Causes of eating disorders

Therapeutic ketogenic diet as treatment for anorexia nervosa

Anorexia nervosa (AN) is a severe psychiatric disorder. However, we lack neurobiological models and interventions to explain and treat the core characteristics of food restriction, feeling fat, and body size overestimation. Research has made progress in understanding brain function involved in the pathophysiology of AN, but translating those results into biological therapies has been challenging. Studies have suggested that metabolic factors could contribute to developing and maintaining AN pathophysiology. Here, we describe a neurobiological model for why using a therapeutic ketogenic diet could address key alterations in brain function in AN and prevent the desire for weight loss and associated eating disorder-specific symptoms. This translational model is based on animal studies and human data and integrates behavioral traits, brain neural energy metabolism, and neurotransmitter function. Pilot data indicate that the intervention can dramatically reduce eating and body-related fears, although larger studies across illness stages still need to be conducted.

Sexual Harassment and Binge Eating Among Chinese Female Undergraduates: A Mediation Model of Self-Objectification and Self-Control

Sexual harassment is a serious health issue prevalent on campuses worldwide, with significant implications for individuals' well-being. Past research has highlighted the close association between sexual harassment and eating disorders, yet little is known about the mechanisms underlying this relationship. This study aimed to investigate the potential mediating roles of self-objectification and self-control in linking sexual harassment to binge eating, drawing upon objectification theory and self-control resource theory. A sample of 801 Chinese female undergraduates, with a mean age of 19.60 years (SD = 1.42), participated in the study by completing questionnaires on sexual harassment experience, self-objectification, self-control, and binge eating. The results indicated that sexual harassment experience exhibited a significant positive correlation with binge eating and self-objectification, while showing a negative correlation with self-control. And an increased frequency of sexual harassment experiences and self-objectification were associated with lower levels of self-control. Furthermore, mediation analyses utilizing Hayes' PROCESS macro (2013) for SPSS (Model 6) demonstrated that both self-objectification and self-control independently and sequentially mediated the relationship between sexual harassment and young women's binge eating. In other words, young women who had experienced sexual harassment were more likely to exhibit increased self-objectification, leading to decreased self-control and ultimately culminating in binge eating behaviors. This study provides valuable insights into how sexual harassment affects young women's binge eating by elucidating the mediating roles of self-objectification and self-control, thus enhancing our understanding of developing strategies to mitigate the negative consequences of experiencing sexual harassment.

Sex Differences in Mental Health Symptoms in Elite Athletes: A Systematic Review and Meta-analysis

CONTEXT

Mental health is a growing area of concern for elite athletes.

OBJECTIVE

To determine the sex differences in mental health symptoms in elite athletes.

DATA SOURCES

PubMed, EMBASE, and Cochrane Library databases were used.

STUDY SELECTION

Included studies included comparisons of mental health symptoms of athletes by sex.

STUDY DESIGN

Systematic review and meta-analysis were conducted following the PRISMA guidelines.

LEVEL OF EVIDENCE

Level 2a.

DATA EXTRACTION

The rate ratio (RR) was calculated as the rates in female and male athletes. Data were pooled using a random-effects model.

RESULTS

Of 1945 articles identified, 60 articles were included. Male athletes reported higher alcohol misuse (RR, 0.74; CI, 0.68-0.80), illicit drug abuse (RR, 0.82; CI, 0.75-0.89), and gambling problems (RR, 0.14; CI, 0.08-0.25). Female athletes reported higher overall anxiety (RR, 1.17; CI, 1.08-1.27), depression (RR, 1.42; CI, 1.31-1.54), distress (RR, 1.98; CI, 1.40-2.81), and disordered eating (RR, 2.19; CI, 1.58-3.02). Sleep disturbances were reported at similar rates in male and female athletes (RR, 1.13; CI, 0.98-1.30).

CONCLUSION

Female and male athletes have significant differences in reported mental health symptoms. Female athletes are more likely to report anxiety, depression, distress, and disordered eating, while male athletes report more alcohol misuse, illicit drug abuse, and gambling. Monitoring and evaluation of mental health is a necessary part of any sport, including access to resources. Longitudinal studies following athletes over time to determine the development and causation for mental health symptoms should be included in future research directions.

A dorsal hippocampus-prodynorphinergic dorsolateral septum-to-lateral hypothalamus circuit mediates contextual gating of feeding

Adaptive regulation of feeding depends on linkage of internal states and food outcomes with contextual cues. Human brain imaging has identified dysregulation of a hippocampal-lateral hypothalamic area (LHA) network in binge eating, but mechanistic instantiation of underlying cell-types and circuitry is lacking. Here, we identify an evolutionary conserved and discrete Prodynorphin (Pdyn)-expressing subpopulation of Somatostatin (Sst)-expressing inhibitory neurons in the dorsolateral septum (DLS) that receives primarily dorsal, but not ventral, hippocampal inputs. DLS(Pdyn) neurons inhibit LHA GABAergic neurons and confer context- and internal state-dependent calibration of feeding. Viral deletion of Pdyn in the DLS mimicked effects seen with optogenetic silencing of DLS Pdyn INs, suggesting a potential role for DYNORPHIN-KAPPA OPIOID RECEPTOR signaling in contextual regulation of food-seeking. Together, our findings illustrate how the dorsal hippocampus has evolved to recruit an ancient LHA feeding circuit module through Pdyn DLS inhibitory neurons to link contextual information with regulation of food consumption.

Sociodemographic correlates of parent and youth-reported eating disorder symptoms in the Adolescent Brain Cognitive Development Study

Purpose

Eating Disorders (EDs) often start in adolescence, though ED-related concerns in diverse youth samples remain understudied. We leveraged data from the Adolescent Brain Cognitive Development (ABCD) Study to identify the prevalence of parent- and youth-reported ED symptoms and their sociodemographic characteristics.

Methods

Data were drawn from baseline (ages 9-11 years, n=11,868) and 2-year follow-up (ages 11-14 years; n=10,908) from the ABCD Study. A tetrachoric factor analysis summarized clusters of ED symptoms, which were compared between parent and youth reports and across sociodemographic variables.

Results

Three factors emerged reflecting "weight distress", "weight control", and "binge eating" (prevalence range: 1.5-7.3%). Symptoms loaded onto similar factors between reporters. Rates of symptom endorsement were similar between sexes, with disproportionately higher endorsement rates for youth who self-identified as sexual minority, Hispanic, Black, or Mixed race participants, and those from a disadvantaged socioeconomic background, compared to the reference ABCD sample. Youth and parent reports at 2-year showed ~12% overlap.

Conclusions

ED-related concerns among historically understudied racial and sexual minority groups call for greater attention to the detection and treatment of these symptoms in these groups. Applying a transdiagnostic approach to ED symptoms can inform effective detection and intervention efforts.

Correction of the Tuberous Breast with Fat Grafting and Implant: Techniques, Evaluation with BREAST-Q, and Preliminary Results

BACKGROUND

The correction of tuberous breast deformity with fat grafting has gained popularity in recent years, but it remains unclear whether this new technique can produce patient satisfaction levels comparable to those achieved with implant-based correction.

METHODS

This study aimed to compare patients' satisfaction and quality of life using the BREAST-Q questionnaire after correction of tuberous breast deformity with fat grafting and implants. Twenty-four patients (36 breasts) were included in our study. Thirteen patients (15 breasts) had a correction with lipofilling (mean 2.67 interventions) and 11 patients (21 breasts) had an implant-based correction (mean 1 intervention).

RESULTS

Both fat and implant treatments showed statistically significant improvements in breast satisfaction (p value=0.001, 0.002, respectively), psychosocial (p value=0.003, 0.003, respectively), and sexual satisfaction (p value=0.008, 0.002, respectively) between the pre-treatment and post-treatment stages. However, the only statistically significant differences between the treatments were observed in the physical condition pre-treatment (p value=0.008) and sexual condition post-treatment (p value=0.030). The outcome of both treatments was not statistically different. Furthermore, the outcome exhibited a statistically significant positive linear relationship with breast satisfaction for both treatments.

