.2% Native American, and 82.4% White. Over ¼ of our sample endorsed at least one episode of objective binge eating in the last 28 days and 62% endorsed a history of NSSI.

RESULTS

Negative urgency was significantly associated with the odds of NSSI, objective binge eating, and general eating disorder symptoms. Lack of premeditation was significantly related to the odds of NSSI only. No other factors were significantly associated with NSSI or symptoms of BN.

CONCLUSIONS

Negative urgency appears to be an important personality construct in understanding increased risk for NSSI and BN symptoms in transgender youth.

Preliminary development of an implicit association test to measure body dissatisfaction and predict disordered eating behaviors

We conducted a preliminary test of a novel implicit association test for body dissatisfaction (BD-IAT). We predicted that BD-IAT would correlate with self-reported BD and predict later eating disorder (ED) attitudes. Female undergraduates (N = 145) self-reported BD and ED attitudes. In the BD-IAT, participants sorted words related to "satisfaction" and "dissatisfaction" to opposite sides of a computer screen. Participants categorized pictures of themselves to the side of the screen with the word "Me," which appeared with the "satisfied" or "dissatisfied" category in separate blocks. The BD-IAT measured the strength of the association between a participant's own body and dissatisfaction. The BD-IAT correlated positively with the EDI-BD (r = 0.21, p < 0.05), supporting its convergent validity. The BD-IAT predicted ED attitudes at one-week follow-up, controlling for explicit BD and baseline ED (b = 0.58, SE = 0.23, t = 2.57, p = .01); IAT scores uniquely accounted for 4.7 % of the variance in ED at one-week follow-up. These results provide preliminary evidence for the BD-IAT as an implicit measure of BD and suggest that it may predict future ED attitudes above and beyond explicit BD. Directions for future work aimed at continued development of this task are discussed.

An examination of negative urgency and other impulsigenic traits in purging disorder

There is extensive evidence for the clinical significance of Purging Disorder (PD), an eating disorder characterized by recurrent purging behavior (self-induced vomiting, laxative use, and diuretic use) in the absence of binge eating and low weight (Smith, Crowther, & Lavender, 2017). Research on the personality profile of PD is still developing but evidence supports an association with impulsivity (Brown, Haedt-Matt, & Keel, 2011). The personality underpinnings of impulsive behavior include several different impulsigenic traits. To investigate personality contributors to impulsive behavior among women with PD, we compared 31 women with PD to 57 women with bulimia nervosa (BN) and 31 healthy control women on four impulsigenic traits: negative urgency, lack of premeditation, lack of perseverance, and sensation seeking. Compared to healthy controls, women with PD reported significantly greater levels of negative urgency, but no significant differences on the other traits. Compared to BN, PD was associated with significantly lower levels of negative urgency, but no other significant differences. Compared with controls, women in the BN group had significantly higher scores on lack of premeditation and lack of perseverance, but no significant difference on sensation seeking. Findings indicate negative urgency is a potentially important personality trait for distinguishing those with PD.

A longitudinal examination of the relationship between eating disorder symptoms and suicidal ideation

OBJECTIVE

Cross-sectional research demonstrates significant correlations between eating disorders (EDs) and suicidal thoughts and behaviors. Although suicide ideation (SI) is a risk factor for suicidal behavior, longitudinal research investigating SI among EDs is limited. Thus, the aim of this study was to offer insight into the dynamic relationship between EDs and SI by investigating if these variables predicted one another at weekly time points.

METHOD

Autoregressive cross-lagged modeling was used to test bidirectional relationships between ED symptoms and suicidal ideation among an ED patient sample (n = 92). Participants completed a measure of suicidal ideation and the Eating Disorder Examination-Questionnaire (EDE-Q) weekly for 5 weeks.

RESULTS

SI and ED symptoms were correlated with each other at each time point. Unexpectedly, the majority of cross-lagged pathways were nonsignificant. However, SI at Week 4 predicted ED symptoms at Week 5, while controlling for Week 4 ED symptoms. This pattern of results was found when the shape concerns, weight concerns, and eating concerns subscales of the EDE-Q were entered into the model. Moreover, Week 2 shape concerns predicted Week 3 SI and Week 3 eating concerns predicted Week 4 SI. No significant cross-lagged pathways were found with the dietary restraint subscale.

