Core beliefs in anorexic and bulimic women

A mixed methods study of schema modes amongst people living with eating disorders

BACKGROUND

Schema therapy is promising for people with eating disorders, especially those unresponsive to cognitive behavioural therapy. Complex underlying psychological constructs include dysfunctional schemas and maladaptive modes. This study aimed to explore people living with eating disorders' schema modes and their identification with and understanding of their high scoring modes.

METHODS

Sixteen women with enduring eating disorders without prior exposure to schema therapy completed the schema mode inventory for eating disorders short form (SMI-ED-SF), then participated in semi-structured interviews discussing their high scoring modes. Interviews were analysed by thematic analysis.

RESULTS

All participants scored above clinical concern on at least one maladaptive mode and many scored high on multiple modes, most commonly Demanding Mode, Vulnerable Child and Detached Self-Soother. Qualitatively, four themes emerged: 1) Adverse family environments related to (a) trauma and the vulnerable and angry child and (b) unrealistically high standards; 2) Mode effects on (a) everyday life and (b) disordered eating; 3) Modes are psychologically protective in (a) avoiding emotion by detachment and soothing, (b) people pleasing by compliance and surrender; 4) Help seeking including (a) barriers to recovery from an eating disorder, (b) dissatisfaction with interventions experienced to date, (c) schema therapy as a promising alternative.

DISCUSSION

Participants recognised and identified with their high scoring schema modes. After negative experiences with previous interventions, they considered schema therapy to be a promising alternative that could understand and work on their deeper psychological issues. This suggests that schema modes are a promising way of understanding and working with enduring eating disorders.

Drunkorexia Among a Sample of Lebanese Adults: The Role of Early Maladaptive Schemas

Background: Drunkorexia is a food and alcohol disturbance described as being a range of disordered and compensatory eating behaviors that co-occur with excessive alcohol consumption. The remarkable correlation, highlighted in the literature, between dysfunctional cognitions and both eating disorders and substance use disorders is able to emphasize that cognitive phenomena can be an intrapersonal factor linked to drunkorexia disorder. The aim of this study was to assess the correlation between early maladaptive schemas (EMSs) and drunkorexia among a sample of Lebanese adults.Method: We conducted a cross-sectional study across all the Lebanese governorates (September-December 2020; N = 258). The Drunkorexia Motives and Behaviors Scales, Drunkorexia Fails Scale, Drunkorexia during an Alcohol Consumption Event Scale, and Post-Drinking Compensation Scale were used to assess drunkorexia, whereas the Young Schema Questionnaire-Short Form three was used to measure EMSs.Results: Emotional deprivation and subjugation were significantly associated with more drunkorexia motives, whereas emotional inhibition was significantly associated with less drunkorexia motives. Failure was significantly associated with more drunkorexia behaviors. Abandonment and mistrust were significantly associated with more drunkorexia fails, whereas unrelenting standards was significantly associated with less drunkorexia fails. Subjugation was significantly associated with more drunkorexia during alcohol consumption on events. Social isolation was significantly associated with more post-drinking compensation, whereas unrelenting standards was significantly associated with less post-drinking compensation.Conclusion: Our findings showed that drunkorexia is positively associated with EMSs, delineating as well the specific relationships between dysfunctional cognitive schemas and drunkorexia's maladaptive behavioral aspects. They support the hypothesis that EMSs might play an important role in drunkorexia's development and perpetuation. This study could therefore serve healthcare professionals for the cognitive approach of patients with concomitant alcohol misuse and eating disorders while emphasizing the value of cognitive-behavioral interventions-namely schema therapy.

The Relationship between the Family Environment and Eating Disorder Symptoms in a Saudi Non-Clinical Sample of Students: A Moderated Mediated Model of Automatic Thoughts and Gender

Eating disorders are a global burden and present personal, family, and societal costs. Most evidence in the literature is based on the relationship between a poor family environment and eating disorders, and the evidence of gender interaction in eating disorders is inconsistent. This study aimed to investigate the relationship between family environment and eating disorder symptoms, the mediating role of negative automatic thoughts, and the moderating role of gender using a non-clinical sample of students. A sample of 440 (70.9% females, aged 18-21) participated in this study. They completed the Eating Attitudes Test (EAT-26), the Automatic Thoughts Questionnaire (ATQ negative), and the Brief Family Relationship Scale (BFRS). PROCESS MACRO was used to study these relationships. The main findings revealed that family environment was negatively associated with eating disorder symptoms and that this relationship was mediated by automatic thoughts. Moreover, gender moderated those relationships, and more intensely in females. The results of this study indicate that the prevention of eating disorders should be directed at training individuals to challenge negative thoughts and encourage healthy individuals to be gender mindful.

What role do early life experiences play in eating disorders? The impact of parenting style, temperament and early maladaptive schemas

OBJECTIVE

Given that most eating disorders develop in adolescence and early adulthood, early life experiences are said to play a key role in the aetiology of eating disorders. There are well-documented relationships between early maladaptive schemas and eating disorders, early maladaptive schemas and temperament and temperament and perceived parenting style. The present study aimed to test a hypothesis that perceived parenting style predicts temperament, which predicts early maladaptive schemas, which predict eating disorder symptoms in young people.

METHOD

An online survey measured perceived parenting style, temperament, early maladaptive schemas and eating disorder symptoms in 397 people with disordered eating between the ages of 18 and 29. Path analysis was used to investigate the relationship between these elements.

RESULTS

The results found support for this hypothesis. Perceived maladaptive parenting ratings for mothers were a stronger predictor of temperament, and only two temperament factors were adequate predictors of early maladaptive schemas.

CONCLUSIONS

Overall, the present study found preliminary support for a linear relationship where perceived parenting style predicts temperament, which predicts early maladaptive schema levels, which predicts eating disorder symptoms. The present study was the first to propose and test this model; however, further research is required to confirm the nature and extent of this relationship.