CONCLUSIONS

This study suggests that lipofilling can achieve breast and outcome satisfaction comparable to that of implants, although this parity in results comes at the cost of more interventions. These preliminary results lend support to the notion that, as surgeons have access to two equally effective techniques, it is crucial to provide appropriate guidance to patients to ensure their satisfaction.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Are Instagram Gym Advertisements Working Out? An Experimental Study of Model Body-Size and Slogan-Type

Previous health communication research has demonstrated the negative psychological and health effects of depicting thin-sized models in mass media advertisements including on social media sites such as Instagram. However, gym advertisements are one common source for the presentation of lean and thin-sized models on Instagram. Therefore, the current study guided by social comparison theory and signaling theory aimed to experimentally examine the effect of thin-sized models relative to plus-sized models as well as slogan-type (health and wellness versus physique-based) on women's appearance comparison, body satisfaction, perceived gym fit, and intentions to join the gym. A sample of 217 undergraduate students who identified as women were randomly assigned to one of four Instagram gym advertisement conditions varying in model body-size and slogan-type. Appearance comparisons, perceived gym fit, and intentions to join the gym were measured post advertisement exposure and body satisfaction was measured pre-and-post advertisement exposure. As expected, exposure to Instagram gym advertisements featuring thin-sized models resulted in greater appearance comparisons and lower body satisfaction than exposure to Instagram gym advertisements featuring plus-sized models. Moreover, the combination of plus-sized models with health and wellness slogans in Instagram gym advertisements resulted in greater gym fit perceptions although there was no effect of model body-size and slogan-type on intentions to join the gym. This study supports social comparison theory, signaling theory, and practically the findings indicate that Instagram gym advertisements that depict plus-sized models (versus thin) with health-and-wellness slogans (versus physique) generate fewer body image concerns and lead to greater gym fit perceptions.

Food insecurity and body dissatisfaction in a sample of Canadian adults

Food insecurity may predict poorer body image, which is associated with increased risk of mental health problems. However, minimal attention has been given to the food insecurity-body image link and to factors that may influence this link, such as assigned sex; importantly, females are more likely to experience both food insecurity and body dissatisfaction. The present study used data from the 2017 to 2018 Canadian Community Health Survey (N = 32,017) to investigate the effects of food insecurity and sex on body satisfaction via generalized ordered logistic regression. Results indicated: (1) Food insecurity predicted lower odds of body satisfaction, (2) Males were more likely than females to be satisfied with their bodies, and (3) Food insecurity no longer predicted body satisfaction following the inclusion of sex. Findings suggest the association between food insecurity and body satisfaction may largely be driven by the link between food insecurity and sex. Further investigation is warranted.

Causal factors in childhood and adolescence leading to anabolic-androgenic steroid use: A machine learning approach

Background

Prior research has demonstrated associations between anabolic-androgenic steroid (AAS) use and features from several childhood and adolescent psychosocial domains including body image concerns, antisocial traits, and low levels of parental care. However, prior approaches have been limited by their focus on individual features and lack of consideration of the relevant causal structure.

Methods

We re-analyzed data from a previous cross-sectional cohort study of 232 male weightlifters aged 18-40, of whom 101 had used AAS. These men completed retrospective measures of features from their childhood and early adolescence, including body image concerns, eating disorder psychopathology, antisocial traits, substance use, and family relationships. Using an approach informed by principles of causal inference, we applied four machine-learning methods - lasso regression, elastic net regression, random forests, and gradient boosting - to predict AAS use.

Results

The four methods yielded similar receiver operating curves, mean area under the curve (range 0.66 to 0.72), and sets of highly important features. Features related to adolescent body image concerns (especially muscle dysmorphia symptoms) were the strongest predictors. Other important features were adolescent rebellious behaviors; adolescent feelings of ineffectiveness and lack of interoceptive awareness; and low levels of paternal care.

Conclusions

Applying machine learning within a causally informed approach to re-analyze data from a prior study of weightlifters, we identified six factors (most prominently those related to adolescent body image concerns) as proposed causal factors for the development of AAS use. Compared with the prior analyses, this approach achieved greater methodologic rigor and yielded stronger and broader findings.

A Systematic Review and Meta-Analysis: Child and Adolescent Healthcare Utilization for Eating Disorders During the COVID-19 Pandemic

OBJECTIVE

To conduct a meta-analysis documenting healthcare service utilization rates for pediatric (age <19 years) eating disorders during compared to before the COVID-19 pandemic.

METHOD

PsycINFO, MEDLINE, Embase, and Web of Science Core Collection were searched for studies published up to May 19, 2023. Studies with pediatric visits to primary care, inpatient, outpatient, and emergency department for eating disorders before and during the pandemic were included. This preregistered review (PROSPERO CRD42023413392) was reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were analyzed with random-effects meta-analyses.

RESULTS

A total of 52 studies reporting >148,000 child and adolescent eating disorder-related visits to >300 health settings across 15 countries were included (mean age, 12.7 years; SD = 4.1 years; 87% girls). There was strong evidence of an increase in healthcare use for eating disorders during the pandemic (rate ratio [RR] = 1.54, 95% CI = 1.38-1.71). Moderator analysis revealed larger rate increases among girls (RR = 1.48, 95% CI = 1.28-1.71) compared to boys (RR = 1.24, 95% CI = 1.06-1.45) and for adolescents (age ≥12 to 19 years) (RR = 1.53, 95% CI = 1.29-1.81) compared to children (RR = 0.87, 95% CI = 0.53-1.43). Moderator analysis demonstrated strong evidence of increased use of emergency department (RR = 1.70, 95% CI = 1.48-1.97), inpatient (RR = 1.56, 95% CI = 1.33-1.84), and outpatient (RR = 1.62, 95% CI = 1.35-1.95) services, as well as strong evidence of increased rates of anorexia nervosa (RR = 1.48, 95% CI = 1.24-1.75).

CONCLUSION

Healthcare use for pediatric eating disorders increased substantially during the COVID-19 pandemic, particularly among girls and adolescents. It is important to continue to monitor whether changes in healthcare use associated with acute pediatric mental distress are sustained beyond the COVID-19 pandemic.

STUDY PREREGISTRATION INFORMATION

Risk factors for eating disorders for youth during the COVID-19 pandemic; https://www.crd.york.ac.uk/; CRD42023413392.

DIVERSITY & INCLUSION STATEMENT

One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as living with a disability. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science.

Eating disorders and related psychological features among Arabs and Jews in Israel: Does culture play a moderating role?

Eating disorders (EDs) have been documented in various cultural settings. A continuous increase in ED' rates among non-Western cultures (e.g., Arab cultures and East-Asian cultures) has been reported. We aimed to investigate the relations among culture, ED symptoms, and psychological features that are highly relevant in EDs through a cultural comparison of three groups. The groups included female university students in Israel with varying levels of exposure to Westernization: 118 Jewish students, 132 Arab students studying at a mixed university with a Jewish majority, and 111 Arab students studying at Sakhnin College, a college for Arab students only. The groups differed significantly on the Conservation Value dimension from the Short Portrait Values Questionnaire. Four psychological features were examined as predictors of ED symptoms: Interoceptive-deficits, Ineffectiveness, Asceticism, and Maturity-fear. The results revealed a comparable prevalence of self-reported ED symptoms among Arabs and Jews, with a small exception for bulimic symptoms, which were less prevalent among those in the Sakhnin group, who also scored lower on Ineffectiveness and higher on asceticism than the other groups. Testing the relations between the four psychological features and ED symptoms revealed that culture played a moderating role in predicting the strength of ineffectiveness and maturity-fear. Ineffectiveness was not a predictor among the Sakhnin group, whereas maturity-fear was not a predictor in the least conservative Jewish group. Asceticism and interoceptive-deficits predicted ED symptoms across all study groups. Our findings indicate that the problem of EDs may be similar among Arab and Jewish women in Israel. Moreover, despite some similarities in the relevance of some ED-related psychological features, other features are moderated by culture.