DISCUSSION

Nonsignificant cross-lagged pathways may indicate that third variables better explain the relations between certain ED symptoms and SI over time. However, there were instances where ED symptoms and SI predicted one another. Given this, targeting suicidal thoughts in therapy may help to reduce eating pathology and vice versa.

Impulsigenic personality: Is urgency an example of the jangle fallacy?

Negative and positive urgency (the disposition to act rashly when in a highly negative or positive mood, respectively) have been identified as strong correlates of problem drinking and other addictive behaviors and potent predictors of subsequent drinking onset and increase (Peterson & Smith, 2017; Smith & Cyders, 2016). An unaddressed, important question about the validity of the urgency traits is whether they represent functionally distinct constructs or simply the interaction between lack of planning (the disposition to act rashly) and negative or positive affectivity (the disposition to experience negative or positive mood). If urgency is better represented by interactions between lack of planning and affect, there is no need for urgency risk models or separate urgency measures (Smith & Cyders, 2016). In a longitudinal adolescent sample, we tested whether (a) negative urgency differed from the interaction between lack of planning and negative affect, (b) positive urgency differed from the interaction between lack of planning and positive affect, and (c) each urgency trait predicted the subsequent onset of, and increases in, drinking behavior separately from the corresponding interaction. We found that (a) the corresponding interaction accounted for only 1-3% of the variance in negative or positive urgency, and (b) negative (or positive) urgency prospectively predicted drinking behavior but the corresponding interaction did not. These findings suggest that the urgency traits are distinct from interactions between affect and lack of planning. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Associations between eating expectancies and Eating disorder symptoms in men and women

Eating expectancies, or learned expectations that an individual has about eating, prospectively predict eating disorder (ED) symptoms. Most studies examining eating expectancies have focused on one or two eating expectancies and their relation with bulimic symptoms. In addition, these studies have been conducted mostly in women. Thus, it is unclear whether: 1) associations between eating expectancies and ED symptoms vary between men and women, and 2) extend to ED symptoms other than bulimic symptoms. The current study (N = 197 undergraduate men and 246 undergraduate women) investigated sex variance in a model of eating expectancies and ED symptoms, including factors associated with ED symptoms (i.e., negative urgency, negative affect, alcohol use, drug use, and body mass index). Sex variance was tested using path analysis in a model including eating expectancies and associated factors, with excessive exercise, negative attitudes toward obesity, restricting, cognitive restraint, binge eating, purging, muscle building, and body dissatisfaction as dependent variables. Unconstrained (i.e., unconstrained paths across men and women) and constrained (i.e., constraining paths across men and women) models were tested. The unconstrained and constrained models differed significantly, indicating that the models varied by sex. For both sexes, eating expectancies were uniquely associated with ED symptoms. For men, Eating Manages Negative Affect was significantly associated with the most ED symptoms. In contrast, for women, Eating Leads to Feeling Out of Control was associated with the most ED symptoms. Previous findings regarding eating expectancies and ED symptoms in women may not generalize to men. Intervening on eating expectancies in a sex-specific way may help reduce specific ED symptoms.

Transactions between early binge eating and personality predict transdiagnostic risk

Psychiatric comorbidities are prevalent in youth eating disorders. In a sample of 1,906 youth from the United States (49.2% female), followed from elementary school into high school, we found support for a model to help explain this comorbidity. Endorsement of binge eating in fifth grade (elementary school) predicted increases in negative urgency, negative affect, and lack of planning in seventh grade (middle school). In turn, seventh grade negative urgency predicted increases in 10th grade (high school) externalizing dysfunction (binge eating, alcohol use problems, and smoking) and internalizing dysfunction (depressive symptoms). Seventh grade negative affect predicted increases in 10th grade binge eating and depressive symptoms. Seventh grade lack of planning predicted increases only in 10th grade externalizing behaviours. Early engagement in binge eating may elevate risk for multiple forms of dysfunction, at least in part due to its prediction of high-risk personality change in middle school.