Factor structure of the Young Positive Schema Questionnaire in an eating disorder sample

PURPOSE

The Young Positive Schema Questionnaire (YPSQ) measures early adaptive schemas (EAS) which could be used to develop positive psychology and schema-based interventions to benefit the treatment of eating disorders (EDs).

METHODS

The present study investigated the factor structure of the YPSQ in a sample of 826 participants (18-73 years; n = 753 women) with ED symptomatology (e.g., restricting, binging, and purging). The sample was randomly split into two groups for exploratory and confirmatory factor analyses. Full sample analysis using Pearson correlations was conducted to explore convergent validity of the new YSPQ factor structure with ED symptomatology, emotional regulation, and cognitive flexibility.

RESULTS

A nine-factor model was found, demonstrating good fit indices and internal consistency (α = 0.77-0.92). The YPSQ showed an inverse relationship to ED symptomatology and emotional suppression, and a positive relationship with cognitive flexibility and emotion reappraisal.

CONCLUSION

Further research is needed to explore the clinical benefits of the YPSQ to identify EAS deficits in individuals with EDs to improve treatment outcomes.

LEVEL OF EVIDENCE

Level V, descriptive study.

A new integrative model for the co-occurrence of non-suicidal self-injury behaviours and eating disorder symptoms

OBJECTIVE

The high co-occurrence of non-suicidal self-injury (NSSI) behaviours and eating disorder (ED) symptoms suggests these conditions share common aetiological processes. We assessed a new integrative model of shared factors for NSSI and ED symptoms, where affect dysregulation, impulsivity, self-esteem, and body dissatisfaction mediated the relationship between insecure attachment and maladaptive schemas and NSSI and ED symptoms. A further aim of the study was to assess whether the model behaved similarly across a clinical eating disorder (ED) and a community sample.

METHOD

123 females with a lifetime ED diagnosis and 531 female individuals from the community completed an online survey, which included measures assessing the variables of interest. A cross-sectional single time point analysis was used.

RESULTS

Invariance testing indicated that the model was structurally non-invariant (different across groups). The proposed integrative model was a good fit for the ED group, but for the community sample only a revised model reached an acceptable fit. Both attachment and maladaptive schemas, included early in the model, were implicated in the pathways leading to ED and NSSI symptoms in the ED and community groups. In the community group, impulsivity, a mediator, was a shared predictor for NSSI and bulimic symptoms. No other mediating variables were shared by NSSI and ED symptoms in the two groups. Overall, the proposed model explained slightly more variance for the ED group relative to the community group in drive for thinness (R² = .57 vs .51) and NSSI (R² = .29 vs .24) but less variance in bulimic symptoms (R² = .33 vs .39).

CONCLUSION

We conclude that the current model provides only limited support for explaining the comorbidity between NSSI and ED symptoms. It is vital to consider both common (e.g., attachment and maladaptive schemas) and specific factors (e.g., impulsivity) to better understand the pathways that lead to the co-occurrence of NSSI and ED symptoms. A new integrative model assessed whether emotion dysregulation, impulsivity, self-esteem, and body dissatisfaction were mediators in the relationship between insecure attachment and maladaptive beliefs about the world and the self and subsequent eating disorder and self-harm symptoms. A further aim was to assess whether the proposed model differed between a clinical eating disorder and a community sample. All participants were female and included 123 patients with a lifetime eating disorder and 531 individuals from the community. Participating individuals completed an online survey at one timepoint, which included measures assessing the variables of interest. The findings of the current study indicated that the proposed model was a good match for the clinical eating disorder sample, but for the community sample only a revised model yielded acceptable statistical fit. Both insecure attachment and maladaptive beliefs about the world and the self, included early in the model, were indirectly related to eating disorder and self-harm symptoms for both the eating disorder and the community groups. Impulsivity, a mediator, was the only shared predictor for self-harm, and bulimic symptoms in the community group. We conclude that the current model provides only limited support for explaining the comorbidity between self-harming behaviours and disordered eating symptoms.

Early maladaptive schemas in eating disorders: A systematic review

OBJECTIVE

Research and theory suggest the aetiological nature and symptomatic profile of eating disorders (EDs) can be explained by multiple factors, including the development of early maladaptive schemas (EMS). Yet, there is lack of consensus regarding the evidence supporting the relationship between EMS and EDs. Therefore, this systematic review aimed to examine existing literature concerning the relationship between different ED diagnoses and EMS to provide a synthesis and evaluation of relevant research.

METHOD

A comprehensive literature search of four electronic databases was conducted and studies were included that examined the association between EMS and EDs. Studies were required to use a variant of Young Schema Questionnaire and establish ED diagnosis or symptomology using self-report questionnaires or clinical interview.

RESULTS

A total of 29 studies were included in the review. Compared to healthy controls and varying clinical populations, individuals with EDs generally reported significantly higher scores across all EMS except for Entitlement. Furthermore, Unrelenting Standards consistently appeared as a significant EMS across all ED diagnoses whilst Insufficient Self-Control was significantly lower in ED diagnoses with restrictive behaviour compared to diagnoses with binge eating or purging behaviour.

DISCUSSION

Research supports significant associations between EMS and EDs, which may contribute to our understanding of ED aetiology, including different diagnostic categories. This review underscores the need for studies to explore more gender and age diverse samples and highlights important implications for practitioners.

Transdiagnostic vulnerability factors in eating disorders: A network analysis

OBJECTIVE

Eating disorder (ED) symptoms and transdiagnostic vulnerability characteristics play a crucial role in the aetiology and maintenance of EDs. Over the last decade, researchers have started to model complex interrelations between symptoms using network models, but the literature is limited in that it has focused solely on symptoms and investigated-specific disorders while ignoring transdiagnostic aspects of mental health.