"It's beautiful and it's messy and it's tragic": exploring the role of compassion in the eating disorder recovery processes of 2S/LGBTQ + Canadians

This research explores experiences of compassion among 2S/LGBTQ + Canadians living with eating disorders in the context of eating disorder treatment and community support. There is a growing body of scholarship showing disparities in eating disorder care for those within 2S/LGBTQ + communities. Among the reported concerns is a potential lack of compassion in eating disorder treatment and recovery settings, something which may serve to exacerbate feelings of isolation and perpetuate misunderstandings of 2S/LGBTQ + people's experiences. In an effort to understand these dynamics more deeply, we conducted semi-structured interviews with 2S/LGBTQ + Canadians who have experienced eating disorder care. The data collected were then subjected to Foucauldian discourse analysis, which produced three interconnected discursive considerations: feeling lack of structural compassion, 2S/LGBTQ + communities as places of respite, and 2S/LGBTQ + caregiving. One of the common threads among these discursive considerations was cis-heteronormativity ingrained in eating disorder treatment settings and health care systems more broadly. Our findings underscore the critical need for more enhanced compassion for 2S/LGBTQ + patients in eating disorder care settings. We conclude that compassion, when implemented on the levels of individual clinicians, policy and procedure, and institutions, may represent an avenue toward disrupting ingrained cis-heteronormativity and the associated discursive power structures contained in health care systems.

An Update on Eating Disorders

Abstract:

It is no surprise that eating disorders (EDs) are increasing all over the planet. With the emergence of global westernization, development in technology, and societal changes, nearly all regions of the globe have been influenced by the concept of a perfect body image and height. EDs are a considerable public concern, a bewilderment for psychologists and a challenge for physicians. The primary EDs include anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). AN is an ED that is psychological and possibly life-threatening. Usually, people with AN experience an exceedingly low body weight due to their height and body shape. The highest rate of occurrence is between 14 and 17 years of age. BN is an extreme, lifethreatening, neurological ED in which you have binge eating cycles. You may not have any sense of balance in your diet throughout these binges. The weight-control engagement of patients with AN and BN results in various physiological shifts. EDs can control your lives and can be quite hard to cope with. Yet you will develop a better understanding of who you are by therapy, return to healthy eating and exercise, and undo any of the severe complications of AN. Investigation into EDs has yielded valuable new information over the past few decades, notably involving the psychological features and care of patients. The purpose of this study/review is to expand the knowledge of the people about these EDs, their global burden, diagnostic criteria, risk factors, medical complications, management, and the newly added avoidant/restrictive food intake disorder.

Cross-sectional and longitudinal associations between self-esteem and BMI depends on baseline BMI category in a population-based study

BACKGROUND

Some studies have reported associations between self-esteem and weight status, but longitudinal data on adults remain scarce. The aim of this population-based study was to analyze the cross-sectional and longitudinal association between self-esteem and body mass index (BMI) and to investigate whether baseline BMI has an impact on this association.

METHODS

In 2016, 29,735 participants aged ≥ 18 years in the NutriNet-Santé cohort completed the Rosenberg Self-Esteem Scale. BMI was self-reported yearly over a 4-year period. Association between self-esteem and BMI was assessed using mixed models and logistic regressions. Analyses were stratified by BMI (categorical) at baseline and adjusted on sociodemographic and lifestyle characteristics.

RESULTS

At baseline, higher self-esteem was associated with higher BMI in normal weight individuals(p = 0.32), and with lower BMI in obese class II and III individuals (p = 0.13). In addition, higher baseline self-esteem was associated with BMI increase over time in normal weight individuals (p = 0.15). Among normal weight individuals, those with higher self-esteem were less likely to show a decrease in their BMI (p = 0.005), while no association was observed with BMI increase (p = 0.81).

DISCUSSION

Our findings suggest that the association between self-esteem and BMI depends on the initial category of BMI, with a negligible effect of self-esteem.

Longitudinal relationships among sociocultural pressure for body image, self-concept clarity, and emotional well-being in adolescents

INTRODUCTION

This study examined the longitudinal relationships among sociocultural pressure for body image (SPBI), self-concept clarity (SCC), and emotional well-being (EWB) at both the between- and within-person levels.

METHODS

The participants were 2001 Chinese adolescents (age range 11-24, 42.9% males). Recruitment of participants occurred for 1 year across three waves (i.e., 6 months apart across three cohorts). The baseline and follow-up questionnaire surveys were utilized to assess SPBI, SCC, EWB, and background variables. Longitudinal associations between the above main variables were tested using a cross-lagged panel model (CLPM) and multilevel regression analysis.

RESULTS

The CLPM and multilevel-model analysis showed that SCC longitudinally mediated the relationships between SPBI and EWB. Besides, gender and age were considered moderators in the associations among SPBI, SCC, and EWB.

CONCLUSIONS

SCC could be an underlying mechanism for the longitudinal relationship between SPBI and EWB among Chinese adolescents, which provides a potential intervention target for improving adolescents' well-being from a sociocultural framework.

Prevalence of Eating Disorders and Their Association with Social Media Addiction among Youths

Eating disorders and excessive attachment to social media are a matter of great concern among youths. This study assessed the prevalence of eating disorders and their association with social media addiction among youths. A descriptive cross-sectional study was conducted on 350 participants aged 14-25 years. Two pre-validated tools were used, i.e., the Eating Attitude Test and the Social Networking Addiction Scale. SPSS was used to analyze the data. Out of the 350 students, 42% had probable eating disorders, and 41.7% had social media addictions. The findings revealed that the chances of having eating disorders were significantly higher among youths who lived in separate places, smoked, and had a family history of eating disorders (p ≤ 0.05). Furthermore, the dieting domain displayed notably higher scores for youths living separately (p ≤ 0.05) and smokers (p ≤ 0.01). Moreover, the scores for bulimia and food preoccupation were significantly higher among participants who were married (p = 0.038), were smokers (p = 0.027), and had a family history of eating disorders (p = 0.001). Higher scores in the oral control domain were reported by females (p ≤ 0.05) and severely obese youths (p ≤ 0.01). Moreover, social media addiction was significantly higher among students aged 18-21 (p ≤ 0.01). Spearman's correlation revealed that social media addiction has a weak positive relationship with eating disorders (r = 0.133, p ≤ 0.01), particularly bulimia and food preoccupation (r = 0.173, p ≤ 0.001). This reflects the need to address the harmful consequences of social media addiction that might raise the likelihood of developing eating disorders, particularly bulimia nervosa.

Daily self-weighing compared with an active control causes greater negative affective lability in emerging adult women: A randomized trial

Age-related weight gain prevention may reduce population overweight/obesity. Emerging adulthood is a crucial time to act, as rate of gain accelerates and health habits develop. Evidence supports self-weighing (SW) for preventing weight gain; however, how SW impacts psychological states and behaviors in vulnerable groups is unclear. This study assessed daily SW effects on affective lability, stress, weight-related stress, body satisfaction, and weight-control behaviors. Sixty-nine university females (aged 18-22) were randomized to daily SW or temperature-taking (TT) control. Over 2 weeks, participants completed five daily ecological momentary assessments with their intervention behavior. A graph of their data with a trendline was emailed daily, with no other intervention components. Multilevel mixed models with random effect for day assessed variability in positive/negative affect. Generalized linear mixed models assessed outcomes pre- and post-SW or TT and generalized estimating equations assessed weight-control behaviors. Negative affective lability was significantly greater for SW versus TT. While general stress did not differ between groups, weight-related stress was significantly higher and body satisfaction was significantly lower post-behavior for SW but not TT. Groups did not significantly differ in the number or probability of weight-control behaviors. Caution is advised when recommending self-weighing to prevent weight gain for emerging adults.

An investigation of the dual continua model of mental health in the context of eating disorder symptomatology using latent profile analysis

OBJECTIVE

The dual continua model of mental health suggests that mental well-being and mental illness are two distinct continua that are interrelated in their contributions to overall mental health. This study investigated the dual continua model in individuals with eating disorder symptoms.