The Role of Sociocultural Factors in the Etiology of Eating Disorders

Most theories emphasize the role of sociocultural factors in the etiology of eating disorders (EDs). This article uses a broad search strategy to identify current etiologic studies. Women with an ED outnumber men in each diagnosis, but gender differences vary by diagnosis. Men were underrepresented in study samples, and information about variable risk factors in men is sparse. Findings suggest transdiagnostic risk factors and disorder-specific risk factors. Extracting data from population-based registers represents a major advance. Novel analytic approaches suggest complex pathways to ED. Although used in several studies, reliance on a transdiagnostic ED category (vs diagnosis-specific groupings) is premature.

Transactions among thinness expectancies, depression, and binge eating in the prediction of adolescent weight control behaviors

OBJECTIVE

Binge eating, the transdiagnostic risk associated with depression, and the eating disorder-specific risk associated with expectancies for reinforcement from thinness have been identified as risk factors for the development of weight control behaviors. The purpose of this study was to examine if these risk factors transact to further predict risk in youth.

METHOD

Binge eating, depressive symptoms, thinness expectancies, and weight control behaviors were assessed in 1,758 adolescents three times during the transitional period between middle school and high school. We tested six different possible transactional processes.

RESULTS

Mediation tests demonstrated that both 8th grade binge eating and 8th grade depressive symptoms predicted 10th grade weight control behaviors through their predictive influence on thinness expectancies in 9th grade. However, our results were not consistent with a mediational process in which 8th grade thinness expectancies predicted 9th grade depression to further predict 10th grade weight control behaviors. No interactions among binge eating, depressive symptoms, or thinness expectancies predicted weight control. Results did not differ between girls and boys.

DISCUSSION

Thinness expectancies appear to mediate the predictive influence of binge eating and depressive symptoms on risk for engaging in weight control behaviors. These results add to theoretical understanding of risk and suggests potential intervention pathways for clinicians.

Associations Between Alcohol Involvement and Drive for Thinness and Body Dissatisfaction in Adolescent Twins: A Bivariate Twin Study

BACKGROUND

Alcohol involvement has familial associations with bulimic symptoms (i.e., binge eating, inappropriate compensatory behaviors), with several studies indicating a genetic overlap between the two. It is unclear whether overlapping familial risk with alcohol involvement extends to other eating disorder symptoms. Understanding the genetic overlap between alcohol involvement and other eating disorder symptoms may aid in more targeted interventions for comorbid alcohol use-eating disorder symptoms. Thus, we investigated associations between alcohol involvement and 2 core eating disorder symptoms: drive for thinness and body dissatisfaction in adolescent female and male twins.

METHODS

We assessed 3 levels of alcohol involvement: alcohol use in the last month, having ever been intoxicated, and alcohol intoxication frequency via self-report. The Eating Disorder Inventory-II assessed drive for thinness and body dissatisfaction. Sex-specific biometrical twin modeling examined the genetic overlap between alcohol involvement and eating disorder symptoms.

RESULTS

Phenotypic associations between alcohol involvement, drive for thinness, and body dissatisfaction were significantly greater in girls compared with boys. A majority of the associations between alcohol involvement, drive for thinness, and body dissatisfaction in girls, but not boys, met our threshold for twin modeling (phenotypic r > 0.20). Moderate genetic correlations were observed between the 3 aspects of alcohol involvement and drive for thinness. Moderate genetic correlations were observed between alcohol use and intoxication frequency and body dissatisfaction.

CONCLUSIONS

Together with the literature on alcohol involvement and bulimic symptoms, these findings suggest a generalized association between alcohol involvement and eating disorder symptoms in girls, whereas this association may be symptom specific in boys. Genetic correlations indicate that the amount and direction of this genetic overlap differs across specific symptoms. When intervening on comorbid alcohol involvement and eating disorder symptoms, it may be important to target-specific eating disorder symptoms.