METHOD

This study tackles these challenges by investigating network relations among core ED symptoms, comorbid clinical symptoms (depression and anxiety) and empirically supported vulnerability and protective mechanisms (personality traits, maladaptive cognitive schemata, perfectionism and resilience) in a sample of 2302 treatment-seeking ED patients. We estimated a regularized partial correlation network to obtain conditional dependence relations among all variables. We estimated node centrality (interconnectivity) and node predictability (the overall magnitude of symptom inter-relationships).

RESULTS

The findings indicate a central role of overvigilance, excessive focus on inhibiting emotions and feelings, interoceptive awareness and perfectionism.

CONCLUSIONS

These results suggest that excessive control of bodily aspects by dietary restraint (possibly through inhibition) and interoceptive awareness may be important constructs that warrant future research in understanding vulnerability in EDs. We provide all code and data via the Open Science Framework.

'Impaired Autonomy and Performance' predicts binge eating disorder among obese patients

PURPOSE

The present study examined the predictive value of early maladaptive schema (EMS) domains on the diagnosis of binge eating disorder (BED).

METHODS

Seventy obese patients seeking treatment for weight loss were recruited and allocated to either group 1 (obese) or group 2 (BED-obese) according to clinical diagnosis. Both groups underwent psychometric assessment for EMS (according to the latest four-factor model), eating and general psychopathologies. Logistic regression analysis was performed on significant variables and BED diagnosis.

RESULTS

In addition to showing higher values on all clinical variables, BED-obese patients exhibited significantly higher scores for all four schema domains. Regression analysis revealed a 12-fold increase in risk of BED with 'Impaired Autonomy and Performance'. Depression did not account for a higher risk.

CONCLUSIONS

Impaired Autonomy and Performance is associated with BED in a sample of obese patients. Schema therapy should be considered a potential psychotherapy strategy in the treatment of BED.

LEVEL OF EVIDENCE

Level III, case-control study.

Testing a new interpersonal model of disordered eating between Australian and East-Asian women: The relationships between theory of mind, maladaptive schemas, and appearance-based rejection sensitivity

The current study tested a new interpersonal model of disordered eating behaviours, whereby maladaptive schemas and theory of mind decoding (ToM-decoding) were related with disordered eating attitudes (body dissatisfaction) and behaviours (binging/purging and food restriction) through the mediating variable appearance-based rejection-sensitivity. A secondary aim was to test whether this model differed between two cultural groups: Caucasian Australian women (N = 197, ages ranging 17-43, M = 19.25, SD = 3.10), and Asian women living in East-Asia (N = 195, ages ranging 18-40, M = 28.60, SD = 5.15). Participants completed an online survey assessing the variables of interest. While the model showed acceptable fit for both groups, invariance testing demonstrated that the model worked differently in each group. Appearance-based rejection-sensitivity mediated the effect of maladaptive schemas on body dissatisfaction and disordered eating in both groups, but only mediated the effect of ToM-decoding on body dissatisfaction in the East-Asian group. Overall, the significant indirect pathways were greater in strength and number for the Caucasian-Australian group. These findings indicate that while the relationships between maladaptive schemas, appearance-based rejection-sensitivity, and disordered eating attitudes and behaviours are present in both cultures, ToM-decoding may only play a role for East-Asian participants.

Development and Validation of the Positive Parenting Schema Inventory (PPSI) to Complement the Young Parenting Inventory (YPI) for Schema Therapy (ST)

The factor structure of an initial item pool of 207 positive parenting items was investigated (Manila; n = 520, 538) to develop the Positive Parenting Schema Inventory. Single group and multigroup confirmatory factor analyses of the Positive Parenting Schema Inventory showed invariance of the factor structure in six out of the seven levels on two other independent samples (Eastern, Indonesia; n = 366, 383; Western, the United States; n = 204, 214). Good values for reliability were obtained for its seven subscales (50 items) using coefficient omegas (.71 to .95). Evidence of validity based on test content, response processes (item responses to desired inferences), internal structure (exploratory and confirmatory factor analyses), relations to other variables (correlations with other instruments), and consequences of testing (correlations with positive schemas) were demonstrated. A core tenet of schema therapy theory was supported in that recall of past positive parenting patterns were associated with current levels of positive schemas.

Insecure attachment and maladaptive schema in disordered eating: The mediating role of rejection sensitivity

AIM

The current study aimed to assess insecure attachment and the disconnection and rejection domain of maladaptive schema in the context of disordered eating. Rejection sensitivity (RS) was proposed as a mediator between maladaptive schema and disordered eating.

METHOD

The sample consisted of 108 female participants with a lifetime eating disorder diagnosis and 508 female control participants. Participants were asked to complete a number of self-report measures related to insecure attachment (anxious and avoidant), maladaptive schema (emotional deprivation, abandonment, mistrust, social isolation, and defectiveness), RS (interpersonal and appearance-based), and disordered eating.

RESULTS

Path analysis indicated that anxious attachment was associated with disordered eating through multiple pathways involving emotional deprivation, abandonment, interpersonal RS, and appearance-based RS. Avoidant attachment was not related to disordered eating behaviours.

CONCLUSION

The results indicate that both interpersonal and appearance-based RS are important mediators for the relationships between insecure attachment, maladaptive schema, and disordered eating.

KEY PRACTITIONER MESSAGE

The results from the current study suggest that insecure attachment leads to maladaptive schema, which in turn leads to sensitivity to rejection and subsequent disordered eating behaviour. Attachment anxiety, but not attachment avoidance, was related to greater endorsement of all five schemas in the disconnection and rejection domain. Path analysis revealed that, of the schema in the disconnection and rejection domain, only emotional deprivation and abandonment were related to disordered eating. Interpersonal and appearance-based rejection sensitivity were significant mediators of the relationship between emotional deprivation and disordered eating as well as the relationship between abandonment and disordered eating. Differentiating between schemas within schema domains has clinical value in further understanding the pathway to disordered eating. The schemas of emotional deprivation and abandonment are implicated in disordered eating, suggesting the need to target these schemas in schema therapy.