METHOD

Female university students (N = 346) completed measures of mental well-being, eating disorder symptomatology, clinical impairment and psychological distress. Confirmatory factor and latent profile analyses were used to derive underlying mental health profiles.

RESULTS

Results revealed two oblique factors representing the mental well-being and eating disorder symptomatology constructs and four unique mental health profiles that were partially consistent with the dual continua model emerged: 'flourishing', 'vulnerable', 'partially symptomatic and content', and 'languishing'. The derived mental health profiles had unique characteristics described by psychological distress and clinical impairment.

CONCLUSIONS

The results did not provide conclusive evidence for the dual continua model as they could also be interpreted in a manner consistent with the unidimensional approach. While the dual continua model is a promising avenue to understand mental health in a way that looks beyond symptoms, these results caution against its rapid adoption and encourage future research to understand how eating disorder symptomatology and positive mental health assets contribute to overall mental health.

The embodiment of childhood abuse and anorexia nervosa: A body mapping study

Childhood trauma has long been implicated in the development of anorexia nervosa and is known to impact more women than men. Still, less is known about the meaning women attribute to food and bodily practices and how they contribute to feminine subjectivity. In this article, we examine the subjective experiences of women with histories of childhood abuse and anorexia and women who did not develop an eating disorder. Through a visual narrative analysis of eight body maps and narratives, we identified five themes: "time and the body have a way of showing what matters," "femininity and family," "sexual subjectivities and food meanings," "voices, dissociation, and sexual subjectivities," and "religion and healthism." In women with anorexia, specific eating and bodily practices reconstructed the traumatic events to align with the available cultural discourses related to health, religion, and family and had implications for their feminine and sexual subjectivities and self-worth. This research showcased how arts-based methodologies add value and advance knowledge about the role of culturally available representations in the development of anorexia and has implications for therapy and prevention of anorexia.

Functions of disordered eating behaviors: a qualitative analysis of the lived experience and clinician perspectives

BACKGROUND

One method to improve treatment outcomes for individuals with eating disorders (EDs) may be understanding and targeting individuals' motives for engaging in DE behaviors-or the functions of DE behaviors. The goal of this study was to investigate and categorize the various functions of DE behaviors from the perspectives of adults who engage in DE behaviors and clinicians who treat EDs.

METHODS

Individuals who engage in DE behaviors (n = 16) and clinicians who treat EDs (n = 14) were interviewed, and a thematic analysis was conducted to determine key functions of DE behaviors.

RESULTS

Four main functions of DE behaviors were identified by the authors: (1) alleviating shape, weight, and eating concerns; (2) regulating emotions; (3) regulating one's self-concept; and (4) regulating interpersonal relationships/communicating with others.

CONCLUSIONS

Differences in participant responses, particularly regarding the relevance of alleviating shape and weight concerns as an DE behavior function, highlight the importance of individualized conceptualizations of DE behavior functions for any given client.

Body image concerns in women with polycystic ovary syndrome: a systematic review and meta-analysis

OBJECTIVE

To assess differences in body image concerns among women with and without polycystic ovary syndrome (PCOS).

DESIGN

This is a systematic review and meta-analysis.

METHODS

Electronic databases (MEDLINE, EMBASE, APA PsychInfo, PUBMED, Web-of-Science Core Collection, and Cochrane Controlled Register of Trials [CENTRAL]) were searched from inception through July 2022. Outcome measures included validated questionnaires reporting on body image concerns. Methodological quality was assessed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system, and included studies were assessed for risk of bias. Meta-analyses were performed using the inverse variance method based on random or fixed effects models (Review Manager, Version 5).

RESULTS

A total of 918 women with PCOS and 865 women without PCOS from 9 studies were included. Meta-analysis of 3 studies using Multidimensional Body-Self Relations Questionnaire Appearance Scale (MBSRQ-AS) showed those with PCOS reported higher dissatisfaction with appearance evaluation and appearance orientation compared to those without PCOS (mean difference [MD] = -0.78, I2 = 0%, P < .00001, and MD = 0.22, I2 = 54%, P = .004, respectively). Meta-analysis of 2 studies showed higher dissatisfaction with overweight preoccupation, lower body area satisfaction, and body weight classification on MBSRQ-AS subscales in those with PCOS compared to those without PCOS (all P < .001). Meta-analysis of 2 studies using the Body Esteem Scale for Adolescents and Adults (BESAA) showed significantly lower scores for the weight subscale in those with PCOS compared to those without PCOS (P = .03).

CONCLUSIONS

Those with PCOS experience more significant body image concerns, emphasising the importance of awareness in the clinical care of PCOS. Considering the limited evidence, further studies are warranted to identify drivers and mitigating factors.

Eating disorder symptoms and control-seeking behavior

OBJECTIVE

Eating disorders (EDs) are a heterogenous group of disorders characterized by disturbed eating patterns. Links have been made between ED symptoms and control-seeking behaviors, which may cause relief from distress. However, whether direct behavioral measures of control-seeking behavior correlate with ED symptoms has not been directly tested. Additionally, existing paradigms may conflate control-seeking behavior with uncertainty-reducing behavior.

METHOD

A general population sample of 183 participants completed part in an online behavioral task, in which participants rolled a die in order to obtain/avoid a set of numbers. Prior to each roll, participants could choose to change arbitrary features of the task (such as the color of their die) or view additional information (such as the current trial number). Selecting these Control Options could cost participants points or not (Cost/No-Cost conditions). Each participant completed all four conditions, each with 15 trials, followed by a series of questionnaires, including the Eating Attitudes Test-26 (EAT-26), the Intolerance of Uncertainty Scale, and the Obsessive-Compulsive Inventory-Revised (OCI-R).

RESULTS

A Spearman's rank test indicated no significant correlation between total EAT-26 score and total number of Control Options selected, with only elevated scores on a measure of obsessions and compulsivity (OCI-R) correlating with the total number of Control Options selected (rs  = .155, p = .036).

DISCUSSION

In our novel paradigm, we find no relationship between EAT-26 score and control-seeking. However, we do find some evidence that this behavior may be present in other disorders that often coincide with ED diagnosis, which may indicate that transdiagnostic factors such as compulsivity are important to control-seeking.

The effect of emotion regulation on emotional eating among undergraduate students in China: The chain mediating role of impulsivity and depressive symptoms

This study aimed to examine the relationship between difficulties in emotion regulation and emotional eating and the role of impulsivity and depressive symptoms in mediating this chain. Four hundred ninety-four undergraduate students participated in the study. A self-designed questionnaire was used in the survey from February 6 to 13, 2022, to finish our purpose, including the Emotional Eating Scale (EES-R), Depression Scale (CES-D), Short Version of the Impulsivity Behavior Scale (UPPS-P) and Difficulties in Emotion Regulation Scale (DERS). The results showed that 1) difficulties in emotion regulation, impulsivity, depressive symptoms, and emotional eating were correlated; 2) impulsivity and depressive symptoms separately mediated the relationship between difficulties in emotion regulation and emotional eating; 3) impulsivity and depressive symptoms played a chain mediating role between difficulties in emotion regulation and emotional eating. The current study provided a better understanding of the psychologically related pathway of emotional eating. The results would be helpful for prevention and intervention of emotional eating among undergraduate students.

Effects of Instagram Body Portrayals on Attention, State Body Dissatisfaction, and Appearance Management Behavioral Intention

Research has suggested that Instagram is detrimental to one's body image and health, as a result of its image-driven nature and the social comparisons that are commonly made between users' bodies and the bodies they see portrayed. This study was designed to provide a better understanding of the effects of thin and fat body types portrayed in Instagram posts. This was done by examining how such body type portrayals influence attention to the posts, in addition to influencing outcomes such as body dissatisfaction and appearance management behavioral intentions. A total of 309 college students viewed 30 Instagram posts in an online experiment with a 2 (portrayed body type: thin vs. fat) X 15 (message repetition) within-subjects design. The findings indicate that thin-body portrayals increase audience self-reported attention to the posts and state body dissatisfaction, but female users who self-perceive themselves as fat report a similar level of attention to the posts regardless of portrayed body types. Additionally, Instagram use (defined as the number of photos users personally post) is found to moderate the effects of the body portrayals.