Do dysfunctional coping modes mediate the relationship between perceived parenting style and disordered eating behaviours?

BACKGROUND

Preliminary studies suggest that both childhood experiences and coping behaviours may be linked to eating disorder symptoms.

METHODS

In this study maladaptive schema coping modes were investigated as mediators in the relationship between perceived negative parenting and disordered eating. A total of 174 adults with eating and/or body image concerns completed questionnaires measuring parenting experiences, schema modes, and disordered eating behaviours.

RESULTS

Perfectionistic Overcontroller, Self-Aggrandiser, Compliant Surrenderer, Detached Protector and Detached Self-Soother coping modes partially explained the variance in the relationships between perceived negative parenting experiences and the behaviours of restricting and compensation (purging and overexercising).

CONCLUSIONS

Our findings suggest that Overcompensatory, Avoidant and Surrender coping mechanisms all appear to play a role in the maintenance of eating disorder symptoms, and that there are multiple complex relationships between these and Early Maladaptive Schemas that warrant further investigation.

Life Event Stress and Binge Eating Among Adolescents: The Roles of Early Maladaptive Schemas and Impulsivity

This study examined the relationships between life event stress, early maladaptive schemas, impulsivity and binge eating among adolescents and investigated the effects of early maladaptive schemas and impulsivity on the relationship between life event stress and binge eating. Specifically, we examined a moderated mediation model in which early maladaptive schemas mediated this relationship and impulsivity moderated the mediation effect. Life event stress, early maladaptive schemas, impulsivity and binge eating were investigated in a sample of 2172 seventh-, eighth- and tenth-grade middle and high school students (mean age = 14.55 years, standard deviation = 1.29). The results indicated that adolescents with greater life event stress, more early maladaptive schemas and higher levels of impulsivity displayed more severe binge eating. In addition, early maladaptive schemas mediated the relationship between life event stress and binge eating, while impulsivity moderated this relationship. Furthermore, impulsivity also moderated the mediation effect of early maladaptive schemas; as impulsivity levels increased, the strength of the association between life event stress and early maladaptive schemas increased. This study illustrates the importance of understanding individual differences and their effects on the relationship between life event stress and binge eating. Copyright © 2015 John Wiley & Sons, Ltd.

Do female dieters have an "eating disorder" self-schema?

BACKGROUND

The processing of schema-related information is important in the maintenance of specific eating disorder (ED)-related belief systems and psychopathology. To date, most research on differences in the processing of ED schematic information has used interview or self-report questionnaire measures. Dieting is a known risk factor for EDs and dieters have been included in some studies. However, they have not been compared with non-dieters on a novel, objective measure of ED related schema processing.

METHODS

The current study recruited healthy female volunteers from the community and divided them into dieting (n = 25) and non-dieting (n = 24) groups using rigorous criteria. ED self-schemas with content unrelated to eating, weight and shape were measured using a self-schema processing task.

RESULTS

Dieters endorsed significantly more ED relevant words compared to non-dieters, whereas non-dieters rejected significantly more ED relevant words compared to dieters. Reaction times to endorsements and rejections were non-significant when the two groups were compared. In a surprise recall task, dieters recalled significantly more ED relevant words.

CONCLUSION

The results of this study support the presence of ED self-schemas with negative content unrelated to eating, weight and shape in otherwise healthy dieters. Implications for future research and the early identification of individuals vulnerable to EDs are discussed.

The relationship between early maladaptive schemas and eating-disorder symptomatology among individuals seeking treatment for substance dependence

Numerous studies have examined early maladaptive schemas (EMS) and their relationship to psychological disorders, including eating disorders (EDs) and substance use disorders (SUDs). However, to date, there are no empirical investigations that have examined the relationship between EMS and EDs among individuals seeking treatment for substance use. In an attempt to further elucidate this relationship, the purpose of the current, exploratory study was to examine the relationship between EMS, ED symptomatology (i.e., bulimia and binge-eating but not anorexia), and substance use and to directly compare EMS among individuals with and without a probable ED diagnosis. Participants were 387 men and 132 women seeking residential treatment for substance use. Results demonstrated that 11 of the 18 EMS were significantly associated with ED. Moreover, patients with a probable ED scored significantly higher than patients without a probable ED on 8 of the 18 EMS. Results suggest that EMS are prevalent among individuals with ED pathology seeking treatment for substance use. Thus treatment programs could potentially benefit from the assessment and treatment of EMS among dually-diagnosed patients. Given the exploratory and preliminary nature of the study, continued research is needed to further examine the relationship between EMS, EDs, and substance use.

A narrative review of schemas and schema therapy outcomes in the eating disorders

Whilst cognitive-behavioural therapy has demonstrated efficacy in the treatment of eating disorders, therapy outcomes and current conceptualizations still remain inadequate. In light of these shortcomings there has been growing interest in the utility of schema therapy applied to eating pathology. The present article first provides a narrative review of empirical literature exploring schemas and schema processes in eating disorders. Secondly, it critically evaluates outcome studies assessing schema therapy applied to eating disorders. Current evidence lends support to schema-focused conceptualizations of eating pathology and confirms that eating disorders are characterised by pronounced maladaptive schemas. Treatment outcomes also indicate that schema therapy, the schema-mode approach, and associated techniques are promising interventions for complex eating disorders. Implications for clinical practice and future directions for research are discussed.

Food for thought: ego-dystonicity and fear of self in eating disorders

Degree of ego-dystonicity in obsessions is clinically relevant to the conceptualization and treatment of eating disorders (EDs). Obsessive-compulsive disorder research has suggested that the transformation of intrusive thoughts into obsessions is linked to the degree to which intrusive thoughts threaten core perceptions of the self. This study aims to explore the relationship between the ego-dystonic nature of obsessions in ED patients and a fear of self, the link between ED symptom severity and ego-dystonicity in obsessions, and differences between non-clinical and individuals with EDs in the presence of ego-dystonic thoughts and a fear of self. Ego-dystonicity (Ego-dystonicity Questionnaire (EDQ)) and feared self (Fear of Self Questionnaire (FSQ)) degrees were measured in a clinical sample (n = 57 with EDs) and a non-clinical sample (n = 45). EDQ and FSQ scores were highly correlated in both samples. EDQ scores were not significantly correlated to ED symptom severity with the exception of the EDQ Irrationality subscale, which was strongly related to compulsion severity. Participants with an ED had significantly higher EDQ and FSQ scores compared with controls.

Maladaptive schemas in adolescent females with anorexia nervosa and implications for treatment

Recent research has highlighted the presence of Young's Early Maladaptive Schemas (EMSs) in individuals with an eating disorder (ED). This study assessed the EMSs reported by adolescent females with Anorexia Nervosa (AN) compared with a community group. Thirty-six adolescent females diagnosed with AN or subthreshold AN and 111 female secondary school students completed a questionnaire that included the Young Schema Questionnaire, the Behavior Assessment System for Children Self-report of Personality, and the Eating Disorder Screen for Primary Care. Two independent AN subtypes and two community subtypes were derived from responses to the questionnaire, and significant differences between the four comparison groups were found. High Pathology AN participants reported the highest level of psychological maladjustment. Social Isolation and Emotional Inhibition appeared to be most characteristic of adolescent AN in this sample. The results suggest that EMSs may require attention in the treatment of AN in adolescent females, and that different AN subtypes may require individualized treatment approaches.

Psychometric properties of the eating disorder belief questionnaire

OBJECTIVE

The purpose of this investigation was to examine the psychometric properties of the eating disorder belief questionnaire (EDBQ).

METHOD

The EDBQ was administered to clinical patients with bulimia nervosa (n = 44) and nonclinical female university students (n = 298). Six types of psychometric testing were conducted: internal consistency, test-retest reliability, convergent validity, ability to discriminate between clinical and nonclinical groups, exploratory factor analysis, and confirmatory factor analysis.

RESULTS

Psychometric testing generally supported the utility of the EDBQ with good internal consistency, 4- to 6-week test-retest reliability, convergent validity, and ability to discriminate between groups. The a priori structure of the EDBQ was shown to provide a good fit to the observed data.

DISCUSSION

The results suggest that the EDBQ is a reliable and valid measure that may assist researchers and clinicians aiming to assess eating disorder cognitions in populations with bulimic symptoms.

Emotion dysregulation and symptoms of anorexia nervosa: the unique roles of lack of emotional awareness and impulse control difficulties when upset

OBJECTIVE

Extant research suggests that individuals with anorexia nervosa (AN) have deficits in emotion regulation across a variety of domains. The current study investigated associations between specific difficulties with emotion regulation and the core symptoms of AN.

METHOD

Participants were 192 patients with AN presenting to an intensive eating disorder treatment facility. Emotion regulation was assessed using the multidimensional Difficulties in Emotion Regulation Scale, and associations with body mass index (BMI) at admission, eating disorder cognitions, objective binge eating, subjective binge eating, and purging were examined.

RESULTS

Eating disorder cognitions were significantly associated with multiple forms of emotion dysregulation; however, only lack of emotional awareness was independently related to these symptoms. In contrast, impulse control difficulties when upset was the only emotion regulation impairment associated with the presence of recurrent objective binge eating and recurrent purging in AN. No significant relationships between emotion regulation and BMI or subjective binge eating were detected.

DISCUSSION

Results point to differential associations between specific emotion regulation deficits and core symptoms of AN. These findings suggest that parsing the construct of emotion regulation as well as the AN phenotype can help to identify the unique ways in which eating disorder symptoms may function to regulate emotions.

Are maladaptive schema domains and perfectionism related to body image concerns in eating disorder patients?

Both maladaptive schemas (MS) and perfectionism have been associated with eating pathology. However, previous research has not examined these variables simultaneously and has not studied possible mediating relationships between MS and multidimensional perfectionism for body image concerns in eating disorder (ED) patients. Eighty-eight female ED patients completed the Young Schema Questionnaire, the Frost Multidimensional Perfectionism Scale, and the Body Attitude Test. Body image concerns were found to be positively related to Personal Standards (PS) and Evaluative Concerns (EC) perfectionism and all five schema domains. PS Perfectionism was positively associated with Disconnection, Other-directedness, and Overvigilance. EC Perfectionism was positively related to Disconnection, Impaired Autonomy, Other-directedness, and Overvigilance. Moreover, EC perfectionism was found to be a significant mediator in the relationship between the schema domains Impaired Autonomy and Overvigilance and body image concerns. These findings denote the importance to address both core beliefs and perfectionism in ED treatment.

Dysfunctional core beliefs, perceived parenting behavior and psychopathology in gender identity disorder: A comparison of male-to-female, female-to-male transsexual and nontranssexual control subjects

BACKGROUND

Research into the association between Gender Identity Disorder (GID) and psychological disturbances as well as on its relation with parenting experiences yielded mixed results, with different patterns for Male-to-Female (MF) and Female-to-Male (FM) transsexual subjects. We investigated vulnerability markers of maladjustment and their possible origins in MF and FM transsexuals by examining maladaptive core beliefs and parenting behaviors thought to be specifically related to them.

METHODS

Dysfunctional core beliefs, parenting experiences and psychiatric symptoms were assessed by the Young Schema Questionnaire indexing 19 Early Maladaptive Schemas (EMS), the Young Parenting Inventory and the Symptom Checklist-90-R, respectively, in 30 MF, 17 FM transsexual and 114 control subjects (43 males, 114 females).