Associations among retrospective parenting styles, retrospective food parenting, and current eating behaviors in Chinese adults

The current study explored the relationships between retrospective parenting styles and food parenting in childhood (≤ 12 years old) and Chinese adults' current maladaptive and adaptive eating behaviors. We recruited 501 Chinese adults (50.30% men, aged 19-46 years). A set of questionnaires were used to measure retrospective parenting styles (i.e., emotional warmth, rejection, and overprotection), food parenting (i.e., parental concern, monitoring, pressure to eat, and restriction), and current maladaptive (i.e., disordered eating) and adaptive (i.e., intuitive eating) eating behaviors. Correlation and mediation analyses were employed to analyze these data. Results revealed that retrospective parenting styles and food parenting were significantly related to current maladaptive and adaptive eating behaviors in both Chinese men and women. Mediation analyses showed that higher retrospective parental warmth was related to higher retrospective parental concern which, in turn, was related to higher current disordered eating in men (indirect effect = 0.14, 95% CI 0.08, 0.24). Furthermore, higher retrospective parental overprotection was related to higher retrospective parental pressure to eat which, in turn, was related to higher current disordered eating in men (indirect effect = 0.06, 95% CI 0.01, 0.14). For women, higher retrospective parental warmth was associated with higher retrospective parental concern which, in turn, was associated with lower current intuitive eating in women (indirect effect = -0.04, 95% CI = -0.10, -0.01). Furthermore, higher retrospective parental overprotection was associated with higher retrospective parental concern which, in turn, was associated with lower current intuitive eating in women (indirect effect = -0.03, 95% CI = -0.08, -0.004). The findings indicate the importance of including childhood parenting styles and food parenting in future research and intervention of adults' current maladaptive and adaptive eating behaviors.

Power, Self-Esteem, and Body Image

Abstract: We expected power – the perceived capacity to influence others – to be an antecedent of positive body image because power is closely linked to self-esteem, which in turn is linked to body image. In a cross-sectional study ( N = 318), sense of power was positively related to body appreciation and satisfaction with one’s appearance. Self-esteem partially mediated this effect. In an experimental study ( N = 114), participants assigned to a high-power group indicated more body appreciation, reported more body satisfaction, and estimated themselves to be taller than participants assigned to a low-power group. Self-esteem mediated all the effects. Altogether, power affected body image directly but also indirectly through elevated self-esteem. Implications refer to clinical prevention and intervention programs.

Evaluation of Insight, Self-Esteem, and Body Satisfaction in Eating Disorders

ABSTRACT

We investigated insight and its relationship with the clinical characteristics in eating disorders (EDs). Thirty anorexia nervosa (AN) and 30 bulimia nervosa (BN) patients, diagnosed based on Diagnostic and Statistical Manual of Mental Disorders , Fifth Edition criteria, were evaluated with Eating Disorder Examination Questionnaire (EDE-Q), the Body Image Satisfaction Questionnaire (BISQ), Rosenberg Self-Esteem Scale (RSES), and the Brown Assessment of Beliefs Scale (BABS). There was no statistically significant difference between the AN and the BN group in clinical scale scores. Thirty percent of AN and 23.3% of BN patients showed "poor insight" according to BABS. In the whole sample, BABS scores were significantly positively correlated with the EDE-Q eating, shape, weight concern subscales, and global scores, and the RSES scores; and negatively correlated with the BISQ general appearance and trunk subscale scores. Manifestation of "poor insight" is frequent in EDs. Poor insight in EDs is associated with eating, shape and weight concerns, body dissatisfaction, and low self-esteem.

Examining the Role of Body Image Instability in Young Adult Women: Conceptualization, Development, and Psychometric Evaluation of the Vacillating Body Image Scale (VBIS)

The current study conceptualized body image instability as a maladaptive tendency to vacillate between different self-perceptions of one's overall body image and developed a corresponding measure to assess body image instability. Results from a series of studies of young adult women demonstrated the validity, reliability, and utility of the Vacillating Body Image Scale (VBIS) as a meaningful measure of body image instability. In Study 1, we found that body image instability, as assessed by the VBIS, represents a unidimensional and reliable construct. In Study 2, we found evidence for both the convergent and discriminant validity of the VBIS in relation to other individual differences measures (i.e., self-concept schema, broad personality factors). In Study 3, the concurrent criterion validity of the VBIS was supported for young adult women in relation to a range of adjustment measures. Finally, in Study 4, we found consistent evidence for the incremental validity of the VBIS in predicting subsequent variations in eating disturbances, even after controlling for global self-esteem and self-concept instability. Overall, our findings offer promising support for our contention that body image instability, as measured by the VBIS, represents an important construct for understanding eating-related disturbances and other health outcomes in young adult women.

A Tale of Childhood Loss, Conditional Acceptance and a Fear of Abandonment: A Qualitative Study Taking a Narrative Approach to Eating Disorders

Eating disorders (EDs) are serious mental health illnesses, yet there is a need to better understand the illness experience to improve treatment outcomes. Qualitative research, and narrative approaches in particular, can elicit life stories that allow for the whole illness journey to be explored. This study aimed to explore the experiences of women with a history of an ED, identifying the life events they perceived were relevant to the onset of their ED through to recovery. Interviews were conducted with 18 women with lived experience of an ED. Through structural narrative analysis, an overarching storyline of childhood loss contributing to a belief of conditional acceptance, fear of abandonment and struggle to seek emotional support due to the fear of being a burden was identified. Negative experiences with the health sector were common. These findings have implications for the way medical professionals respond to help seeking and deliver treatment.

Overweight and obesity in adult patients with phenylketonuria: a systematic review

BACKGROUND

Excess weight is a rising concern in patients with phenylketonuria (PKU). It is commonly observed in children and adolescents with PKU; but data on adults are inconsistent. This review aims to summarize available data on excess weight in adult PKU individuals.

METHODS

We conducted a systematic search of literature in English, from inception to October 2021, on PubMed and Embase to identify articles on overweight and obesity in adult PKU patients. Prevalence of overweight and obesity, body mass index (BMI) and gender differences were the outcomes of interest.

RESULTS

Of 260 articles identified, only 8 fulfilled quality criteria for inclusion after screening of titles, abstracts and full texts. The mean BMI of adult PKU patients in these studies ranged from 26 ± 5.4 to 30.3 ± 1.8 kg/m². When compared to matched controls, adult PKU patients had higher BMI and higher prevalence of obesity. However, results were inconsistent when PKU adults were compared to the general population. The prevalence of obesity in the included studies varied widely between 4.5% up to 72% in individual studies. Obesity was 2-3 times more frequent in female PKU patients.

CONCLUSIONS

Excess weight is frequent in adult PKU patients, especially in females, even if the difference with the general population is debatable. The heterogeneity of the studies makes it difficult to interpret the results and the factors that contribute to obesity. Content of the diet, psychological status, diet-associated disordered eating, patient's social environment and lifestyle are listed as potentials contributors to excess weight in PKU adult population. Further studies are needed to better elucidate this question. In the meantime, weight control and healthy eating habits should be considered in the management and follow-up of these patients.

Intuitive Eating Behaviour among Young Malay Adults in Malaysian Higher Learning Institutions

Despite the significance of dietary knowledge interventions, there is a lack of established studies on intuitive eating behaviour among young Malay adults in Malaysia. This cross-sectional study aimed to determine the intuitive eating score, identify the intuitive eating factors, and determine the association of intuitive eating with weight-control behaviours and binge eating. A total of 367 respondents completed self-administered questionnaires on sociodemographic characteristics, namely the Intuitive Eating Scale (IES-2) and The Diabetes Eating Problems Survey (DEPS). The findings reported IES-2 mean scores of 3.52 ± 0.32 and 3.47 ± 0.35 for both men and women. No difference in total IES-2 scores was found between genders for Unconditional Permission to Eat (UPE) and Reliance on Hunger and Satiety Cue (RHSC) subscales (p > 0.05). However, among all four subscales of IES-2, there was a gender difference in the mean EPR and B-FCC subscale scores (p < 0.05). A statistically significant difference was found in intuitive eating, which refers to a belief in one's body's ability to tell one how much to eat, in women across living areas (p < 0.05). The result shows that there is a relationship between weight-control behaviour and binge eating and dieting, with the coefficient of the relationship (R²) of 0.34. As a result, intuitive eating throughout young adulthood is likely to be related to a decreased prevalence of obesity, dieting, poor weight-management behaviours, and binge eating.

Eating Disorders and Metabolic Diseases

Eating disorders are complex diseases with multifactorial causes. According to the Diagnostic and Statistical Manual of Mental Disorders text version (DSM-5-TR) and the WHO International Classification of Diseases and Related Health Problems (ICD-11), the major types of eating disorders include anorexia nervosa, bulimia nervosa, and binge eating disorder. The prevalence of eating disorders is alarmingly increasing globally. Moreover, the COVID-19 pandemic has led to more development and worsening of eating disorders. Patients with eating disorders exhibit high rates of psychiatric comorbidities and medical comorbidities such as obesity, diabetes, and metabolic syndrome. This paper aims to review and discuss the comorbidities of eating disorders with those metabolic diseases. Eating disorder treatment typically includes a combination of some or all approaches such as psychotherapy, nutrition education, and medications. Early detection and intervention are important for the treatment of eating disorders.

Associations among Intimate Partner Violence, Posttraumatic Stress Disorder Symptoms, and Disordered Eating among Women Intimate Partner Violence Survivors Residing in Shelter

Previous research has not assessed the association between intimate partner violence (IPV) and disordered eating (DE), nor the potential indirect effect through posttraumatic stress disorder (PTSD) symptoms, among residents of IPV shelters. Among 212 IPV survivors, this study examined these and the differential associations by PTSD symptom cluster and types of DE. In the current sample, 67.9% met criteria for probable PTSD, 20.3% met criteria for a probable eating disorder, and 18.4% had probable comorbid diagnoses. Consistent with escape theory, there was an indirect effect of IPV on DE through PTSD symptoms. Additionally, there was an indirect effect of IPV on weight/shape concerns and binge symptoms through PTSD symptoms. Although there was a significant total effect of IPV on compensatory behaviors, there was no indirect effect through PTSD symptoms. When PTSD symptom clusters were examined concurrently, the only indirect effect of IPV on weight/shape concerns was via the PTSD symptom cluster of negative alterations in cognition and mood. Although there was an indirect effect of IPV on binge symptoms via PTSD symptoms overall, no specific PTSD symptom cluster drove this association. Implications highlight the need for attention to DE within this population. Consistent with escape theory, survivors' DE might serve to distract from psychological distress.

The body satisfaction and psychological well-being of retired women athletes: A long-term qualitative analysis of bodies in motion

We conducted a qualitative evaluation of Bodies in Motion (BIM), a dissonance, mindful self-compassion-based program that addresses the unique experiences and needs of female athletes with respect to their bodies and their well-being. Using semi-structured interviews, 12 collegiate female athletes (retired 2 - 6 years) reflected and provided feedback on the enduring impact of BIM on their body image, relationship to food and exercise, and overall psychological well-being. Through thematic analysis, we found that these retired athletes, extending from their initial program learning, reported increased awareness of sport and societal messages and their impact on body image, shifted perspectives in their view of themselves and their bodies, and used learned skills to manage body image in their lives. Further, with the passage of time, athletes emphasized how what they had learned in BIM remained essential as they navigated challenging life transitions, such as their retirement from collegiate sports. Our findings indicate that the benefits female athletes report accruing in the immediate aftermath of BIM remain with them, even growing and becoming more salient as they continue to reflect on the program and its impact on their body awareness and how they navigate their lives as women and former athletes.

Negative childhood events and the development of the anorexic voice: A grounded theory

BACKGROUND

Many individuals diagnosed with anorexia nervosa (AN) describe their disorder as being represented by an internal 'anorexic voice' (AV). Previous studies have identified associations between eating psychopathology and multifarious forms of adverse life experiences.

AIMS

This study explores the relationship between adverse experiences in childhood and the development of the AV.

MATERIALS AND METHODS

Twelve women who had the experience of the AV in the context of a diagnosis of AN took part in semi-structured interviews. The interview data were analysed using a constructivist grounded theory methodology.

RESULTS

Participants recalled feeling unsafe in a variety of relationships and a theory was constructed in which the AV provides a sense of conditional safety, becoming increasingly hostile and belittling when it is disobeyed, revealing similar characteristics to abusers and bullies in childhood.

DISCUSSION

Findings are related to the broader literature on the link between trauma and eating disorders, and to existing theories of internal voices.

CONCLUSIONS

The findings have implications for a trauma-focused approach when working with the AV.

"Balancing within a closed family system": a grounded theory study of how family life is affected by having a family member with an eating disorder

BACKGROUND

This qualitative study explores how having an adult daughter or sister with anorexia nervosa or bulimia nervosa affects the family's daily life. Previous research has focused on the family's role in the development of an eating disorder, while more recently the focus has been on the illness's impact on the family. Caring for an individual with an eating disorder can involve distress, guilt, extra burdens, and unmet needs. By interviewing the family members of adults with eating disorders this study aims to gain insights into how the family members experience the impact of the eating disorder over time.

METHODS

A constructivist grounded theory approach was comprised to gather and analyse data to develop a theory on how families experience life with an adult daughter or sister with an eating disorder. Semi-structured individual interviews were conducted with 21 parents and siblings from across Norway.

RESULTS

The participants reported a lack of professional help and the families had to handle the challenges related to the illness themselves, hence being left to themselves as a family was identified as the participants' main concern. To manage this concern the families had to balance a pattern of care within the closed family system, and this comprises the core category of the study. Families balanced a pattern of care by shifting roles, adapting meal routines, and maintaining openness within the family.

CONCLUSIONS

The findings implicate that families need clarification of roles and responsibilities in relation to the health services in caring for the individual with an eating disorder. More research on taking a family perspective concerning adults with eating disorders is needed.

The impact of discrimination on binge eating in a nationally representative sample of Latine individuals

OBJECTIVE

Latines have higher rates of eating disorders characterized by binge eating compared to their non-Latine white counterparts, yet culturally and socially relevant factors related to binge eating in Latines have been largely understudied. The purpose of the current study was to examine how discrimination and acculturative stress were associated with binge eating in a nationally representative sample of Latines. An additional aim was to test the extent to which family cohesion and social support could buffer against the effects of discrimination and acculturative stress on binge eating.

METHOD

Participants (56% female, N = 2550) were Latines enrolled in the National Latino and Asian American Study. Structural equation modeling using 1000 re-sampled data sets built from machine learning iterative sampling procedures was used to examine the effects of discrimination, acculturative stress, family cohesion, and social support on binge eating.

RESULTS

Results indicated that only discrimination was significantly associated with binge eating. Neither the direct effect of acculturative stress, interaction of family cohesion and acculturative stress, interaction of social cohesion and acculturative stress, nor the interaction of social support and discrimination were significantly associated with binge eating.

DISCUSSION

This study highlights the need for mental-health providers to understand and assess discrimination among Latines presenting with concerns of binge eating. Treatments that effectively provide coping strategies to manage discriminatory experiences and reduce binge eating could improve both effectiveness of treatment and retention rates for Latine individuals with binge eating.