RESULTS

Subjects with GID demonstrated a level of psychiatric distress comparable to that of controls. They did display elevated scores, however, on multiple EMSs compared to nontranssexual subjects, indicating feelings of isolation, emotional deprivation and an urge to meet others' needs, with MF transsexuals conceptualizing themselves also as more vulnerable and deficient than controls. Parenting experiences of transsexual subjects were characterised by increased maternal dominance, emotional abuse and neglect compared to controls, with males being exposed to a disengaged maternal style and more paternal emotional neglect and criticism. Both MF and FM transsexuals were made felt that in areas of achievement they will inevitably fail.

CONCLUSIONS

There is no evidence of elevated levels of psychiatric symptoms in GID, but potential predisposing factors, particularly in MF transsexuals, are present; these may originate from the more intense rejection they experience.

A multidimensional measure of core beliefs relevant to eating disorders: preliminary development and validation

Core beliefs associated with eating disorders are likely to be multidimensional, and may not be adequately captured by existing measures. The current study aimed to develop such a measure and examine its relationship to eating disorder symptoms, anxiety, depression and putative diagnoses of their related disorders. Core belief items were rated by 500 female participants aged 18-65, who also completed self-report measures of eating disorder symptomatology, depression, anxiety, and self esteem. Factor analysis revealed five subscales, with themes related to (a) self loathing, (b) unassertive/inhibited, (c) high standards for self, (d) demanding and needing help and support and (e) abandoned/deprived. Thirty two items were selected for a final scale, the Eating Disorder Core Beliefs Questionnaire (ED-CBQ). The ED-CBQ subscales showed adequate internal consistency and construct (convergent and discriminant) validity. Self loathing appeared to be particularly associated with putative eating disorder diagnosis, while abandoned/deprived was more characteristic of putative anxiety and depression diagnoses. The findings suggest that negative core self beliefs relevant to those with an eating disorder are a multidimensional construct and that self loathing as a core belief merits further research and clinical attention.

Group schema therapy for eating disorders: a pilot study

This paper describes the use of Group Schema Therapy for Eating Disorders (ST-E-g) in a case series of eight participants with chronic eating disorders and high levels of co-morbidity. Treatment was comprised of 20 sessions which included cognitive, experiential, and interpersonal strategies, with an emphasis on behavioral change. Specific schema-based strategies focused on bodily felt-sense and body-image, as well as emotional regulation skills. Six attended until end of treatment, two dropped-out at mid-treatment. Eating disorder severity, global schema severity, shame, and anxiety levels were reduced between pre- and post-therapy, with a large effect size at follow-up. Clinically significant improvement in eating severity was found in four out of six completers. Group completers showed a mean reduction in schema severity of 43% at post-treatment, and 59% at follow-up. By follow-up, all completers had achieved over 60% improvement in schema severity. Self-report feedback suggests that group factors may catalyze the change process in schema therapy by increasing perceptions of support and encouragement to take risks and try out new behaviors, whilst providing a de-stigmatizing and de-shaming therapeutic experience.

Early maladaptive schemas in Finnish adult chronic pain patients and a control sample

Engel (1959) suggested that negative physical or emotional experiences in childhood predispose to the development of chronic pain. Studies have shown that physical and sexual abuse in early life is connected with chronic pain. Emotional adversities are much less studied causes contributing to the development of chronic pain and disability. Early emotional abuse, neglect, maltreatment and other adversities are deleterious childhood experiences which, according to Young's schema theory (1990), produce early maladaptive schemas (EMSs). The primary goal of this study was to examine whether early adversities were more common in chronic pain patients than in a control group. A total of 271 (53% women) first-visit chronic pain patients and 331 (86% women) control participants took part in the study. Their socio-demographic data, pain variables and pain disability were measured. To estimate EMSs the Young Schema Questionnaire was used. Chronic pain patients scored higher EMSs reflecting incapacity to perform independently, catastrophic beliefs and pessimism. The most severely disabled chronic pain patients showed an increase in all the EMSs in the Disconnection and Rejection schema domain, namely Abandonment/Instability, Mistrust/Abuse, Emotional Deprivation, Defectiveness/Shame and Social Isolation/Alienation EMSs. The results of the study suggested that chronic pain patients had suffered early emotional maltreatment.

Invalidating childhood environments and core beliefs in women with eating disorders

It can be hypothesised that invalidating environments in childhood influence the negative core beliefs that are found in the eating disorders. This study of eating-disordered women aimed to test the relationships between perceived childhood invalidating environments and negative core beliefs. Forty-one eating-disordered females completed the measures of childhood invalidating experiences and core beliefs. Such core beliefs were most closely related to the individuals' perceptions of having grown up in a 'chaotic' family environment. Future clinical practice should continue to target core beliefs in formulating cases of eating disorders. Explaining those core beliefs may depend on understanding the individual's experiences of invalidation in early years.

Eating disorder behavior and early maladaptive schemas in subgroups of eating disorders

To examine relationship between Eating Disorder Behaviors (EDB) and Early Maladaptive Schemas (EMS) across eating disorder (ED) subgroups. EMS and ED behaviors were measured by Young Schema Questionnaire and Eating Behavior Severity Scale, respectively, among patients diagnosed with Restrictive or Binge/purging Anorexia, or bulimia nervosa. Canonical component analysis showed significant association between ED behaviors and EMSs. Canonical factor-pairs (EDB and EMS) revealed specific associations between certain patterns of EDBs, including binge-purging and physical exercise, and certain patterns of maladaptive cognitive schema, including Emotional deprivation, Abandonment, Enmeshments, Subjugation, and Emotional inhibition. ED subgroups significantly differred between the EMS and EDB canonical factors, respectively. Our findings indicate that EMS and EDB are associated, and that the factors that potentially mediate the association differ significantly among ED subgroups. These results are consistent with the notion that EMSs play a specific role in the development and maintenance of ED behaviors.