PUBLIC SIGNIFICANCE

This study examined the association of discrimination, acculturative stress, family cohesion, and social support with binge eating in Latines. Only discrimination was significantly associated with binge eating, highlighting the importance for providers to assess discrimination among Latines with binge-eating concerns and to improve equity, inclusion, and belonging at a societal level. Modifying existing treatments to address coping with discrimination could improve the effectiveness for Latines with binge-eating concerns.

Compulsive Study Behaviors Are Associated with Eating Disorders and Have Independent Negative Effects on Well-Being: A Structural Equation Model Study among Young Musicians

Compulsive overworking and eating disorders (EDs) show considerable similarities in terms of risk factors (e.g., rigid perfectionism), clinical manifestation (e.g., excessive controlling behaviors), and consequences (e.g., physical exhaustion and depression). This study aimed to examine the hypotheses that compulsive study behaviors (conceptualized as study addiction) are related to EDs and that they have independent negative effects on well-being among young musicians, who constitute a highly vulnerable population for these types of problematic behaviors. The relatively high prevalence of study addiction and its pronounced negative relationship with psychosocial functioning make it a pending challenge for sustainable education. A total of 255 students from various music academies in Poland took part in the study. The Bergen Study Addiction Scale, assessing compulsive studying (conceptualized as addictive behavior), the Eating Attitude Test-26 (EAT-26), the Perceived Stress Scale, the Hospital Anxiety and Depression Scale, and the quality-of-life measure were used. A structural equation model was investigated. Study addiction was positively related to the general factor of EDs and the social pressure component. Both problematic behaviors showed negative and independent effects on the well-being of young musicians. EDs may be 8 to 16 times more prevalent among the students of music academies who are addicted to studying than among the general population. About 80% of those students showing all seven symptoms of study addiction exhibited at least mild depression, while more than half had clinically significant levels of depression. Almost 90% had clinically significant levels of anxiety. Without addressing co-occurring study addiction and eating disorders, including their commonalities and idiosyncrasies, their prevention and treatment cannot be effective and it will substantially affect the sustainability of education and work.

A feminist phenomenological approach to the analysis of body maps: Childhood trauma and anorexia nervosa

Body mapping is an arts-based research technique that uses a life-sized outline of the participant's body and symbols that visually represent their lived experiences. In this article, we describe the methods of body mapping and analytic techniques used in a research inquiry exploring how child abuse influenced the embodied processes in anorexia. We aim to contribute to methodological research practice in anorexia using a method that can potentially add value in other areas of ED research or be adapted for treatment settings. Our research findings suggest that body mapping can add value to the interview method and extend the range of methods for researchers interested in interrogating the hard-to-reach subjective embodied processes.

Where Sex Meets Gender: How Sex and Gender Come Together to Cause Sex Differences in Mental Illness

Sex differences are prevalent in multiple mental disorders. Internalizing disorders are more commonly diagnosed in women, whereas externalizing and neurodevelopmental disorders are more often diagnosed in men. Significant sex/gender differences are reported in prevalence, symptom profile, age of onset, comorbidities, functional impairment, prognosis, as well as in responses to various treatments. In this conceptual article, we discuss theories and empirical studies of sex- and gender-related influences in mental health, by focusing on three examples: autism spectrum disorder (ASD), acknowledged as a disorder whose roots are mainly biological; eating disorders, whose origins are considered to be mainly psychosocial, and posttraumatic stress disorder (PTSD), an environmentally caused disorder with both psychosocial and biological underpinnings. We examine the ways in which sex differences emerge, from conception through adulthood. We also examine how gender dichotomies in exposures, expectations, role assumptions, and cultural traditions impact the expression of our three selected mental illnesses. We are especially interested in how sex-based influences and gender-based influences interact with one another to affect mental illness. We suggest that sex and gender are multi-faceted and complex phenomena that result in variations, not only between men and women, but also within each sex and gender through alterations in genes, hormone levels, self-perceptions, trauma experiences, and interpersonal relationships. Finally, we propose a conceptual diatheses-stress model, depicting how sex and gender come together to result in multiple sex/gender differences across mental disorders. In our model, we categorize diatheses into several categories: biological, intrapersonal, interpersonal, and environmental. These diatheses interact with exposure to stressors, ranging from relatively minor to traumatic, which allows for the sometimes bidirectional influences of acute and long-term stress responses. Sex and gender are discussed at every level of the model, thereby providing a framework for understanding and predicting sex/gender differences in expression, prevalence and treatment response of mental disorders. We encourage more research into this important field of study.

Relations between emotion regulation strategies and affect in daily life: A systematic review and meta-analysis of studies using ecological momentary assessments

Emotion regulation (ER) is a central target in the study of psychological and neurobiological processes of emotions for numerous psychological disorders. Ecological momentary assessments, overcoming retrospective self-reports, allow a better understanding of the relation between the use of ER strategies and daily life affective experiences. A systematic review and meta-analyses of studies testing these relations through experience sampling methods (ESM) and daily diaries were conducted. ESM studies showed significant large effect sizes in contemporaneous relations between negative affect (NA) and rumination, suppression, and worry, and in both contemporaneous and prospective relations between positive affect (PA) and reappraisal; medium effect sizes in prospective relations between NA and rumination, and PA and distraction; and a small effect size in the prospective relation between NA and suppression. Daily diary studies showed significant large effect sizes in contemporaneous relations between NA and rumination and suppression, and in both contemporaneous and prospective relations between PA and reappraisal; medium effect sizes in contemporaneous relations between PA and acceptance, and problem-solving; and a small effect size in the prospective relation between NA and reappraisal. These findings shed light on the temporal relations between the use of ER strategies and affective experiences and highlight conceptual and methodological limitations in the field.

Risk factors in body image dissatisfaction: gender, maladaptive perfectionism, and psychological wellbeing

Discontent with one's appearance (body image dissatisfaction) has become a global phenomenon, associated with the development of extreme behaviours in order to correct perceived body image problems. Much of the literature has focused on associated destructive behaviours that result from body image dissatisfaction; however, there has been a dearth of research examining risk factors for body image problems in adults. Thus, the current study aimed to investigate risk factors associated with adult body image problems, focusing on two variables highlighted in the literature (gender and maladaptive perfectionism). The current study (1) compared gender differences in body image dissatisfaction and (2) investigated psychological wellbeing as a mediator between maladaptive perfectionism and body image dissatisfaction. The sample included 139 Australian adults from universities (55.7%) and the community (44.3%). Participants completed demographic questions, the Frost Multidimensional Perfectionism Scale, the Psychological Wellbeing questionnaire, the Multidimensional Body-Self Relations Questionnaire, and Marlowe-Crowne Social Desirability Scale. In contrast to predictions, females had higher body area satisfaction and appearance evaluation scores. Furthermore, in line with the hypotheses, psychological wellbeing fully mediated the relationship between maladaptive perfectionism and poor body image. The findings suggest gender, maladaptive perfectionism, and psychological wellbeing may act as risk factors for body image dissatisfaction.

GABAergic interneurons' feedback inhibition of dorsal raphe-projecting pyramidal neurons of the medial prefrontal cortex suppresses feeding of adolescent female mice undergoing activity-based anorexia

Anorexia Nervosa (AN) is characterized by voluntary food restriction, excessive exercise and extreme body weight loss. AN is particularly prevalent among adolescent females experiencing stress-induced anxiety. We used the animal model, activity-based anorexia (ABA), which captures these characteristics of AN, to reveal the neurobiology underlying individual differences in AN vulnerability. Dorsal raphe (DR) regulates feeding and is recruited when coping inescapable stress. Through chemogenetic activation, we investigated the role of mPFC pyramidal neurons projecting to DR (mPFC→DR) in adolescent female mice's decision to eat or exercise following ABA induction. Although the DREADD ligand C21 could activate 44% of the mPFC→DR neurons, this did not generate significant group mean difference in the amount of food intake, compared to control ABA mice without chemogenetic activation. However, analysis of individuals' responses to C21 revealed a significant, positive correlation between food intake and mPFC→DR neurons that co-express cFos, a marker for neuronal activity. cFos expression by GABAergic interneurons (GABA-IN) in mPFC was significantly greater than that for the control ABA mice, indicating recruitment of GABA-IN by mPFC→DR neurons. Electron microscopic immunohistochemistry revealed that GABAergic innervation is 60% greater for the PFC→DR neurons than adjacent Layer 5 pyramidal neurons without projections to DR. Moreover, individual differences in this innervation correlated negatively with food intake specifically on the day of C21 administration. We propose that C21 activates two antagonistic pathways: (1) PFC→DR pyramidal neurons that promote food intake; and (2) GABA-IN in the mPFC that dampen food intake through feedback inhibition of mPFC→DR neurons.

The effect of leisure boredom and A1C level on diabetes eating problems in adolescents with type 1 diabetes

PURPOSE

Eating out of boredom, the changes in daily routine, physical inactivity and longer exposure to screens have made glycemic control difficult at home during the COVID-19 pandemic among adolescents with Type 1 Diabetes Mellitus. Adolescents with diabetes are at higher risk of developing eating problems than are their healthy peers. The aim of this study is to examine the effects of leisure time boredom and A1C level on eating problems in adolescents with Type 1 Diabetes Mellitus.

DESIGN AND METHODS

A descriptive, correlational, and cross-sectional design was used in this study. The study was conducted in Turkey, with the participation of 173 adolescents diagnosed with Type 1 Diabetes Mellitus. Convenience sampling was used to recruit patients from pediatric endocrinology outpatient clinics of hospitals.

RESULTS

It was determined that the diabetes eating problems of adolescents with Type 1 Diabetes were mostly affected by the level of leisure time and A1C, respectively. In the overall model, 58% (F = 4119.701, p < .001) of the factors affecting diabetes eating problems could be explained by the level of leisure boredom and A1C level.

CONCLUSION

It has been found that the adolescents with diabetes with high A1C levels and who cannot use their leisure time and have boredom are more at risk in terms of diabetes eating problems.

PRACTICE IMPLICATIONS

It should be determined how the adolescents with diabetes spend their lesiure time by diabetes health care team, which should be supported to develop leisure time skills. Effective use of leisure time and strategies to cope with boredom should also be included in diabetes education.

Body-Related Attitudes, Personality, and Identity in Female Adolescents with Anorexia Nervosa or Other Mental Disorders

The psychological integration of body-related attitudes (BodyRA) is a critical developmental task in adolescence. Adolescents must adapt to their changing body image and body satisfaction. For young people, BodyRA (body dissatisfaction, bulimia, and drive for thinness) are connected to insecurities, which can disturb identity integration and personality development. Our goal was to evaluate the importance of BodyRA also for other mental disorders other than anorexia nervosa (AN), and the association between BodyRA with temperament and personality traits and identity diffusion. Data for the period of 2012 to 2019 were retrospectively analyzed from a convenience sample of patients in a child and adolescent psychiatric hospital (n = 114). The patients were 13 to 17 years of age and had a BMI of 11.9−36.1 kg/m2. As expected, BodyRA were found to be more pronounced in AN, as well as in borderline personality disorder (BPD), depression (DD), and attention deficit hyperactivity disorder (ADHD). BodyRA correlated significantly with internalizing problems in patients with DD (r = 0.428−0.565, p < 0.01) and BPD (r = 0.680, p < 0.01) as well as with BMI (r = 0.404, p < 0.01) in patients with DD. Moreover, we detected significant correlations with impaired identity development in patients with DD (r = 0.482−0.565, p < 0.01) and BPD (r = 0.681−0.703, p < 0.01). BodyRA also correlated significantly with the personality traits of harm avoidance (r = 0.377−0.541, p < 0.01) and self-directedness (r = −0.537−−0.635, p < 0.01) in DD. These personality traits and bulimia were used as predictors for identity diffusion in the investigated disorders of this study. We conclude that BodyRA, harm avoidance and self-directedness are associated with identity development in adolescent females with mental disorders.

Has the COVID-19 pandemic lockdown worsened eating disorders symptoms among patients with eating disorders? A systematic review

Objective

During the coronavirus pandemic lockdowns, general medical complications have received the most attention, and few studies have examined the association between the COVID-19 lockdown and eating disorders (ED). This study aimed to investigate the impact of the coronavirus lockdowns on ED symptoms severity and summarize factors associated with lockdowns that led to changes in eating disorders.

Method

PubMed, Scopus, and Cochrane Library databases were searched for studies measuring the impact of coronavirus lockdowns on ED symptoms.

Results

A total of 132 studies were retrieved, after abstract screening and removal of duplicates, 21 papers were full-text screened, and 11 eligible papers were identified. Factors associated with symptomatic deterioration in ED patients during COVID-19 lockdowns included disruption of lifestyle routine, social isolation, reduced access to usual support networks, limited or no access to healthcare and mental care services, and social anxiety.

Discussion

Overall, the pandemic lockdowns were associated with worsening of eating disorders.

This triggering environment can lead to increased anxiety and depression symptoms, change in dietary habits, and eventually result in worsening eating disorder symptoms.

The Mediating Effect of Negative Appearance Evaluation on the Relationship Between Eating Attitudes and Sociocultural Attitudes Toward Appearance

Objective

Body-image disturbance and eating disorders are significant physical and mental health problems in China. Attitudes toward the body are thought to work in conjunction with other established risk factors for dietary pathology, which include body dissatisfaction, dieting, and negative effects. Negative appearance evaluation may be valuable for extending our understanding of measuring factors and potential causal relationships associated with body image and eating problems. Therefore, this study aimed to determine the association between negative appearance evaluation and a combination of eating attitudes and sociocultural attitudes toward appearance and the mediating effect of negative appearance evaluation on the relationship between eating attitudes and sociocultural attitudes toward appearance.

Methods

We invited 339 Chinese adults to undergo the Eating Attitudes Test (EAT-26), the Fear of Negative Appearance Evaluation Scale (FNAES), and the Sociocultural Attitudes toward Appearance (SATAQ-3) scale, and used AMOS 24.0 for model construction and mediating effects testing.

Results

There was a significant positive correlation between EAT-26 scores and FNAES (p < 0.001) and SATAQ-3 scores (p < 0.001), and all dimensions except internalization general were significantly positively correlated (p < 0.05). There was a significant positive correlation between FNAES and SATAQ-3 scores for all dimensions (p < 0. 01). There was no significant direct effect of eating attitude on sociocultural attitude toward appearance; however, there was a significant mediating effect of fear of negative appearance evaluation.

Conclusion

Our results demonstrate that negative appearance evaluation fully mediates the relationship between eating attitudes and sociocultural attitudes toward appearance. An individual's attitude toward eating affects negative body perceptions and thus their perception of their own body shape. Our exploration of the specific effects of eating attitudes on body perception provides a psychological basis for guidance and developing interventions regarding attitudes toward the body.

Validation of the English Version of the General Dietary Behavior Inventory (GDBI-E)

In medical science and practice, dietary behavior is mostly assessed by item-extensive questionnaires (e.g., food-frequency-questionnaires) or by questionnaires focusing on psychological aspects of dietary behavior neglecting dietary quality or quantity. In consequence, these questionnaires do not capture the full bandwidth of dietary behavior or are less effective in the assessment of dietary behavior because of the large item pools. Therefore, the aim of this validation study was to translate the existing General Dietary Behavior Inventory (GDBI), which was constructed as a behavior-related, as well as effective, instrument, and verifying its construct and criterion validity. This inventory is based on the general nutrition recommendations of the World Health Organization (WHO). Our English-speaking convenience sample consisted of 263 participants. The study results confirmed convergent, as well as criterion validity of the English version of the GDBI (GDBI-E). Discriminant validity of the GDBI-E could mainly be verified. Different dietary behavior clusters were identified in a cluster analysis. The found clusters represented a rather healthy and a rather unhealthy dietary behavior in the sample according to the recommendations of the WHO. The results underpinned the validity of the GDBI-E. The GDBI-E is applicable in research and clinical practice to assess dietary behavior in the English-speaking population.