Relationship of negative self-schemas and attachment styles with appearance schemas

The purpose was to test, among women, the relationship between negative self-schemas and styles of attachment with men and women and two types of appearance investment (Self-evaluative and Motivational Salience). Predominantly Caucasian undergraduate women (N=194) completed a modified version of the Relationship Questionnaire, the Young Schema Questionnaire-Short Form, and the Appearance Schemas Inventory-Revised. Linear multiple regression analyses were conducted with Motivational Salience and Self-evaluative Salience of appearance serving as dependent variables and relevant demographic variables, negative self-schemas, and styles of attachment to men serving as independent variables. Styles of attachment to women were not entered into these regression models because Pearson correlations indicated they were not related to either dependent variable. Self-evaluative Salience of appearance was related to impaired autonomy and performance negative self-schema and the preoccupation style of attachment with men, while Motivational Salience of appearance was related only to the preoccupation style of attachment with men.

Eating disorders and multi-level models of emotion: an integrated model

This paper examines the relationship between emotions, depression and eating disorders. Initially, a review is undertaken of the current state of the research and clinical literature with regard to emotional factors in eating disorders. This literature is then integrated within a version of the multi-level model of emotion proposed by Power and Dalgleish. The aim of this paper is to incorporate a basic emotions, multi-modal perspective into developing a new emotions-based model that offers a theoretical understanding of psychological mechanisms in eating disorders. Within the new Schematic Propositional Analogical Associative Representation System model applied to eating disorders, it is argued that the emotions of anger and disgust are of importance in eating disorders and that the eating disorder itself operates as an inhibitor of emotions within the self. It is hoped that the development of a multi-levelled model of eating disorders will allow for the construction of number of specific testable hypotheses that are relevant to future research into the psychological treatment and understanding of eating disorders.

Do schema processes mediate links between parenting and eating pathology?

OBJECTIVE

Adverse parenting experiences are commonly linked to eating pathology. A schema-based model of the development and maintenance of eating pathology proposes that one of the potential mediators of the link between parenting and eating pathology might be the development of schema maintenance processes--mechanisms that operate to help the individual avoid intolerable emotions.

METHOD

To test this hypothesis, 353 female students and 124 female eating-disordered clients were recruited. They completed a measure of perceived parenting experiences as related to schema development (Young Parenting Inventory-Revised (YPI-R)), two measures of schema processes (Young Compensatory Inventory; Young-Rygh Avoidance Inventory (YRAI)) and a measure of eating pathology (Eating Disorders Inventory (EDI)).

RESULTS

In support of the hypothesis, certain schema processes did mediate the relationship between specific perceptions of parenting and particular forms of eating pathology, although these were different for the clinical and non-clinical samples.

DISCUSSION

In those patients where parenting is implicated in the development of eating pathology, treatment might need to target the cognitive processes that can explain this link.

Core beliefs and narcissistic characteristics among eating-disordered and non-clinical women

OBJECTIVES

Narcissism is a personality trait that can interfere with the application of evidence-based therapies for the eating disorders, influencing collaboration and the patient's willingness to take responsibility for participating in change. In order to understand and work with this personality characteristic, it is important to understand the cognitions that underpin the traits concerned.

DESIGN

This study examined the associations between schema-level core beliefs and narcissism in eating disorders. Narcissism was conceptualized in terms of both its core element (entitlement and grandiosity) and the narcissistic defences (bad you and poor me attitudes).

METHODS

Validated measures of the different elements of narcissism and of core beliefs were completed by 80 eating-disordered patients and 70 non-clinical comparison women. Multiple regression analyses were used to determine the core beliefs associated with each aspect of narcissism.

RESULTS

The pattern of association differed across the two groups. Among the eating-disordered women, different core beliefs were associated with core narcissism and with each of the two defences.

CONCLUSIONS

Unconditional schema-level beliefs are associated with narcissistic personality traits in the eating disorders suggesting that these therapy-interfering personality characteristics might be addressed by modifying the relevant core beliefs, thus making it possible to work more directly with the eating disorder itself.

Emotional awareness and core beliefs among women with eating disorders

Patients with eating disorders have been shown to experience the emotional components of alexithymia-difficulties in identifying and describing emotions. In keeping with cognitive theories, which stress the role of schema-level beliefs in understanding emotions, this study examined the core beliefs that are associated with this difficulty in women with eating disorders. Seventy eating-disordered women completed standardised measures of core beliefs and alexithymia. There were no differences in alexithymia between diagnostic groups, so the women were treated as a single, transdiagnostic group. Multiple regression analyses showed specific patterns of association between the core beliefs and the emotional elements of alexithymia. Difficulties in identifying emotions were associated with entitlement beliefs, while difficulties in describing emotions were associated with both abandonment and emotional inhibition beliefs. These findings suggest that it may be necessary to work with core beliefs in order to reduce levels of alexithymia, prior to addressing the emotions that drive and maintain pathological eating behaviours.

Using imagery to identify and characterise core beliefs in women with bulimia nervosa, dieting and non-dieting women

Women with bulimia nervosa (BN), dieters and non-dieting control participants were questioned about spontaneous imagery linked to concern with food and eating, weight and shape. The downward arrow technique was used to access any associated negative or core beliefs, which were examined for belief, distress and content. A semi-structured interview with open and closed questions was used. Negative self (core) beliefs were successfully accessed, and responses to the interview items had good test-retest and good inter-rater reliability. Patients with BN reported significantly more negative self (core) beliefs than those in the other two groups. Only a very small number of core beliefs about other people or the world in general were reported. Emotional belief ratings appeared to be higher overall than rational belief ratings. Patient's negative self-beliefs contained themes of "self-value", followed by "failure", "self-control" and "physical attractiveness", in descending order of frequency. The findings are discussed in relation to existing research, and implications for cognitive theories of bulimia nervosa and clinical practice are briefly discussed.

Assessing motivation to change in bulimia nervosa: the Bulimia Nervosa Stages of Change Questionnaire

OBJECTIVE

To assess motivation to change in adolescent patients with bulimia nervosa through the Bulimia Nervosa Stages of Change Questionnaire (BNSOCQ), an instrument adapted from the Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ) already validated in anorexic patients.

METHOD

Subjects were 30 bulimia nervosa patients (mean age = 16.3 years) who were receiving treatment at an eating disorders unit. The evaluation instruments were: the BNSOCQ, the Eating Disorders Inventory (EDI-2) and the Beck Depression Inventory (BDI). The BNSOCQ was re-administered 1 week later to evaluate test-retest reliability.

RESULTS

The BNSOCQ demonstrated good internal consistency (Cronbach's alpha = 0.94) and one week test-retest reliability (Pearson's r = 0.93). Negative significant correlations were found between the BNSOCQ and several EDI-2 scales (Pearson's r between -0.51 and -0.84) and the BDI (r = -0.74).

CONCLUSION

The study provides initial support for the reliability and validity of the BNSOCQ as a self-report instrument for assessing motivation to change in adolescents with bulimia nervosa.

Cognitive content and process in eating-disordered patients with obsessive-compulsive features

OBJECTIVE

This study examined the schema-level cognitive content and processes that might explain the presence of compulsive behaviours among patients with eating disorders.

METHOD

Each of 62 eating-disordered women completed standardised measures of schema-level core beliefs and cognitive processes, and was interviewed for diagnosis and obsessive compulsive features.

RESULTS

Compulsive behaviours were associated with four core beliefs--'mistrust/abuse', 'defectiveness/shame', 'dependence/incompetence' and 'subjugation'. Higher levels of avoidance of emotional arousal were also associated with compulsivity.

DISCUSSION

Schema-level beliefs and processes are associated with the presence of compulsivity. The key cognitions might impact via the activation of negative affect, meaning that the compulsive behaviours serve the function of emotion regulation. Such cognitions are likely to be a necessary target in CBT for those presenting with compulsive behaviours in the eating disorders.

Early maladaptive schemas and body mass index in subgroups of eating disorders: a differential association

OBJECTIVE

The objectives were (1) to examine whether 3 eating disorder subgroups, as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) classification system, exhibit a specific profile in terms of early maladaptive schema (EMS) factors, and (2) to investigate the relationship between body mass index (BMI) and EMS factors in each of the individual eating disorder subgroups.

METHODS

The presence of EMS was measured by the Young Schema Questionnaire Long Form among patients affected by restrictive anorexia nervosa, binge/purging-type anorexia nervosa, and bulimia nervosa. Principal component factor analysis was used to investigate the factor structure of the EMS across eating disorder subgroups. General linear model analysis was applied to examine the differences of the subgroups in terms of their EMS factors. Differential association between BMI and schema factors was tested by analysis of covariance.

RESULTS

Four EMS factors were extracted, which accounted for approximately 72% of the variance. The 3 eating disorder subgroups differed in terms of their EMS factor profiles. The analysis of covariance resulted in a significant negative relationship between BMI and EMS factor 2 in the bulimia nervosa group (P < .0099), indicating that higher severity on defectiveness, failure, dependence, enmeshments, subjugation, approval-seeking (EMS factor 2) was associated with lower values on BMI.

CONCLUSION

The findings of this study indicate that EMSs based on Young's conceptualization of EMS, as measured by the Young Schema Questionnaire, differ significantly among eating disorder subgroups defined by the phenomenological approach used by the DSM-IV diagnoses. These results are consistent with the notion that dysfunctional cognitions may play an important role in the development and maintenance of the symptoms that underlie the DSM-IV classification of the eating disorder subtypes.

Father-daughter relationship and eating psychopathology: the mediating role of core beliefs

OBJECTIVE

The study aimed to establish the relationships between recalled paternal rearing behaviours, core beliefs and eating symptomatology and to test whether core beliefs play a mediating role between the father-daughter relationship and eating psychopathology.

DESIGN

Associations between eating psychopathology, core beliefs and recalled parental rearing behaviours were examined in women with and without eating disorders. Regression analyses were used to test whether core beliefs played a mediating role in the relationship between paternal rearing behaviours and eating psychopathology.

METHOD

Sixty-six eating-disordered women and fifty female controls completed three self-report questionnaires measuring parental rearing behaviours, core beliefs and eating psychopathology.

RESULTS

In eating-disordered women, paternal rejection and overprotection were found to predict aspects of eating psychopathology via the mediating role of abandonment, defectiveness/shame and vulnerability to harm core beliefs.

DISCUSSION

Core beliefs relating to feelings of abandonment and inherent defectiveness appear to be important in the relationship between unhealthy father-daughter relationships and eating disorder symptoms.

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.

The eating disorder belief questionnaire: psychometric properties in an adolescent sample

The current study aimed to investigate the psychometric properties of the Eating Disorder Belief Questionnaire in older adolescent females. Three hundred and sixty-seven girls aged 17 or 18 who were in secondary school education completed the Eating Disorder Belief Questionnaire, the Beck Depression Inventory and the Eating Attitudes Test. They also provided information on height and weight. The Eating Disorder Belief Questionnaire had an almost identical factor structure to that previously found in adult women, although the factors were not quite as discrete as those in the original validation study. Internal consistency for each factor was high and construct validity (including convergent and criterion related validity) was very good. The almost identical factor structure, and other good psychometric properties, found for the Eating Disorder Belief Questionnaire in the current study suggests that it is an appropriate measure for use in clinical settings and in research studies involving 17-18 year old girls. This includes older adolescents with eating disorders. The possibility that adolescents show a developmental tendency for less separation between the constructs assessed, when compared with adults, is of particular interest, and requires further exploration.